{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T07:19:14Z","timestamp":1784618354196,"version":"3.55.0"},"reference-count":93,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T00:00:00Z","timestamp":1766275200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Over recent decades, the medical profession has undergone significant changes due to the influence of managerialism, which is characterised by standardisation, efficiency and cost control. Although these principles aim to improve sustainability and transparency within healthcare systems, they often conflict with fundamental aspects of medical professionalism and patient\u2010centred care. This perspective explores how managerialism may negatively affect the medical profession, focussing on its impact on clinician autonomy, the changing nature of medical work, professional identity and collegial relationships within hospital settings. Key challenges faced by doctors include diminishing control over patient care, growing administrative burden, increasing burn\u2010out, erosion of professional values and identity, and fragmentation of collegiality. To address these issues, this perspective advocates for institutional change such as hybrid governance models that integrate professional and managerial expertise to ensure managerial goals remain aligned with clinical realities. Professional bodies and institutions should empower doctors with managerial and leadership competencies to influence organisational change, reconcile clinical and managerial priorities, and uphold professional values and quality patient care within the evolving healthcare landscape. Effective reform requires the considerate integration of managerial systems into healthcare to strengthen, rather than undermine, the professional foundations and ethical values that give medicine its integrity and meaning.<\/jats:p>","DOI":"10.5694\/mja2.70117","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T07:50:23Z","timestamp":1766389823000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Influence of Managerialism on Medical Professionalism: Challenges, Risks and Future Directions"],"prefix":"10.5694","volume":"224","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1736-3425","authenticated-orcid":false,"given":"Evelyn","family":"He","sequence":"first","affiliation":[{"name":"Department of Radiology Austin Health  Heidelberg Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Behnam","family":"Shaygi","sequence":"additional","affiliation":[{"name":"Radiology Department London North West University, Healthcare NHS Trust  London UK"},{"name":"Medical School, Imperial College  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anousha","family":"Yazdabadi","sequence":"additional","affiliation":[{"name":"Eastern Health Clinical School, Monash School of Medicine Monash University  Melbourne Victoria Australia"},{"name":"Department of Dermatology Eastern Health  Box Hill Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christen D.","family":"Barras","sequence":"additional","affiliation":[{"name":"Department of Radiology Royal Adelaide Hospital  Adelaide South Australia Australia"},{"name":"School of Medicine, Faculty of Health and Medical Sciences University of Adelaide  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-2854","authenticated-orcid":false,"given":"Paul M.","family":"Parizel","sequence":"additional","affiliation":[{"name":"Department of Radiology Royal Perth Hospital  Perth Western Australia Australia"},{"name":"Medical School University of Western Australia  Perth Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamed","family":"Asadi","sequence":"additional","affiliation":[{"name":"Department of Radiology Austin Health  Heidelberg Victoria Australia"},{"name":"Department of Imaging Monash Health  Clayton Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,21]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001888-200006000-00010"},{"key":"e_1_2_14_3_1","first-page":"214","volume-title":"Managerialism and the Public Services: The Anglo\u2010American Experience","author":"Pollitt C.","year":"1990"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja15.00170"},{"key":"e_1_2_14_5_1","first-page":"276","volume-title":"Managerialism: The Emergence of a New Ideology","author":"Enteman W. F.","year":"1993"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1108\/LHS-02-2016-0012"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203467329"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9566.2011.01393.x"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0268580903018002005"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2014.01.011"},{"key":"e_1_2_14_11_1","first-page":"1486","article-title":"How Islam Changed Medicine","volume":"331","author":"Zahedi F.","year":"2006","journal-title":"BMJ"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11420-007-9054-3"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-136-3-200202050-00012"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/01421590400019518"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0011392111402585"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/104973200129118598"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1076\/jmep.24.3.243.2523"},{"key":"e_1_2_14_18_1","article-title":"Between Professional Autonomy and Economic Orientation\u2014The Medical Profession in a Changing Health Care System","volume":"2","author":"K\u00e4lble K.","year":"2005","journal-title":"Psychosocial Medicine"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2022.01.026"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2016.01.006"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/M22-1575"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/joms.12003"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2017.35"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2002.tb04920.x"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2013.01.008"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011248222755"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.4300\/JGME-D-12-00377.1"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.2190\/5N2R-MWAN-FWY2-JVHQ"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.4300\/JGME-D-15-00240.1"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-3684"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsurg.2018.10.010"},{"key":"e_1_2_14_32_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.0811"},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1620263"},{"key":"e_1_2_14_34_1","volume-title":"How Tech Can Turn Doctors Into Clerical Workers","author":"Verghese