Protecting Your Surgical Career During Workplace Conflicts

by Andrea L. Merrill, MD

Imagine yourself several years into your first job as a surgery attending. Things have been going well, but occasionally, you hear from your division chief that a nurse has complained about your “behavior.” Your chief hasn’t given you specific details, and no formal complaints have been 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 receiving those complaints. You aren’t concerned because you have heard stories about male colleagues yelling, swearing, and demeaning learners, which you never do. Additionally, you rationalize that your RVU’s are high, your patient satisfaction scores are above average, the learner evaluations are favorable, and you are publishing research in peer review journals – you’re a rock star and untouchable.

Then one day, you express concern about a patient safety issue with suggestions for improvement. Or, you speak up about the mistreatment of a resident. 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. 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 again after dedicating yourself to becoming a surgeon.

If you think the scenario above 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 rather than used to ensure the standard 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, I have seen a huge increase in women reporting sudden termination for reasons such as “fit”, “behavior”, “communication style”, “professionalism”, or in retaliation to whistleblower claims.

Most of us went into surgery for altruistic reasons. In addition to being surgeons, 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 bottom line is financial or driven by insecurity and/or ego. 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 practice environment type you practice in.

There are some basic frameworks for how to protect yourself below.

1. Review all your contracts and hospital, foundation, and/or medical staff bylaws (aka the rules & regulations that govern all your practice environments)

2. Do not attend a “Surprise” AKA “Ambush” Meeting without preparation (i.e. seek out peer support and legal counsel immediately)

3. Be aware of how Sham Peer Review is weaponized against surgeons4–7

4. Understand when to retain a lawyer
   

When you are experiencing workplace injustice, you may feel isolated and alone. You may be forbidden from talking to your colleagues about the situation. This is a common corporate medical playbook strategy used to keep surgeons 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 is 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 workplace trajectory of women in surgery after workplace conflicts, as 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. 74.4% of those supported self-identified as   women, and 53.5% were in surgical disciplines. If you or someone you know is experiencing a workplace conflict, please reach out to PJE via the website contact page at https://physicianjustequity.org/contact/.  

For more detailed information about how to protect yourself consider purchasing the PJE Guidebook here.

References:

1. Pfifferling JH, Meyer DN, Wang CJ. Sham peer review: perversions of a powerful process. Physician Exec. 2008;34(5):24-29.
2. McKenna J. Seeking Fairness and Real Guidance: Medscape Physicians and Peer Reviews Report 2024. Medscape. 1204/2024. Accessed February 16, 2025.
3. Miller P. Breaking the ‘corporate medical playbook’ that silences physicians’ reports of inequity. STAT. September 8, 2022. Accessed February 18, 2024. 
4. Huntoon LR. Sham peer review: Resources for physicians. AAPS | Association of American Physicians and Surgeons. November 17, 2023. Accessed February 16, 2025. 
5. Huntoon LR. Sham peer review: Recognizing possible early warning signs. 2011. Accessed February 16, 2025. 
6. American Medical Women’s Association, Physician Just Equity. What Is Physician Peer Review.; 2022.
7. O’Connell T. The sham peer review: a hidden contributor to the doctor shortage. Kevinmd.com. July 30, 2024. Accessed February 16, 2025. 
8. Physician Just Equity. 2025. Accessed February 16, 2025. 
   

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.