Abstract
Over thirty years since Eliot Freidson’s seminal account of re- stratification and the emergence of administrative elites in professions, we still know little about how far this process has been associated with changes in the criteria for determining seniority and authority. Have new criteria emphasising proven management competency for advancement in professional management hierarchies displaced those of professional status, and if so, under what conditions? In this paper, we investigate this matter focusing on senior medical management roles in English public hospitals. Drawing on a mix of administrative data sources and applying fsQCA, we highlight both change and continuity in the prevailing status hierarchy of medicine. Our findings reveal the continued influence of externally derived professional status criteria for access to the highest-ranking professional manager roles. Additionally, the configurational approach shows how, in situations where hospitals have achieved greater formal autonomy (corporatisation), different criteria emphasising management competency have also been influential.
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