Egos, EQ, and Influence: The Hidden Rules of Medical Leadership

Episode 124: Egos, EQ, and Influence: The Hidden Rules of Medical Leadership

Welcome back to Medical Money Matters, where we help physicians and medical group leaders make sense of the business side of medicine. I’m glad you’re here, because today we’re diving into a topic that’s often whispered about—but rarely addressed head-on.

In every medical group, there’s a silent script running behind the scenes. One that influences decisions, leadership roles, and even day-to-day operations. It’s not in your bylaws. It’s not in your policy manual. But it definitely impacts your group’s future.

We’re talking about the politics of practice. The power dynamics. The unspoken rules of leadership that determine who really holds the keys in your organization.

Understanding these dynamics isn’t about manipulation—it’s about mastering the art of influence, alignment, and strategic leadership. Because here’s the truth: ignoring the political landscape of your group doesn’t make you noble. It makes you vulnerable.

So in this episode, we’re going to unpack:

• What office politics actually look like in the context of medicine.
• The high cost—financial and cultural—of not understanding how the game is played.
• Why medical groups often have a unique cocktail of big egos and low EQ.
• And most importantly, how to lead in a way that cuts through the noise and creates a culture free of political mayhem.

Let’s get into it.

First, let’s redefine a term that tends to make a lot of physicians cringe: office politics. What does that even mean in the context of healthcare?

Politics in this sense isn’t about backstabbing or scheming. It’s about influence. It’s the informal web of relationships, alliances, perceptions, and agendas that operate alongside the formal structure of your group. It’s how things really get done, regardless of what the org chart says.

In a medical group, politics play out in subtle ways. Maybe it’s the senior partner who has no official title but always gets the last word. Or the administrator who knows how to “read the room” and nudge decisions behind the scenes. It’s the power of influence over authority.

What makes this dynamic even more unique in medicine is the dual hierarchy: clinical authority versus operational authority. You’ve got physician partners, employed physicians, executive leaders, and support staff—each with different roles and different levels of influence. And that complexity creates a fertile ground for political dynamics.

Now, some of you might be thinking, “I don’t do politics.” And that’s admirable. But here’s the kicker—just because you’re not playing the game doesn’t mean it’s not being played around you.

And that leads us to the cost of political naïveté.

When leaders fail to acknowledge and engage with the informal power structures in their group, the consequences can be significant. Let’s talk dollars and culture.

On the financial side, groups often see higher turnover among both physicians and staff when political tensions go unaddressed. That costs time, money, and continuity of care. Projects get delayed or derailed when key players block progress behind the scenes. And in some cases, entire strategic plans fail—not because they were bad ideas, but because no one aligned the internal stakeholders.

On the cultural side, unchecked politics create resentment. Distrust. People stop speaking up in meetings. Innovation takes a backseat to self-preservation. You’ll start seeing “meeting after the meeting” dynamics, where decisions are re-litigated in hushed hallway conversations. And when a group culture starts to feel unsafe or unfair, the best people quietly check out—or leave altogether.

I once consulted with a group that was losing market share in a competitive area, not because of external forces, but because they couldn’t get alignment on basic strategic moves. There were factions. Alliances. Silos. Every initiative became a political football. They weren’t short on ideas or talent. They were short on trust. And that’s a political problem.

Now, let’s zoom in on something that’s particularly relevant in physician groups: the people problem.

Healthcare is full of incredibly smart people. Driven. Detail-oriented. Committed to excellence. But here’s the rub: intelligence doesn’t always come with emotional intelligence.

Many medical groups are a perfect storm of high-performing individuals who have big egos and low EQ. That’s not a dig—it’s an observation.

Medicine selects for independence. For self-confidence. For the ability to make high-stakes decisions under pressure. That’s great in the OR. But it’s not always great in a boardroom or a committee meeting.

We see physicians who are brilliant in their clinical role but struggle to collaborate effectively. We see leaders who are technically in charge but lack the social skills to bring people along. And we see peers who don’t know how to give—or receive—constructive feedback, because the culture has never demanded it.

The result? Dysfunction. Turf wars. Passive-aggressive communication. People who dominate meetings and people who disappear from them.

