Identity types
3
shift, as the number of physicians who work as employees rose 50 percent between 1983 and
1993 and approximately 40 percent of physicians now work as employees (Hoff, 2001a).
How do physicians respond to being employees? Some have felt a freedom from
entrepreneurial and bureaucratic roles enhanced their ability to do their jobs and as one physician
quoted in Hoff and McCaffery (1996) said, these physicians get to do what they were trained to
do in medical school and residency. “In the HMO, I get to spend more time doing what I’m
trained to do and less time on the things I’m not trained to do. All that other stuff I would just as
soon leave to someone else” (p. 180). This enhanced sense of professionalism of salaried
physicians working in HMO-style organizations has been found elsewhere (Gross & Budrys,
1991), and it contradicts images of salaried physicians as unhappy because they work as
employees. However, not all physicians believe that being an employee is a good way for
physicians to practice medicine. Self-employed physicians interviewed by Hoff and McCaffery
(1996) liked having control over their practice, including staffing, equipment purchases, and the
types of patients they would see. Hoff (2001a) argues that physician-employees think, act, and
experience their settings much differently than self-employed physicians and wonders whether
physicians in different organizational contexts may have distinctive identities because certain
settings might allow these doctors more time to embrace other roles in their life such as parent,
coach or citizen. This leads to the first research question:
RQ1: What is the relationship between organizational context and physician identity?
In addition to organizational influences, physicians are also influenced by their profession.
Physician identity
A profession is “an occupation that regulates itself through systemic, required training, and
collegial discipline; that has a base in technical, specialized knowledge; and that has a service
Convention