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This article is drawn from doctoral research exploring the identity struggles faced by professionals who take on management and leadership roles. The research focused on the experience of medical directors – the most senior doctor‐manager with board responsibility for medical affairs. Based on the fact that a medical director is a hybrid manager this research has implications for any professional who takes on a managerial or leadership role while continuing to practice their profession. Some challenges of working as a hybrid are associated with the difference in orientations between professionals and managers. While the notion of who and what a professional is has changed and new forms of accommodation have been forged the hybrid identity remains a site of potential conflict for the individual and those they work with. The purpose of this paper is to explore the experience of the hybrid identity.

The experience of the hybrid identity is explored through social identity theory (Tajfel and Turner).

The analysis reveals that the medical director role is ambiguous, that medical identity is robust and that medical management is difficult compared to clinical work. Managerial identity in general is constructed negatively and from the perspective of doctors. The importance of maintaining clinical credibility is both embraced as a resource which bolsters and maintains medical identity and so distinguishes medical directors from the taint associated with the pejorative managerial identity that doctors construct of managers.

The implications for the selection, training and development of doctors and medical directors are raised as are those for the relationship between doctors and patients, and doctors and the organisation. Some implications identified, specifically for leadership in practice are as follows: leadership/management is challenging and difficult compared to professional work; language use is significant for how leaders are perceived; language use has implications for leader effectiveness; early exposure to leadership for professionals is important; and leadership role definition is important for consistency and role credibility.

Doctor–medical institution collaboration (DMIC) services are an emerging service mode in focal online health communities (OHCs). This new service mode is anticipated to affect user satisfaction and doctors' engagement behaviors. However, whether and how DMIC occurs is still ambiguous because the topic is rarely examined. To bridge this gap, this study explores doctors' participation in DMIC services and its effects on their online performance, as well as its effect on patients' evaluation of them on OHC platforms.

The authors propose hypotheses based on structural holes theory. A unique dataset obtained from one of the most popular OHCs in China is used to test the hypotheses, and difference-in-differences estimation is adopted to test the causality of the relationship.

The results demonstrate that providing DMIC services improves doctors' online consultation performance and patients' evaluations of them but has no significant effect on doctors' knowledge-sharing performance on OHC platforms. Doctors' knowledge-sharing performance and consultation performance mediate the relationship between participation in DMIC services and patients' evaluation of doctors. Regarding doctors' participation in DMIC services, its impact on doctors' consultation performance and patients' evaluation of them is weaker for doctors with higher professional titles than for doctors with lower professional titles.

The findings clarify the value creation mechanisms of online collaboration between doctors and medical institutions and thereafter facilitate doctors' participation in DMIC services and enhance the sustainable development of OHCs.

The last decade has seen a significant increase in self-initiated expatriation research across various cohorts; however, limited research exists on the self-initiated expatriation of medical doctors despite their high mobility rates. The purpose of this paper is to investigate the determinants of cross-cultural adjustment among self-initiated medical doctors working and living in a host culture.

A questionnaire was distributed to self-initiated expatriate (SIE) doctors working in Irish hospitals. In total, 193 valid responses were collected. Three linear regression analyses were conducted to explore factors influencing cross-cultural adjustment among SIE medical doctors, along with qualitative insight into their adjustment to working and living in Ireland.

This study found that age, marital status, cultural novelty, previous international work experience, length of time working in the host culture did not influence the cross-cultural adjustment of SIE doctors. However, gender, language ability and perceived fair treatment were found to influence their cross-cultural adjustment in the study. Specifically, female SIE doctors reported higher levels of general adjustment to that of SIE male doctors. SIE doctors' language ability was found to influence their work adjustment, and those who perceived unfair treatment in the host culture reported lower levels of general adjustment.

This paper contributes to the limited knowledge and understanding surrounding the self-initiated expatriation of medical doctors and their cross-cultural adjustment to the host hospital and host culture.

Despite the prevalent use of professional status and service feedback in online healthcare markets, the potential interaction relationship between two types of information is still unknown. This study used the signaling theory to examine the substitute relationship between professional status and service feedback in patients' doctor choice, as well as the moderating effect of illness severity.

