Analysis of Career Stage, Gender, and Personality and Workplace Violence in a 20-Year Nationwide Cohort of Physicians in Norway
Authors: Sara Tellefsen Nøland, Hildegunn Taipale, Javed Iqbal Mahmood, Reidar Tyssen
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Workplace violence (WPV) is a worldwide problem in health services. Several studies have pointed to organizational factors, such as working in psychiatry and work stress. However, there is a lack of long-term longitudinal cohort studies with respect to trends during the career and individual factors among physicians. <h3>Objective</h3> To investigate WPV trends during Norwegian physicians' careers and assess individual and work-related factors associated with WPV in a long-term longitudinal study. <h3>Design, Setting, and Participants</h3> This cohort study involved 2 nationwide medical student cohorts who graduated 6 years apart and were surveyed at graduation (T1: 1993-1994 and 1999) and 4 years later (T2), 10 years later (T3), 15 years later (T4), and 20 years after graduation (T5). Generalized estimated equations were used. Statistical analysis was performed from January to September 2020. <h3>Exposures</h3> Medical career during 20 years in Norway. <h3>Main Outcomes and Measures</h3> WPV was measured as threats or acts of violence from a patient or visitor experienced at least twice, at each of the stages after leaving medical school. Individual factors were obtained at T1 and work-related factors at T2 through T5. We analyzed WPV by repeated measures. <h3>Results</h3> At T1, a total of 893 participants (with a mean [SD] age of 28 (2.83) years; 499 [56%] women) responded to the questionnaire. The prevalence of multiple threats of violence was 20.3% (156 of 769) at T2, 17.1% (118 of 691) at T3, 11.2% (66 of 588) at T4, and 8.6% (46 of 536) at T5; and the prevalence of multiple acts of violence was 4.3% (33 of 763) at T2, 5.2% (36 of 687) at T3, 3.1% (18 of 584) at T4, and 2.2% (12 of 532) at T5. There was a decline from T2 to T5 of both multiple threats (β = −1.06; 95% CI, −1.31 to −0.09;<i>P</i> &lt; .001) and acts of violence (β = −1.13; 95% CI, −1.73 to −0.53;<i>P</i> &lt; .001). In adjusted analysis, factors associated with multiple threats of violence were male gender (odds ratio [OR], 2.76; 95% CI, 1.73 to 4.40;<i>P</i> &lt; .001), vulnerability trait (neuroticism) (OR, 0.90; 95% CI, 0.82 to 0.99;<i>P</i> = .03), young physician cohort (OR, 1.63; 95% CI, 1.04 to 2.58;<i>P</i> = .04), and working in psychiatry (OR, 7.50; 95% CI, 4.42 to 12.71;<i>P</i> &lt; .001). Factors associated with multiple acts of violence in adjusted analysis were male gender (OR, 3.37; 95% CI, 1.45 to 7.84;<i>P</i> = .005), young physician cohort (OR, 6.08; 95% CI, 1.68 to 21.97;<i>P</i> = .006), and working in psychiatry (OR, 12.34; 95% CI, 5.40 to 28.23;<i>P</i> &lt; .001). There were no interactions with gender or cohort in the significant associated factors. <h3>Conclusions and Relevance</h3> Higher rates of multiple threats and acts of violence were observed during early medical careers, among male physicians, and in psychiatry. Low levels of the vulnerability trait (neuroticism) were associated with the experience of multiple threats. There was an association between the young physician cohort and WPV. Preventive efforts should include early-career and male physicians, with additional emphasis on personality.