The mediating role of contemporary medical professionalism: The case of primary care physicians

Where no normative definition of medical professionalism exists, primary care physicians (PCPs) can potentially adopt a definition to suit their circumstances. With PCPs required to do more with fewer resources, the influence of medical professionalism on those PCPs who receive both private and public income is a rich avenue for research, particularly given the tensions between PCPs meeting their own needs and serving the public interest. A theoretical framework of institutional logics, organisational response strategy, and dual-income theory was applied to this study. A subjectivist qualitative research methodology was employed to analyse historical documents (newspaper articles) and semi-structured interviews with 25 Irish PCPs. This study poses research questions; as to how PCPs conceptualise and operationalise the construct of medical professionalism, how the construct influences PCPs preferred method of remuneration and their strategic responses. This study's findings reveal that PCPs poorly defined medical professionalism, although operationalisation of the construct was described through the interviews. Medical professionalism was found to constrain PCPs statements concerning dual-income and preferred methods of remuneration. Temporal variation was found in medical professionalism and strategic responses, with responses being influenced by a new representative body's entrance. In adopting an institutional lens to study PCPs at a micro-level, this study deepens an understanding of how multiple logics influence the dynamic multi-layered construct of medical professionalism. The study provides qualitative evidence for dual-income PCPs motivation for remaining in practice and their response to means and goal-based institutional change. In identifying PCPs lack of differentiation between medical professionalism and professional ethics, practice and teaching can be improved to enhance trust between a PCP and patients. This study offers a template to qualitative medical research through sequential research methodologies built upon each other to give robustness to the research findings