Ethics, a neglected dimension of power relationships of physician leaders

Objective Physician leaders in obstetrics and gynecology find themselves in complex power relationships with administrative subordinates, administrative peers, and administrative superiors. The ethical dimensions of these power relationships have not been examined previously. Study design The authors draw on the work of 3 major historic figures (John Gregory, Thomas Hobbes, and Friedrich Hoffmann) to identify for the first time 3 major types of power relationships and organizational cultures. Gregorian power relationships and organizational cultures are characterized by shared fiduciary responsibility that advances the core mission of a health care organization. Hobbesian power relationships and organizational cultures are characterized by relentless self-interest in a zero-sum game. Hoffmannian power relationships and organizational cultures are characterized by enlightened self-interest in a win-win game. Results The authors analyze the ethical dimensions of power relationships of physician leaders with subordinates, peers, and superiors and of organizational cultures. Conclusion The authors support transformational leadership toward Gregorian power relationships and organizational cultures, using, when necessary, Hoffmannian power relationships and organizational cultures as a way station.