How do elite doctors respond to tensions in hybrid healthcare organizations?

In this paper we explain how and why elite doctors in public service healthcare respond to increasing hybridity through different forms of identity work, accommodation and resistance. We draw on a conceptual framework developed by Besharov and Smith and on research into identity work to explain how senior hospital doctors have become increasingly differentiated in their responses to multiple logics. Our analysis produces three contributions to the study of professions in healthcare. Firstly, based on their responses to hybridity, we identified four distinct groups of elite doctors. Secondly, we found that a new generation of doctors have been more able to assimilate multiple logics into their identities than earlier generations. Although tensions may be reduced as later career doctors leave the labour force, we argue that they are unlikely to disappear because the notion of an 'authentic' identity of medical professionalism is embedded in the social identities of doctors. Thirdly, we problematize the notion of hybrid professional leaders as a form of reprofessionalization. In contrast to earlier literature, our research indicates that doctors resist hybrid medical leadership and subscribe to the notion of elitism defined largely by 'who they are definitely not'