Workplace violence against junior doctors in Iraq: implications for job satisfaction and retention

Abstract

IntroductionHealth workers worldwide report being exposed to workplace violence, but those in conflict settings (or post-conflict settings) are especially targeted, as political conflict shifts societal norms. Iraq has suffered war and conflict for decades. A 2013 study of 567 Iraqi-trained physicians found nearly 2/3 had emigrated to mostly English-speaking countries; further, half of those remaining wished to leave Iraq. While prior studies have examined the phenomenon of violence against health workers in Iraq, no qualitative study has characterized Iraqi front line junior doctors’ experiences of workplace violence within a workplace violence causal framework, to inform an educational and policy response.MethodsWe consented and interviewed 73 junior physicians at six teaching hospitals across Central Iraq between December 2021, and January 2022. We analyzed 22 of the 73 conversations, after rejecting 29 because they were terminated prematurely when doctors were called away for patient care, and 22 others where doctors indicated they had no experience with workplace violence. (Our goal was to understand these interactions, not to quantify them).ResultsThe physicians we interviewed had been practicing an average 3 years since graduating from medical school (ranging from 6 months to 7 years). Interviewees represented eight hospital departments, with most coming from internal medicine and surgery. Within a socio-ecological framework, we identified two primary individual-level factors prompting patient-associated violence: patients and their families don’t understand triage (and resent being pushed to the side when doctors focus on more serious cases), and junior doctors (by definition) are young and inexperienced. At the family level, doctors reported patient relatives often demonstrate their devotion to the patient by acting out. At the hospital level, institutions are operating in an environment of scarcity, which generates high emotions as patients compete for attention, supplies and space. At a societal level, doctors reported family attacks persist because perpetrators face no real legal consequences. In addition to causes of violence, there are consequences. Doctors who are targets of violence reported experiencing mental health problems, including depression and loss of self-esteem, and reported thoughts of leaving their positions and even their country. Doctors also expressed regret for choosing a career in medicine.ConclusionYoung, inexperienced junior doctors in Iraq are bearing the brunt of patient frustrations with the scarcity of resources in the health system. Hospitals would likely improve the job satisfaction of junior physicians, and their longevity in the health system, by attending to this problem.