Modern Studies in Management and Organization

Modern Studies in Management and Organization

Administrative Medicoacy and Policy Capture: A Comparative Study of Iran with Developed and Developing Countries

Document Type : Original Article | Persian

Author
Department of Public Administration, Faculty of Management, Islamic Azad University of Sciences and Research, Tehran, Iran.
Abstract
Purpose: The disproportionate presence of medical graduates in Iran's managerial and policy-making positions is a long-standing phenomenon that has rarely been framed as an organizational and governance problem. This study seeks to conceptualize and critically explain the phenomenon of "administrative medicoacy" and to identify the mechanisms through which it is reproduced and leads to policy capture.
Methodology: The study is qualitative and explanatory-critical, conducted in two stages: a thematic analysis of legal documents, oversight reports, and scholarly literature using the thematic network approach; and a most-different comparative study setting Iran against developed countries (Britain, the Netherlands, Switzerland) and developing countries (Colombia, Peru, Mexico, China). The validity of the findings was secured through source triangulation and peer review.
Findings: The analysis yielded six reproducing mechanisms that form the links of a self-reinforcing chain: educational closure, vertical integration of governance and provider roles, spillover of professional prestige, formalistic hybrid professionalism, policy capture, and outward diffusion into non-health domains. The professional representation ratio indicated that physicians' share of Iran's legislative body is tens of times their demographic weight. The comparative analysis made clear that what distinguishes the Iranian case is not the presence of physicians in management, but rather the absence of an institutional counterweight alongside the vertical integration of roles.
Conclusion: Administrative medicoacy is a form of policy capture that operates through the legitimate channel of professional prestige and is therefore harder to restrain than overt corruption. Managerial credentials alone are not a remedy and, absent structural reform, serve a legitimating function. The study recommends separating governance roles from provider roles, establishing a job-based merit system, and managing conflicts of interest.
Keywords
Subjects

Article Title Persian

پزشکی‌سالاری اداری و تسخیر خط‌مشی؛ مطالعه تطبیقی ایران با کشورهای توسعه‌یافته و در حال توسعه

Author Persian

مهدی مهدویان صدر
گروه مدیریت دولتی، دانشکده مدیریت، دانشگاه آزاد اسلامی علوم و تحقیقات، تهران، ایران.
Abstract Persian

هدف: حضور نامتناسب دانش‌آموختگان پزشکی در مناصب مدیریتی و سیاست‌گذاری ایران پدیده‌ای دیرپاست که کمتر به‌مثابه مسئله‌ای سازمانی و حکمرانی صورت‌بندی شده است. این پژوهش می‌کوشد پدیده «پزشکی‌سالاری اداری» را مفهوم‌پردازی و تبیین انتقادی کند و سازوکارهای بازتولید آن را که به تسخیر خط‌مشی می‌انجامد، شناسایی نماید.
روش‌شناسی: پژوهش کیفی و تبیینی-انتقادی است و در دو مرحله انجام شد: تحلیل مضمون اسناد قانونی، گزارش‌های نظارتی و ادبیات علمی با رهیافت شبکه مضامین؛ و مطالعه تطبیقی موردمحور با منطق بیشترین تفاوت که ایران را در برابر کشورهای توسعه‌یافته (بریتانیا، هلند، سوئیس) و در حال توسعه (کلمبیا، پرو، مکزیک، چین) نهاد. اعتبار یافته‌ها از راه تثلیث منابع و بازبینی همتایان تأمین شد.
یافته‌ها: تحلیل به شش سازوکار بازتولیدکننده انجامید که حلقه‌های یک زنجیره خودتقویت‌کننده‌اند: بستار آموزشی، هم‌گرایی عمودی نقش‌های حاکمیتی و تصدی‌گری، سرریز اعتبار حرفه‌ای، حرفه‌گرایی دورگه صوری، تسخیر خط‌مشی، و برون‌ریزی به قلمروهای غیرسلامت. شاخص نسبت نمایندگی حرفه‌ای نشان داد سهم پزشکان در نهاد قانون‌گذاری ایران ده‌ها برابر وزن جمعیتی آنهاست. مقایسه تطبیقی روشن ساخت آنچه مورد ایران را متمایز می‌کند، نه حضور پزشکان در مدیریت، بلکه نبود وزنه متعادل‌کننده نهادی در کنار هم‌گرایی عمودی نقش‌هاست.
نتیجه‌گیری: پزشکی‌سالاری اداری شکلی از تسخیر خط‌مشی است که از مسیر مشروع اعتبار حرفه‌ای عمل می‌کند و از همین رو دشوارتر از فساد آشکار مهارشدنی است. اخذ مدارک مدیریتی به‌تنهایی درمان آن نیست و در غیاب اصلاح ساختار، کارکرد مشروعیت‌بخشی دارد. پژوهش، تفکیک نقش‌های حاکمیتی از تصدی‌گری، استقرار نظام شایستگی شغل‌محور و مدیریت تعارض منافع را پیشنهاد می‌کند.

