I'm not sure what to make of those loose wires between the pylons, but other than that it shows a definite progression from your early examples of the same composition.
Yeah, this would have been improved with either more negative space to the right or a third, distant pylon in the background to the left. I would assume there's no real way of changing the wires in this version, but what you could do in future is use string as guides? I d'know, I'm not sure on how these are processed.
You're too short to make a surgeon anyway, you'd need a stool just to get at patients; and given your track record with steps, that'd only ever end in disaster.
I can see that but it's lost in the border. The perspective drop-off needs to be sharper, then. Pulling the first pylon in from the edge so it's equal with the space from the top edge would fix that.