Every physician knows the feeling: walking into a hospital that relies on your expertise, your time, and your ability to perform at the highest level, only to find yourself struggling to locate a working coffee machine or a place to sit for five minutes between patients or cases. I even remember getting yelled at by a nurse for eating saltine crackers in the hospital once! It becomes easy to shrug it off, to tell yourself that this is simply how medicine works now. But occasionally, something happens that throws the disparity of second class treatment for doctors into sharp relief. That happened to me this past week, so I sent out a quick post about it. And it sparked a wave of responses from doctors across the country who felt the same way.

Below is the original one-minute blog I sent out, followed by a deep dive into the themes that emerged from the tons of responses I received. The consistent patterns in these replies paint a clear picture of why physicians tolerate second-class treatment and what, if anything, we can do to change it.

Original One Minute Blog – Why Do Doctors Tolerate Second Class Treatment?

I spent this past Monday in Jacksonville at the headquarters of a medical company that developed a microsurgical robot for micro and supermicrosurgery. We just got one at our hospital, and this quick 24-hour trip was necessary so I could earn the certificate to get credentialed.

The trip was successful, fun, and informative. But one thing stuck with me. When I walked in with my host, before entering the lab portion of the office, he pointed down the hallway to a modern kitchenette stocked with refreshments. Help yourself, he said.

Early afternoon, after a few hours training on the robot, I wandered over. Two refrigerators filled with soda, energy drinks, yogurt smoothies, and sports drinks. A full coffee bar, which was impressive even though I don’t drink caffeine. Shelves packed with healthy snacks and protein bars.

In my head, I immediately contrasted this with the two main hospitals where I operate. One used to have a surgeon lounge with food, but it disappeared a few months ago due to cost. At the other, a five-year fight to get snacks in the lounge finally yielded Chex Mix and Milano cookies.

And that is the difference between being a regular professional and being a doctor. The difference between a private company and a hospital of any type. It feels like a fitting metaphor for how physicians are treated in practice.

The real question is why we accept it and how we can change it?

What Doctors Said: Five Major Themes

After sending out the post, my inbox filled up with stories about and reactions to perceived second class treatment of doctors. The stories and insights painted a vivid picture of a profession that has undergone massive cultural and structural changes. While the comments came from physicians in different specialties, regions, and practice types, the themes were remarkably consistent.

1. Loss of Leverage

Over and over again, physicians pointed to one central issue: leverage.

One orthopedic surgeon wrote about how hospitals used to court independent physicians because those physicians could bring or take their cases anywhere. That autonomy created natural negotiating power. But as employment models replaced independent practice, physicians became less mobile, less competitive as a workforce, and ultimately less influential.

Several readers echoed this idea with striking clarity: leverage drives treatment. When doctors became employees, hospitals no longer needed to “entice” them. With fewer places to go, and with large systems dominating markets, hospitals no longer felt pressure to maintain amenities or conveniences.

Another doc summarized it simply: whoever has the money has the leverage. In modern healthcare, that rarely describes physicians.

2. Historical Contrast: When Doctors Were Treated Differently and Not Second Class

Older physicians recalled a very different era. One reader shared a story he learned from his father, a dentist, about the only ENT doctor in Savannah who once refused to operate because the hospital failed to stock tomato juice in the surgeon lounge. The administrator herself walked across the street to buy it. The point was not the tomato juice; it was the recognition that physicians had power because they generated indispensable revenue and had alternatives.

Another surgeon described two very different training environments. In Georgia, he had a fully stocked physician lounge, hot lunches, and a level of institutional respect that communicated value. When he moved to New York for fellowship, he was struck by how abruptly that dynamic changed. Doctors became a commodity. Even learning his name was optional to the staff who depended on him.

His story reinforced a common thread: large academic centers, especially in urban markets, often see doctors as interchangeable. Smaller community hospitals, where differentiation matters, continue to treat physicians with more respect and consideration.

3. The Rise of APPs and the Crowding of Physician Spaces

Several readers raised a newer frustration: physician lounges increasingly filled with nonphysician providers. As hospitals expand APP staffing and flatten titles into the generic term “provider,” traditional physician spaces have become crowded or repurposed. Many doctors noted that the expanding non-physician workforce dilutes the recognition of the distinct responsibilities and training associated with being an MD or DO.

One reader put it bluntly: doctors do not address these changes, and the result is that physicians now find themselves competing for snacks with residents, NPs, and PAs in spaces originally designed to support physicians between patients.

