A Physician's Guide to Navigating a Bureaucracy


To get what you need to create a more ideal practice, you must learn to navigate the bureaucracy of your organization. Here's how.

Fam Pract Manag. 2020 May-June;27(3):26-30.

Author disclosure: No relevant financial affiliations disclosed.

© 2020 Dike Drummond, MD, CEO, TheHappyMD.com

Back in 2018, we reached a significant tipping point in medicine. For the first time, physician practice owners were not in the majority. Instead, most practicing physicians reported being employed, with family medicine having the highest share of employed physicians.1

Loss of autonomy is a major frustration for many employed doctors, particularly those who used to practice independently. Suddenly, you are not “the boss” or “in charge” because this is not your practice. The practice exists inside an organization that is a vast bureaucracy, and you are smack in the middle of the org chart with several layers of bosses above you. These individuals often are not doctors, but they have the power to dictate the specifics of your practice and possibly decrease your job satisfaction unless you figure out a way to have some influence over their decisions.

For example, let's say you are spending one to two hours each night doing pajama-time charting at home, and you would like to try working with a scribe to ease your documentation workload so you don't burn out. You make a great case to your administrator, who shoots down the idea, saying, “If I give you a scribe, I have to give everyone a scribe.”

Here's another example: Your organization uses centralized scheduling with inflexible templates, and you are wanting some control over your schedule. You would like to be able to schedule two 10-minute walk-in visits after lunch each day to unload your afternoon. It would be good for patients too, but your boss says no.

In both examples, you disagree with the decision and feel your organization's bureaucracy is causing harm. It's not a matter of life and death, such as a pandemic, where you might be asked to do things that put your life in danger and need to say “No!” In this article, we're not talking about crisis or emergency situations. We're talking about routine circumstances, but there's still real harm involved — inefficiency, overworked doctors, unhappy patients, etc.

So what should you do?

A. You could leave the organization and go work somewhere else, but you'll likely encounter a bureaucracy wherever you go.

B. You could say nothing, keep your head down, and accept the bureaucracy, which will eventually lead to job dissatisfaction, resentment, burnout, or worse.

C. You can learn how to navigate the bureaucracy and gradually take back some control over your practice.

Option C involves developing two essential skill sets: 1) managing your boss and 2) maintaining a position of influence in your organization. Here's how to do both.


  • An organization's bureaucracy can cause real harm — inefficiency, overworked doctors, unhappy patients, etc. — but physicians can influence it by learning to manage their boss.

  • Once you've built a positive balance in your relationship “bank account” with your boss, it's time to ask for what you need; pick the highest priority change you want to make to your practice.

  • As you relate to


Dr. Drummond is a family physician, CEO of TheHappyMD.com, and author of Stop Physician Burnout: What to Do When Working Harder Isn't Working. He is an author, speaker, and consultant on the subject of physician burnout.

Author disclosure: No relevant financial affiliations disclosed.

© 2020 Dike Drummond, MD, CEO, TheHappyMD.com


1. AMA. Employed physicians outnumber self-employed. May 06, 2019. https://www.ama-assn.org/press-center/press-releases/employed-physicians-outnumber-self-employed


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