THE “SCOURGE OF
MANAGERIALISM” AND A ROYAL
COLLEGE CONFLICT
Gordon R. Tobin, MD
H
alf a world away, a conflict within a respected physicians’ organization, the
Royal Australasian College of Physicians, highlights principles that have far wider
implications. Writing in the Medical Journal
of Australia, Komesaroff and colleagues describe the rise of managerialism and its role in
their organization.1 Managerialism is a recent
trend in business management practice, and
more broadly, in hospitals and universities across the Commonwealth and beyond. The authors strongly decry its effects, and they
label it a “scourge.” American physicians voice similar complaints
about recent trends in health care, especially in hospitals and proposed vertically integrated systems. Recent articles in Louisville
Medicine by Griffin2 and by Roberts3 raise some related concerns.
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LOUISVILLE MEDICINE
First, Komesaroff et al. describe the rise of management practices
in the 19th and 20th centuries. As large corporations with multiple
stockholders evolved from small businesses with a single or few owners, management teams appeared. The new profession of managers
gradually developed its own principles and practices of efficiency
and ethics, but rapid change labeled “managerialism” rapidly evolved
over the last three decades.4 Komesaroff et al. describe the harmful
sequelae of this trend, especially to medical institutions, universities
and public organizations. The new managerial goals narrowed to
the following: (1) the market became the sole or dominant criterion for decision making, using performance indicators, externally
imposed targets and budget end-points; (2) traditional values, such
as trust, loyalty, compassionate care and critical reflection were
eroded; and (3) management substantially consolidated power
and suppressed dissent and criticism.5 Increasingly, hierarchical