Abstract

A reform in 2007 created a new role for doctors in French public hospitals: the head of a medical pole. This hybrid, doctor-manager role is supposed to resolve tensions between clinical and managerial practices under condition, of course, that doctors accept to assume it. This article has come out of three years of research in three hospitals outside the Paris area. Despite the reform’s prescription of this hybrid role, the heads of the medical poles declare that they are “doctors first of all” — evidence that their deep sense of identity is still medical. When looking more closely at the positions that these doctors adopt during meetings however, we notice that they use economic arguments. The passage from the self-declared role to the one actually played can largely be set down to budgetary pressures, managerial tools and interventions by third parties. The identity of these managers is still medical, but these doctors are “enrolled” in management through the context of their actions. This hybridization is more a matter of “individual bricolage” — makeshift arrangements related to the career paths of individuals and local contexts of action — than a question of organization.