Doctor-managers as decision makers in hospitals and health centres

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=4144) from the baseline group (n=8232). 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.