Most physicians do not need a report to tell them that violence in healthcare is rising. They have seen the clenched fists, heard the threats, watched verbal abuse become background noise, and felt helpless as the system told them to carry on as if nothing happened.
In a recent Sermo poll, 53% of physicians said they have personally experienced violence or aggression at work, either recently or remotely. Another 14% said they have not personally experienced it, but have witnessed it. Only 33% said no.
The American Hospital Association (AHA) reported that in 2023 the estimated cost of violence to hospitals in the U.S. was $18.27 billion, including prevention costs, medical costs, lost productivity, staffing impact, and infrastructure repair. The AHA also notes that violence affects recruitment, retention, job satisfaction, and psychological safety.
This article outlines a guide to tackling workplace violence for practicing physicians and healthcare professionals who already know the problem is real, want to shine a spotlight on it, and collaborate to get the proper support in place.
How common is violence against healthcare workers?
Violence against healthcare workers is common enough that many physicians now describe it as part of their daily risk environment. According to the U.S. Bureau of Labor Statistics, in the two-year period between 2021-2022 it was found that the healthcare industry experienced the highest count of workplace violence out of all industry sectors. A Sermo poll aimed to establish how often physicians experience or witness violent or aggressive behavior in their workplace. 15% said not at all, 45% said rarely, but a combined 40% said occasionally or frequently.
The AHA’s 2025 report estimates the prevalence of workplace violence among physicians to be anywhere from 24.4% to 59.3%, depending on setting and specialty. Threat rates ranged from 14% to 57.4%, and physical assault reached as high as 15.9% among healthcare workers. The highest-risk settings include psychiatric departments, emergency departments, waiting rooms, geriatric units, and rural areas. The American College of Surgeons has also warned that active-shooter incidents in healthcare settings overwhelmingly target healthcare workers.
In emergency medicine, the picture is even sharper. In a January 2024 ACEP poll, 91% of emergency physicians said they had either personally experienced workplace violence in the past year or knew a colleague who had. And 40% knew of an attack in a trauma center that caused moderate-to-severe disability or death.
A recent Sermo poll asked physicians: “Have you personally experienced violence or aggression at work?” Only 33% said “No”.
- 19% said “Yes, recently”
- 34% said “Yes, remotely”
- 14% said “I haven’t but I’ve witnessed it”
A Clinical and Radiation Oncologist shares on Sermo, “Just recently I got physically attacked by a patient who was manic and she just lost control. I got a black eye and scratches all over my face.”
Another Sermo member and physician in Internal Medicine recounted, “”When I was a resident, alone late at night in a VA hospital ER, I was attacked by a mentally ill patient because I refused to refill his medication until his previous records were faxed to me. When I was a medical student, I was attacked by a lady with paranoid schizophrenia, while I was attempting to draw her blood.”
This is why the question “Are hospitals safer than they used to be?” is difficult to answer optimistically. The data points to escalation in danger, not improvement.
Why don’t physicians report workplace violence?
“Unfortunately, underreporting is a huge issue because many of us feel that nothing will change even if we speak up. I’ve witnessed how verbal abuse quickly turns into physical threats while the administration looks the other way,” writes a GP on Sermo.
Physicians often do not report workplace violence because they believe nothing will change, fear retaliation or reputational consequences, lack time during overloaded shifts, or have internalized the idea that aggression is ‘part of the job.’ When violent incidents are not reported, they are not measured. When they are not measured, employers rarely take action.
A General Practice physician put it plainly: “Healthcare staff are often trained to tolerate whatever is thrown at us. We are supposed to understand the aggressive behavior because ‘they are grieving’ or ‘they are not feeling well’. Because we are ‘seeing them at their worst’, as if that is supposed to make it acceptable for people to scream at, threaten, wave a fist at, threaten to call the police on healthcare staff.” An Ophthalmologist further adds, “Yes, I feel that violence in health care has been accepted as ‘part of the job’ for far too long. Verbal abuse has become almost commonplace, and physical threats are often downplayed. This tacit acceptance sends the wrong message – to staff as well as patients.”
The AHA report identifies underreporting as a major barrier, citing unclear reporting channels, fear of retribution, fear of not being believed, and reluctance to become involved in litigation.
More than half of physicians believe health care organizations are not doing enough to reduce professional burdens, while a global Sermo study found that 34% of physicians would be more likely to seek help handling incidents if they believed there would be no health administration repercussions.
