Health Systems in Transition: Professional Identity Work in the Context of Shifting Institutional Logics

Abstract

We investigate how established professionals manage their identities in the face of identity threats from a contested shift in the professional logic that characterizes their field. To do so, we draw on interviews with 113 physicians from five European transition countries who faced pressure for change in their professional identities due to a shift in the logic of health care from a "narrow specialism" in primary care, which characterized the Soviet health system, to "generalism," which characterizes primary care in the West. We found three important forms of professional identity threats experienced by physicians during this period - professional values conflict, status loss, and social id..