How physician-employees experience their work lives in a changing HMO.
The present study advances our understanding of both physician adaptation and the physician-organization relationship in a managed care environment defined by structural diversity and constant change. It does so through a longitudinal examination of a single group of physician-employees experiencing their work lives within a nonprofit health maintenance organization (HMO) in the midst of major strategic developments. Using interview, observation, and archival data collected over a five-year period, the analysis reveals that the form and substance of individual physician adaptation to organizational life is dependent upon social exchanges over time with the HMO, making it an emergent, evolutionary process rather than a pre-determined, static phenomenon. However, the results also demonstrate that physician adaptive response to rapid, unpredictable organizational change is slow and delayed, in particular when this change makes physicians more dependent on their employing organization. This confers an advantage onto the organization vis-à-vis professionals in interpreting and responding to environmental change. These insights should encourage sociologists to employ research designs and contingency models of physician attitudes and behavior that capture the dynamic and particularistic nature of everyday physician work life in contemporary health care.
Department of Health Policy, Management and Behavior, School of Public Health, University at Albany, SUNY, One University Place, Rensselaer, New York 12144-3456, USA. thoff@albany.edu
Timothy J
TJ
Hoff
D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D004651:Employment / Q000523:psychology; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008503:Medical Staff / Q000523:psychology*; D008875:Middle Aged; D009511:New England; D009936:Organizational Innovation; D009939:Organizations, Nonprofit / Q000458:organization & administration; D010558:Personnel Loyalty; D017009:Professional Autonomy; D000078329:Workforce