We examine how healthcare professionals enacted different forms of identity work when aspects of their professional identity became threatened by organizational change driven by shifts in the prevailing logics of healthcare management. More specifically, our study focuses on the identity work engaged in by senior physicians when new managerial practices clashed with their professional, ethnic and religious identities. In 2015, the local government of Khyber Pakhtunkhwa province in Peshawar, Pakistan, passed a reform bill to modernize state healthcare. The resulting organizational changes required physicians to adapt to new work regulations and accountability systems that strongly challenged their professional identity and self-view. Drawing on interviews with 46 senior physicians from three state-run teaching hospitals, we find that the three main perceived threats to identity—conflict with core professional values, increased professional accountability, and curtailment of professional autonomy—all relate to the fragmentation of work and competing professional values. In response to this threat, the physicians engaged in two discrete forms of identity work, identity distinctiveness and identity growth, both of which were strongly influenced by their specific cultural and institutional context. We contribute to identity theory by showing that cultural, social, and religious identity can strongly influence professional identity, and that it can shape both defensive and constructive identity work.
