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Competitive and regulatory forces have spurred the consolidation of health care provider and payer groups into large integrated care delivery systems that purchase freestanding clinics. Many private practitioners, unable to stand alone against these competitive pressures, are selling their practices and becoming employees, often for the first time in their careers. Consequently, many physicians are now embarking on transition journeys into dual organizational/professional careers. Anecdotal evidence suggests that many transitioning physicians feel alienated and are ‘grieving’ their loss of autonomy. Others, however, seem enthusiastic about employment and embrace their new organization. What explains these differences in physician transitions?In this chapter, we develop a model to explain the variation in transition experiences. We induce the components of this model from two sources. First, we use four case studies to illustrate themes that emerged from our interviews with 21 physicians recently employed by a large integrated health system. Second, we draw upon received theory from management literature, including research on career transitions and organizational and professional commitment.Integrating the concepts induced from the interviews and the literature, we specify a model of physician transition, in which dual commitment to both profession and organization serves as the key indicator of transition. We propose that transition to dual commitment is a function of: (a) individual differences in demographics and value orientation and (b) organizational characteristics such as hygiene factors and enablement. We also propose that dual commitment will produce benefits in terms of job satisfaction, patient satisfaction, and clinical quality. Finally, we discuss the model's implications for practice and theory.

The aim of the chapter is to examine whether the challenges to administering the EU outlined by Les Metcalfe in his famous article, ‘After 1992, can the Commission manage Europe?’ have now been met. Metcalfe not only identified a ‘management deficit’ in the implementation of the single market programme arising from an oversight among policy makers, but highlighted a neglect of the administrative dimension of European integration among scholars.

The chapter draws on primary and secondary literature to track developments in respect of the three elements identified by Metcalfe: the small size of the European Commission, its poor internal coordination and weak leadership; the responsiveness of administrative bodies in the member states to the need for inter-organizational coordination; and the network-building and management capacity of the Commission.

Despite changes, such as further enlargement, agencification at national and EU levels, and the expansion of EU competencies that have exacerbated the management challenge confronting the EU, there have been significant developments that have closed the deficit. First, the Commission has become far better integrated, coordination upgraded, and leadership strengthened. Second, through networking, cooptation and other strategies the Commission has sought to assure the effective implementation and enforcement of the single market rules. Third, member state governments, ministries and agencies have sought to cultivate networked relations that have increased the manageability of EU administration.

To the knowledge of this author, this is the first attempt to revisit Metcalfe’s diagnosis and to review the extent to which the management deficit he identified has been addressed subsequently.

The chapter has implications for how inter-organizational coordination within the EU administrative system could be improved.

The chapter bears on the administrative capacity of the EU to deliver the policies decided by EU policy makers.

As well as offering an assessment of the extent to which progress has been made in addressing the management deficit identified by Les Metcalfe in his classic article, this chapter conceptualizes the EU administration as an entity that encompasses both EU institutions and administrative bodies in the member states. It advances the concept of the EU as a multi-level administration.