Office Politics for Physicians: An Introduction to the “Dark Side”

Office Politics for Physicians: An Introduction to the “Dark Side”

“Office politics” -the words bring up images of movie villains with slicked black hair who thwart the hero every step of the way with backstabbing and unfair business practices.  Most of us have an inherent dislike of the concept and very little understanding of what office politics really entails. Whether you want to admit it, office politics will play a dominant role in your career and your ultimate success.

Defining Office Politics: All organizations have a political structure.  They have inherent manners of interpersonal and institutional interactions, regulations, standards of behavior, hierarchy, and communication systems or styles. These arrangements may be formal or informal, but define the daily functioning of the organization. For instance, you may call your Medical Assistant by their first name, but they refer to you “Doctor Smith”, especially when patients are present. This would be considered a behavioral norm within your political structure.

Introduction: There are lots of great doctors out there. But, some are more respected, well known, or successful than others. Chances are, that successful physician has excellent professional and medical business skills like negotiation, networking, or public speaking that they leveraged to accelerate their careers. This post is one of a continuing series from Physician Advocates LLC discussing often overlooked skillsets that Healthcare Professionals can utilize to grow their careers. 

Office politics is simply the effective use of power and social networking within an organizational or political structure to achieve your goals. Hopefully, you will be acting to benefit your patient, department, and yourself in a positive manner.  There is one important thing to consider, if you are not actively acting to influence your organization, someone else will be.  You may be passively allowing others to negatively impact and control your career.

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There are several “bases” or “sources” of power and focusing on these is a good way to improve your influence.  Let me give you an example of how these “bases of power” work in a real-life occurrence. A patient called me out of concern.  He had an abscessed and painful tooth and the only dentists in his insurance plan could not see for him for 8 weeks. I collected his insurance information and called a friend of mine in billing (relational, networking, or connection power) and obtained a list of all dentists and maxillary surgeons within 25 miles who took his insurance (informational power).  I called the nearest one and stated that I am the Director of the Comprehensive Stroke Center (legitimate power) and I would consider it a personal favor if my patient could be seen in a rapid manner (reward power). If he couldn’t be seen quickly, please let me know, so I could speak to the president of the health system (coercion power). My patient had an appointment arranged for 7am the next morning. I’d like to think this was an effective and helpful use of office politics. Certainly, it led to better patient care and effective use of resources. At least better than bacterial endocarditis from an untreated abscess.

You may have been on the receiving end of office politics and it can be unpleasant. To wield power wisely, you need minimize the negatives and emphasize rewards.  For instance, I have referred several patients to this surgeon (reward power) and spoke to the president of the board praising her for her dedication to patient care (referential power). We since become mutual fans with a strong pattern of referrals, recommendations, and support (relational power).


Here is a list of the generally recognized bases of power. Future posts will delve deeper into some of these, so please sign up for our newsletter to keep informed

  • Coercive power: the ability to force others. In medicine this power is wielded by chairpersons, Chief Medical Officers, or hospital presidents. This type of power is often used by poorly skilled leaders and nearly always backfires in the end. Kings don’t just lose power; they also lose their heads…
  • Reward power: the ability to offer tangible or intangible awards. This is usually thought of as bonuses or pay raises. However, recognition or non-monetary rewards are often effective
  • Legitimate power: power that comes from an appointed or recognized position. Having a title associated to your name gives you automatic influence. Whether it’s DO/MD, Medical Director, or Deputy Sheriff; the power of the title has advantages.
  • Expert Power: The power that comes from skills, talents, experience, or other personal knowledge. You may be the expert in negotiation or billing in your department. This expertise grants you more influence in any decisions made along these lines. You may even hold a form of “veto power”, where nothing would move forward in your field of expertise without your approval. The same holds true for any number of subject topics. As a physician, you likely have many developed areas of expertise.
  • Informational Power: The ability to effectively obtain information. This differs subtly from expert power. Expert power would be the ability to perform robotic prostate surgery. Information power would be the ability to use resources and contacts to learn about third party payer plans to change future compensation as the surgery becomes more available. Being able to obtain valuable information not typically available to everyone is a powerful source of influence.
  • Referent Power: The ability to influence others through affiliations or approving individuals or groups. If you have great charisma, influence, or a large network you will be able to influence others through allowing association or by giving tacit or public approval. This may sound a little like “middle-school lunchroom” drama, but is actually one of the most valuable sources of influence. Look at an athlete being paid millions of dollars to wear a brand of athletic shoes for example. The ability to influence through giving personal approval to a group, individual, or idea can make a huge difference.
  • Relational, Networking, or Connection Power: the use of social contacts to influence. Your group of friends, contacts, colleagues, classmates, and former patients all represent a valuable resource. When used wisely, they can be a profound source of influence, especially when skillfully employed to influence more powerful partners. For instance, you may want to institute a new antibiotic policy for Community Acquired Pneumonia, but your Lab Medicine colleagues disagree. Calling your medical school classmate who is now the head of the CDC to give a grand rounds on the topic may be just the influence you need. The head of the CDC agreeing with your idea and openly approving it would be an example of referent power.

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Office politics is the effective use of “bases or power” to influence your organization and achieve your goals. Despite the negative connotations often associated with office politics, it is a vital skill that you must learn to truly achieve your potential.   Not paying attention to office politics can shortchange your career, harm your patients, and even lead to physician burnout. Study your bases of power and consider how to use this to influence others, watch how others wield power and learn the positive and negative lessons, and take a course to strengthen your professional and medical business skillset.

Although office politics is not taught as part of your medical training you can master this important professional skill. Through study, mentorship, and educational resources like books and seminars you can improve your ability to influence your organization in a positive manner and succeed… really succeed.

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What do you think? Have you ever worked with an office politics genius who wielded influence like a maestro? Are you always on the losing end of conflict or office politics? Were you surprised to learn that this is such a large field of formal study? How did you learn office politics- through the school of hard knocks or a formal course? Share your thoughts in the comment section.

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1 Comment

Nelson Hippe

With thanks! Valuable information!


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