Authored by Andrea Merrill, MD and Pringl Miller, MD, FACS on behalf of the AMWA Gender Equity Task Force
Imagine yourself several years into your first job as an attending physician in an academic or community practice setting. Things have been going well but occasionally you hear from your division chief that a nurse from clinic or an inpatient unit has complained about your “behavior.” Your chief hasn’t given you specific details and there have been no formal complaints made. To your dismay, your division chief has not asked you how communication and interprofessional interactions have been with the nursing staff as necessary context to assessing the validity of those complaints. You aren’t concerned because you have heard stories about male colleagues patronizing, belittling and raising their voice at nursing staff. which you never do. Additionally, you rationalize that your productivity is on board with your peers, your patient satisfaction scores are above average, and you’ve received no negative evaluations from trainees or anyone else.
Then one day, you express concern about a patient safety issue with suggestions for improvement. Or you speak up about mistreatment of a co-worker. Or perhaps you have a patient complication despite providing the standard of care. Out of the blue you receive an email about a meeting with the Department Chair and are put on “administrative leave” while an investigation into your behavior and practice is covertly conducted. You are assured the investigation will be fair, and you’ll be involved but no one ever talks to you to get your side of the story. Your administrative leave drags on for several months until one day another meeting is called, and you are abruptly terminated without due process or proven cause. Because your administrative leave was longer than 30 days, your institution is obligated to report this to the National Practitioner Data Bank (NPDB). You apply for other jobs but face challenges getting credentialed due to the NPDB report. You begin to worry you may never practice medicine again after dedicating so many years of your life to becoming a physician.
If you think this scenario could never happen to you, this article is for you.
Unfortunately, there aren’t good data to know exactly how often this scenario occurs, but it is more common than you think. As physicians going through workplace injustices like these, we don’t often talk about them due to shame and embarrassment or having signed a non-disclosure agreement (NDA). It is estimated that at least 10% of peer review investigations are “sham peer reviews” and that peer review is being weaponized against talented ethical physicians rather than ensuring standards of care.1 A recent study by Medscape showed that 56% of physicians are worried that peer reviews could be misused to punish them.2 Anecdotally, we have observed a huge increase in women from all specialties reporting sudden termination for reasons such as “fit”, “behavior”, “communication style”, “professionalism” or in retaliation to unlawful behavior or whistleblower claims.
Most of us went into medicine for altruistic reasons. In addition to being physicians, many of us are advocates for a patient’s right to have quality care in a safe and respectful environment. We assume others in our workplaces have similar intentions and will listen when we speak up about quality and safety concerns. All too often this is not the case and for many in leadership roles, the financial bottom line is the priority and there are insecurities and egos often involved complicating matters. We are all at risk of experiencing some version of the above scenarios and unfortunately every one of us is expendable.3 This is true no matter what type of environment you practice in.
There are some basic frameworks for how to protect yourself:
- Review all your contracts and hospital, foundation, and/or medical staff bylaws (aka the rules & regulations that govern all your practice environments)
- Do not attend a “Surprise” AKA “Ambush” Meeting without preparation (i.e. seek out peer support and legal counsel immediately)
- Be aware of how Sham Peer Review is weaponized against physicians4–7
- Understand when to retain a lawyer
- DO NOT sign or agree to anything until you have consulted with a trusted advisor and attorney
When you are experiencing a workplace injustice, you may feel isolated and alone. Commonly, you may be forbidden from talking to your colleagues about the situation. This is a common corporate medical playbook strategy to keep physicians from being empowered and exactly why the organization Physician Just Equity (PJE) was founded by Dr. Pringl Miller. PJE is a 501(c)3 organization made up of 50 physicians who are dedicated to preserving justice in medicine.8 Everyone in PJE has experienced workplace injustices and are now giving back by helping others. PJE provides free confidential peer support in teams upon request by physicians in need.
Additionally, PJE is collecting data on the nature of workplace conflicts and the employment trajectory of women in medicine after experiencing a workplace injustice because there is a lack of data in this area. The collective has supported 150 peers since February 2021. To learn more about the PJE peer support initiative read the Research Letter here. In 2024 alone 43 peers were supported, a 159% increase in requests from 2023 and the need continues to increase. 74.4% of those supported were self-identifying women. If you or someone you know is experiencing a workplace injustice, please reach out to PJE via the website contact page: https://physicianjustequity.org/contact/.
For more detailed information about how to protect yourself consider purchasing the PJE Guidebook here.
References:
- Pfifferling JH, Meyer DN, Wang CJ. Sham peer review: perversions of a powerful process. Physician Exec. 2008;34(5):24-29.
- McKenna J. Seeking Fairness and Real Guidance: Medscape Physicians and Peer Reviews Report 2024. Medscape. 1204/2024. Accessed February 16, 2025. https://www.medscape.com/slideshow/2024-doctor-peer-reviews-6017750?icd=login_success_email_match_norm#9
- Miller P. Breaking the ‘corporate medical playbook’ that silences physicians’ reports of inequity. STAT. September 8, 2022. Accessed February 18, 2024. https://www.statnews.com/2022/09/08/breaking-the-corporate-medical-playbook-silencing-physicians-reports-inequity/
- Huntoon LR. Sham peer review: Resources for physicians. AAPS | Association of American Physicians and caeons. November 17, 2023. Accessed February 16, 2025. https://aapsonline.org/sham-peer-review-resources-for-physicians/
- Huntoon LR. Sham peer review: Recognizing possible early warning signs. 2011. Accessed February 16, 2025. https://www.jpands.org/vol16no3/huntoon.pdf
- American Medical Women’s Association, Physician Just Equity. What Is Physician Peer Review.; 2022.
- O’Connell T. The sham peer review: a hidden contributor to the doctor shortage. Kevinmd.com. July 30, 2024. Accessed February 16, 2025. https://kevinmd.com/2024/07/the-sham-peer-review-a-hidden-contributor-to-the-doctor-shortage.html
- Physician Just Equity. 2025. Accessed February 16, 2025. https://physicianjustequity.org/
About the Authors
Dr. Andrea Merrill is a surgical oncologist specializing in breast surgery, currently practicing in Charlottesville, VA. She completed her medical education at Tufts University, followed by a general surgery residency at Massachusetts General Hospital and a surgical oncology fellowship at Ohio State University. Beyond her clinical duties, Dr. Merrill is passionate about narrative medicine, surgical ergonomics, and advocating for physician rights and workplace equity. Through her work with Physician Just Equity (PJE), she lends her expertise to guide and support fellow physicians facing workplace conflicts related to discrimination and gender bias. Dr. Merrill’s commitment to equitable treatment in the medical profession drives her contributions to enhancing workplace justice and mentorship in healthcare.
Dr. Pringl Miller is board certified in general surgery and hospice and palliative medicine with fellowship training in clinical medical ethics. She is a fierce advocate for Justice, Equity, Diversity, and Inclusion (JEDI) in the medical profession. To this end she founded the 501(c)3 advocacy organization Physician Just Equity (PJE). A Research Letter published in JGIM in 2023 describing the novel PJE approach to peer support can be found here: rdcu.be/c7DLH.