Rethinking “Servant Leadership” in Modern Health Care

As part of my residency’s practice-management coursework, I was assigned readings that encouraged physicians to adopt a “servant leadership” mindset. To be honest, the concept didn’t sit right with me. Its framing felt disconnected from the world primary care physicians actually practice in today.

Robert Greenleaf, who coined the term servant leadership in 1977,¹ didn’t mean “servant” in the feudal sense, of course; he meant service-driven, supportive, and humble. But Greenleaf’s book was published years before the rise of private-equity-owned clinics and hospitals, productivity quotas, and endless quality improvement projects. He was writing for leaders in mission-driven nonprofits, not billion-dollar corporations focused on quarterly revenue targets.

In many practice settings, physicians don’t have the operational authority or autonomy we once did, and we can’t compensate for broken systems simply by serving more. We don’t set staffing ratios, design our electronic health records, or shape the quality metrics we’re judged on. Telling burned-out physicians to “serve more” feels outdated at best, and insulting at worst.

To fix the structural problems we face in health care today, leadership virtues are important, but they’re not a substitute for healthy organizational design. Accomplishing that requires partnership, not servanthood.

Rutger Bregman argues in Humankind: A Hopeful History that leadership happens within systems, and people thrive in systems that are humane and built on trust.² So the challenge becomes how do we build a more humane system — one that treats doctors as humans too, instead of extracting more emotional labor from them? This requires shared accountability, shared governance, and collaborative leadership. If physicians are responsible for outcomes, we need a seat at the decision-making table.

At the care-team level, we must focus on fostering the trust, communication, and purpose Simon Sinek emphasizes in Leaders Eat Last.³ At first glance, his message might sound like servant leadership, but it’s really about prioritizing psychological safety instead of self-sacrifice.

The bottom line is that leadership is most effective when it is distributed. It should be a practice, not an identity⁴ — and definitely not an identity rooted in servitude.

First, we must stop expecting physicians to serve their way out of system dysfunction. Instead, we should adopt leadership models that acknowledge reality, honor professional identity, and treat team members as human beings. Second, we should embrace team-based models (e.g., dyads and triads) that decentralize power and distribute leadership to where the expertise actually lives. This would encourage shared governance and require fewer administrators. Finally, we must reframe physician leadership as stewardship — protecting people from threats to their safety, including their psychological safety.

Real leadership is about taking care of the people who do the work. We don’t need more servant leaders; we need partners working to create humane systems for all of us.