While a vast majority of physicians lead honorable careers serving their patients, the few who do not can cause harm beyond the patient-physician dyad. Physician sexual misconduct (PSM) is one such harmful event that impacts the public’s overall trust in the field. However, this damage is amplified, in part, due to how medical boards respond to reports and how they discuss their consequences for offending physicians. This chapter will review what constitutes PSM, outline current trends in how medical boards handle such cases, and delineate how some of these actions can be experienced as institutional betrayal. It then makes recommendations for trauma-informed and institutionally courageous actions across the timeline of a PSM event.