I work at a large Non academic hospital which is a part of 15 hospital health system. I was hired as the Director of Interventional Cardiology and Cardiac cath lab by the CEO with the sole purpose of reviewing quality data, national metrics and improve it to meet or exceed national standards. We were at the bottom 25 th percentile in terms of mortality, complications and need for urgent repeat procedures in the management of coronary artery disease with percutaneous coronary interventions. Our hospital has a mix of employed cardiologists (50%) and private cardiologists mainly solo practitioners and small groups of 2 and 3 cardiologists. Many have them have been there for > 15 years and hold important administrative positions in the hospital which are elected positions by medical staff (not appointed by the administration). They control the medical staff services, credentialing committees and medical council of the hospital where these issues needs to be addressed. I reviewed the quality data and implemented several changes in how we function and who are qualified to do certain high end procedures and established a monthly conference to review cases to discuss how we can approach these cases better. It has been met with stiff resistance from other cardiologists as many of them are not trained enough or have the necessary skills but do not want to refer patients to competent individuals who can do these procedures with high quality. The CEO who hired me left unexpectedly. The new CEO though sharing the same vision wants no conflict and wants a certain period of status quo. I have had many discussions with the senior administration of the hospital regarding these issues. Our compensation model currently is RVU (productivity based) and this encourages a lot of inter physician competition and not a collaborative environment working towards a common goal. I have no control over these nor does my position have the authority to change any of these. Implementation of many of the suggested changes though agreed upon have not happened as I have no authority to enforce them. I am at a point of considering resignation from my position as I have not been able to influence this process and have sustained quite a bit of negative publicity from the cardiologists threatened by these proposed changes.