One of the things I am most grateful for, as a doctor who has worked in at least a dozen different hospitals over the last decade, is the broad range of experiences I’ve had and the variety of physicians I’ve met and gotten to know. I enjoy hearing experienced physicians’ perspectives on how the practice of medicine has changed from what it used to be in the 1970s to 1990s.

I recall one conversation I had with a fine surgeon not so long ago, who began discussing with me the huge power shift that’s happened from doctors to administrators over the last twenty years. He recounted to me an incident that occurred when he was a young surgeon, which perfectly illustrates this fact. There was a patient care issue on one of the floors that had really angered him, when his patient wasn’t quite getting the care they needed. It was a system issue, and he told me that he was so upset that he just grabbed the chart and walked straight to the administration offices, stormed right into the CEO’s office and slammed the chart down on the table.

He raised his voice and said that if his patient ever suffered a problem like this again in that hospital, he would take all his patients elsewhere. The CEO for his part, according to what he told me, slipped back meekly into his chair. His voice quivered, and he began apologizing profusely for this problem, vowing to fix it as soon as possible! This surgeon walked out, and the problem was fixed soon after. As he finished up his story, he then went on to tell me about how interactions like that were commonplace back in the day (whether a surgeon or internist), and how such an interaction with a CEO would never happen today. Especially with today’s generation of physicians — who very much view top-level administration as their leaders.

The above story hit home several different points, as I’ve heard many experienced doctors tell me similar things over the years. Firstly, I am all for civil interactions. This surgeon was quite a humble person and good with other staff members including nurses — far from the nightmare type old-style caricature doctor who would raise their voice for no reason or throw tantrums in the OR. He was simply passionate about making sure his patients got the best. I don’t think rude interactions are ever the way forward. If it was me back then, I would have at least knocked before storming in and slamming the chart down (that’s a joke, folks).

But think about the bigger paradigm shift here in how administrations now interact with physicians, and how physicians view administrations. Back when that surgeon was young, administrations existed to serve their independent physicians. They worked for the doctors and their panel of patients. Now, it’s the other way round. And this sea-change has enormous implications for patients too, as the cart now pulls the horse.

I am frequently amazed by how the newer generation of physicians feels intimidated by high-level administration. I have always made it a point, in every hospital I have worked, to meet top-level administrators and even schedule an appointment with the CEO himself (I hope that we are moving to more gender equality, but I am yet to meet a female hospital CEO, although look forward to it hopefully very soon). I have heard many of my fellow colleagues remark to me: “Gosh, that is so ballsy of you Suneel to go and meet the CEO!” I am so surprised to hear that. I like sitting down with them, introducing myself, and giving them some of my thoughts on how we can improve systems and processes. I am not the least bit intimidated by any administrator, and neither should any highly educated physician. In today’s system, we need to be amicably working together to improve health care.

But back to the original story of that surgeon storming into the office. All newly graduating doctors should keep hearing stories like that to reinforce how much medicine has changed. They now know little else apart from working as employees in a hierarchical corporate system. Whether or not the days of administrations working for physicians will ever return, every doctor should remember that they should at the very least keep that spirit alive: Of being independent-minded leaders, standing up unapologetically for good clinical care, and being fierce advocates for their patients.

Suneel Dhand is an internal medicine physician, author, and an independent health care experience and communication consultant. He is co-founder, DocsDox.

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