The `Bureaucratization' of Professional Roles: The Case of Clinical Directors in UK Hospitals

This article analyses the process by which some hospital doctors have adopted medical-manager hybrid roles by joining the new cadre of clinical directors. The article has two main aims. The first is to enhance understandings of professional role change by contributing empirical evidence to the debate concerning the alleged `de-professionalization' of expert roles. The second is to assess the ways in which institutional forces influence change and inertia in professional roles. Drawing on data collected during a study of UK hospitals between 1991 and 1995, the author attempts to analyse the development of the clinical director role. Particular consideration is given to indicators of de-professionalization such as weakening occupational closure, reduced autonomy and the enhanced managerial control of professional work. The findings demonstrate that the physicians who become clinical directors are, to some extent, `bureaucratized' through their acceptance of increased commercial and managerial responsibility. Less evidence emerges to support the de-professionalization thesis. Rather, it is shown that clinical directors maintain the occupational closure of the medical domain. They also protect high levels of clinical autonomy and resist attempts to enhance the managerial control of medical practice.