1 Professionalism in Retreat? How New Public Management has Affected Swedish Doctors

New Public Management (NPM) has been a revolutionary force in, for example, many OECD countries during the past fifteen years (Brunsson and Sahlin-Andersson, 2000; Pollitt and Pouckaert, 2000; Osborne and McLaughlin, 2002). In Swedish health care various effects of NPM have been observed. These include downsizing, structural transformation and new management reforms, which have been successively tried out one after the other, in the attempt to make work and organizations more effective, efficient and easily controlled. An important aspect of these changes is their encounter with, and effect on, existing forms of control, for instance the autonomy of the medical profession. Traditionally, doctors themselves have had full control over the division, organization and performance of their work, as well as scrutinizing each other and defining quality (Abbot, 1991; Friedson, 1994). Ideology, in terms of morals, ethics and values is another important aspect of doctors’ professionalism, which has historically been based on medical and humanitarian foundations. However, the state and doctors have long been mutually dependent in defining the scope of the profession in terms of legitimacy and working area (Dent, 1995; Ferlie, Ashburner, Fitzgerald and Pettigrew, 1996; Friedson, 2001). Whether or not the limits of doctors