This NEJM essay discusses transformation of medical culture. It bridges a few realities as physicians go from independent professionals to employees who can be manipulated or leveraged. Being one of them, supervised by decent people who were themselves supervised by people who I didn't know but I'd wonder a bit about, the top-down model has some real flaws. While I was on the direct interface of the mission of patient care, I was never solicited for my experience. I saw myself as part of the team, never a gadfly, but never enthusiastic. I could be a loyal steward, but never an owner. Doctors follow the rules for the most part, both rules of mainstream patient care and rules of our employers. We are very much a part of the culture of what is around us, but far less contributory than we should be. Professional satisfaction is no longer a high priority in a medical culture. The NEJM authors seem disturbingly content with that.
