Politics is All About Aligning Competing Interests
In my last post, the first in a 3-part series, we saw why physicians can’t sit out politics.
Now let’s dig into something even more uncomfortable — but also freeing: Politics isn’t a character flaw. It is an integral part of the human experience.
Even well-intentioned, kind, and good people get pulled into politics because of psychology, not because they go over to the dark side.
In fact, organizations are political simply because people work within them.
Why Politics Exists in Every Hospital, Clinic, and Health System
Humans compare constantly
Abraham Zaleznik wrote in Power and Politics in Organizational Life that organizations are political structures built on authority, competition, and comparison.
Translation: Humans compare everything — workload, recognition, budgets, parking spots.
We compare because that’s how we judge fairness and protect our self-esteem.
Put 30 smart, competitive people into one system with limited operating time, limited FTEs, and one Keurig machine in the physicians’ lounge…and you get politics!
Not because people are evil, arrogant, or dumb. But because they are human.
Resources Are Always Scarce
I have never worked in a hospital that never ran short on beds, nursing staff, funds, or attention from senior leadership.
In my last post, I wrote that the only situation in which we never have to deal with politics is when we are alone on an island. There is only one other scenario — If there were unlimited resources for all eternity, there would be no politics.
Whether we like it or not, embracing this reality is essential to effective leadership.
We All Have Three Evolutionary Needs
Psychologist Robert Hogan famously said that human group dynamics boil down to three needs: get along, get ahead, and find meaning.
In other words, we want to belong, rise, and understand our place. Different people may want each of these to varying degrees, but desiring them naturally creates friction, alliances, rivalries, and power currents within organizations.
Relationship Currency > Performance Alone
In his article, You Can’t Sit Out Office Politics, Niven Postma describes office politics as a combination of relationship currency and Influence capital.
Hate these terms all you want, but they rule your assignments, promotions, and ability to get anything done.
Postma warns that those who avoid politics often get blindsided — fired, reassigned, or ignored — not for lack of performance, but for lack of relationships.
The Psychological Truths Physician Leaders Must Understand
Politics Trigger Identity and Ego
Being a doctor is an identity forged by sacrificing almost a decade of youth to school, long nights on call, skipped parties, and missed holidays. By the time you finish training, “patient first” isn’t a slogan. It’s in your bones. Part of who you are.
New to leadership roles, you realize that in a healthcare system, money always flows in one direction. Away from the patient. As a leader, your job is to ensure the flow is unimpeded. That the flow of green happens in only one direction is true even in solo practices.
In small practices, that flow is a brook. In large organizations, it can be it can be raging river. Physician leaders trained in a “patient first” mentality may view this, especially ensuring the flow of the raging river, as a threat to their identity.
But in a world with finite resources, there’s no way around this.
Coalitions Are Natural and Necessary
From the C-suite to the clinic workroom, humans form coalitions:
- “the old guard”
- “the new leadership team”
- “the surgeons”
- “the pediatricians”
- “the quality folks”
- “the EMR nerds”
- “the people who actually read all their emails”
Organizations run on coalitions—visible and invisible—that determine how decisions are made and who is heard.
If you don’t intentionally form alliances, you will unintentionally be excluded from them.
People Confuse Compliance with Commitment
A familiar political mistake physicians new to leadership make is thinking that just because everyone said “yes” in a meeting, they are all on the same page.
Nope.
People say yes for all sorts of reasons, ranging from being inattentive to not fully understanding the implications of their yes. When those implications later dawn on them, they backtrack.
Physician leaders must learn early to distinguish between compliance, as in, “I’ll pretend to agree so I can get out of this meeting,” and commitment, as in, “I will help make this happen.”
Commitment = “I will help make this happen.”
Learning to make this distinction alone can save years of frustration.
Unspoken Rules Shape Every Conversation
Doctors love explicit rules: “Give x mg/kg.”
“Fall precautions” means much the same thing across hospitals.
But political rules are mostly implicit:
- “Don’t surprise the VP in a meeting.”
- “Run big ideas by nursing leadership first.”
- “Finance hates being last to know.”
- “If Dr. Santos supports it, we can pass it.”
These aren’t written anywhere.
But they shape everything.
A Made-Up Example That Feels Very Real
Meet Dr. Kevin Alvarez, a new ICU director.
He rolls out a new workflow for ICU consults.
It’s brilliant.
Evidence-based.
Streamlined.
Saves time.
Saves lives.
One problem:
He didn’t talk to anesthesia.
He didn’t speak to cardiology.
He didn’t loop in nursing leadership.
By noon on Monday, three departments are upset.
By Tuesday, rumors spread that ICU is “trying to take over.”
By Wednesday, the CMO schedules a meeting titled “Concerns About ICU Process Changes.”
By Friday, the workflow is dead.
Dr. Alvarez is confused. “It was the right thing to do!”
It might have been.
But he treated the organization like a machine, when it actually behaves more like a family with 4,000 relatives and a group chat full of strong feelings.
The Big Psychological Insight Physicians Must Accept
Here’s the sentence that frees you:
Politics is how humans coordinate desire, fear, power, and meaning inside a system of scarcity.
Politics isn’t evil. It is inevitable. And when used ethically, it can be a force for:
- better patient care
- better teamwork
- better decisions
- better outcomes
In Part 3, we’ll get practical and tactical:
How to “read” your organization like a map
How to build political intelligence without feeling fake
How ot build relationship currency (without schmoozing)
How to use politics ethically, transparently—and effectively
Part 3 is where everything comes together.