Decoding Physician Friction: Agreeability as the Hidden Driver of Team Complaints
Physician leaders frequently wonder if certain personality traits naturally cluster within specific medical specialties. When it comes to “Agreeability,” one of the Big Five personality traits associated with cooperation, flexibility, and “getting along” harmony-seeking, the differences can be striking. Let’s explore why certain specialties tend to score lower on this particular trait, and why this matters for physician leaders.
Across specialties, surgeons consistently score lower on the Big Five trait of agreeableness—a finding supported by multiple peer-reviewed studies and by our own internal data at PULSE. While “low agreeableness” may sound negative in lay terms, it often reflects professional strengths such as emotional restraint, assertiveness, and unilateral decision-making under pressure—key ingredients in many surgical environments.
A BMJ Open study (2018) examining personality traits by specialty confirmed that surgeons score significantly lower in agreeableness than physicians in other specialties, with distinct patterns of competitiveness and lower interpersonal warmth. Similarly, a 2020 Journal of Surgical Education study of orthopedic surgeons reported consistently lower agreeableness scores, aligning with the stereotype of orthopedics as a specialty dominated by direct, no-nonsense communicators.
These findings are echoed in a peer-reviewed article co-authored by PULSE in the Journal of Surgical Education (“Dr. Congeniality”) in 2018. Using 360 feedback data, the article illustrates how nontechnical skills like collaboration and self-awareness remain a challenge for some surgeons—not because of incompetence, but because of a personality style that deprioritizes social harmony.
Our 2025 internal analysis of a large-scale project involving 2,500 surgeons and over 25,000 written Start/Stop feedback comments found a strong association between low agreeableness and poor PULSE 360 ratings—particularly in the “Yellow” (1+ SD below the PULSE database mean) and “Red” (2+ SD below) ranges. These patterns were especially pronounced in high-intensity surgical specialties.
- Orthopedic Surgery: Known for its assertiveness and results-driven culture, orthopedic surgery often attracts individuals less inclined toward deferential or consensus-based communication.
- Neurosurgery & Cardiothoracic Surgery: These fields demand precise execution and high-stakes decisions under stress—traits often accompanied by lower expressed empathy or emotional accessibility.
Taken together, these data suggest that low agreeableness isn’t a flaw in surgeons—it’s a predictable pattern at the macro level (though individuals vary, of course!). The challenge isn’t to “fix” these traits but to help surgical teams develop shared language and systems that balance decisiveness with the human dynamics of team-based care.
Anesthesiology: Precision Without Pleasantries
Anesthesiologists, who typically work behind the scenes, tend to score lower on agreeability because their role demands meticulous, assertive attention to patient safety rather than sustained interpersonal engagement. A BMC Medical Education study (2020) underscores this, showing anesthesiology trainees displaying lower agreeability traits, especially those in high-intensity subspecialties like Critical Care Anesthesiology.
Lower Agreeability More Likely to Select Surgical Pathways as Medical Students
A 2016 Korean Journal of Medical Education study found Korean medical students choosing surgical paths were notably lower in agreeability compared to their clinical medicine peers, who tend toward higher empathy. Similarly, the 2020 BMC Medical Education study showed anesthesiology and emergency medicine students reflecting lower-agreeability profiles, likely due to the demands for decisiveness and independence inherent in their roles.
Higher Agreeability Physicians Emphasize Empathy, Long Term Patient Relationships, and Collaboration
From our experience with more than 15,000 physicians and nearly 1 million completed PULSE surveys, we have noticed many patterns in both quantitative and qualitative feedback. While certain specialties tend to attract individuals with lower agreeability, others naturally appeal to physicians who thrive in cooperative, harmonious environments, and are further drawn to specialties with long term patient relationships, as opposed to the single-engagement leanings found in more intense and high-stakes specialties.
