First entrants in a new medical specialty: Resolving relational ambivalence during Dutch hospitalists’ identity formation

Our case study analyses individuals' professional identity formation and resulting identity outcomes in the first cohorts of ‘Dutch hospital medicine’, a specialty introduced top-down within the Netherlands in 2012 that remained controversial for a long time. First entrants in any newly introduced health occupation will have a hard time in experiencing both their professional selves and their occupation as somewhere in-between existence and non-existence. Therefore, they will need to engage in dual professional identity formation: the process by which individuals form their professional selves, parallel to, yet intertwined with, contributing to their specialty's identity development. Using 93 interviews plus supplementary sources, we zoom in on nine individual hospitalists' trajectories, complemented with 11 retrospectively validating accounts. We show how the dual nature of first entrants' professional identity formation brings along role-based tensions, evoking ambivalence in first entrants' relationships with seniors of incumbent health occupations and among themselves as peers. We find that first entrants differ in how they resolve such relational ambivalence during their professional identity formation. Three pathways emerge that result in different outcomes in terms of professional self and contribution to their specialty's development: (1) specialty-oriented incremental pioneering, (2) self-oriented adaptive role development, and (3) career-oriented struggling. We contribute, firstly, by highlighting and clarifying the relational ambivalence that dual professional identity formation in a new health occupation evokes. Secondly, as first entrants cannot be expected to form a homogeneous group, the pathways provide a model for future inquiry and inform seniors how to offer first entrants guidance.