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. 2022 May 2;5(5):e2210768.
doi: 10.1001/jamanetworkopen.2022.10768.

Mistreatment Experiences, Protective Workplace Systems, and Occupational Distress in Physicians

Susannah G Rowe  1   2 , Miriam T Stewart  3 , Sam Van Horne  4 , Cassandra Pierre  1   2 , Hanhan Wang  5 , Makaila Manukyan  1 , Megan Bair-Merritt  1   2 , Aviva Lee-Parritz  1   2 , Mary P Rowe  6 , Tait Shanafelt  5 , Mickey Trockel  5
Affiliations

Mistreatment Experiences, Protective Workplace Systems, and Occupational Distress in Physicians

Susannah G Rowe et al. JAMA Netw Open. .

Abstract

Importance: Reducing physician occupational distress requires understanding workplace mistreatment, its relationship to occupational well-being, and how mistreatment differentially impacts physicians of diverse identities.

Objectives: To assess the prevalence and sources of mistreatment among physicians and associations between mistreatment, occupational well-being, and physicians' perceptions of protective workplace systems.

Design, setting, and participants: This survey study was administered in September and October 2020 to physicians at a large academic medical center. Statistical analysis was performed from May 2021 to February 2022.

Main outcomes and measures: Primary measures were the Professional Fulfillment Index, a measure of intent to leave, and the Mistreatment, Protection, and Respect Measure (MPR). Main outcomes were the prevalence and sources of mistreatment. Secondary outcomes were the associations of mistreatment and perceptions of protective workplace systems with occupational well-being.

Results: Of 1909 medical staff invited, 1505 (78.8%) completed the survey. Among respondents, 735 (48.8%) were women, 627 (47.1%) were men, and 143 (9.5%) did not share gender identity or chose "other"; 12 (0.8%) identified as African American or Black, 392 (26%) as Asian, 10 (0.7%) as multiracial, 736 (48.9%) as White, 63 (4.2%) as other, and 292 (19.4%) did not share race or ethnicity. Of the 1397 respondents who answered mistreatment questions, 327 (23.4%) reported experiencing mistreatment in the last 12 months. Patients and visitors were the most common source of mistreatment, reported by 232 physicians (16.6%). Women were more than twice as likely as men to experience mistreatment (31% [224 women] vs 15% [92 men]). On a scale of 0 to 10, mistreatment was associated with a 1.13 point increase in burnout (95% CI, 0.89 to 1.36), a 0.99-point decrease in professional fulfillment (95% CI, -1.24 to -0.73), and 129% higher odds of moderate or greater intent to leave (odds ratio, 2.29; 95% CI, 1.75 to 2.99). When compared with a perception that protective workplace systems are in place "to a very great extent," a perception that there are no protective workplace systems was associated with a 2.41-point increase in burnout (95% CI, 1.80 to 3.02), a 2.81-point lower professional fulfillment score (95% CI, -3.44 to -2.18), and 711% higher odds of intending to leave (odds ratio, 8.11; 95% CI, 3.67 to 18.35).

Conclusions and relevance: This survey study found that mistreatment was common among physicians, varied by gender, and was associated with occupational distress. Patients and visitors were the most frequent source, and perceptions of protective workplace systems were associated with better occupational well-being. These findings suggest that health care organizations should prioritize reducing workplace mistreatment.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Rowe reported receiving occasional honoraria offered to her for presentations on the topic of clinician wellness and well-being, delivered at health care and educational organizations and professional conferences. Dr Shanafelt reported that Mayo Clinic received a patent for Well-being Index instruments and the Participatory Management Leadership Index he codeveloped; Mayo owns these tools and has licensed them to Corporate Web Services (CWS) and Mayo Clinic pays Dr Shanafelt a portion of any royalties received; and Dr. Shanafelt reported receiving honoraria for grand rounds/keynote lecture presentations and provides advising for health care organizations. Dr Trockel reported receiving occasional honoraria offered to him for grand rounds or other talks on the subject of physician wellness, delivered at health care organizations or professional conferences. No other disclosures were reported.

Figures

Figure.
Figure.. Conceptual Model of Association of Protective Workplace System and Mistreatment With Physician Occupational Well-being
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