‘It’s an Interesting Conversation I’m Hearing’: The Doctor as Manager

TLDR

The profession of clinical medicine, the resource‑efficiency discourse of management, and an interpersonalizing discourse of hedging and mitigating contradictions form the three incommensurate discourses that frame the doctor‑manager’s boundary position. The article aims to describe, in discursive‑linguistic terms, how doctor‑managers manage the incommensurate dimensions of their boundary between profession and organization. The authors conducted a discourse‑analytic study of recorded situated talk and open interview data focusing on a single doctor‑manager navigating between professional and organizational roles. The study shows that the doctor‑manager navigates the three incommensurate discourses by weaving them into a single heteroglossic stream of talk, thereby managing their contradictions and concealing the tension between reluctance to impose organizational rules and the belief that such rules will eventually be necessary.

Abstract

The aim of this article is to outline in discursive-linguistic terms how doctor-managers (or ‘physician-executives’ as they are termed in the USA) manage the incommensurate dimensions of their boundary position between profession and organization. In order to achieve this we undertook a discourse analytical study of both recorded, situated talk and open interview data focusing on one doctor-manager navigating between profession and organization. The doctor-manager at the centre of this study locates himself on the boundary of at least three discourses which, in many respects, are incommensurate. These are the profession-specific discourse of clinical medicine, the resource-efficiency and systematization discourse of management, and an interpersonalizing discourse devoted to hedging and mitigating contradictions. While this multi-vocality in itself is not surprising, data show that the doctor-manager positions himself across these discourses and manages their inherent incommensurabilities before a heterogeneous audience and on occasions even within the one utterance. In this particular case, boundary management is achieved by weaving incommensurable positions together into the social and linguistic dynamics of a single, heteroglossic stream of talk. This highly complex and dialogic strategy enables the doctor-manager to dissimulate the disjunction between his reluctance to impose organizational rules on his medical colleagues and his perception that such rules, in the future (to some extent at least), will be the appropriate means for managing the clinical work, and through that the organization.