Role-meanings as a critical factor in understanding doctor managers' identity work and different role identities

- To provide understanding of doctor managers' identity work in the Spanish NHS.
- To examine role-meanings as the source of doctor managers'different role identities.
- To extend theory on manager-professionals' identity work in the health context.
- To explain why the term leadership rather than management is adopted by DMs.
- To consider certain issues when training doctors to engage in management.

This study examines “identity work” among hybrid doctor-managers (DMs) in the Spanish National Health System to make sense of their managerial roles. In particular, the meanings underlying DMs experience of their hybrid role are investigated using a Grounded Theory methodology, exposing distinctions in role-meanings. Our findings provide evidence that using different social sources of comparison (senior managers or clinicians) to construct the meaning of managerial roles leads to different role-meanings and role identities, which are the source of the two established types of DM in the literature, the reluctant and the enthusiast. The contribution is twofold: our findings lead us to theorize DMs' identity work processes by adding an overlooked role-meaning dimension to identity work; and raise practical reflections for those who wish to develop enthusiast doctor managers.