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Abstract
The practice of corporate occupational medicine represents an extreme case of the problem of professional work in bureaucracies. Social control is a central issue for physician and patient. "Professional expertise" is often expected overtly and covertly to serve organizational purpose.
An exploratory study of the roles of corporate medical directors in large American firms, this historical, structural and phenomenological analysis draws on interviews (127), case studies, field observations, and an extensive literature review. It portrays a medical specialty struggling to win recognition and to articulate a credible mission. Progress reflects technical and social changes in medicine and management, but only when industry comes under external pressure. There are pressures now seeming to militate for a broadened role for corporate physicians, but problems continue to plague the field.
Five case studies illustrate the range of corporate medical directors' activities and of corporate cultures and mandates. The functions, structures, and missions of corporate health programs are catalogued.
A model of corporate medical directors' roles reveals tensions and pressures within and between specific medical and managerial demands on their time and loyalty. The intersection of a medical with a managerial axis divides the role into four sectors: clinical and population medicine, operational and strategic management. The operational management sector draws the physician into areas of conflict, as "medical comptroller," "investment analyst," and "expert medical witness."
Corporate medical directors use conflict-escaping devices (notably "the credo" and "medical Taylorism"). Competing expectations for their performance are complicated by lack of consensus on the essence of the role itself: Is "medical adjudication" incompatible with "health-care service"? Does service deflect attention from a mission in "environmental health"?
The study suggests that a more significant role is developing for the corporate physician, characterized by movement along the medical axis from a clinical to a population orientation and along the management axis from an operational to a strategic outlook. These suggestive findings raise a number of subsidiary research questions.
