The article based on the analysis of foreign experience of commercialization of health care and introducing management methods typical for business into the work of medical organizations, shows the difficult conflict of interests within the medical community itself, as well as the clash of organizational cultures of doctors and managers. As a result, the population suffers as it either cut of from medical care or pays for imposed medical services. And the doctors suffer because of the pursuit of their leadership for economic efficiency and productivity without taking into account the specifics of the medical profession, and this leads to overwork, stress and early professional burnout. Based on a survey of Russian experts, the authors show that while in the West they come to a conclusion about the need for a management revolution that returns doctors to their priority role and prioritizes not patient's profits, but patient interests, Russia is rapidly moving along the path of unrestrained health care commercialization and fetishization indicators in the medical industry. The article describes a system of economic and organizational-legal factors that provoke a conflict of interest that arise management and staff, and also reveals the absence of mechanisms that are designed to contain its negative consequences and to some extent operate in countries whose approaches to organization Russia is rapidly adopting in health care. In addition, the opinions and arguments of the experts are given in relation to the new question for Russia as to whether the head of the medical organization should be a clinician or a manager.