The double nexus of clinical management - hybrid doctor-manager roles in Danish hospitals

This study investigates the impact of a recent management reform in Danish hospitals that introduced the managing consultant as a new, hybrid doctor-manager role. Rooted in the framework of professional restratification, this paper examines how the reform, spearheaded by the Danish Medical Association and the Danish Regions, reshapes professional hierarchies and redefines boundaries between clinic and management. Drawing on qualitative interviews primarily with doctors in management positions across three hospitals following the implementation of the reform, we analyze micropolitical negotiations around personnel management, financial responsibility, and professional expertise. On this basis, we introduce the Double Nexus Model, which captures two axes of tension: clinical expertise versus managerial accountability (the source of authority and responsibility), and daily operational concerns versus long-term strategic orientation (the horizon of leadership practice). The model illustrates four ideal-typical articulations of the managing consultant role: the Organizational Strategist, the Clinical Strategist, the Clinical Lead, and the Organizational Executor. Each role presents opportunities and challenges, from strategy integration to safeguarding autonomy and supporting the team. Highlighting these ideal types, this study deepens sociological understandings of professional restratification and hybridization in healthcare management, while also offering practical insights into the work of connecting professional and managerial priorities within hospitals.