Priced not praised: professional identity of GPs within market-oriented healthcare reform

Abstract

To interpret and perform their tasks, professionals’ perceptions of their professional identity are crucial. This article examines the perceptions of professionals—as members of institutionalized occupations—in light of public policy reform. It focuses on general practitioners (GPs) in the Netherlands in relation to market-oriented policy reform. It conceptualizes professional identity as dynamic relationship between abstract ‘self-image’ and the enactment of a concrete ‘role’, and suggests the Good Work framework of excellence, ethics, and engagement—the three ‘Es’—to examine how professionals define their professional identity and navigate tensions between self-image and role. Based on a qualitative research strategy, the data indicate a growing gap between these two, indicating an emergent professional identity conflict. Using the three ‘Es’, it finds that GPs report important role changes in relation to policy reform, that emphasize medical-technical excellence at the expense of medical-social excellence, thereby compromising ethics and endangering engagement. However, despite these role changes, their self-image does not change: they continue to see themselves as autonomous professionals who should always put patients’ interests first, indicating that self-image is resilient. To bridge the resulting discrepancy between self-image and role in their professional identity, GPs tend to miscode patient contact moments and play the system in various ways. While tensions between professionalism and managerial imperatives are well-known in literature, this article underlines the resilience of self-image in the face of role changes and evidences how physicians navigate identity conflicts to retain their self-image despite these changing role expectations.