Leadership plays favorites, not just with individuals but with the different departments as well, playing each department against the other and then sending passive aggressive "thank you" messages to everyone's home on office stationery. Priorities are skewed regarding what is needed in the office, there is micromanagement from almost everyone in top leadership and the in-office managers are never actually given real power to change anything. They will also go back on their word, and unless you have something in writing no conversations with upper management ever happened. The main surgeon is a salesman, he will convince anyone who will listen that they need surgery and has mood swings like a stereotypical teenage girl in an adolescent movie, which you are expected to manage for him. And anyone who disagrees with even a sentence that he says if subjected to up to an hour of what he calls "coaching"" to prove how you were wrong and he was right. The pay is really good, if you are willing to put up with all of this.