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The paper aims to explore the increasing feminisation of the medical profession and career progression of women in the medical profession. Furthermore, the paper explores the implications of gender segregation in the medical profession for health service provision.

The paper presents an overview of studies in this area and draws upon primary, empirical research with medical practitioners and medical students. However, unlike most other studies the sample includes male and female participants. The research involved élite interviews and self‐completion questionnaires in order to provide perspectives of both male and female medical practitioners and medical students.

The findings are consistent with those of other studies; that gender discrimination and segregation is still prevalent in the medical profession. But there are significant differences in perceptions between the genders. Moreover, it is concluded that the gendered career structure and organisational culture of the health sector and medical profession create a role conflict between personal and professional lives. The current difficulties in reconciling this role conflict create barriers to the career progression of women in the medical profession.

Further research in this area could include a longitudinal study of medical students and the impact of changes in the design of medical training and career structures to assess whether these changes enable female career progression in the medical profession. Further analysis is needed of gendered practices and career development in specific specialist areas, and the role of the medical profession, NHS and Royal Colleges should play in addressing gender and career progression in medicine.

Gender segregation (vertical and horizontal) in the medical profession will have implications for the attraction, retention and increased shortages of practitioners in hospital and surgical specialities with the resultant economic and health provision inefficiencies.

The paper provides a review of literature in this area, thereby providing a longitudinal perspective of gender and the medical profession. Moreover, the research sample includes both male and female medical practitioners and medical students, which provides perspectives from both genders and from those who have experience within the medical profession and from those beginning their career in the medical profession. The research will be of value to the medical profession, the NHS and Royal Colleges of Medicine.

The purpose of this paper is to extend the discussion of the recursive relationship between the identity of a profession and the professional identity of individuals in the context of change.

The paper draws on qualitative data collected as part of a pilot study into change in the NHS. It draws on structuration theory and insights from social identity theory (SIT) to propose that the relationship between the collective level of the profession and the individual level of the professional is recursive.

The data suggest that individual professionals use and rewrite scripts of their profession but also draw upon new scripts as they engage with local change. To that extent they contribute from the local level upwards to the changing identity of their profession. Further more detailed micro level studies are required.

The argument is based on a limited data set and points towards the need for further microlevel studies which examine the recursive relationship between professionals' identity and the identity of a profession.

Further research can contribute to better understanding of local variance as professionals engage with change.

The paper fuses structuration theory and SIT and examines the agency/structure nexus in a specific change context.

This paper aims to outline and comment on the changes to medical regulation in the UK that provide the background to a special issue of the Journal of Health Organization and Management on regulating doctors.

This paper takes the form of a review.

Although the UK medical profession enjoyed a remarkably stable regulatory structure for most of the first 150 years of its existence, it has undergone a striking transformation in the last decade. Its regulatory form has mutated from one of state‐sanctioned collegial self‐regulation to one of state‐directed bureaucratic regulation. The erosion of medical self‐regulation can be attributed to: the pressures of market liberalisation and new public management reforms; changing ideologies and public attitudes towards expertise and risk; and high profile public failures involving doctors. The “new” UK medical regulation converts the General Medical Council into a modern regulator charged with implementing policy, and alters the mechanisms for controlling and directing the conduct and performance of doctors. It establishes a new set of relationships between the medical profession and the state (including its agencies), the public, and patients.

This paper adds to the literature by identifying the main features of the reforms affecting the medical profession and offering an analysis of why they have taken place.

The hospital sector has expanded in Norway with reforms and a strong demand for better management. The purpose of this paper is to examine: first, how this has affected physicians and nurses in management; second, how management roles in hospitals are changing; and third, how these two professions are tackling their new roles.

The paper presents a review of the secondary literature and a case study undertaken in the spring, 2012.

In Norway, two reforms have been introduced aimed at creating stronger management positions with less professional influence. The leader has full responsibility for a particular unit, which means that the jurisdiction of managers has expanded and that management has become more time consuming. Physicians – traditionally those in charge of hospitals – are facing competition from other professions, especially nursing, which has gained representation in top management positions, particularly at middle management level.

The originality of this paper is the comparison of the evolvement of management among physicians and nurses since the reforms. While the medical profession was critical of management to begin with, i.e. viewing management positions as a trap, it is gradually adapting to the new ideas. Physicians are facing competition from nurses, who readily adjust to the new conditions, and perceive management as a new career track.

The management of human resources is of crucial importance in enabling the delivery of efficient and effective services. The purpose of this paper is to explore one issue relevant to Human Resource Management, that is, the management of hospital doctors in the NHS. The present‐day UK National Health Service faces countless challenges at both the macro and operational level.

The paper examines the implications for the NHS in general, and the medical profession in particular, of the continued dominance of the medical profession over the career management of hospital doctors.

The paper argues that HRM must play a pivotal role in the management of clinicians to ensure the effective and efficient delivery of NHS reforms. The challenges to HRM and the medical profession that are inherent in this process are outlined.

It is argued that the potential long‐term gains to be derived from the development of closer working relationships between human resource managers and medical managers are crucial for the delivery of an effective health service.

A new and innovative way of looking at the management of doctors and their careers within a changing NHS.

