This chapter examines the communication challenges associated with the hierarchical structure of power relationships among the health professions. It is commonly believed that balancing power relationships is crucial for successful interprofessional collaboration in providing patient care, but because hierarchy is deeply embedded in healthcare organizations, balancing power among health professionals may be an unrealistic ideal. This chapter therefore reframes thinking about professional hierarchy—from a monolithic absolute to a flexible and negotiable social order that can serve multiple purposes at different points in the patient care process. It proposes a communicative framework of interprofessional hierarchy negotiation that can help us to understand how interprofessional care groups can negotiate hierarchical power relationships in a way that improves collaboration without increasing conflict.