I still remember the first time I saw what bullying in medicine could do to a physician in training. It was not loud at first. It was not always obvious. It came wrapped in authority, tone, pressure, and the quiet threat that a career could be damaged by people in power. A resident nearing her final year of dermatology training was being bullied by program leadership and others in the residency. She was being cornered, undermined, and made to feel small. The message was clear. Stay quiet. Accept it. Do not fight back. I was serving as a psychiatrist for a physician health program at the time. I supported her. I advised her to go above the people who were targeting her and contact the chief executive officer (CEO) of the hospital system, who was himself a dermatologist. He did something rare. He acted. He stood up for her. She completed her residency uneventfully. Today she is a successful dermatologist in the community. I still tell her how proud I am of the courage she showed.

The reality and definition of bullying in medicine

That experience stayed with me because it exposed a truth many physicians know but too few say out loud. Bullying in medicine is real. It is common. It is corrosive. And it survives because too many institutions still protect hierarchy more fiercely than they protect people. I have been practicing for 25 years. I have seen bullying happen to residents, nurses, attending physicians, and medical staff. I have intervened when I could. I have also been bullied myself. In 2013, I was bullied by a hospital CEO who was asking me to provide care and narcotic prescriptions to family members and girlfriends. I refused. I was then fired from my position as department chair. I sued the hospital and received a substantial financial settlement. That experience removed any lingering doubt. Bullying in medicine is not always yelling, insults, or public humiliation. Sometimes it is coercion by a person with power who expects you to violate your ethics and punishes you when you do not.

This is why the profession needs to stop using weak language for strong abuse. Bullying is not a misunderstanding. It is not a personality conflict. It is not leadership. It is not a rite of passage. The American Medical Association (AMA) defines workplace bullying as repeated abusive conduct that is intimidating, humiliating, or threatening, often tied to a real or perceived power imbalance. That definition matters because medicine has a long history of excusing conduct that should have been condemned. The damage reaches far beyond the target. A bullied resident is less likely to ask for help. A bullied physician is less likely to challenge a bad decision. A bullied team becomes a silent team. Silence in medicine is dangerous. When fear enters the room, patient care suffers. The AMA and related literature have made clear that bullying contributes to burnout, depression, anxiety, turnover, and moral injury. It also undermines safety, professionalism, and trust.

Hypocrisy, culture, and the traits of a bully

Medicine loves to talk about wellness. It holds conferences on resilience. It tells physicians to seek support. Yet many organizations still tolerate leaders who intimidate, retaliate, and demean. That is hypocrisy. You do not get to promote wellness while protecting bullies. You do not get to preach professionalism while rewarding abusive behavior from high producers, powerful chairs, or protected executives. The bully also has a recognizable pattern. I am not assigning diagnoses from a distance. I am describing traits physicians see every day. Some bullies show the cold entitlement, manipulation, lack of remorse, and exploitation often associated with antisocial traits. Others split people into allies and enemies, create chaos, react with rage to perceived slights, and resemble patterns seen in borderline pathology. Others are driven by impulse, poor judgment, cravings, and disinhibition that echo addiction. Different styles, same playbook. Control others. Evade accountability. Punish resistance.

Actionable steps to combat bullying in medicine

So, what should physicians do when bullying happens?

• First, call it what it is. Bullies thrive when institutions use soft words. If the behavior is repeated, demeaning, threatening, or coercive, name it clearly.
• Second, document everything. Dates. Times. Emails. Texts. Witnesses. Exact language. Specific demands. Specific consequences. Memory fades. Documentation does not.
• Third, do not stay isolated. Bullying works by making the target feel alone and ashamed. Find people with credibility and courage: a mentor, a department ally, a compliance officer, a board member, an attorney, or a trusted colleague. The resident I supported did not succeed because the bully changed. She succeeded because the truth reached someone willing to act.
• Fourth, escalate when necessary. If your immediate supervisor is the problem, go higher. If internal channels are compromised, use external ones. Physicians need to stop assuming the chain of command is sacred when the chain itself is abusive.
• Fifth, refuse unethical demands. This is where many physicians freeze because they know the consequences can be severe. Jobs can be lost. Contracts can be threatened. Reputations can be attacked. But our profession is built on duty, not obedience. When someone in power asks you to cross an ethical line, your answer must be no.

The AMA has taken an important stand in recognizing bullying as a systemic issue in medicine and calling for stronger prevention, mitigation, reporting, and accountability. That matters. Policy matters. Language matters. Culture matters. But none of that matters enough if physicians still whisper about bullying in private and stay silent in public. I am now speaking at a conference about bullying because this issue demands more than another committee statement. It demands action. It demands leaders who stop protecting the wrong people. It demands residency programs that stop confusing cruelty with rigor. It demands hospitals that stop treating physician intimidation as a human resources nuisance instead of a moral failure.

If you are being bullied, hear me clearly. Protect your license. Protect your name. Protect your conscience. Write it down. Tell the truth. Escalate it. Get help. Stand your ground. If you are a witness, intervene. Silence is collaboration. If you are a leader, stop asking for anonymous surveys and start building real accountability. Medicine does not need more polished slogans about culture. It needs courage. It needs physicians willing to stand up, speak plainly, and refuse to bow to intimidation. Bullying survives when good people decide the cost of resistance is too high. That is exactly why resistance matters.

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.