As an MD, I can tell you that your view is extremely skewed. There absolutely is an annoying hierarchy. Endless departmental rules that get in the way of your practice, constant messages from the billing department asking you to edit old notes so the hospital can bill for more, fighting with insurance companies, fighting with pharmacies, fighting with patients...it doesn't really end.

For your friends in derm, I would ask them how hard they had to work to earn their careers. Dermatology is consistently one of the few hardest subspecialties within medicine to get into. You may be able to work 4 days/week later on in your career, but you'll be working non-stop through medical school pumping out research papers and studying for top board scores just to get in to derm. These days, a huge percentage of medical students end up taking an extra year just to get more research out before applying to derm.