title: Doctor-managers as decision makers in hospitals and health centres.
abstract: OBJECTIVE
  This paper describes factors influencing doctor-managers' decision making in specialised health care, health centres and at different levels of management.
  
  
  METHODS
  Data were collected as part of a survey on physicians graduating in 1977-1991 as drawn from the register of the Finnish Medical Association. The study sample was formed by selecting all physicians born on odd days (n=4144) from the baseline group (n=8232). The category of doctor-managers comprised physicians reporting as their main occupation: principal or assistant principal physician of hospital, medical director or principal physician of health centre, senior ward physician of hospital, and health centre physician in charge of a population area.
  
  
  RESULTS
  Independent of gender, all doctor-managers responding to the survey reported that the most important base for decision making was personal professional experience. Position in organisation (first-line manager, principal physician) had no impact on the base of decision making. Doctor-managers in primary health care utilised knowledge on norms and knowledge available from their organisation in support of their decision making to a greater degree compared with doctor-managers in specialised health care.
  
  
  CONCLUSIONS
  Evolution discourse from public administration is not yet receiving much response in Finnish doctor-managers' activities, instead, they still act as clinicians.
  
  
  CONCLUSIONS
  Facing the growing challenges of the future, the paper shows that doctor-managers should reconstruct their orientation and to act more like managers.
authors.affiliation: School of Public Health, Tampere University, Tampere, Finland. elina.viitanen@uta.fi
authors.forename: Viitanen
authors.initials: V
authors.lastname: Elina
authors.forename: Lehto
authors.initials: L
authors.lastname: Juhani
authors.forename: Tampsi-Jarvala
authors.initials: TJ
authors.lastname: Tiina
authors.forename: Mattila
authors.initials: M
authors.lastname: Kari
authors.forename: Virjo
authors.initials: V
authors.lastname: Irma
authors.forename: Isokoski
authors.initials: I
authors.lastname: Mauri
authors.forename: Hyppölä
authors.initials: H
authors.lastname: Harri
authors.forename: Kumpusalo
authors.initials: K
authors.lastname: Esko
authors.forename: Halila
authors.initials: H
authors.lastname: Hannu
authors.forename: Kujala
authors.initials: K
authors.lastname: Santero
authors.forename: Vänskä
authors.initials: V
authors.lastname: Jukka
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003659:Decision Making, Organizational; D004503:Education, Medical, Graduate; D005260:Female; D005387:Finland; D017144:Focus Groups; D006739:Hospital Administration; D018578:Hospital-Physician Relations; D006801:Humans; D019359:Knowledge; D008297:Male; D008875:Middle Aged; D008486:Physician Executives / Q000193:education / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration*; D011361:Professional Competence; D011795:Surveys and Questionnaires