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.