Management in medicine or medics in management? The changing role of doctors in German hospitals

Abstract

Purpose – Internationally, management in medicine has become a topical issue in health care research and policy. Against this background, the purpose of this paper is to examine the changing role of doctors in the management of German hospitals. Design/methodology/approach – The paper is based on a literature review on the one hand, explorative research drawing on field document and expert interviews, on the other. In the light of basic assumptions of neo-institutionalist and contingency theory, major developments regarding the relationship between medicine and management in Germany are sketched. Findings – In the German health care sector, the importance of management in medicine is generally increasing, with more managerial (administrative) functions included in the clinicians’ activity. However, the current situation proves complex. On the one hand, there is more management within medicine, materializing, e.g. in further education schemes embracing economic training or in a general expectation that physicians striving for higher ranks within a hospital's hierarchy should exhibit economic knowledge. On the other hand, the authors see a hesitant attitude of the medical profession toward a greater involvement in management. In addition, policies of hospital owners affecting management roles prove diverse. They range from organizing medical departments as autonomous profit centers to ensuring strong hierarchical control by top management, with this entailing different demands regarding a doctor's managerial skills. Due to the advent of powerful non-clinician managers in part of the sector, moreover, medics are losing influence at top level. Altogether, there seems to be a polarization within the hospital system concerning the role of doctors in hospital management. This, to some extent, sits uneasy with key propositions from neo-institutionalist and contingency theory. Originality/value – The paper retraces general developments concerning the involvement of German hospital doctors in management. Given the paucity of research in this field, it provides preliminary insights on the dynamics that influence the way and degree of this involvement. The major result is that there is structural polarization within an environment which, though streamlining both institutional mind-maps and organizational structures, leaves considerable discretion to the organizational level.