In this paper we present comparative qualitative data on the influence of patients on the relationship between health professionals and hospitals in France and Canada. We elaborate specifically on a typology that depicts the structural influence of patients in terms of open and closed communities. Our analysis reveals some key differences between the open and closed communities across the two countries. Health professionals in open communities in France were able to establish a stronger relationship with patients than those in Canada. Professionals in France described a weaker connection with their colleagues than in Canada, and this may be one of the triggers of stress, burnout and high turnover. There were more similarities among closed communities in Canada and France. Conceptualizing the structural influence of patients in terms of open and closed community ideal types is a useful heuristic device that moves the implicit and explicit influence of patients to the foreground of the analysis of the relations between health professions and organizations.