Extremely high agreeability might be described as Soothe Only, while extremely low agreeability might come off to others as Solve Only, while the rest are placed somewhere on a spectrum of Solve AND Soothe, with the low agreeability leaning toward Solve first and the high agreeability toward Soothe first.
Is High Agreeability Always an Advantage? Not Necessarily.
While higher agreeability is beneficial for fostering harmony, collaboration, and positive interpersonal relationships, it also carries many potential drawbacks, especially in high-stakes or critical clinical settings:
- Difficulty with Confrontation: Highly agreeable physicians may struggle to deliver necessary but tough feedback, potentially allowing performance issues or errors to persist longer than ideal.
- Overcommitment and Burnout: Physicians high in agreeability often have trouble setting firm boundaries, frequently agreeing to extra tasks or shifts, which can lead to increased stress, exhaustion, and eventual burnout.
- Avoidance of Necessary Conflict: Agreeable individuals might shy away from necessary professional conflicts, risking unresolved disagreements or suboptimal clinical decisions due to excessive compromise in the aim of avoiding friction/conflict.
- Delayed Decision-Making: Prioritizing consensus can slow decision-making processes, potentially hindering timely action in critical medical situations.
- Reluctance to Assert Expertise: Overly agreeable physicians may hesitate to firmly assert their expert opinions, particularly when faced with dominant personalities or hierarchical pressure, which can compromise patient safety or optimal clinical outcomes.
Recognizing these potential pitfalls helps physician leaders appreciate the nuanced value that lower agreeability can bring in healthcare settings (such as decisiveness, clear communication, and willingness to address tough issues head-on).
5 Tips for Physician Leaders Managing Low-Agreeability Team Members:
- State Expectations Clearly and Early: Use explicit, concrete language when setting expectations. Instead of saying, “We should improve patient safety,” say, “Complete the patient safety checklist before every procedure,” or “Bring your concerns first to the Nurse-Manager rather than the nurses.”
- Give Objective, Specific Feedback: Avoid vague or emotional feedback. Rather than “Your attitude is disruptive,” try, “When you interrupt during rounds, it slows us down. Please give others a chance to finish speaking before making a comment.”
- Create Opportunities for Independent Decision-Making: Allow low-agreeability physicians to lead specific tasks or projects independently. Clearly define the goals, timelines, and deliverables, and trust them to handle the details.
- Establish Structured Communication Protocols: Set clear protocols for communication, such as scheduled one-on-one meetings, brief daily huddles, or regular email updates, to minimize misunderstandings and reduce conflicting messages.
- Use Forward-Looking Language for Corrections: Instead of dwelling on past mistakes, frame corrections positively toward future improvements. For instance, say, “In future cases, please double-check the equipment list before surgery to make sure everything is ready,” rather than focusing on past oversights.
Why Does It Matter?
First of all, individual physicians and providers vary. You will certainly find high agreeability surgeons and low agreeability pediatricians out there. However, these are very strong patterns that PULSE has noticed over our 22 years of healthcare-specific coaching.
Interestingly, PULSE 360 Survey findings show no significant differences on Teamwork Index Scores (essentially measuring professionalism and interpersonal communication) between surgeons (n=2049), medicine specialists (n=1770), and non-surgical specialists (n=1390). This suggests that there may be differences between specialties in personality, but workplace behavioral patterns, assessed by mean teamwork index scores, are similar across specialty categories. Of course, within these larger groups, there are substantial differences in individual behavioral patterns.
Low agreeability isn’t inherently negative at all. In fact, it’s often an advantage in medical environments where skepticism, independence, and assertiveness can save lives. Physician leaders equipped with this knowledge can better navigate interpersonal dynamics, anticipate conflicts, and tailor communication strategies to harness the strengths of their less agreeable colleagues effectively.
Do You Need Personalized Insights?
Curious about your own personality profile or the profiles of physicians on your team? Explore our Leadership Compass Assessment, dialed in specifically for physician leaders. Gain insights, improve communication, and strengthen your team’s effectiveness.