“I Want to Break Free”: German Locum Physicians Between Managerialism and Professionalism

Abstract

In the last decades, managerial instruments have gained importance to medical decisions and the logic of managerialism is juxtaposed with the logic of medical professionalism. Recent changes in the hospital employment structure raise the question of contradictory logics not only at the organizational but also at the individual level. Therefore, we investigate the rise of locum doctors which is a relatively new phenomenon in Germany. Our qualitative interview study with 21 locum tenens, permanently employed physicians, and chief physicians shows that locum physicians re-contextualize professional standards in hospitals. According to their self-perception, patient care stays at the center of their medical practice regardless of economic, bureaucratic, and hierarchical requirements as well as hospital-specific routines. We argue that the interrelationship between professionalism and managerialism exists not only within organizations but also on an individual level of locum doctors.

Labour market collectivism: New solidarities of highly skilled freelance workers in medicine, IT and the film industry

“…In contrast, film and IT projects allow greater personal or direct control and control of outputs as well as self-control and identification with the product (see also Apitzsch, 2013; Blair, 2001; Smith and McKinlay, 2009). Struggles over the organisation of work also occur in medicine, such as those related to the role of economic and organisational versus professional criteria in medical decisions (Ruiner et al, 2020; Wilkesmann et al, 2020). In addition, the deployment of freelancers in hospitals and IT projects is less clear and more legally disputed because of freelancers’ strong integration into the organisational core.…”

“…in Germany, Frege and Kelly, 2003) or where the workplace has been the predominant focus of organising campaigns (Simms, 2012). Although freelance workers may operate within the organisational core, they are typically less attached to firm-internal communities (Wilkesmann et al, 2020). Additionally, they are not usually integrated into employment protection and social security systems (Murgia and Pulignano, 2018) and are particularly exposed to market risks (D’Amours and Legault, 2013; Saundry et al, 2012).…”

The perceived impact of physician shortages on human resource strategies in German hospitals – a resource dependency perspective

“…In sum, the RDT facilitates explaining organizational strategies or structures by their resource environment. In the case of hospitals, physicians are a critical resource because hospitals highly depend on them and their expertise (Wilkesmann et al, 2020). Dependencies are even higher when hospitals need highly specialized physicians, such as geriatricians or gastroenterologists, who are in short supply (Russo et al, 2020;Martin, 2019;Petriceks et al, 2018).…”

“…In sum, the RDT facilitates explaining organizational strategies or structures by their resource environment. In the case of hospitals, physicians are a critical resource because hospitals highly depend on them and their expertise (Wilkesmann et al. , 2020).…”

Мир Профессий В Контексте Труда И Занятости: Пандемическое И Цифровое Вертиго

“…В сфере медицины продолжаются процессы трансформации профессионального статуса врачей в ходе длительных и глубоких реформ здравоохранения, одной [Wilkesmann et al, 2019]. При этом авторы исследования видят новые перспективы репрофессионализации в медицинской сфере, которая может быть основана на выращивании новых форм низовой peer-to-peer солидарности, самоменеджмента и медицинского профессионализма, опирающегося на научное знание, а также стремлении повысить свой финансовый статус, то есть на появлении «гибридного профессионализма» в терминологии Ноордеграафа [Noordegraaf, 2015].…”