Is There a Power Shift Happening in Medicine?

Rosy Thachil, MD


November 18, 2021

As a junior attending still nascent in her clinical and leadership journeys, I have observed that there are an array of unique approaches to power, leadership, and management.

When a mentor of mine introduced me to this Harvard Business Review article from 2014, it struck me that the phenomena described in this article are very much reflected not only in society and work culture at large, but also in medical culture, practice, and leadership. 

The piece describes two distinct types of power: 

"Old power," which tends to be hierarchical, more formal, "inaccessible," structured, and leadership driven, 


"New power," which is open source, collaborative, accessible to all, transparent, and open to innovation; everyone can participate (not just those at the top).

This shifting culture of power is one that is certainly applicable to medicine and healthcare. There are those who believe medicine operates best with its strict hierarchies, transmittance of information from teacher to pupil in a unidirectional format, and rigid curricula and structures. Then there is another school of thought that believes that medicine needs to embrace a newer era of collaboration, innovation, and bidirectional communication. 

It must also be pointed out that oftentimes (at the risk of overgeneralization), it is a younger physician generation that subscribes to "new power." As an early-career millennial physician, I find that my de facto style is new power — I'd rather collaborate than compete, and I consider most interactions to be a two-way exchange of information. I find more inspiration in being empowered than being given direct orders, and I find that I learn from those both senior and junior to me. 

However, new power and old power may in fact be a spectrum, instead of a dichotomy. The two may not be mutually exclusive, and I believe both can coexist and work synergistically within the medical ecosystem. There may be situations where one is preferable over the other. For example, during medical training or academic promotions, hierarchy provides a critical framework and learning path to follow: medical student to intern to junior resident to senior resident to fellow to junior attending. In some ways, there is a certain "comfort" and familiarity to long-standing hierarchy. However, gone overboard, it can also potentially stifle innovation and alternative paths or ways of thinking. 

Inherently, medical culture operates on "old power" with ladder-like hierarchies and organizational structures. However, as medicine and medical leadership innovate and advance, bridging old power and new power may give us unique ways to bring together different generations, peoples, and ideas. If we collectively lean into this, it may help us create a culture that is empowering, empathetic, collaborative, and inclusive for all.

What are your thoughts on the changing culture of medicine and medical leadership?

Disclaimer: The above article is intended for informational purposes only. It is not professional medical advice. If you believe you may have a medical emergency, immediately call your physician or 911.

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About Dr Rosy Thachil
Rosy Thachil, MD, is a noninvasive cardiologist and assistant professor of medicine at Albert Einstein College of Medicine. She is a graduate of Jefferson Medical College and completed cardiology training at Mount Sinai Hospital. She is a fellow of the American College of Cardiology.

Dr Thachil's clinical interests including acute cardiovascular care, cardiac critical care, and health disparities. Her nonclinical interests include personal development, blogging, and writing (at


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