Administrative violence in medicine is often understood as harm to patients due to systemic issues; however, administrative violence in medicine is also a process used to inflict harm on physicians, destabilizing the medical field on both systemic and individual levels. While much attention is given to how institutions and governments perpetuate administrative violence, it can also be enacted by individuals toward individual physicians with great harm, particularly by other physicians and colleagues, patients, and even former partners/spouses—who exploit administrative structures to target physicians for personal, professional, or legal gain or retribution. In the medical field, administrative violence is perpetuated using regulations and policies that are necessary for accountability, patient safety, and efficiency yet harm physicians in various ways when used maliciously to perpetuate abuse, control, and retribution.

As a treating psychiatrist for many physicians who focuses on physician health, healthy workplaces, and medical training, I explore the range of mechanisms of administrative violence a physician may face in their practice, its impact, and potential solutions to mitigate its harmful effects.

Administrative violence: physician to physician

While physicians are trained to uphold ethical standards and prioritize patient care, professional rivalries, power imbalances, and institutional hierarchies can foster and perpetuate administrative violence within the medical community itself. Physicians in positions of authority or influence may use regulatory frameworks—meant for self-regulation and patient safety—to undermine, punish, or eliminate trainees or colleagues they perceive as threats. I have supported multiple colleagues as a peer and as a treating psychiatrist who faced such traumatizing and targeting actions that not only can derail one’s career and ability to earn an income but also have a greater domino effect on their families and destabilize patient care access and quality of care. The examples below are generic and not all-inclusive, as the level of administrative violence I have seen among physicians defies what one can imagine in their wildest imaginations, despite the social expectation that physicians are caring and ethical individuals.

Some examples of administrative violence between physicians may include:

1. Targeted peer reviews and licensing complaints

• Peer review, intended to uphold professional standards, can be manipulated as a weapon against physicians. Some doctors exploit review boards to file unwarranted complaints against colleagues, leading to lengthy investigations, reputational damage, and emotional and financial damages. Unfortunately, foreign-trained physicians are a major target of such administrative violence as they are vulnerable with less networking, less experience in the new country, less knowledge about procedures or legal options, or even peer support to help navigate such allegations.
• Malicious reporting to medical boards and regulatory colleges can trigger administrative scrutiny, requiring physicians to spend extensive resources on legal defense, even if the claims are unfounded, which can delay one’s ability to practice, damage reputation, or even jeopardize employment opportunities, let alone the financial and emotional toll.

2. Hospital politics and credentialing barriers

• Senior physicians or administrators may use credentialing processes to block competitors from practicing in certain hospitals or networks.
• Triangulating the department and staff against a physician, isolating them from communication or departmental activities, and turning nursing teams and allied health professionals against them via gossip and rumors.
• Spreading gossip that undermines a physician’s reputation in collegial discussions or unfounded allegations reported to a credentialing committee, delaying credentials or work opportunities.
• Undermining physician autonomy, micromanaging, and closely monitoring for any mistakes that are then used to discipline the physician rather than through growth-oriented approaches.

3. Retaliation for whistleblowing

• Physicians who report unethical or unsafe practices may face administrative retaliation, including suspension, firing, unwarranted complaints, regulatory reporting, and the ruining of their reputation among other departments/institutions, especially in small towns.
• The use of excessive compliance audits or shifting performance metrics can be a tool to remove whistleblowers under the guise of poor job performance.

4. Weaponizing malpractice lawsuits against peers

• Some physicians, particularly those in competitive private practice, may encourage patients to file malpractice suits or regulatory college and board complaints against competitors to damage their reputations or drive them out of business.

5. Weaponizing the complaints process

• Encouraging or intentionally seeking out or creating complaints against a physician and weaponizing non-specific “professionalism” concerns—often targeting foreign-trained physicians who may be more vulnerable due to licensing or visa status.

6. Weaponizing professionalism

• Professionalism is the pattern of behavior expected of a physician upholding the standards of medicine. Although physicians should be professional in their behavior with patients and colleagues, unfortunately, the vague definition can often be used for vague, non-specific complaints used against fellow physicians and trainees, with subjective interpretation of what professionalism can mean, including targeting cultural variability in emotional expression, eye contact, and speech.

7. Weaponizing physician health programs

• Physician health programs can be valuable in supporting physicians and their health with resources and programs. However, in toxic workplaces, they can be weaponized with false reports of “concerns” over a physician’s mental health and stability—forcing the physician to undergo investigations and assessments—at times using a false narrative provided by the workplace as part of the evidence the physician has to defend against. Many physicians, unfortunately, avoid seeking help from physician health programs due to fear that reaching out for help will be used against them—especially if it is found out in their toxic workplace or by colleagues who are targeting them.

