The first of those is in a few ways similar to the
Class Warfare suggestion, although part of what I was suggesting there was that it take place over time, rather than being a base feature.
Toady has said in the past that he wants the first few years to be more like a captain at sea, where everyone just does what they're told because it's for survival. When you get more accomplished, that's supposed to change.
Would you even consider changing the relationship that the player has with the dwarves right now (as unquestioned overlord and direct allower and denier of all things dwarves can and cannot do), so that dwarves can become more autonomous and individual, and possibly create a better simulation, while on the other hand, potentially dramatically upping the potential for Fun because dwarves are stupid and very likely to hurt themselves unless continually babysat, or perhaps more importantly, if it meant that the player had less direct control over his fortress, and had to rely more on coaxing the ants in his/her antfarm to do his/her bidding?
Our eventual goal is to have the player's role be the embodiment of positions of power within the fortress, performing actions in their official capacity, to the point that in an ideal world each command you give would be linked to some noble, official or commander. I don't think coaxing is the way I'm thinking of it though, as with a game like Majesty which somebody brought up, because your orders would also carry the weight of being assumed to be for survival for the most part, not as bounties or a similar system. Once your fortress is larger, you might have to work a little harder to keep people around, but your dwarves in the first year would be more like crew taking orders from the captain of a ship out to sea or something, where you'd have difficulty getting them to do what you want only if you've totally flopped and they are ready to defy the expedition leader.
The overall idea in Class Warfare is that it starts out a Communist Command Economy, and gradually turns into something more capitalist over time as the dwarves' unity against a hostile environment decays into interpersonal squabbling as your fortress grows more established. (This, in turn, is a way to counteract the game's current hard-at-first-but-easy-when-established "learning cliff", where, once survival is achieved, there's basically nothing left to do but wait for the next FB or siege or go start a megaproject to kill time.)
Hence, I like the idea of ownership, but think it should be more of a gradual thing. Your fortress has no money and communal ownership at first, but slowly turns to privatization and
mercantilism.
Also, keep in mind that the Chief Medical Dwarf is appointed by the Mayor or Expedition Leader, not God. (And the player is supposed to be those appointed or elected nobles, for the most part.)
That said, forcing more relationships between CMD and practicing doctors does make more good sense. Right now, the CMD just
knows the health of all dwarves. Requiring the CMD to check up on doctors after some period of time to get status updates the same way that bookkeepers need to go back to the desk to renew their magic memorization of the location of every item in the map would work for that, and having dwarves have some forced check-ins with superiors also would make some great sense.