In 2008, when I left my medical studies in China during the rise of workplace violence (WPV) directed toward doctors and relocated to finish my training in the U.S., my parents were unhappy with the thought of me -- their only child -- being on the other side of the world. But they took comfort in saying, "At least you will be safer there as a practicing physician one day."
They assumed I'd be safer as a doctor in the U.S. However, after years of working here and the growing number of attacks, it has become overwhelmingly clear to me and my family that this isn't the case. When the healers become the ones targeted by deadly bullets, we ask: Are any of us safe?
Last Wednesday, June 1, four lives were taken in Tulsa, Oklahoma by a gunman who blamed a doctor for his pain. Among those killed was an orthopedic surgeon, Preston Phillips, MD, and a sports and internal medicine specialist, Stephanie Husen, DO. A receptionist at the clinic, Amanda Glenn, and a patient, William Love, also lost their lives. Our hearts sank in the medical community.
Patient-initiated WPV against healthcare workers is an urgent global public health threat. According to the World Health Organization, between of healthcare workers globally suffer from physical violence while working at some point in their careers. Attacks may include physical assault, emotional abuse, threats, and sexual harassment or abuse. Violence against healthcare workers is a growing but often hidden epidemic, with serious consequences for healthcare workers as well as the future healthcare professional pipeline.
Mainland China, where I grew up and completed part of my medical training, has among the highest prevalences of healthcare WPV in the world (42.2% to 83.3%). In a large , 56.4% of healthcare workers reported having experienced WPV, 15.9% of which were physical assaults. , based on available news reports, found that between January 2004 and December 2018, 34 incidents in China resulted in deaths of healthcare workers. In 2012 alone, as a result of WPV. It is possible that many more went unreported.
What led to these violent attacks? Refusing to accept a death and being dissatisfied with treatment outcomes were among the main drivers. Of the perpetrators in these attacks, , all of which were non-firearm due to the strict national gun control law in China. As one apparent "safety measure," it is not uncommon for hospitals to recommend that healthcare workers to work.
WPV has severe consequences for healthcare systems. Less than a quarter (23.9%) of Chinese healthcare workers who participated in the reported that they still would have chosen the medical profession if they had been more aware of the risks. And over 90% of participants indicated they would not support their children going into medicine. It is not surprising that the rise of WPV is negatively impacting to practice medicine. In fact, in a , experts estimated that only one in six medical graduates would eventually wear a white coat in China. While there are multiple factors at play, one of the major contributors was the high-risk work environment due to WPV.
In the U.S. too, violence against healthcare workers is growing, and will likely accelerate the Great Resignation in medicine. There is currently a dire shortage of healthcare workers. The Association of American Medical Colleges predicts a shortage between by 2034. The American Association of Colleges of Nursing expects an additional in 2029 to help fill the workforce demand. And Mercer estimates a shortage of other healthcare workers by 2025 -- just 3 years from now.
The COVID-19 pandemic, a time when surged, has only highlighted this acute shortage of healthcare human resources. The inability for healthcare workers to remain safe at work has largely contributed to the Great Resignation in healthcare. According to the U.S. Bureau of Labor Statistics, from January to April this year, over quit their jobs. If we can learn anything from China's decades-long experience with fatal attacks toward healthcare workers, it is that this violence will undoubtedly drive more people out of medicine. This effect will persist far beyond our current generation, as those who quit medicine today will likely discourage their children from entering the field.
Shortly after the shooting in Tulsa, I received my mother's panicked phone call inquiring about my safety "against so many gunmen in America." This was not the first time I received such a phone call from my worried mother in the past 3 years as an attending doctor in the U.S. At first, it was the alarmingly high COVID-19 related healthcare worker mortality, then it was the disturbing anti-Asian hate crimes, and most recently, the mass shootings and gun violence in medical facilities.
Each time, I soothed my mother's concern by telling her how far the attacks were from my rural Washington town. But each time, she sounded less and less convinced. "You are still young enough to change to a different career," she said to me. As a first-generation college graduate and physician in my family, who is finally living her dream to practice medicine, I know it hurt my mother deeply to ask this question. But when we spoke, my reassurance for her was armed with an agonizing hesitation.
is a Family Medicine doctor in Washington State and a .