Management reforms, re-stratification and the adaptation of professional status hierarchies: The case of medicine in publicly owned hospitals

Public management reforms worldwide have triggered processes of re-stratification in professions leading to the emergence of 'administrative elites' and potential changes in the nature of social status hierarchies. We investigate the nature of these adjustments and their supporting conditions in the context of English publicly owned hospitals. Applying fsQCA, our analysis shows a form of adaptation of the social status hierarchy of medicine to management demands. However, the emergence of a management criterion for seniority is only apparent under certain conditions. This suggests a form of path-dependent adaptation which reinforces, rather than challenges, the status position of elite doctors.

Automated summary

Public management reforms have resulted in re-stratification of professions and the emergence of administrative elites. We examine this phenomenon in English publicly owned hospitals and find that the social status hierarchy of medicine has adapted to management demands. However, the establishment of a management criterion for seniority is only evident under certain conditions, supporting the status position of elite doctors.