Workforce and system implications of unprofessional behavior: a nationwide mixed-methods study in Thai emergency...

Medical councils and associations frequently stress the importance of professionalism, yet unprofessional behaviors remain common. Such behaviors can compromise patient safety, especially in emergency departments, which face diverse conditions, heavy workloads, and demanding team interactions. Therefore, the present study aimed to investigate the incidence, pattern, and factors associated with unprofessional behavior experienced by emergency physicians in a developing country.

In this convergent parallel mixed-methods study, a nationwide online survey of emergency physicians and residents was conducted alongside in-depth interviews with residents and specialists from emergency medicine and other specialties between November 5 and December 5, 2024.

Among 262 respondents (response rate: 40.3%), the majority were board-certified physicians (71.4%), were female (58.8%), and had 1-10 years of experience (81.7%). Approximately 90.8% of participants reported experiencing unprofessional behavior in the emergency departments during the past year. In particular, verbal aggression (85.9%) had the highest frequency, followed by online misconduct (33.6%) and physical aggression (7.6%). Younger physicians (< 35 years of age), those with 1-10 years of experience, and those who were dissatisfied with their income were more likely to encounter such behavior than others. Most incidents of unprofessional behavior occurred during consultations or patient handovers, with surgery and internal medicine specialists most commonly identified as perpetrators. Although most hospitals had reporting systems, less than half of the incidents were reported, mainly because of low perceived severity and lack of effective resolution. The reported consequences included reduced job satisfaction (67.2%), decreased professional confidence (46.2%), and negative effects on patient safety and outcomes (27.3%), including compromised clinical decision-making. The qualitative findings revealed that unprofessional behavior is often normalized in emergency departments, driven by high workload and inadequate communication. Concerns regarding clinical competency among emergency physicians and residents also emerged as a contributing factor.

Unprofessional behavior is widespread in Thai emergency medicine, which disproportionately affects younger physicians and undermines provider well-being and patient care. The results highlight not only individual challenges but also systemic gaps within the healthcare system. Thus, urgent, multilevel strategies are needed to address this issue and improve patient safety.