The Psychological Contracts of Hybrid Physicians: A Qualitative Study in The Saudi Arabian Public Health System.

Abstract

Hybrid physicians play a vital role in today's complex healthcare environment, balancing clinical and administrative duties to enhance patient care and operational efficiency in health organisations. They face unique challenges due to the multiplicity of their roles, which creates role conflict, a high workload, and burnout. The findings from this study offer valuable insights into these hybrid physicians’ expectations, motivations, and perceptions regarding their roles and responsibilities. Having a better understanding of the nature of their psychological contracts with stakeholders can enable organisations to offer appropriate support, resources, and policies to effectively meet these complex needs. In light of this, the current study explores the nature of hybrid physicians' psychological contracts, a topic that remains unexplored in the extant research, as well as understanding their progression as hybrids and the implications for effective management of their roles.

This interpretivist study involved 39 conducted interviews with hybrid physicians from four public hospitals in Saudi Arabia. The findings revealed that hybrid physicians form multiple relationships with various parties. Externally, they form transactional contracts with the Ministry of Health, as well as relational contracts with the wider medical profession. Internally, within their hospitals, they form mixed psychological contracts with senior managers, transactional contracts with HR professionals, and relational contracts with medical and non-medical colleagues. The study identified factors that contributed to the formation of these multiple contracts with various parties. For example, transactional contracts with the Ministry of Health stem from its role in setting pay and employment terms for hybrid roles, creating a dependent relationship based on economic exchange. Conversely, a strong identification with shared values such as dignity, altruism, compassion, and a sense of accountability underpins the relational contract with the wider medical profession. The findings reveal additional factors that influence the formation of PCs with the internal parties mentioned above in the hospital where hybrid physicians work. The study offers a unique contribution to the literature that has not previously addressed the underlying causes for developing such contracts.

Additionally, the study identified two categories of physicians: those willing to continue on the hybrid career path and those unwilling to remain on the hybrid path. Findings indicate that perceived relational psychological contracts have a significant influence on hybrid career progression. This study fills a gap in the extant literature related to the nature of the psychological contracts of hybrid physicians in the Saudi Arabian healthcare context and the HR implications for the careers of these individuals.