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SAN DIEGO -- Nearly half of more than 3,500 American emergency physicians polled said they'd been physically attacked on the job, according to a survey commissioned by the American College of Emergency Physicians (ACEP) and reported here at the group's annual meeting.

Most said they weren't injured and few needed to take time off work. Still, that number reflects actual attempts to injure, not including verbal threats or harassment that other surveys have included under the rubric of "assault."

Asked about verbal harassment, 96% of female physicians and 80% of male physicians who responded said they'd been subject to inappropriate comments or unwanted advances at work.

More than two-thirds of respondents agreed that violence in the emergency department has risen over the past 5 years.

"This study shows us that right here in United States, ER physicians are in the cross hairs of violence in our society," said Maryland emergency physician Leigh Vinocur, MD, a spokeswoman for ACEP, in a press conference at the meeting.

The ACEP commissioned the August 2018 online survey, which was sent to 32,714 members of the organization. Of those, 3,539 physicians from every state and Puerto Rico responded.

A total of 71% of the respondents were male. Most worked at emergency departments with annual patient counts of more than 50,000.

Just under 50% of the physicians said they'd been physically assaulted at work. (There was a slight gender difference at 48% for men and 44% for women). Just over 70% said they'd witnessed someone else be assaulted.

Of those who were assaulted, 27% said they were injured. The most common methods of assault were hitting/slapping (44% of cases), spitting (30%), punching (28%), kicking (27%), scratching (17%), and biting (6%). Among those reporting physical attacks, 5% reported they needed to take time off work due to injuries.

Overall, physicians who were assaulted said hospital security responded 70% of the time; arrests were made in just 21% of those cases.

"As physicians we want to help and heal, we don't want to prosecute," Vinocur said, and doctors understand that attacks can be "part of the disease process."

In some states, however, victims don't have to press charges for the authorities to take action: "You are to just notify the police of it, and they take it from there," she said.

According to Michigan emergency physician Terry Kowalenko, MD, there's also a common belief that reporting an assault won't lead to prosecution, he said. "The perception is that it doesn't go much further."

Among those reporting any physical assault ever, 61% said at least one had occurred in the past year -- including 24% who reported two to five recent attacks and 3% who said they had suffered six or more.

When asked what hospitals could do to boost safety, 49% of respondents pointed to increased security.

Other strategies such as better enforcement of policies and reporting of incidents weren't nearly as popular. Only 1% supported self-defense training.

Physicians were most likely to blame violence in the emergency room on lack of an adequate response to the attacker (34%) and behavioral health patients (32%). Few blamed opioid seekers (5%) and boarding in emergency departments (2%).

"This lack of civility in our country that people are talking about is certainly a contributing factor," Vinocur said.

The poll's margin of error is plus or minus 1.6%.

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