I was recently asked what I thought were some of the biggest evolving obstacles to physicians and health care in 2024 and beyond.

My answer:

Health care has become America’s most dangerous profession due to workplace violence, with health care workers now being five times more likely to be assaulted “on the job” than in any other type of workplace in this country.

This is one of the most critical obstacles that must be immediately addressed.

But as dangerous as this explosion in health care workplace violence is, in reality, it is just one of multiple deep critical disruptors within, and one red flag warning of rampant and escalating consumer dissatisfaction toward our whole health care system.

This surging level of dissatisfaction, distrust, and increasing hostility, now at an all-time high and reaching a tipping point, is further highlighted by the huge public outpouring of sympathy and support for the alleged shooter of a health care insurance company executive, with multiple copycat threats being reported.

To further grasp the anguish of consumers, consider that we now have the most expensive but worst-performing health care system in all the industrialized world. Also, the most common cause of personal bankruptcy filings in the U.S. is overwhelming medical debt. In addition, consumer trust in doctors and the health care system as a whole has now reached an all-time low.

One result is increasing violence directed toward the health care system.

It is, in some ways, understandable that health care consumers, increasingly frustrated by a seemingly impenetrable, increasingly unaffordable, and perceptibly denial-inclined, inaccessible system will strike out at the few accessible targets. In clinical situations, this will be doctors, nurses, and other hands-on health care workers.

But targeting hands-on health care workers is particularly unfortunate and misdirected, as physicians—who have been reduced to employee status—now join other hands-on health care worker-employees in having no input into or “seat” at management tables on the issues that so outrage health care consumers.

Trapped between these steadily worsening, system-abusive, assault-prone workplaces and increasingly discontented, more frequently hostile patient-consumers—and with no voice or meaningful way to effect change—one result of this escalating workplace violence and disruption is accelerating departures of doctors (nurses and other workers) out of hands-on health care into safer, less abusive professions. This in turn further aggravates the already critical shortage of hands-on health care workers, thus further worsening patient access to timely and needed health care.

This accelerating worker exodus also paradoxically further contributes to consumer perception of an inaccessible and denial-based system.

To further add to the shortage and access problems, we are now seeing fewer and fewer bright young minds seeking hands-on health care careers due to these increasingly abusive and violent conditions.

It is also important to note that in our current society, “violence as a means to address perceived wrongs” is becoming a more and more utilized pathway to express dissatisfaction and seek change, now even advocated among some within our political leaderships. This trend has ominous implications for the safety of doctors and other health care workers, for patients, and for the timely and safe delivery of patient care.

Thus, with this level of consumer distrust, hostility, and aggression toward the whole health care system, and with workers increasingly leaving the system, the only real way to stop the increasing violence is to repair the system and return it to one that is more responsive to patient needs and more affordable.

There is, even at this tipping point juncture, still some time left and pathways available to reverse this dangerous violence trend, these crippling worker exits, and to address other critical issues that so outrage health care consumers, disrupt physician (and other worker) clinical efforts, degrade workplace conditions, and further impede health care delivery.

Failure to do so will lead rapidly to a totally broken system and one increasingly without physicians and other hands-on workers.

This essay is cited in the KevinMD record on nursing.

Harry Severance is an emergency physician.