A.","year":"2018"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.9609"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocaa339"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.2196\/54811"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2016.05.007"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0139"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-954X.1993.tb00065.x"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-016-1826-3"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(02)00151-X"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001081"},{"issue":"1","key":"e_1_2_14_44_1","first-page":"23","article-title":"Evidence\u2010Informed Managerial Decision\u2010Making: What Evidence Counts? (Part One)","volume":"6","author":"Liang Z.","year":"2011","journal-title":"Asia\u2010Pacific Journal of Health Management"},{"issue":"2","key":"e_1_2_14_45_1","first-page":"12","article-title":"Evidence\u2010Informed Managerial Decision\u2010Making: What Evidence Counts? (Part Two)","volume":"6","author":"Liang Z.","year":"2011","journal-title":"Asia\u2010Pacific Journal of Health Management"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.1080\/0142159X.2024.2331048"},{"key":"e_1_2_14_47_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.24.4.1150"},{"key":"e_1_2_14_48_1","doi-asserted-by":"publisher","DOI":"10.1108\/14777261011088683"},{"key":"e_1_2_14_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15901-1"},{"key":"e_1_2_14_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2012.02766.x"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-9299.2006.00600.x"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.2307\/3349912"},{"key":"e_1_2_14_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-954X.1972.tb03218.x"},{"key":"e_1_2_14_54_1","doi-asserted-by":"publisher","DOI":"10.2190\/JBMN-C0W6-9WFQ-Q5A6"},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.2307\/2579098"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.5172\/hesr.2006.15.5.432"},{"key":"e_1_2_14_57_1","doi-asserted-by":"publisher","DOI":"10.5172\/hesr.2006.15.5.421"},{"key":"e_1_2_14_58_1","doi-asserted-by":"publisher","DOI":"10.2190\/YEVW-6C44-YCYE-CGEU"},{"key":"e_1_2_14_59_1","article-title":"David Oliver: Why Shouldn't Doctors Defend Our Distinct Professional Identity?","volume":"382","author":"Oliver D.","year":"2023","journal-title":"BMJ (Clinical Research Ed.)"},{"key":"e_1_2_14_60_1","volume-title":"The Leng Review: An Independent Review Into Physician Associate and Anaesthesia Associate Professions","author":"Leng G.","year":"2025"},{"key":"e_1_2_14_61_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.q1412"},{"key":"e_1_2_14_62_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12752"},{"key":"e_1_2_14_63_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001888-199807000-00010"},{"key":"e_1_2_14_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31279-X"},{"key":"e_1_2_14_65_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12995-016-0091-z"},{"key":"e_1_2_14_66_1","doi-asserted-by":"publisher","DOI":"10.1177\/1077558719856787"},{"key":"e_1_2_14_67_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-325"},{"key":"e_1_2_14_68_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-070442"},{"issue":"4","key":"e_1_2_14_69_1","article-title":"Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy","volume":"3","author":"Friedberg M. W.","year":"2014","journal-title":"RAND Health Quarterly"},{"key":"e_1_2_14_70_1","article-title":"Professionalism and Its Role in the Formation of Medical Professional Identity","volume":"32","author":"Forouzadeh M.","year":"2018","journal-title":"Medical Journal of the Islamic Republic of Iran"},{"key":"e_1_2_14_71_1","doi-asserted-by":"publisher","DOI":"10.5465\/amj.2006.20786060"},{"key":"e_1_2_14_72_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126450-200504000-00010"},{"key":"e_1_2_14_73_1","doi-asserted-by":"publisher","DOI":"10.1097\/00115514-200407000-00007"},{"key":"e_1_2_14_74_1","volume-title":"Leading the NHS: Proposals to Regulate NHS Managers Consultation Response [Internet]","author":"United Kingdom Government Department of Health and Social Care","year":"2025"},{"key":"e_1_2_14_75_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7390.646"},{"key":"e_1_2_14_76_1","volume-title":"Independent Investigation of the NHS in England","author":"Darzi A.","year":"2024"},{"key":"e_1_2_14_77_1","doi-asserted-by":"publisher","DOI":"10.1111\/padm.12119"},{"key":"e_1_2_14_78_1","doi-asserted-by":"publisher","DOI":"10.1177\/0170840601224003"},{"key":"e_1_2_14_79_1","doi-asserted-by":"publisher","DOI":"10.1108\/14777260911001653"},{"key":"e_1_2_14_80_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpo\/jou010"},{"key":"e_1_2_14_81_1","doi-asserted-by":"publisher","DOI":"10.1258\/0951484041485638"},{"key":"e_1_2_14_82_1","doi-asserted-by":"publisher","DOI":"10.1111\/soc4.12178"},{"key":"e_1_2_14_83_1","doi-asserted-by":"publisher","DOI":"10.1177\/1350508410380762"},{"key":"e_1_2_14_84_1","doi-asserted-by":"publisher","DOI":"10.5172\/hesr.2013.22.3.255"},{"key":"e_1_2_14_85_1","volume-title":"Payment by Results in the NHS in England: Addressing the Challenges and Improving Health Outcomes. Series 3 Briefing 4","author":"Aktas P.","year":"2023"},{"key":"e_1_2_14_86_1","doi-asserted-by":"publisher","DOI":"10.1097\/01974520-200310000-00002"},{"key":"e_1_2_14_87_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199610243351721"},{"key":"e_1_2_14_88_1","doi-asserted-by":"publisher","DOI":"10.1111\/1467-9566.13115"},{"key":"e_1_2_14_89_1","first-page":"232","volume-title":"Visualising Health Care Practice Improvement: Innovation From Within","author":"Iedema R.","year":"2013"},{"key":"e_1_2_14_90_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpo\/jov002"},{"key":"e_1_2_14_91_1","doi-asserted-by":"publisher","DOI":"10.1177\/0951484819844778"},{"key":"e_1_2_14_92_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540962.2014.865932"},{"key":"e_1_2_14_93_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-016-1396-4"},{"key":"e_1_2_14_94_1","doi-asserted-by":"publisher","DOI":"10.1177\/1355819614524946"}],"container-title":["Medical Journal of Australia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.5694\/mja2.70117","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.5694\/mja2.70117","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.5694\/mja2.70117","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T04:15:41Z","timestamp":1769746541000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.5694\/mja2.70117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,21]]},"references-count":93,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.5694\/mja2.70117"],"URL":"https:\/\/doi.org\/10.5694\/mja2.70117","archive":["Portico"],"relation":{},"ISSN":["0025-729X","1326-5377"],"issn-type":[{"value":"0025-729X","type":"print"},{"value":"1326-5377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,21]]},"assertion":[{"value":"2025-08-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70117"}}