When the CEO of United Health Care was assassinated in broad daylight on the streets of New York City, the media lit up. News outlets scrambled for interviews. Security protocols were analyzed. His death was treated with the gravity such a high-profile loss warrants.

But I wonder: Where is that outrage when physicians die?

Every year in America, doctors are killed — not by administrative burnout, malpractice lawsuits, or government prosecutions, but by acts of violence, often from the very patients they are committed to helping. These deaths happen quietly. No presidential statement. No primetime headlines. No national mourning. Just another white coat, bloodied and buried, while the rest of us are told to “move on” and “keep serving.”

This silence is not just disheartening — it’s dangerous.

Consider Dr. Wayne Fenton, a towering figure in schizophrenia research and a leader at the National Institute of Mental Health. Dr. Fenton was killed in 2006 during a weekend appointment with a new patient. The young man, later diagnosed with psychosis, beat him to death inside his own office. This was not in a war zone. This was suburban Bethesda, Maryland. At NIMH. Inside the temple of American psychiatric innovation.

Fenton’s loss was a seismic blow to psychiatry, but outside the academic world, it barely registered. His murder received only passing attention in the mainstream press. For those of us who walk the tightrope of psychiatric practice, it was a grim reminder: Even the best among us are not safe.

Then came July 2023. At UPMC Mercy Hospital in Pittsburgh, a man walked into the ICU, weapon drawn, intending to kill. Police responded swiftly, and thankfully no lives were lost that day. But the fact that such an attempt even occurred — in a space meant for healing — reflects how perilously thin the line between care and chaos has become.

This is not just about psychiatry. Consider Dr. Benjamin Mauck, a Tennessee hand specialist, shot and killed in July 2023 by a patient inside a medical center in Collierville. A month earlier, in Tulsa, Oklahoma, Dr. Preston J. Phillips, an orthopedic surgeon, was murdered by a disgruntled patient who blamed him for post-operative pain. The gunman also killed three others before taking his own life. Both Drs. Mauck and Phillips had devoted their careers to healing. Their clinics were spaces of trust, not combat zones. Yet, in both cases, that trust was betrayed in the most brutal way imaginable.

The American Medical Association has sounded the alarm. Between 2011 and 2018, violent attacks against health care workers surged by 67 percent. Physicians are now five times more likely to experience workplace violence than workers in other sectors. Yet these assaults remain grossly underreported — partly due to stigma, partly due to futility. We are taught to absorb pain, not speak it. But silence has not served us well.

In fact, it’s killing us.

As chilling as these stories are, there are also physicians who have resisted — who, in moments of unspeakable terror, fought back. One such story comes from my home state of Pennsylvania. In July 2014, a patient named Richard Plotts walked into the psychiatric clinic at Mercy Fitzgerald Hospital just outside Philadelphia. Agitated and angry, he pulled a gun and fatally shot his case worker execution-style. His next target was his psychiatrist, Dr. Lee Silverman. But Dr. Silverman was not unarmed.

In an unprecedented twist, Silverman — who had a concealed carry permit — pulled out his .32 caliber handgun and fired back, hitting Plotts multiple times and stopping what could have been a massacre. Investigators later found 39 additional bullets on Plotts. The implication was chilling: Had Silverman not defended himself, many more could have died. Some in our profession recoiled at the idea of a physician carrying a firearm. I understand the discomfort. But ask yourself: What would you have done? Would you rather write prescriptions or eulogies?

This case, like others, exposes the raw vulnerability of doctors in modern America. We walk into exam rooms blind to what’s waiting on the other side of the door. Our oaths ask us to “first, do no harm” — but what recourse do we have when harm comes for us? Global studies suggest that violence against physicians is endemic, with prevalence rates as high as 90 percent in some specialties. Emergency departments and psychiatric units are especially high-risk. But the truth is, no specialty is immune. From obstetrics to orthopedics, from family practice to surgery, the white coat is no longer a shield.

The psychological toll is immense. We experience fear in our own offices. We check exits before sitting down with new patients. We lose sleep. We burn out. Some of us leave medicine. Some even take their own lives.

So what can be done?

First, let’s name the problem. This is not “part of the job.” Violence against physicians is a national crisis. It should be tracked, investigated, and prosecuted with the same urgency as school shootings or airline threats.

Second, hospitals and clinics must invest in real security — not just cameras and policies, but trained personnel, panic buttons, secure entrances, and de-escalation training. The same energy we devote to cybersecurity must be extended to physical safety.

Third, we need legislative reform. Just as assaulting a flight attendant is a federal offense, so too should be violence against a physician in the workplace. The AMA has called for stronger laws. Now we need Congress to act.

Fourth, we must give doctors a voice. Reporting systems must be anonymous, accessible, and taken seriously. The culture of silence must end.

Lastly, we need to reframe the narrative. Physicians are not just providers. We are humans. Fathers. Mothers. Sons. Daughters. And like anyone else, we deserve to go to work without fear that we may not return home.

As a psychiatrist, I sit daily with people navigating despair, delusions, trauma, and rage. I do not believe that violence is inevitable. But I do believe we have ignored its warning signs for far too long. Every physician who has died at the hands of violence deserves more than a passing mention in a hospital memo. They deserve remembrance. They deserve justice. They deserve for their deaths to mean something — to awaken a profession that can no longer afford to look away.

We cannot bring back Dr. Fenton, or Dr. Mauck, or Dr. Phillips. But we can fight to ensure the next doctor doesn’t have to die in silence. We are healers, not heroes. But if no one will protect us — we must, at the very least, protect each other.

This essay is cited in the KevinMD record on violence against health care workers.

Muhamad Aly Rifai is a nationally recognized psychiatrist, internist, and addiction medicine specialist based in the Greater Lehigh Valley, Pennsylvania. He is the founder, CEO, and chief medical officer of Blue Mountain Psychiatry, a leading multidisciplinary practice known for innovative approaches to mental health, addiction treatment, and integrated care. Dr. Rifai currently holds the prestigious Lehigh Valley Endowed Chair of Addiction Medicine, reflecting his leadership in advancing evidence-based treatments for substance use disorders.

Board-certified in psychiatry, internal medicine, addiction medicine, and consultation-liaison (psychosomatic) psychiatry, Dr. Rifai is a fellow of the American College of Physicians (FACP), the American Psychiatric Association (FAPA), and the Academy of Consultation-Liaison Psychiatry (FACLP). He is also a former president of the Lehigh Valley Psychiatric Society, where he championed access to community-based psychiatric care and physician advocacy.

A thought leader in telepsychiatry, ketamine treatment, and the intersection of medicine and mental health, Dr. Rifai frequently writes and speaks on physician justice, federal health care policy, and the ethical use of digital psychiatry.

You can learn more about Dr. Rifai through his Wikipedia page, connect with him on LinkedIn, X (formerly Twitter), Facebook, or subscribe to his YouTube channel. His podcast, The Virtual Psychiatrist, offers deeper insights into topics at the intersection of mental health and medicine. Explore all of Dr. Rifai’s platforms and resources via his Linktree.