title: Workplace violence: a survey of emergency physicians in the state of Michigan.
abstract: OBJECTIVE
  We seek to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians.
  
  
  METHODS
  A mail survey of self-reported work-related violence exposure during the preceding 12 months was sent to randomly selected emergency physician members of the Michigan College of Emergency Physicians. Work-related violence was defined as verbal, physical, confrontation outside of the emergency department (ED), or stalking.
  
  
  RESULTS
  Of 250 surveys sent, 177 (70.8%) were returned. Six were blank (3 were from retired emergency physicians), leaving 171 (68.4%) for analysis. Verbal threats were the most common form of work-related violence, with 74.9% (95% confidence interval [CI] 68.4% to 81.4%) of emergency physicians indicating at least 1 verbal threat in the previous 12 months. Of the emergency physicians responding, 28.1% (95% CI 21.3% to 34.8%) indicated that they were victims of a physical assault, 11.7% (95% CI 6.9% to 16.5%) indicated that they were confronted outside of the ED, and 3.5% (95% CI 0.8% to 6.3%) experienced a stalking event. Emergency physicians who were verbally threatened tended to be less experienced (11.1 versus 15.1 years in practice; mean difference -4.0 years [95% CI -6.4 to -1.6 years]), as were those who were physically assaulted (9.5 versus 13.1 years; mean difference -3.6 years [95% CI -5.9 to -1.3 years]). Urban hospital location, emergency medicine board certification, or on-site emergency medicine residency program were not significantly associated with any type of work-related violence. Female emergency physicians were more likely to have experienced physical violence (95% CI 1.4 to 5.8) but not other types of violence. Most (81.9%; 95% CI 76.1% to 87.6%) emergency physicians were occasionally fearful of workplace violence, whereas 9.4% (95% CI 5.0% to 13.7%) were frequently fearful. Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%).
  
  
  CONCLUSIONS
  Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.
authors.affiliation: Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109-0305, USA. terryk@med.umich.edu
authors.forename: Terry
authors.initials: T
authors.lastname: Kowalenko
authors.forename: Bradford L
authors.initials: BL
authors.lastname: Walters
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Khare
authors.forename: Scott
authors.initials: S
authors.lastname: Compton
mesh_terms: D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005239:Fear; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data*; D008824:Michigan / Q000453:epidemiology; D012637:Security Measures; D011795:Surveys and Questionnaires; D014754:Violence / Q000706:statistics & numerical data*; D017132:Workplace