To test the paper's hypotheses, we constructed a panel data model using 418 doctors' data collected over a period of six months from an online healthcare market in China. Then, according to the results of the Hausman test, we estimated a fixed-effects model of patients' choice in online healthcare markets.

The empirical results showed that the effect of a doctor's professional status and service feedback on a patient's doctor choice was substitutable. Moreover, patients' illness severity played a moderating role, in that the influence of professional status on a patient with high-severity illness was higher than that on a patient with low-severity illness, whereas the influence of service feedback on a patient with low-severity illness was higher than that of a patient with high-severity illness. In addition, we found that illness severity negatively moderated the substitute relationship between professional status and service feedback on a patient's choice.

These findings not only contribute to signaling theory and research on online healthcare markets, but also help us understand the importance of professional status and service feedback on a patient's choice when seeking a doctor online.

A 2 × 2 full factorial between subjects experimental design was used to examine how three elements of the health care experience (patients’ freedom to choose a physician; patients receiving their preferred physician; health care outcome) impacted on patient satisfaction with health care service. All constructs with corresponding measurements were discussed, and their relationships with satisfaction were examined. Hypotheses were developed and tested for each relationship using a pencil and paper scenario of a patient’s first time service encounter at a health clinic. Results of the experiment indicated that given an undesirable health outcome, allowing patients a choice of physicians favorably raised patient satisfaction levels. Further, patients who were treated by a physician whom they preferred rated the health care experience more positively than did patients who received non‐preferred physicians.

An experiment was conducted to examine the impact of patients’ freedom to choose a physician and health locus of control on patient satisfaction. The experiment was set within the scenario of a patient suffering from a lengthy viral infection after visiting a health clinic for the first time. All constructs with corresponding measurements are discussed and their relationships with satisfaction are examined. Hypotheses are developed and tested for each relationship using pencil and paper scenarios of a patient’s service encounter at a health clinic. A 2 × 2 full factorial between subjects experimental design was used with 99 subjects. Results of the experiment indicated different patterns of satisfaction among subjects based on measures of health locus of control (HLC). Individuals with an internal HLC were more satisfied with having a choice of a physician than not having a choice and were also more satisfied than external HLC individuals who had a choice. In contrast, individuals with an external HLC did not discriminate between having or not having the opportunity to choose a physician.

Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland.

A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October–November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question “If you had concerns about your working conditions, would you raise them?”. In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions.

Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships.

This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.

Based upon empirical research conducted in 1993, attempts to illustrate the implications of efforts to bring doctors into management. It addresses in particular the role of key appointments such as the medical director and clinical directors and the perceptions of these roles. Doctors continue to demonstrate themselves to be reluctant managers and this continues to pose problems for the aspirations contained in Working for Patients. Crucial questions must be asked about whether management represents a productive use of doctors′ time and whether the NHS can afford premium rates for largely inexperienced managers. Identifies changes that have taken place to date and indicates that doctors are, for the most part, still lukewarm about a career in medical management.

We explore the effects and interplay of physical and social environments on the inaccessibility of gynecological health care for women with spinal cord injury. We also explore women’s responses to the inaccessibility of this care, in hopes of trying to understand better how women navigate their gynecological health and health care when faced with physical and social environmental constraints.

The data for this phenomenological study were gathered using in-depth, qualitative interviews with 20 women living with spinal cord injuries in or around Detroit, Michigan. Each interviewee was questioned about overall health and physical functioning, accessibility of doctor offices, interactions with health care providers, gynecological health-seeking behaviors, and complementary and alternative medicine use. In this paper we report on data on women’s difficulties in securing gynecological health care experiences and related attitudes and practices.

Findings echo past literature about the inaccessibility of doctor’s offices, including the lack of suitable exam tables and medical equipment. Office staff varied in their willingness to help transfer women from wheelchairs to exam tables as well, often creating what we term an inaccessible social environment. Individual women in our sample found different strategies for navigating the environmental contexts of a doctor’s office and the encounters that they had with providers within medical settings. These strategies had varying impacts on individuals’ abilities to secure gynecological health care.

Our findings point to the possibility of an interplay between and intersection of physical and social environments within medical settings that needs to be explored further and, potentially, the primary importance of the social environment over the physical environment in determining whether an individual’s disability makes health care inaccessible.