The Emotional Abuse of Physicians-Part 1: The Cycle of Abuse

Emotional despair amongst physicians is at an all-time high. What physicians have experienced as a result of the COVID pandemic and the resulting clinical and workplace stresses brought about has been called many things from burn-out to moral injury to compassion fatigue.

But let’s call it what it really is……abuse.

This series will cover the emotional abuse of the physician. From the battered physician syndrome to the feedback trap, it’s time we uncover the truth that lies behind the medical walls.

The medical establishment in the United States is extremely toxic, and its toxic character has been exasperated by the COVID pandemic. The relationship that the medical establishment has with physicians follows the pattern of that of a narcissistic abuser: idealization, devaluing, and replacement.

Step 1: Idealization

This is often referred to as the “honeymoon phase.” When a new relationship begins, the abuser idealizes the victim and often “places them on a pedestal.” This is commonly seen in medicine as new hires are often initially praised. More recent examples of this in medicine have been seen during the COVID pandemic in which physicians who are working on the “frontlines” are called “heroes.”

Step 2: Devaluing

The second phase in a narcissistic relationship is the devaluation by the abusive partner. Let’s take a look at some of the ways physicians are devalued.

  1. Midlevel providers – One obvious example is the way physicians are devalued is by the presence of and replacement by midlevel providers. Midlevel providers have a fraction of the knowledge, training, or expertise as physicians, but are often touted by the medical establishment as being “just as good as physicians.”
  2. Financial disregard – Another way physicians are devalued by the medical establishment is financially. For example, many physicians found themselves being furloughed as a result of the COVID pandemic or were asked to volunteer, while many other clinical staff got paid “hazard rates.”
  3. Lack of recognition – A third way physicians are constantly devalued by the medical establishment is by the lack of formal recognition and appreciation of the hard work they do. For example, all hospitals celebrate Nurses Week, but until 2017, they only celebrated Doctors Day. Although National Physicians Week is now celebrated in many health care organizations, it often includes mid-level providers in those celebrations, thus making it more like “National Providers Week” as opposed to “National Physicians Week.”
  4. Lack of concern for health and safety – Another way physicians have been devalued during the COVID pandemic occurred when hospitals showed a blatant disregard for the health and safety of physicians by the inability to provide adequate PPE.
  5. Lack of support – Many physicians feel unvalued and unsupported by their organization due to the belief that “the patient/family is always right” and the prevalent attitude that they must always be accommodated.

Step 3: Replacement

The third phase of a narcissistic relationship is the replacement of the partner by the abuser.  Physician job loss seems to be at an all-time high. There are countless instances in which physicians have been replaced by midlevel providers, some of whom they actually trained. There are other instances in which physicians have been forced to leave their jobs because the alternative is accepting a new contract that substantially decreases their salary. And of course, there are times in which physicians are fired simply because, “without cause.”

We see this narcissistic pattern of abuse by the medical establishment towards physicians played out time and time again. A physician is touted as a hero as he/she works tirelessly during each of the COVID surges, only to be furloughed or asked to take a pay cut because the organization has lost money as a result of the pandemic. Then, he/she ultimately is fired as the organization hires mid-level providers to do his/her job to save money.

This pattern of behavior has left many physicians emotionally scarred and has been mislabeled as burnout….when what it really is… is abuse.

And it is time for the abuse of physicians to stop.



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