Why hospitals are still under-prepared to address violence in healthcare
Hospitals are under-prepared because workplace violence prevention is often treated as a compliance module, not an applicable operating system. Many healthcare facilities have inconsistent training, limited security capacity, clunky reporting tools, and staffing models that leave too few people available to intervene before a situation escalates.
A recent Sermo poll revealed how confident physicians felt in their training to handle potentially violent situations. Nearly half of respondents (44%) felt “not very” or “not at all” confident. Another 44% said “somewhat” while only 11% said “very”. One emergency medicine physician noted that “”Violence is a common situation in the ED. We have emergency alarms and react as a team but with no specifications training. Some specialized learning should be helpful.”
The Crisis Prevention Institute’s 2025 Workplace Violence Prevention Report found only 26% of healthcare organizations reached a satisfactory “Leaders” benchmark in safety preparedness, highlighting the February 2025 UPMC Memorial incident in West Manchester Township, where a gunman entered an ICU, took hostages, killed a police officer, and injured others.
Haphazard occupational safety training by health administration is not enough. Formal education cannot prepare doctors for every practical, emotional, administrative, and interpersonal challenge of medicine, including the growing range of different types of workplace aggression. Physicians can understand de-escalation theoretically and still be alone in an exam room with no panic button, no support staff, no rapid response plan, and no confidence that reporting will lead to consequences. As a Pediatric Neurologist explains on Sermo, “We are offered self-defense courses, but what is the point if physicians are ultimately left alone when violence occurs? Without institutional backing, without clear reporting pathways that lead to consequences, and without certainty of legal repercussions, these initiatives feel symbolic rather than protective.”
An Emergency Medicine physician shares, “current training modules and attitude puts blame on staff. What did we do wrong.” A GP adds, “”I believe de-escalation and conflict-management skills should be taught early in training for all healthcare professionals, not learned only on the job.”
Hospitals also face unprecedented staffing problems. Shortages intensify pressure on physicians to provide social service and care to patients. Regarding violence prevention, understaffing means fewer safety nets on escalating behavior, longer waits, more frustrated patients, and fewer colleagues available to step in.
A retrospective study found that 37.1% of reported workplace violence cases were not prosecuted. Staffing shortages across healthcare facilities combined with accountability and training prevention and response gaps only compound the problem.
How does workplace violence affect the physician workforce?
Nearly half of the surveyed physicians said workplace violence is at least a significant or minor consideration in their decision to continue practicing. Threats to workplace safety can accelerate burnout, erode trust, increase intent to leave, and make high-exposure specialties harder to sustain.
According to research published by the National Center for Biotechnology Information, it also affects patient care because clinicians working under chronic threat can become hypervigilant, emotionally depleted, or less able to engage with patients in the calm, attentive way medicine requires. As an Orthopedic Surgeon resident explains, “Normalizing this hostility erodes trust, fuels burnout, and ultimately compromises patient care. Protecting healthcare workers is therefore not a matter of privilege—it is a prerequisite for a safe and functional healthcare system.”
HIPAA Journal reported that workplace violence contributes to stress, burnout, job dissatisfaction, and recruitment difficulty. It also shines a light on the bleak labor statistics, citing a 2023 nursing survey in which 6 in 10 nurses had changed jobs, left the profession, or considered doing so because of workplace violence. Admin workload, workplace stress, understaffing, and lackluster support systems are detrimental to physicians, nurses, and HCP’s well-being.
Rural physicians face a distinct version of the problem. Smaller communities can create a “goldfish bowl” effect where anonymity is limited, out-of-office harassment may follow physicians beyond the clinic, and delayed law enforcement response can make a violent encounter feel even more isolating. As a result, these high-pressure settings can intensify moral injury and severe burnout. If a community’s only physician takes leave or resigns due to safety fears, the entire local population faces the immediate risk of a total collapse in essential healthcare access.
A Sermo member and Neurologist summarizes the issue succinctly, “”What concerns me most is the normalization of this climate: when violence is seen as ‘part of the job,’ it stops being reported and therefore stops being visible. This not only affects our well-being, but also the quality of care we can provide to patients with acute neurological conditions who require calm, time, and clear thinking.”
What can be done to reduce violence against healthcare workers?
Reducing violence against healthcare workers requires improvements in system-wide reporting, administrative follow-through, adequate staffing, real de-escalation training, rapid-response security, safer facility design, and legal accountability. Individual physicians can document and report incidents, but lasting change must be spearheaded by institutional and policy-level changes.