This paper reports on a comparative qualitative study across four European countries which explored the formation of work identity amongst nurses and other professionals in the field of health care. Within this sector, it identifies trends towards a more flexible, more highly skilled and more mobile workforce. Conversely, however, it is becoming difficult to recruit and retain staff due to increasing workload, decreasing job satisfaction and comparatively low pay. Occupational identity is theorised as a multi‐dimensional phenomenon, with structural, social and individual‐psychological components. A number of emerging common themes across the three dimensions and across the four national settings include structural conflicts between cost efficiency and quality of care, and individual conflicts between the core activity of caring for patients and the increasing demands of administration and other peripheral work. The study identifies a number of strategies used by nurses to balance these conflicting demands. Overall, the professional identity of nurses remains strong, but it is important for policy makers to be aware of the potential negative effects, in terms of staff turnover, mobility and job (dis)satisfaction, of the current state of the health care sector.

The purpose of this paper is to explore different health care professionals’ discourse about privacy – its definition and importance in health care, and its role in their day-to-day work. Professionals’ discourse about privacy reveals how new technologies and laws challenge existing practices of information control within and between professional groups in health care, with implications not only for patient privacy, but also for the role of information control in professions more generally.

The authors conducted in-depth, semi-structured interviews with n=83 doctors, nurses, and health information professionals in two academic medical centers and one veteran’s administration hospital/clinic in the Northeastern USA. Interview responses were qualitatively coded for themes and patterns across groups were identified.

The health care providers and the authors studied actively sought to uphold the protection (and control) of patient information through professional ethics and practices, as well as through the use of technologies and compliance with legal regulations. They used discourses of professionalism, as well as of law and technology, to sometimes accept and sometimes resist changes to practice required in the changing technological and legal context of health care. The authors found differences across professional groups; for some, protection of patient information is part of core professional ethics, while for others it is simply part of their occupational work, aligned with organizational interests.

This qualitative study of physicians, nurses, and health information professionals revealed some differences in views and practices for protecting patient information in the changing technological and legal context of health care that suggest some professional groups (doctors) may be more likely to resist such changes and others (health information professionals) will actively adopt them.

New technologies and regulations are changing how information is used in health care delivery, challenging professional practices for the control of patient information that may change the value or meaning of medical records for different professional groups.

Qualitative findings suggest that professional groups in health care vary in the extent of information control they have, as well in how they view such control. Some groups may be more likely to (be able to) resist changes in the professional control of information that stem from new technologies or regulatory policies. Some professionals recognize that new IT systems and regulations challenge existing social control of information in health care, with the potential to undermine (or possibly bolster) professional self-control for some but not necessarily all occupational groups.

This paper examines the historical background of accountingization, colonization and hybridization in the health services by exploring the relationship between hospital accounting and clinical medicine in Britain between the late 1960s and the early 2000s.

The paper draws on an analysis of professional journals, government reports and other documentary sources relating to accounting and medical developments. It is informed by Abbott's sociology of professions and Eyal's sociology of expertise.

The paper shows that not only accountants but also elements within the medical profession sought to make the practice of medicine more visible, calculable and standardized, and that accounting and medical attempts to make medicine calculable interacted in a mutually reinforcing manner. Consequently, it argues that a movement towards clinical forms of quantification within the medical profession made it more open to economic calculation, which underpinned hospital accounting reforms and the accountingization, colonization or hybridization of health services.

The paper demonstrates that a fuller understanding of the relationship between accounting and public sector professions can be developed if we examine their mutual interactions rather than restricting ourselves to analyzing accounting's effects on public sector professions. The paper moreover illustrates instances of intraprofessional conflict and inter-professional cooperation, and draws on the sociology of expertise to suggests that while hospital accounting reforms have curbed the power of medical professionals, they have also enhanced the power of clinical expertise.

The purpose of this paper is to explore whether official inquiries are an effective method for holding the medical profession to account for failings in the quality and safety of care.

Through a review of the theoretical literature on professions and documentary analysis of key public inquiry documents and reports in the UK National Health Service (NHS) the authors examine how the misconduct of doctors can be understood using the metaphor of professional wrongdoing as a product of bad apples, bad barrels or bad cellars.

The wrongdoing literature tends to present an uncritical assumption of increasing sophistication in analysis, as the focus moves from bad apples (individuals) to bad barrels (organisations) and more latterly to bad cellars (the wider system). This evolution in thinking about wrongdoing is also visible in public inquiries, as analysis and recommendations increasingly tend to emphasise cultural and systematic issues. Yet, while organisational and systemic factors are undoubtedly important, there is a need to keep in sight the role of individuals, for two key reasons. First, there is growing evidence that a small number of doctors may be disproportionately responsible for large numbers of complaints and concerns. Second, there is a risk that the role of individual professionals in drawing attention to wrongdoing is being neglected.

To the best of the authors’ knowledge this is the first theoretical and empirical study specifically exploring the role of NHS inquiries in holding the medical profession to account for failings in professional practice.

This chapter explores the inequalities and restrictions faced by women as they entered the medical profession in the United Kingdom. A case study in the first hospital in the United Kingdom to be founded and run by women, the Edinburgh Hospital for Women and Children, it demonstrates the importance of history for understanding women doctor’s early career choices and opportunities. The chapter begins with an outline of nineteenth-century notions of feminine propriety. It considers how middle-class women sought to subvert these restrictions and gain an active role in public life, and explores how this impacted upon arguments in favour of medical women. It reveals the significance of the changing nature of medical knowledge in this period, and considers how this contributed to the emergence of two distinct specialisms, both of which became the preserve of women doctors: maternal welfare schemes in the 1900s, and the treatment of VD in the inter-war period. The chapter concludes with its contribution to this edited collection.