Physician executives: The evolution and impact of a hybrid profession

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Abstract
In this paper, I review the many research contributions that have advanced our knowledge about the role and impact of physician executives during the recent era of managed care. The interpretive framework for this review is guided by Freidson's restructuring thesis, which posits that physician executives — the administrative elite of the medical profession — represent the segments of the profession whose role will be to balance the needs of the organization with the desires of the medical profession. Although substantial research supports the proposition that physician executives are well positioned, prepared, and willing to undertake such boundary-spanning responsibilities, there is only minimal research specifically addressing the effectiveness of this hybrid profession. In this void, I suggest that another approach to assessing effectiveness is to focus on the process of trust building and maintenance, since trust is central to achieving the primary responsibilities of physician executives. A model of the process of trust development is presented as a guide for future research, along with discussion about particular challenges to physician executives in gaining trust from clinicians and non-physicians.