| The Paradox of Legitimacy: Factors Decreasing the Likelihood of Physician Executives Practicing Medicine |
| | Hoff, Timothy J. | State U. of New York, Albany | thoff@cnsvax.albany.edu | 518-402-0333 |
| | This study looks at the legitimation of medical management and its effect on the likelihood of
physician executives practicing medicine. The findings of a national survey of physician executives
employed in managed care settings support the growing legitimacy of medical management as a
unique occupational group in medicine. Compared to earlier studies of physician executives, the present
group of respondents were newer to the field of management and two to five times more likely to be
employed in a for-profit organization, possess a graduate management degree, and work in
a senior management position. However, these three characteristics were shown to lower the probability
of a physician executive also being an active clinician.
These findings suggest that the legitimation process presents a paradox that over time could
undermine the ability of a medical management specialty to maintain its unique jurisdictional claim as
the "bridge" between organizational and clinical interests in health care. By gaining credibility as
managers, physician executives may ultimately lose credibility as physicians by distancing themselves
from the everyday world of patient care. Medical management must find ways to pursue its legitimacy
without jeopardizing the one quality which makes it a truly unique group in health care.
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| | Keywords: specialty legitimation; medical management ; managed care |
| Physician Transition Journeys: Developing Dual Commitment on the Road from Private Practice to Employment |
| | Thompson, Jeffery A. | U. of Minnesota | jthompson@csom.umn.edu | (612) 626-1812 |
| | Competitive and regulatory forces have spurred the consolidation of health care provider and payer groups into large integrated care delivery systems that purchase freestanding clinics. Many private practitioners, unable to stand alone against these competitive pressures, are selling their practices and becoming employees, perhaps for the first time in their careers. Consequently, many physicians are now embarking on transition journeys into dual organizational/professional careers. Anecdotal evidence suggests that many transitioning physicians feel alienated and are "grieving" their loss of autonomy. Others, however, seem enthusiastic about employment and embrace their new organization. What explains these differences in physician transitions?
In this paper, I develop a model to explain the variation in transition experiences. I induce the components of this model from two sources. First, using four case studies, I illustrate themes that emerged from my interviews with 12 recently employed physicians. Second, I draw upon received theory from management literature, including research on career transitions and organizational and professional commitment.
Integrating the concepts induced from the interviews and the literature, I specify a model of physician transition, in which dual commitment to both profession and organization serves as the key indicator of transition. I propose that transition to dual commitment is a function of a) individual differences in demographics and value orientation and b) organizational characteristics such as hygiene factors and enablement. I also propose that dual commitment will produce benefits in terms of job satisfaction, patient satisfaction, and clinical quality. Finally, I discuss the model's implications for practice and theory.
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| | Keywords: physician transitions; dual commitment; enablement |
| Relationship Navigator or Relationship Ostrich? Linking Stakeholder Management Styles to Key Firm Resources |
| | Blair, John D. | Texas Tech U. | odjdb@coba2.ttu.edu | 806-742-2134 |
| | Blair, Starr A. | Texas Tech U. | sblair@coba.ttu.edu | (806) 743-3013 |
| | Fottler, Myron D. | U. of Alabama, Birmingham | mfottler@fms.uab.edu | 205-934-1649 |
| | Nix, Timothy W. | Texas Tech U. | tnix@coba.ttu.edu | (806)-742-2230 |
| | Payne, Gregory Tyge | Texas Tech U. | tspooon@aol.com | (806) 742-0432 |
| | Savage, Grant T. | U. of Alabama, Tuscaloosa | gsavage@cba.ua.edu | (205) 348-2926 |
| | We propose a typology and develop five propositions for differentiating stakeholder management styles among firms. Using this framework, we investigate the how stakeholder management styles affect medical group executives’ self-reports of both tangible and intangible firm resources. Results indicate that medical groups may be distinguished by their stakeholder management styles, and that these styles of managing stakeholders are differentially correlated with the bundling of key firm resources. |
| | Keywords: Stakeholders; Strategy; Firm resources |