Bureaucratic flexibility : large organizations and the restructuring of physician careers

This thesis contributes to theory and research at the intersection of professions, labor markets, and careers. To do so, it draws on longitudinal and cross-sectional data on physicians in different organizational arrangements. Physicians have been migrating into larger medical practice organizations over the past three decades, creating a valuable research opportunity. Previous writing on the professions and on careers implies that large, bureaucratic organizations constrain autonomy and are therefore anathema to professionals. Instead, I observe that many physicians find these larger structures to be emancipating because such organizations provide unique access to highly-valued career options. These career options are possible because large organizations have scale and systems that address a fundamental temporal problem for doctors: availability whenever the patient requires attention. With a pool of substitutes for the individual physician, and systems that facilitate patient hand-offs, the large organization offers a predictable schedule and moderate hours when compared with traditional private practice. As a result, large organizations open up an expanded portfolio of career options, including part-time clinician, and facilitate transitions between different roles. These career options are greatly valued within the current physician workforce, particularly among the growing ranks of female physicians and those physicians in dual-career families. The dissertation is organized into three papers. The first paper asks which types of physicians are employed in large organizations, testing two competing accounts from professions theory and careers research using national survey data.

Department dc:contributor.department

Sloan School of Management.

Grantor dc:publisher

Massachusetts Institute of Technology

Year dc:date.issued

2003

Author dc:creator

• Briscoe, Forrest

Advisor dc:contributor.advisor

• Thomas A. Kochan.

• Sloan School of Management.

Statement dc:rights

• M.I.T. theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission. See provided URL for inquiries about permission.

Licence dc:rights.uri

• http://dspace.mit.edu/handle/1721.1/7582

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/1721.1/17603

OAI identifier oai:identifier

oai:dspace.mit.edu:1721.1/17603