And unfortunately, EQ isn’t something that magically appears with seniority. In fact, some of the most politically disruptive people in a group are the ones who’ve been there the longest—and have never been challenged to grow beyond their clinical identity.

So what do you do?

The first step is diagnosis. Just like in medicine, you can’t treat what you don’t understand.

Start by asking: Who really holds influence in your group? Not who’s on the masthead—but who do people turn to when decisions need buy-in?

What conversations are happening outside the room? Who consistently shapes opinions, even informally? Are decisions being undermined after the fact?

You might see patterns of favoritism. Or disengagement. Or certain people who hold outsize power because of tenure, revenue generation, or simply force of personality.

One way to get honest answers is through anonymous climate surveys or 360 leadership assessments. Another is to bring in a neutral third party—like what we do at Health e Practices—to assess the cultural and political terrain objectively.

Once you’ve diagnosed the dynamics, it’s time to treat the dysfunction.

Start by raising your group’s political literacy. That doesn’t mean encouraging scheming or alliance-building. It means teaching leaders and members how to recognize influence patterns, how to map the informal networks, and how to communicate with clarity and purpose.

If someone in your group is being politically manipulative, you don’t beat them at their own game. You change the game. That starts with transparency.

Communicate decisions clearly. Share the rationale behind them. Create structures that promote open dialogue, not backroom deals.

Next, invest in emotional intelligence. EQ isn’t fluff—it’s a strategic asset.

Offer coaching for high-potential leaders who struggle with feedback or interpersonal dynamics. Implement structured feedback loops that help people develop social self-awareness. And normalize conversations around communication styles, not just clinical outcomes.

Here’s another powerful move: rotate leadership responsibilities. Sometimes the most effective way to diffuse political cliques is to broaden the circle of involvement. Let more people lead projects. Chair committees. Run meetings. It breaks up entrenched power structures and gives emerging leaders room to grow.

And of course, formalize your governance. Clear roles. Clear expectations. Conflict-of-interest policies. These aren’t just compliance tools—they’re guardrails against political chaos.

I worked with a group that implemented monthly alignment sessions—essentially a dedicated space for airing tensions, addressing misalignments, and proactively discussing group culture. It wasn’t always comfortable. But it saved them from countless hallway dramas and eroded trust, and it kept their initiatives—and their group—moving forward.

Ultimately, the goal isn’t to eliminate politics. That’s impossible. The goal is to create a culture where politics don’t derail progress—and where leadership is earned through trust, not just tenure or volume.

That brings us to the deeper work: culture transformation.

To shift from a reactive, politically-charged environment to a healthy, high-trust culture, you need more than just policies. You need values. And you need behaviors that align with those values.

Psychological safety is the bedrock. People need to feel safe speaking up, challenging assumptions, and asking hard questions—without fear of retaliation or being frozen out of the inner circle.

That only happens when leaders model vulnerability. When they admit mistakes. When they invite dissent. And when they prioritize team success over individual ego.

Strategic collaboration means aligning incentives—not just financially, but behaviorally. If you reward only revenue, you’ll get competition. If you reward collaboration, innovation, and mentorship, you’ll get culture.

Culture redesign takes time. But with intention and structure, it’s absolutely possible. And at Health e Practices, we’ve seen it transform groups from dysfunctional to dynamic.

So let’s land the plane here.

Politics in your medical group aren’t optional. They’re happening—right now. The question is: are you navigating them, or are they navigating you?

Leadership isn’t just about strategy. It’s about social intelligence. Influence. Awareness. And the courage to create systems that support integrity over ego.

So if you’re a physician leader, or an administrator trying to guide your group through turbulent waters—don’t ignore the politics. Learn the playbook. Teach it to others. And build a culture that doesn’t just tolerate leadership—it demands the kind that makes everyone better.

Thanks for listening to Medical Money Matters. If this episode resonated with you, share it with a colleague. And if you’re ready to get serious about diagnosing and fixing the hidden dynamics in your group, reach out to us at Health e Practices. We’d love to help.

Next time, we’re digging into what happens when medical groups merge—and their cultures don’t. You won’t want to miss it.

Until then, lead well.