Before we get started, the actual comments and the factual basis behind what people post on Reddit matter far more than a Reddit karma number. People are entitled to have opinions, share their experiences, and allow others to decide for themselves what they find credible.

What Is Narcissistic Leadership?

A narcissistic Program Director (PD) is not simply a confident, demanding, or strong-willed leader. Narcissistic leadership behavior can involve an excessive need for admiration or control, a sense of entitlement, difficulty accepting criticism or disagreement, diminished empathy, and a tendency to elevate oneself while devaluing people whose expertise, accomplishments, or independence may challenge that self-image.

The American Psychiatric Association describes Narcissistic Personality Disorder as involving a pervasive pattern of grandiosity, a need for admiration, and lack of empathy, with associated behaviors such as entitlement, exploiting others, envy, and arrogant or haughty attitudes. Importantly, having narcissistic traits or describing behavior as narcissistic is not the same as making a psychiatric diagnosis of Narcissistic Personality Disorder.

What Can This Look Like in a Residency Program?

A PD exhibiting narcissistic leadership behaviors may:

• Take disproportionate credit for the accomplishments of others while minimizing or ignoring their contributions.

• Become threatened when a program manager, coordinator or other staff member demonstrates substantial expertise or independently identifies a compliance issue.

• Experienced and perceptive program managers, however, often recognize these dynamics and can distinguish genuine leadership from attempts to diminish another person's contributions including towards other residents, attendings.

• Dismiss or attack the person rather than objectively addressing the substance of what they have raised.

• Have difficulty acknowledging when someone else is correct.

• Surround themselves with individuals who consistently support or reinforce their views while marginalizing people who challenge them.

• Treat employees differently depending on whether they are perceived as loyal or supportive.

• React to disagreement as a personal challenge to their authority rather than as an opportunity for professional discussion.

• Publicly or privately belittle, humiliate, or undermine individuals whose competence or expertise may make them feel threatened.

• Expect loyalty and admiration while providing little recognition or appreciation in return.

• Reframe legitimate professional disagreement as a problem with the employee's attitude, personality, competence, or character.

My Experience

My experience with a PD whom I came to view as exhibiting narcissistic leadership behavior was particularly troubling because I was not attempting to undermine his authority. I was doing my job and sharing my ACGME/GME expertise.

On one of many occasions, I raised an ACGME compliance issue based on my knowledge and experience. Before a subsequent meeting, I provided the PD with the applicable section of the ACGME Common Program Requirements supporting what I had stated.

Rather than addressing the substance of the ACGME requirement professionally, the meeting became focused on me personally. The PD told me that I had “something wrong with my brain” and that I was not a leader. Two other individuals closely aligned with him were present.

What was particularly troubling was that my professional expertise was being characterized as a personal problem even though I had provided the actual ACGME authority supporting my position. Moreover, I question whether the PD was qualified to make a medical or psychological assessment that there was ‘something wrong with my brain,’ making the comment both inappropriate and deeply concerning.

Of course, anyone is free to disagree with my perspective, and I respect that. My purpose in sharing this is not simply to complain about my own experience. I am sharing it because I believe this type of treatment should not happen to anyone in a professional workplace. People should be able to raise concerns, share their expertise, and disagree respectfully without being personally attacked, humiliated, or made to question their competence or character.

Over time, I also experienced what I perceived as a pattern in which my contributions were minimized, my expertise was discounted, and my efforts were not acknowledged to the same degree as those of my counterpart.

My counterpart had been with the company as a program coordinator for more than 35 years. Yet, she herself told me on several occasions that I was needed because she did not know ACGME. I nevertheless found that when I shared my ACGME expertise, identified compliance concerns, or spoke about my own contributions, my input was often discounted rather than recognized.

When I attempted to speak up about my contributions and correct what I believed were inaccurate characterizations of my work, I was ultimately characterized as a liar rather than having the substance of my concerns addressed.

For me, the defining issue was not that the PD disagreed with me. Professional disagreement is normal. The problem was the repeated shift from addressing the work itself to attacking me personally when I expressed an independent professional opinion or relied upon my ACGME expertise.

More concerning, this culture of suspicion was not limited to me. Concerns about residents’ use of sick time ultimately resulted in a faculty lecture focused on “lying,” which further eroded morale. Residents are entitled to sick leave under their union contract, and treating resident physicians as though they must prove their honesty undermines trust, professionalism, and morale.

More recently, a point-based system related to sick calls was implemented, which I find deeply concerning. Closely monitoring and effectively policing sick leave seems unnecessarily paternalistic—especially in a hospital, of all places, where we care for people when they are sick. Throughout my career and education in both business and healthcare, I was taught that if you are genuinely unwell, you should call in sick—that is precisely what the sick days provided under your contract are for. This is why it is important not only to read the resident union contract, but also to understand the program's culture and leadership—and whether those contractual rights are genuinely respected in practice.

That distinction matters.

A strong leader can say:

“I disagree with your interpretation of this requirement. Let's review the evidence.”

Likewise, why should a resident exercising their contractual right to sick leave be made to feel as though they must justify or prove that they are genuinely ill—or risk losing points? In medicine, questioning clinical judgment can be appropriate; questioning whether a resident is legitimately sick when they are exercising their contractual sick leave is an entirely different matter.

A leader exhibiting narcissistic behaviors may instead respond as though the employee's disagreement itself is the problem and shift the discussion away from the substantive issue and toward the employee's competence, personality, or character.

When that happens repeatedly, the result can be deeply demoralizing and humiliating for the person on the receiving end.

My experience taught me that one of the most important things prospective residents and staff should evaluate is not merely whether a program looks impressive on paper, but how its leadership responds when someone respectfully disagrees, raises a compliance concern, or demonstrates expertise. Also important is how they treat program coordinators.

That is why I would encourage anyone considering a residency program to ask questions, interview broadly, speak with current and former residents and staff when possible, and pay close attention to how leadership treats people who are not simply telling them what they want to hear.

I am sharing my experience in the hope that it can help make a difference in this program and remind residents and program staff everywhere that they are not alone. No one should feel isolated, intimidated, or diminished for speaking up or doing their job. Your experience matters, your voice matters, and your professional expertise matters.

Do your due diligence. Ask difficult questions. Interview broadly. And make your own informed decision.

And, last but not least, thank you for the unexpected education in narcissistic behavior. Unfortunately, this was not my first experience with this type of leadership. In the past, I simply absorbed it, said very little, and moved on. This time, I decided to speak up, document my experience, and share what I learned. So, in an unexpected way, thank you for the lesson—I now know exactly what it feels like to be on the receiving end of narcissistic behavior. I suppose every education has its price, but at least this one came with a rather valuable lesson in recognizing red flags, setting boundaries, and finally finding my voice. And yes, strangely enough, that has been both empowering and freeing.

From Article to Stage

This article became the creative starting point for The NARCISSUS Project, inspiring the original song “NARCISSUS” and the one-act theatrical musical comedy ME, NARCISSUS!—The Myth Was Wrong. Just Ask Me.

Watch the official trailer: https://www.youtube.com/watch?v=DUg35hdBr7k