The medical director and the use of power: limits, challenges and opportunities

The organizational leadership in mental health agencies frequently resides in executives who are not psychiatrists and who may or may not have clinical backgrounds. Psychiatrists who are medical directors (MDs) of organizations with this structure are responsible for the success of the clinical programs, but are subordinate to the executive director (ED). The MD/ED relationship therefore is an example of the complexities and challenges of a relationship in which supervisor and supervisee have different types of power, but are mutually dependent on each other for the organization's success. Clarity and differentiation of the types of power of the MD and ED can be helpful in determining appropriate boundaries and facilitating a cooperative relationship that allows the organizational mission to be well served. Raven's model of the bases of social power (French and Raven, Studies in Social Power, 1959; Raven, Analyses of Social Issues and Public Policy 8(1):1-22, 2008) provides a useful framework to explore this relationship and the challenges and opportunities inherent in it.