The Social Organization of Physician-Managers in a Changing HMO

This study examines identity and solidarity among 22 physician-managers working in a changing health maintenance organization. It describes two distinct identities among these professionals and the social relations associated with them. The identities are labeled organization-compatible and profession-compatible. Social relations between physician-managers are characterized by conflict, distrust, and game-playing rather than collegiality. The findings support the existence of fragmented solidarity within the group as a whole. Understanding the social organization of physicians under managed care means moving beyond the collective solidarity ideal implied by the professionalism model toward more communal, grassroots notions of cohesion. On a practical level, these results question the long-term meaningfulness of a medical management specialty in health care.