As many as four in five medical specialists who are currently working in a partnership within a hospital, do not want a mandatory employment contract. Although the pressure on medical specialists to enter into a contract of employment is being stepped up by politicians, hospitals and various economists, only twenty percent of self-employed medical specialists desire such a contract. Thirty percent of medical specialists opt for the existing, usually small medical partnership that participates in their own hospital. The largest group of medical specialists (38 percent) would prefer to work within one large collective of specialists in the hospital. Finally, ten percent express a preference for working in a private clinic (ZBC).
This appears from the research by Wout Koelewijn, who will obtain his doctoral degree at the University of Twente on 28 March with his PhD thesis entitled "Doctors in Business - A study into what drives physicians' entrepreneurship". In his research, Koelewijn shows that hospitals would be wise to also allow space for entrepreneurship by (groups of) medical specialists after 2015.
New research
With a view to the new position of the medical specialist in 2015, many hospitals are working on the development of a new cooperation model based on one collective of medical specialists. New research by Koelewijn shows that it is vitally important to allow space for medical specialists who would like to continue working within the existing structure of smaller medical partnerships.
The research was based on a literature review and an exploratory qualitative study consisting of forty interviews with medical specialists and hospital administrators. Finally, a large-scale measurement was conducted among 1,475 medical specialists. The results show that hospitals still form the battleground for two, sometimes conflicting, worlds or logics: on the one hand the medical specialist, whose logic emphasizes autonomy in medical practice based on medical expertise, and on the other hand the management, the centralized and coordinating role within the hospital organization, whose logic is more focused on efficiency and cost control.
Taking entrepreneurship into account
The current debate about the positioning of medical specialists is very much guided by economic, legal and tax arguments. Logics that form the undercurrent for the cooperation between medical specialists and hospitals are excluded from this. As a result, there is a risk that structures are developed that exacerbate contradictions between doctors and managers instead of bridging them. Research results show that this can lead to medical specialists wanting to leave the hospital in order to look for possibilities to gain more control of their own setting. Koelewijn therefore argues that account should be taken of the specialists who want space for entrepreneurship or, on the basis of their medical logic, opt for the medical partnership, if hospitals are to retain experienced and entrepreneurial medical specialists.
Koelewijn's research formed part of the research groups Health Technology and Services Research (HTSR) and NIKOS, the University of Twente's Netherlands Institute for Knowledge Intensive Entrepreneurship. Koelewijn was supervised by Prof. Dr Wim van Harten, Prof. Dr Aard Groen and Dr Michel Ehrenhard.
A summary of the research is available via: www.doctorsinbusiness.nl
