The paradoxical role of the hybrid clinician manager

![CDATA[“Paradox denotes contradictory yet, inter-related elements – elements that seem logical in isolation but absurd and irrational when appearing simultaneously” (Lewis 2000, p. 760). Changes to Australian health care policy have altered how work is organised in health care organisations (Fitzgerald, Lum, & Kippist, 2004). One of those changes has been an increase in the role of the medical clinician manager. Clinician managers are doctors who work in dual clinical and managerial roles in health care organisations (Dopson, Fitzgerald, Ferlie, Gabby, & Locock, 2002; Iedema, Degeling, Braithwaite, & White, 2003; Lopopolo, Schafer, & Nosse, 2004). The clinician manager role was developed to focus on the business of the health care organisation by leading the required and appropriate improvement of effectiveness and efficiency of clinical service provision (Degeling, Kennedy, & Hill, 2001). We believe the role of the hybrid clinician manager is paradoxical. Theoretically, the role of the clinician manager sounds logical. Clinician managers bring their clinical knowledge to their managerial decision making role and they are seen as a bridge between managers and their clinical peers. As such, clinician managers are bringing the business of health to the practice of health (Braithwaite, 2004). However, from our exploratory research, clinician managers come into the role, at times, reluctantly with little or no management training or knowledge and spend little time on the managerial issues that may address the policy changes that the role requires. This poses the following questions: Are clinician managers adequately equipped?; and, can they be fully committed to both an organisational managerial role as well as a clinical role? Current research reported in this paper does not question the contribution of current clinician managers, rather it questions the continuation of the clinician manager role within health care organisations. Through interviews and observation of clinician managers working in Australia and New Zealand health care organisations it was found that clinician managers spend more time „fighting fires‟ than working on long term strategic issues required to improve effectiveness and efficiency of clinical service provision and delivery. These preliminary findings suggest clinician managers are having difficulty finding the right balance between clinical and managerial work. Some refer to their clinical role as their “real” work and thus take their managerial role less seriously. This may be due to lack of managerial knowledge or skill resulting in questionable managerial practice. Clearly there is a gap between the policy implementation of the clinician manager role and the practice of that role which requires further research.]]