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This paper describes factors influencing doctor‐managers' decision making in specialised health care, health centres and at different levels of management.

Data were collected as part of a survey on physicians graduating in 1977‐1991 as drawn from the register of the Finnish Medical Association. The study sample was formed by selecting all physicians born on odd days (n=4,144) from the baseline group (n=8,232). The category of doctor‐managers comprised physicians reporting as their main occupation: principal or assistant principal physician of hospital, medical director or principal physician of health centre, senior ward physician of hospital, and health centre physician in charge of a population area.

Independent of gender, all doctor‐managers responding to the survey reported that the most important base for decision making was personal professional experience. Position in organisation (first‐line manager, principal physician) had no impact on the base of decision making. Doctor‐managers in primary health care utilised knowledge on norms and knowledge available from their organisation in support of their decision making to a greater degree compared with doctor‐managers in specialised health care.

Evolution discourse from public administration is not yet receiving much response in Finnish doctor‐managers' activities, instead, they still act as clinicians.

Facing the growing challenges of the future, the paper shows that doctor‐managers should reconstruct their orientation and to act more like managers.