Workplace Violence Against Junior Doctors in Iraq: Implications for Job Satisfaction and Retention

Abstract

Introduction: Previous quantitative research has suggested the majority of physicians report being exposed to workplace violence. 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. Prior studies on violence against Iraqi health care workers have been conducted, but none have used qualitative methods to describe motivations and implications to understand this phenomenon. Methods: We consented and interviewed 73 junior physicians at six teaching hospitals across Central Iraq between December 2021, and January 2022. After selecting the transcripts with the most vivid narrations, we analyzed 22 interviews in depth. Results: The 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. Half the group had never worked in a facility different from their current one. We found the structure of the medical care system creates a sense of scarcity, which generates high emotions as patients compete for attention, supplies and space. Further, the public doesn’t fully understand the concept of triage, explaining anger at delays in receiving health care services. The structure of the medical education pipeline generates doctors who are quite young, may not be fully prepared for these challenging roles, and lack skills and authority to respond in the moment to attacks. Doctors believed family attacks persist because patient families are not facing legal consequences. Doctors who are targets of violence reported experiencing mental health problems, including depression and loss of self-esteem, and contemplated leaving their positions. Doctors also experienced regret for choosing a career in medicine, as well as a need to leave the country. Conclusion: Young, 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. A long legacy of armed conflict in Iraq has planted seeds of violence in everyday human interactions.