From Burnout to Broken Bonds: An Integrated Study of Workplace Violence and Its Consequences on Doctors’ Practice and Patient Care in India

Abstract

Workplace violence (WPV) against doctors has become a serious concern in healthcare settings as the consequences are not limited to direct safety concerns. This study examined how WPV influences doctors’ psychological well-being, clinical behaviour, doctor-patient relationship, and turnover intentions in Punjab and Chandigarh. The study further introduced Perceived Systemic Protection (PSP) as a newly integrated, context-specific construct including doctors’ perceptions of organizational, legal, and societal protection against WPV.
A quantitative and cross-sectional research design was adopted for this study. Data was collected from 526 doctors through a structured questionnaire measuring WPV, burnout-related emotional exhaustion, job satisfaction, Risk Avoidance Behaviour (RAB), Changed Patient-Management Behaviour (CPMB), deterioration in the Doctor-Patient Relationship (DPR), turnover intentions, and PSP. The data was analyzed using descriptive statistics, regression, reliability analysis, confirmatory factor analysis, structural equation modeling, mediation analysis, moderation analysis, and moderated mediation analysis.
The findings showed that WPV significantly increased burnout-related emotional exhaustion and reduced job satisfaction among doctors. Burnout-related emotional exhaustion significantly predicted both RAB and CPMB, while job satisfaction significantly reduced RAB. However, the relationship between job satisfaction and CPMB was not significant. RAB significantly predicted deterioration in the DPR, whereas CPMB did not significantly influence DPR, indicating that avoidance-based withdrawal had stronger relational consequences than protected clinical engagement. Deterioration in DPR significantly increased turnover intentions, confirming its role as an important relational and downstream mediator leading to attitudinal withdrawal. As RAB, CPMB, and PSP were exploratory constructs with limited convergent validity, findings involving these constructs are viewed as preliminary rather than conclusive and require further validation.
The mediation findings supported a layered and partially parallel model in which WPV influenced turnover intentions through psychological outcomes, behavioural adaptation, and relational deterioration. RAB emerged as a stronger behavioural mediator in this process. PSP was directly associated with lower burnout-related emotional exhaustion and higher job satisfaction, but it did not significantly moderate the effect of WPV on psychological outcomes or the indirect pathways leading to turnover intentions.
The study concludes that WPV against doctors is not an occasional but a constant occupational concern affecting doctors’ emotional health, clinical decisions, patient relationships, and job stability. Strong institutional assistance, effective law enforcement, well-organized reporting mechanisms, and a comprehensive support system are essential for safer and more sustainable healthcare practice.