Physicians are being attacked in many ways and in many places.  It is no longer about how able, available, and affable you are.  It is about how well you toe the line when it comes to going along to get along while being watched by an ever increasing line up of watchdogs.  Many of whom have sharp teeth.

Here are a few questions that might indicate you are headed for trouble:

Do you speak your mind when you are concerned about quality of care?
Do you give directions in an authoritative way?
Do you command a large practice which is the envy of others with whom you compete?
Do you ever question the hospital administration about procedures or policies?
Do you ever use seemingly appropriate humor to defuse a situation that is tense?
Do you ever go against the tide of opinion about the clinical care of patients?

Well, if you answered “yes” to any of these questions, and I surely hope that you did, then you might very well be regarded as a “disruptive” physician and headed for some real trouble.  Physicians’ relationships with each other, with hospitals, and with regulatory agencies are becoming ever more complex, and ever more dangerous for physicians.  Physicians are increasingly being targeted when they get in the way.  Loss of your practice, your hospital privileges and even your medical license can result.  While this can happen to both men and women physicians, women physicians face additional challenges.

So what does this mean for women physicians?

Women physicians are increasing in numbers, but the workplace has not yet adapted to their different attitudes and work habits and work styles.  Thus, much of what they do can be misinterpreted and they can become easy targets for disciplinary action.  Let’s take each of these “situations” and see where the danger lays.

Communication.  When you speak your mind, be careful in the use of language, voice, and context.  Assertive women are out of character (i.e. they don’t demonstrate gender stereotypical “good girl” behavior) and are vilified more easily.  This also goes for how you give direction (i.e. orders) to staff members. Learn to modulate tone and language otherwise you might be “written up.”

Competition.  Being competitive was one of the reasons you made it all the way through the difficult road to becoming a doctor.  Most of us want to be successful.  But when you are, be careful to respect your competition. They can and will get very jealous.  And they will try to bring you down, usually citing bogus quality issues.  There are many who still think that women don’t need to work because others are there to care for them.

Corporatization.  Wondering why a quality issue is not being investigated?  Are you puzzled because some policy is being changed without appropriate physician input?  Questioning a hospital administration today can be regarded as an act of insubordination, especially if you a hospital employee.  And the “administrative physicians” are aligned with the corporation which in most cases is not aligned with your interests or the interests of your patients the same way you are.  Be very careful and make sure you understand the politics and who is really “in charge.”

Collegiality. One of the greatest tragedies in today’s medical workplace is the loss of collegiality.   Appropriate humor helps to diffuse tension and to build camaraderie.  Recognizing that some humor was sometimes hurtful to women physicians, no humor is equally, if not more, harmful.  Humor bridges gaps and can lets everyone in.  Try to find ways to be collegial and professional by keeping good humor in the workplace.

Change agent.  Some women are entrepreneurial.  Some think out of the box.  Some have different points of view.  These women are agents of change.  In this day and age of protocols and guidelines, make sure you are familiar with “the standard of care” in your community before you start changing the game too radically.  This is especially true for the young and inexperienced.

These words of warning are to help you stay out of trouble and avoid becoming a target of an investigation for being a disruptive physician. Some environments welcome physicians who speak up, are clearly directive, who are sought after, question the status quo, have a sense of humor and innovate.  And then, sadly, there are far too many places that are not.   Look not only for the policies and procedures where you are on medical staff but also read the medical staff by-laws.  These are important documents for you to have mastered, otherwise you might find yourself targeted as a disruptive physician.

Linda Brodsky is a pediatric surgeon who blogs at The Brodsky Blog.  She is founder of Women MD Resources.