4. Cultural Adaptation: Doctors Are Conditioned to Endure (Even Second Class Treatment)

Doctors are, by training, adaptable. Residency teaches us to tolerate inconvenience, cut corners on self-care, and push forward no matter how inefficient or unreasonable the system becomes. This conditioning does not simply vanish after training; it becomes a professional default.

Multiple readers pointed out that hospitals know this. Physicians will not quit because the lounge lost coffee. They will not refuse cases because the snacks disappeared. They will keep providing care because they care about their patients and their craft, and because the stakes are too high.

This predictability creates a situation where hospitals can cut support services without fearing consequences. The physician culture of endurance becomes a structural weakness.

5. The Financial Reality: Declining Reimbursements and a Shifting Landscape

Several physicians linked the issue of second-class treatment with a larger economic decline in the value of physician labor. Reimbursements have stagnated or fallen for decades. Productivity expectations rise while compensation fails to keep pace with inflation or workload.

Another orthopedic surgeon described joint replacements reimbursing around eleven hundred dollars, including a ninety-day global period, and yet orthopedic surgeons still do them. Because the system is structured such that doctors must continue performing high-complexity work for diminishing returns.

Another reader noted that the shift toward private equity ownership, employed models, and consolidation has left physicians economically dependent on entities that prioritize cost containment over physician satisfaction.

The result is a perfect storm: doctors have less leverage, less financial independence, and fewer alternatives than before.

What Can Physicians Do? Practical Approaches to Reclaiming Value

The readers did not simply identify problems. Many offered strategies or mindsets that may help physicians regain some control.

1. Recognize and Assert Economic Value

As multiple readers emphasized, physicians generate enormous revenue for hospitals. That fact is often forgotten or intentionally minimized. Recognizing this value is the first step. Physicians must feel justified asking for better treatment, whether that means improved lounges, better call rooms, or more functional operating room support.

One reader described telling administration that poor physician treatment makes it harder to recruit and retain talent, which directly affects hospital revenue. In other words: frame your requests in terms of business impact.

As an example, here are 3 Ways I Defined My Value Ahead of My Contract Negotiations.

2. Use Collective Action Through Medical Staff Leadership

The tomato juice story illustrates something simple: when physicians act together, hospitals listen. Multiple readers shared examples of successfully advocating for amenities or resisting charges for physician meals by using the medical staff organization.

While physicians may lack employment leverage, they still hold structural leverage when united.

3. Strengthen Individual Leverage Through Financial Independence

Several readers pointed out a less obvious but powerful method: financial independence. When a physician does not rely entirely on their clinical income, they become less fearful of rocking the boat. That confidence translates into leverage, even quietly.

It's like I always say, a nation of financial free doctors will change healthcare in powerful ways that we can barely even imagine!

Physician side gigs, expert witness work, real estate, and smart investing were common strategies described by readers who now feel freer to speak up, negotiate, or walk away.

4. Advocate for Structural Distinctions Between Clinical Roles

Some readers recommended drawing clear boundaries about who belongs in physician lounges or surgeon-specific spaces. While this can be a sensitive topic, it reflects a broader principle: different roles require different types of support. Protecting physician-specific spaces is not about hierarchy; it is about ensuring surgeons have what they need to perform safely and efficiently.

5. Remember That Respect Is a Culture, Not a Perk

Multiple themes pointed back to a cultural issue: environments that treat doctors poorly often suffer in other ways too. Burnout rises. Staff morale falls. Patient throughput suffers. Institutions that treat physicians well do so because they recognize the value of creating a supportive culture.

Physicians can help shape this culture, but only if they speak up.

A Parting Note

The overwhelming message from physicians was this: doctors tolerate second class treatment because systemic forces have reduced their leverage, conditioned them to endure hardship, and placed them in environments where their contributions are undervalued or taken for granted.

But that does not mean we are powerless. I know. Because, remember, I am still a full time, 1.0 FTE practicing physician in the trenches with you.

Doctors can advocate, unite, negotiate, and build personal leverage through financial independence. They can remind institutions that their work drives the revenue and reputation of every hospital in the country. And they can push back, even in small ways, against a culture that expects them to accept less.

As always, thanks to everyone who responded. The conversation is just beginning. Let's keep it going so we can see the change we deserve!

What do you think? Why do doctors tolerate second class treatment? Have you had any experiences like that? What did you do? What can we all do? Let me know in the comments below!