This study examines identity and solidarity among 22 physician-managers working in a changing health maintenance organization. It describes two distinct identities among these professionals and the social relations associated with them. The identities are labeled organization-compatible and profession-compatible. Social relations between physician-managers are characterized by conflict, distrust, and game-playing rather than collegiality. The findings support the existence of fragmented solidarity within the group as a whole. Understanding the social organization of physicians under managed care means moving beyond the collective solidarity ideal implied by the professionalism model toward more communal, grassroots notions of cohesion. On a practical level, these results question the long-term meaningfulness of a medical management specialty in health care.
Get full access to this article
View all access options for this article.
References
1.
Abbott, A.
(1989). The new occupational structure: What are the questions. Work and Occupations, 16, 273-291.
2.
Abbott, A.
(1991). The future of professions: Occupation and expertise in the age of organization. In S. R. Barley & P.S. Tolbert (Eds.), Research in the sociology of organizations (Vol. 8, pp. 17-42). Greenwich, CT: JAI Press.
3.
American Medical Association
. (1997). Physician characteristics and distribution in the U.S. Chicago: Author.
4.
Blau, P.M.
(1955). The dynamics of bureaucracy. Chicago: University of Chicago Press.
5.
Brint, S.
(1994). In an age of experts: The changing role of professionals in politics and public life. Princeton, NJ: Princeton University Press.
6.
Burawoy, M.
(1979). Manufacturing consent: Changes in the labor process under monopoly capitalism. Chicago: University of Chicago Press.
7.
Collinson, D.L.
(1992). Managing the shop floor: Subjectivity, masculinity, and workplace culture. Berlin: Walter de Gruyter.
8.
Dalton, M.
(1959). Men who manage. New York: John Wiley.
9.
Freidson, E.
(1975). Doctoring together. New York: Elsevier.
10.
Freidson, E.
(1989). Medical work in America. New Haven, CT: Yale University Press.
11.
Goldner, F.H.
, & Ritti, R.R. (1967). Professionalism as career immobility. American Journal of Sociology, 72, 489-503.
12.
Gouldner, A.W.
(1954). Patterns of industrial bureaucracy. New York: Free Press.
13.
Hafferty, F.W.
, & Light, D.W. (1995). Professional dynamics and the changing nature of medical work. Journal of Health and Social Behavior (Extra Issue), 132-153.
14.
Hoff, T.J.
, & McCaffrey, D.P. (1996). Resisting, adapting, and negotiating: How physicians cope with organizational and economic change. Work and Occupations, 23, 165-189.
15.
Hughes, E.C.
(1958). Men and their work. New York: Free Press.
16.
Iglehart, J.
(1992). The American health care system: Managed care. The New England Journal of Medicine, 327, 742-747.
17.
Janowitz, M.
(1960). The professional soldier. Glencoe, IL: Free Press.
18.
Leicht, K.T.
, & Fennell, M.L. (1997). The changing organizational context of professional work. Annual Review of Sociology, 23, 215-231.
19.
Lipsky, M.
(1980). Street-level bureaucracy. New York: Russell Sage Foundation.
20.
Manning, P.K.
(1977). The social organization of policing. Cambridge: MIT Press.
21.
McArthur, J.H.
, & Moore, F.D. (1997). The two cultures and the health care revolution. Journal of the American Medical Association, 277, 985-992.
22.
Pfeffer, J.
(1981). Power in organizations. Massachusetts: Pitman.
23.
Punch, M.
(1983). Officers and men: Occupational culture, inter-rank antagonism, and the investigation of corruption. In M. Punch (Ed.), Control in the police organization (pp. 227-250). Cambridge: MIT Press.
24.
Reuss-Ianni, P.
, & Ianni, F.A. (1983). Street cops and management cops: The two cultures of policing. In M. Punch (Ed.), Control in the police organization (pp. 251-273). Cambridge: MIT Press.
25.
Schein, E.H.
(1992). Organizational culture and leadership. San Francisco: Jossey-Bass.
26.
Schneller, E.S.
, Greenwald, H.P., Richardson, M.L., & Ott, J. (1997). The physician executive: Role in the adaptation of American medicine. Health Care Management Review, 22(2), 90-96.
27.
Strauss, A.
(1987). Qualitative analysis for social scientists. New York: Cambridge University Press.
28.
Trice, H.M.
, & Beyer, J.M. (1993). The cultures of work organizations. Englewood Cliffs, NJ: Prentice Hall.
29.
Van Maanen, J.
(1984). Making rank: Becoming an American police sergeant. Urban Life, 13, 155-176.
30.
Van Maanen, J.
, & Barley, S.R. (1984). Occupational communities: Culture and control in organizations. In B.M. Staw & L.L. Cummings (Eds.), Research in organizational behavior (Vol. 6, pp. 265-287). Greenwich, CT: JAI Press.
31.
Weber, M.
(1947). The theory of social and economic organization. New York: Oxford University Press.
32.
White, H.C.
(1993). Careers and creativity: Social forces in the arts. Boulder, CO: Westview.
33.
Whyte, W.F.
, & Gardner, B.B. (1945). The position and problems of the foreman. Applied Anthropology, Spring, 17-26.
34.
Wilkerson, J.D.
, Devers, K.J., & Given, R.S. (1997). Competitive managed care: The emerging health care system. San Francisco: Jossey-Bass.