What physicians can do to prevent violence in healthcare
As a physician, you cannot fix violence in healthcare alone. But, you can help to make the problem more visible.
- Report every incidence of workplace violence, including verbal threats, physical assaults, aggression, even if immediate action seems unlikely.
- Document the types of workplace incidents in your own records, including date, location, description, witnesses, and your response.
- Join or advocate for a workplace safety committee with physician, nursing, security, and administrative representation.
- Ask leadership to publish aggregate healthcare workplace violence data internally.
- Advocate for practical de-escalation training from employers.
- Advocate for clear internal code words or safe words that signal escalating aggression, imminent violence, or active danger. An Internal Medicine resident shares on Sermo, “We have in-house security at my facility with two different code words. One for standby to deescalate and the second to use force if needed.”
- Be open about and discuss the reality of your work environment with peers in a secure space, such as communities like Sermo, because pattern recognition across institutions helps fight the “this is just how it is” narrative.
What has to be done on an institutional level to prevent violence in healthcare?
While federal organizations like the Occupational Safety and Health Administration (OSHA) exist to set and enforce standards to protect health care workers, there is much more that can and should be done to prevent physical assaults, incidents, and verbal harassment.
The best health administration includes systems such as zero-tolerance policies that are actually enforced, trained on-site security, weapons screening at appropriate high-risk entry points, occupational safety audits, real-time alert systems, clear violence reporting pathways, and adequate health care staffing.
In the Sermo poll, physicians voted for what they think would make the greatest impact in reducing workplace violence:
- 23% said “Implementing zero-tolerance policies for aggression and violence”
- 20% said “Increasing security presence and rapid response teams”
- 18% said “Providing comprehensive staff training on de-escalation and conflict management”
- 14% said “Improving reporting systems and follow-up for violent or aggressive incidents”
- 12% said “Addressing staffing shortages and reducing clinical workload”
- 11% said “Enhancing mental health support for staff and patients”
The Save Healthcare Workers Act is one potential policy shift. H.R. 3178 and S. 1600 were introduced in May 2025 to make assault or intimidation of hospital employees a federal crime, similar to protections for aircraft and airport workers. The proposed penalties include up to 10 years in prison, or up to 20 years for attacks involving a weapon, serious bodily injury, or emergency circumstances. As of writing, it has been introduced but not yet enacted into law.
The bill has been supported by major healthcare and government organizations, including the AHA, ACEP, ENA, AAMC, AONL, OSHA, and others.
This sits inside a larger health care policy environment. Physicians are not just affected by policy. They can also be credible voices in shaping it.Doctors are well positioned as non-biased leaders to act as public health and policy ambassadors. Physician advocacy can influence public understanding and policy change.
Hospitals and institutions also need to stop repeating predictable mistakes: treating violence as inevitable, collecting reports without acting on them, relying on thin annual training, framing physician complaints as performance problems, ignoring staffing, and medicalizing every aggressive act without distinguishing impairment from criminal behavior.
As one Sermo member in Family Medicine said, “What would actually move the needle isn’t another poster about reporting—it’s real consequences and real prevention: zero-tolerance policies that are enforced, visible security and rapid response teams, and mandatory, practical de-escalation training that’s refreshed regularly. Just as importantly, we have to address the fuel for these incidents: understaffing, overload, long waits, and lack of mental health resources for patients and staff.”
Silence is no longer neutral
Violence in health care is widespread, well-documented, and increasingly difficult to dismiss. The institutional response remains uneven, and one of the largest barriers is the normalization that aggression is simply ‘part of the job’.
It is not and has no place in health care. An Orthopedic Surgeon summarizes it well on Sermo, saying “We are trained to save lives, but we shouldn’t have to risk our own to do it. True change requires more than just ‘Security’ posters on the wall; it requires a system that values the healer as much as the patient.”
The path forward is not one magic policy, one security guard, or one de-escalation module. It is honest reporting, visible follow-through, adequate staffing, practical training, safer environments, and policy advocacy that treats violence against health care workers as a threat to patient care itself.
Sermo is where physicians and health care professionals can discuss the realities they may not feel safe discussing inside their own institutions. The community conversation on workplace violence is exactly the kind of peer dialogue that surfaces what is happening in the clinic and helps move medicine forward one conversation at a time.
