THE EFFECTS OF HOSPITAL CHARACTERISTICS AND RADICAL ORGANIZATIONAL-CHANGE ON THE RELATIVE STANDING OF HEALTH-CARE PROFESSIONS

This paper examines the effects of hospital characteristics and radica l organizational change on the relative representation of health care professions in hospitals over the period of the 1980s. Health care org anizations, and hospitals in particular, represent organizations where multiple professional groups make competing claims of expertise that often conflict. The question our research seeks to answer is whether d ifferent constellations of organizational characteristics and organiza tional changes affect the outcome of these professional conflicts. Usi ng the annual census of hospitals compiled by the American Hospital As sociation, we examine the effects of several characteristics of commun ity hospitals on the relative representation of specific professional groups. We find that hospital mergers favor physicians at the expense of administrators, and multihospital system affiliation favors technic al core occupations at the expense of administrators. Measures of orga nizational growth and decline increase the relative representation of physicians and administrators compared to nurses, and increase the pro bability that hospitals will employ physicians' assistants and nurse p ractitioners. Our results are evaluated in light of recent development s in the sociology of medicine and research on the relative standing o f occupations in other industries.