PhD Importance and Key Contribution
This study examines the conceptualisation and instantiation of medical professionalism and financial self-interest in primary care physicians, and whether the source of a primary care physicians’ income influences the constructs. Medical professionalism emphasises a set of values, behaviours and relationships that underpin public trust in a physician and can be contrary to a primary care physicians’ self-interest (Hausman & Le Grand,1999).
This study makes the following contributions: First, in developing the understanding, through a micro-level study, how individuals in action experience and cope with seemingly contradictory institutional beliefs. Secondly, to improve the understanding of the potential conflict between medical professionalism and financial self-interest arising from primary care physicians receipt of income for public and/or private health care. Thirdly, the study responds to calls for research into conflict arising from contradictions in institutional beliefs, which give rise to organisational responses (Greenwood et al., 2011; Lander et al., 2013; Pache & Santos 2010, 2013).
The purpose of this paper is to present a theoretical framework which considers the centrality of competing institutional logics influence on primary care physicians focusing on the institutional orders of profession (medical professionalism), market (self-interest) and state (funding). The framework acknowledges that institutional orders sometimes require trade-offs with each other and can be incompatible (Smith, Gonin, & Besharov, 2013).
Theoretical Base
A review of institutional logics, dual-income and organisational response literature allowed the construction of a theoretical framework. Scott et al. (2000) describe institutional logics as being about the specification of the countervailing and moderating effects on self-interest and rationality. Medical professionalism represents an expression of value rationality, being a passionately and expressively orientated unobservable value that has been internalised and in whose unconditional requirements primary care physicians’ believe.
Research Questions
Through the application of qualitative interpretive research and drawing upon the literature of institutional logics, organisational response strategies and dual-income theories, this study will address the following:
1) How do primary care physicians conceptualise and instantiate medical professionalism and financial self-interest?
2) In the context of medical professionalism and financial self-interest, does the source of income influence primary care physicians delivery of health care, and if so why?
3) How do medical professionalism and financial self-interest influence the responses’ of primary care physicians to changes in state healthcare funding?
Early Findings
A conclusion from the literature review is that there are few qualitative studies into the competing beliefs and responses of professional groups, with no explicitly formulated theoretical frameworks which assist, or give additional insight into, the exploration of the effect of public and private income primary care physicians’ medical professionalism and financial self-interest.
Implications
Neither primary care physicians nor the state in their delivery of health care can act independently of each other. Because primary care physicians can accept or resist healthcare reforms, it is in the interest of those seeking change to address the factors that may influence their attitude to change (Martinussen and Magnussen 2011). Through the study of the medical professionalism and financial self-interest of primary care physicians, evidence-based health care initiatives can be undertaken and healthcare policies developed.
References
Greenwood, R. Raynard, M. Kodeih, F. Micelotta E. Lounsbury, M. (2011). 'Institutional complexity and organizational responses'. The Academy of Management Annals, 5(1), pp.317–371.
Hausman, D. & Le Grand, J. (1999). Incentives and health policy: primary and secondary care in the British National Health Service. Social Science & Medicine, 49(10), 1299-1307.
Lander, M. W., Koene, B. A., & Linssen, S. N. (2013). ‘Committed to professionalism: Organizational responses of mid-tier accounting firms to conflicting institutional logics’. Accounting, Organizations and Society, 38(2), 130-148.
Martinussen, P. E., & Magnussen, J. (2011). ‘Resisting market-inspired reform in healthcare: The role of professional subcultures in medicine’. Social Science & Medicine, 73(2), 193-200.
Pache, A. C., & Santos, F. 2010. When worlds collide: The internal dynamics of organizational responses to conflicting institutional demands. Academy of Management Review, 35: 455–476.
Pache, A. C., & Santos, F. (2013). Embedded in hybrid contexts: How individuals in organizations respond to competing institutional logics in Lounsbury, M, & Boxenbaum E. (2013). Institutional logics in action. Vol. 39. Bingley: Emerald Group Publishing.
Scott, W. R., Ruef M., Mendel P. J. & Caronna C. A. (2000). ‘Institutional Change and Healthcare Organizations: From Professional Dominance to Managed Care’. University of Chicago Press, Chicago.
Smith, W. K., Gonin, M., & Besharov, M. (2013). Managing social-business tensions: A review and research agenda for social enterprise. Business Ethics Quarterly, 23: 407– 442.