Administrative violence from patients toward physicians

Patient safety and good professional medical care are the goals for most of us physicians who sacrificed years of their lives learning medicine and upholding continued medical standards. Safe and professional medical practice requires regulations and policies that are necessary for accountability, patient safety, and efficiency; furthermore, mechanisms for complaints that patients can pursue if an issue arises are a right every patient should have. Having been a medical patient myself at some points in my life, and my whole family as well—safe medical care is important. Patient trust and the regulation of medical professionals are crucial. Unfortunately, the same systems and regulations used to protect patients and regulate medicine can be used to harm physicians. We know that modern physicians face increasing workplace violence that includes physical, sexual, and emotional abuse, and administrative violence has now become another domain of abuse physicians face daily.

Administrative and legal processes meant to protect patients can be used to target physicians relentlessly—ranging from reputational attacks online via social media or rating sites, legal threats, and threats of disciplinary complaints if something is not done as expected.

Some examples of administrative violence from patients:

1. Malpractice claims and licensing board complaints

• Some patients may file malpractice claims against physicians that take years to work through the systems. Even when cases are dismissed, the legal costs and psychological damage to physicians can be devastating, with many physicians changing their practice or wanting to leave medicine, aside from the development of psychological trauma, mood disorders, and addiction, and can even lead to suicide.
• Patients can file complaints with state medical boards, triggering mandatory investigations that force physicians to divert time and money into defending themselves. Although filing a board complaint is a right every patient should have, at times this becomes a way of retribution and administrative violence—where the complaints were filed as a threat or retribution to coerce a physician into a certain action (i.e., ordering tests that are not indicated, providing legal paperwork or a medical opinion with which the patient did not agree, or intentional abuse toward a physician).

2. Social media smear campaigns and online harassment

• Patients sometimes use rating review platforms to post one-sided, misleading, or defamatory reviews about physicians. Social media platforms allow for widespread misinformation about physicians, leading to threats, harassment, and reputational damage. Given confidentiality laws and professionalism expectations, physicians do not have much recourse to engage on social media or rating websites to provide details of cases/events for a more comprehensive representation of the alleged event/care/behavior, thus allowing a one-sided opinion online to paint a limited picture of the situation. Unfortunately, online as well, it is easy to threaten physicians or gather support with mob mentality over an issue that a physician treats or deals with—resulting in complaints about that physician by non-patients—causing more administrative tasks and emotional, time, and financial costs in dealing with these complaints.

3. Refusal to pay bills and insurance fraud

• Patients may claim mistreatment or incorrect billing due to a limited understanding of how billing works or what insurance criteria are required for payment, or to avoid paying medical bills, not wanting to pay a physician with whom they disagreed on an opinion, treatment plan, or expectations, or out of retribution—leading to administrative reviews and potential financial penalties for physicians. Some patients may refuse to update their health cards, credit cards, or other payment methods as well.

4. Reports to physician health programs

• Patients may make allegations to regulatory bodies, hospitals, or physician health programs regarding a physician’s health or mental stability—and again, although it is essential to have a mechanism for reports of impaired physicians during clinical encounters and if a patient is concerned—I have seen cases where allegations were made for other reasons.

5. Administrative violence from former partners toward physicians

• Physicians are particularly vulnerable to administrative violence from former spouses or partners, especially in contentious divorces or custody battles. Due to the stringent rules around medical licensure and reputation, administrative tools such as medical board complaints, legal claims, and workplace interference are often used as weapons in personal disputes.

Mechanisms of administrative violence from former partners

1. Weaponizing custody battles and allegations of neglect

• Physicians, due to their demanding schedules and on-call shifts, are often accused of neglect or unfitness as parents in custody disputes. Courts may use their long work hours and on-call duties as a basis for denying custody, restricting parental rights, or making assumptions about parental involvement or capacity—even if the physician parent is a sole provider for the whole family and there was an agreement between the couple on childcare and financial responsibilities. Female physicians are often judged harshly for their work hours and time away from family by the court and society—making various assumptions about their motherhood abilities or commitment to children versus their career; unfortunately, this tactic has been used by abusive ex-partners in separation/divorce proceedings either to control the partner from leaving or to harm the partner when they are trying to leave the relationship.
• Former partners sometimes claim that a physician’s stress levels, exposure to disease, or access to medications make them unfit parents.

2. Filing false licensing board complaints

• Ex-partners may file fraudulent complaints with medical boards, alleging misconduct, substance abuse, or unethical behavior. These complaints trigger automatic investigations that can harm the physician’s hospital privileges and ability to work, even if they are ultimately dismissed—and can range from accusations of mental fitness or substance abuse to other alleged criminal behavior that would make regulatory boards concerned.

3. Restraining orders and criminal allegations

• Although intimate partner violence is a horrible reality for so many people daily, for physicians, especially those trying to leave abusive relationships, abusive partners may perpetuate abuse even further via administrative violence with threats or actual complaints claiming domestic abuse or harassment, leading to criminal charges/proceedings that can impact a physician’s ability to practice. Physicians who require certain security clearances or background checks for hospital privileges may lose these rights if they are subjected to even unproven legal claims while the criminal investigation drags out—leaving them without a source of income and ruining their reputation socially, with patients, and colleagues—thus forcing many physicians to tolerate abusive relationships out of fear of such false accusations.

