Institutional phronesis: theorizing how US primary care clinicians navigate competing incommensurate logics of efficiency, care, and market in clinical practice

In the highly privatized United States primary care environment, physicians must attend to incommensurate logics of quality care. That is, they must attempt to holistically care for patients within a system that has been described as highly commodified and bureaucratically violent. I introduce the concept of institutional phronesis as a key component of the professional skills required to navigate this complex organizational environment. The article uses ethnographic insights garnered through 18 months at a rural medical center to demonstrate how primary care physicians experience disparate logics and seek to provide high-quality care through institutional phronesis in this setting. I close with recommendations for how institutional phronesis might be incorporated in physician professional development and continuing education.