City Research Online

Abstract

Purpose: Hospital physician job satisfaction is critically low, leading to turnover and compromising patient care. This study examines how clinical directors’ clinical expertise influences subordinate physicians’ job satisfaction and intention to stay, exploring the mechanisms through which expert clinicians become effective managers.

Methods: We analysed multisource survey data from 184 clinical directors and 803 subordinate physicians in Danish public hospitals. Clinical expertise was measured through experience, education and peer recognition. We examined how expertise relates to human resource management (HRM) practices, perceived expertise and leader identity, and their effects on subordinates’ job satisfaction and retention intentions.

Results: Directors with higher clinical expertise implement better HRM practices, which significantly mediate the relationship between expertise and subordinate job satisfaction (β=0.03, p<0.05) and intention to stay (β=0.03, p<0.05). Clinical expertise correlates positively with leader identity (β=0.18, p<0.05), contradicting expectations that expert clinicians make reluctant managers. Perceived expertise showed weaker relationships than actual expertise.

Practical implications: The findings challenge assumptions that outstanding clinicians resist leadership roles, suggesting that clinical excellence and leader identity can coexist and are both important. Organisations should focus on developing HRM capabilities alongside leadership identity among expert clinicians to maximise subordinate satisfaction and retention.

Publication Type:	Article
Additional Information:	© 2026, the Authors. This is the accepted manuscript of an article published by BMJ Group. Please refer to the publisher’s terms and conditions for information on re-use.
Subjects:	H Social Sciences > HD Industries. Land use. Labor H Social Sciences > HM Sociology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine
Departments:	Bayes Business School Bayes Business School > Faculty of Management
SWORD Depositor:	Symplectic Administrator

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