Impact of administrative violence on physicians

The cumulative effects of administrative violence—whether from colleagues, patients, or former partners—can be devastating, impacting a physician’s mental and physical health, career, and family, and, in the worst case, even lead to suicidal ideation and suicide. A single malicious complaint or lawsuit can cost physicians tens or hundreds of thousands of dollars in legal fees and lost income, and hours away from patient care and their personal life. Even when physicians are cleared of wrongdoing, the reputational damage can be irreversible, leading to job loss or difficulty finding new employment, especially if allegations included inappropriate behavior, alleged criminal acts, or had such a grave emotional impact that physicians will develop trauma disorders and significant mental health challenges. Some physicians will change their medical practice or leave medicine. Their families and children are often affected by this administrative violence—as the struggling physician parent may be withdrawn, struggling with irritability, and anxiety, and life plans regarding where one lives may be altered by these proceedings, uprooting the whole family. Some physicians will face several processes at the same time, such as online reviews, board complaints, and other complaints, making it even more challenging to cope.

What can you do if you are facing administrative violence?

1. Name it to tame it—name what you are facing. Knowing that you are not alone and that thousands of physicians are dealing with this in silence is a first realization that often helps physicians accept that they are not defective or the only ones dealing with this traumatizing, painful, and often unpredictable process that often shapes their view of the medical and justice system, psychological and physical safety, predictability, career planning, and relationships with peers, patients, and family. You are not alone—you do not know other people’s cases due to confidentiality, nondisclosure agreements, shame and trauma reactions, and because in medical training our mentors do not teach us about the “badness” but focus on the guidelines, with which we may all contend at any point. You may not even be the only physician in the same hospital or department dealing with this issue—and you will never know due to confidentiality or the legal processes involved.

2. Administrative violence in one way or another likely happens to all physicians across their career—we do not have enough information or discussion at this point. In my psychiatric practice, I see the increase of such processes and the impact on physicians involved—especially with social media and the impact of one-sided review sites on physician self-esteem, confidence as a physician and person, and mental health, let alone reputation. When administrative violence happens earlier in one’s career, people learn and tend to become more resilient with the right support—or they quit and pursue other careers. When administrative violence happens to more senior physicians, the discrepancy between their performance or professionalism over years of their career and the accusations can often make it much harder to process emotionally and professionally.

3. Getting the right legal support as soon as possible is crucial to help the physician navigate this process about which most physicians were never educated in training. Getting your own legal advice—employment, malpractice, family law—is important for a physician to understand their rights, possibilities, and legal options. Often, lawyers working in this field can provide validation that the physician is not alone and that others have dealt with similar issues. Lawyers are very important to the practice of medicine and to our careers and employment—speaking to a lawyer should be one of the first steps to take. Lawyers can be costly; however, their expertise and skill level will help navigate these uncharted waters of misery. Lawyers who support physicians with administrative issues often also know good therapists and other sources of support relating to your situation.

4. Getting personal support through own therapy and psychiatric care if needed is also crucial. Going through administrative violence of any sort is absolutely devastating for many reasons, let alone if there are personal vulnerabilities such as a history of trauma or limited personal and family support. No administrative issue should cost physicians their life—please seek help, including local crisis supports, crisis phone lines, or the ER if needed. You are more valuable as a human being than any complaint, online review, or lawsuit in your physician role.

5. Administrative violence can last a long time—from weeks to years. Having short-term and long-term coping plans is important: What can you do daily to get through each day, email, and meeting, and how can you tolerate the long-term emotional, financial, and physical distress without making impulsive decisions?

6. Radical acceptance of painful reality: Most physicians will preoccupy themselves with ruminations about “why” and unfairness—Why is this happening to them? Why are they targeted? Why is the patient doing this after everything they have done? Why does their colleague target them so much to ruin their career? Why is their ex-partner so abusive? We will never know the true “why”; we can spend hours guessing and ruminating, losing more time, energy, and life we will never get back. Reasons why people engage in administrative violence range from misunderstanding, preconceived judgments, jealousy, hatred, blame, and projection, to persuasion by other parties whose involvement you may not even realize. Shifting focus to nonjudgmental acceptance of “this is happening,” and focusing on how you can respond, cope, and what you can learn, is pivotal to containing the impact of administrative violence. Shifting from “why me?” to “what can I learn here? What do I need to do here?” is a more accepting and problem-focused approach that allows us to focus on our coping and learning instead of being stuck in judgments about everyone involved. People are complex and their behaviors are complex—we will never figure them out with “why” in our heads, only spend more time we will never get back.

Administrative violence in medicine is a serious issue facing modern physicians, often with severe consequences of reputational and career ruin, and personal and mental health costs. Awareness of administrative violence can empower physicians facing it with better coping, as most physicians are alone and isolated when facing administrative violence, as well as provide tools for our future physicians on how to recognize and cope with this detrimental aspect of medical practice that can affect anyone at any stage of their career.

Maryna Mammoliti is a psychiatrist.