Keywords Persian

پزشکی‌سالاری اداری
سلطه حرفه‌ای
تسخیر خط‌مشی
تعارض منافع
شایسته‌سالاری
Abbott, A. (1988). The system of professions: An essay on the division of expert labor. University of Chicago Press.
Abedi Jafari, H., Taslimi, M. S., Faghihi, A., & Sheikhzade, M. (2011). Thematic analysis and thematic networks: A simple and efficient method for exploring patterns embedded in qualitative data. Strategic Management Thought, 5(2), 151–198. [In Persian]
Academy of Medical Sciences of the Islamic Republic of Iran. (2020). Conflict of interest in the country's health system and effective solutions to prevent it. Academy of Medical Sciences. [In Persian]
Anckar, C. (2020). The most-similar and most-different systems design in comparative policy analysis. In G. Fontain (Ed.), Handbook of research methods and applications in comparative policy analysis (pp. 71–87). Edward Elgar Publishing.
Antonini, M., Costa-Font, J., Marchi, N., & Winberg, D. (2026). Do medical health ministers make different health system choices? Governance, 39(3), e70135. https://doi.org/10.1111/gove.70135
Carpenter, D., & Moss, D. A. (2014). Preventing regulatory capture: Special interest influence and how to limit it. Cambridge University Press.
Currie, J., & MacLeod, W. B. (2017). Diagnosing expertise: Human capital, decision making, and performance among physicians. Journal of Labor Economics, 35(1), 1–43. https://doi.org/10.1086/687896
Dal Bó, E. (2006). Regulatory capture: A review. Oxford Review of Economic Policy, 22(2), 203–225. https://doi.org/10.1093/oxrep/grj013
Dargent, E. (2015). Technocracy and democracy in Latin America: The experts running government. Cambridge University Press.
Ebrahimi, S. A., & Eynali, M. (2019). Developing a framework to explain the public policies capture using thematic analysis and interpretive structural modeling. Journal of Public Administration, 11(3), 403–430. [In Persian]
Fountaine, A., Shepherd, M. E., & Skinner, D. (2025). Physicians in congress: Professional backgrounds and legislative effectiveness. Legislative Studies Quarterly, 50(3), 1–28. https://doi.org/10.1111/lsq.12482
Freidson, E. (1970). Profession of medicine: A study of the sociology of applied knowledge. Dodd, Mead & Company.
Goodall, A. H. (2011). Physician-leaders and hospital performance: Is there an association? Social Science & Medicine, 73(4), 535–539. https://doi.org/10.1016/j.socscimed.2011.06.025
Gorsky, M. (2013). 'Searching for the people in charge': Appraising the 1983 Griffiths NHS management inquiry. Medical History, 57(1), 87–107. https://doi.org/10.1017/mdh.2012.84
Imani, H., Gholipour, A., Azar, A., & Pourezzat, A. A. (2019). Identifying the components of the human resource supply system to promote the health of the administrative system. Journal of Public Administration, 11(2), 254–281. [In Persian]
Jameson, M. G. (1983). Physicians and American political leadership. JAMA, 249(7), 929–930. https://doi.org/10.1001/jama.1983.03330310057030
Kumar, B., Kamal, M., & Shakir, A. (2022). The doctors in the house: Examining physician legislators in the US Congress from 2011 to 2020. Southern Medical Journal, 115(5), 322–327. https://doi.org/10.14423/SMJ.0000000000001389
Larson, M. S. (1977). The rise of professionalism: A sociological analysis. University of California Press.
Mahdavian Sadr, M. (2026). Governance with adjectives: A typology and critical appraisal of the Persian-language literature on Islamic, religious, Alavi and transcendent governance. Journal of Modern Studies in Management and Organization. [In Persian]
Mahdavian Sadr, M., Daneshfard, K., & Givarian, H. (2025). Performance management model of policy studies system in Iran's geography (Case study: Research Center of the Islamic Consultative Assembly). Journal of Technology in Entrepreneurship and Strategic Management, 4(1), 1–15.
Mintzberg, H. (1983). Structure in fives: Designing effective organizations. Prentice Hall.
Mohammadi, M., Zandian, H., & Pourreza, A. (2024). The role of external factors in shaping the supply and demand of general practitioners in Iran: A qualitative study. BMC Primary Care, 26, 1–14. https://doi.org/10.1186/s12875-024-02420-6
Noordegraaf, M. (2007). From pure to hybrid professionalism: Present-day professionalism in ambiguous public domains. Administration & Society, 39(6), 761–785. https://doi.org/10.1177/0095399707304434
Qaiser, F., Gershon, A., & Petrescu, D. (2026). There is a doctor in the house: Physicians in the Canadian Parliament (1867–2025). University of Toronto Medical Journal, 103(1), 6–14.
Smith, A., Buadze, A., Stute, P., & Liebrenz, M. (2023). Political representation of medical doctors in Switzerland's executive and legislative branches in 2023. F1000Research, 12, 219. https://doi.org/10.12688/f1000research.130986.3
Veronesi, G., Kirkpatrick, I., & Vallascas, F. (2013). Clinicians on the board: What difference does it make? Social Science & Medicine, 77, 147–155. https://doi.org/10.1016/j.socscimed.2012.11.026
Wardle, J. (2016). Defining deviation. Journal of Law and Medicine, 23(3), 662–677.
Volume 3, Issue 1 - Serial Number 9
This issue corresponds to Spring 2026 and was published with a delay in September 2026.
Spring 2026
Pages 107-126

  • Receive Date 27 April 2026
  • Revise Date 06 June 2026
  • Accept Date 08 June 2026
  • Publish Date 14 September 2026