“I Want to Break Free”: German Locum Physicians Between Managerialism and Professionalism

Abstract

In the last decades, managerial instruments have gained importance to medical decisions and the logic of managerialism is juxtaposed with the logic of medical professionalism. Recent changes in the hospital employment structure raise the question of contradictory logics not only at the organizational but also at the individual level. Therefore, we investigate the rise of locum doctors which is a relatively new phenomenon in Germany. Our qualitative interview study with 21 locum tenens, permanently employed physicians, and chief physicians shows that locum physicians re-contextualize professional standards in hospitals. According to their self-perception, patient care stays at the center of their medical practice regardless of economic, bureaucratic, and hierarchical requirements as well as hospital-specific routines. We argue that the interrelationship between professionalism and managerialism exists not only within organizations but also on an individual level of locum doctors.