- Competition with other established staff members.
- Competition against the hospital itself, since this may be easier than trying to enforce a no-compete clause.
- Professional jealousy (yes, it does exist).
- The physician may be a perfectionist, too thorough, who likes that?
- A whistle blower.
- A physician whose opinions are not conforming with the culture of the establishment in the hospital.
- A surgeon who is not liked by some OR staff who favor another surgeon
- A physician who is not liked by some connected nurses
These are just examples. You never know where the smearing may come from. Remember, the peer review process can be initiated by a hearsay evidence. The system is so badly open to exploitation, that the above reasons may start a process that may end a physician's career in the USA.