We examine how established professionals manage threats to their identity when they encounter structural reforms that represent changes to their roles and routine practices. In 2015, the local government of Khyber Pakhtunkhwa (KP) province in Peshawar, Pakistan, passed a reform bill to modernize state healthcare. The reform demanded that physicians abandon certain established practices and adopt new ones that appeared to conflict with their social and professional identities. Drawing on 59 interviews focusing on three state-run teaching hospitals, this study contributes to a better understanding of struggles experienced by healthcare professionals when they are pressured to abandon their old identities. We find that three threats to physicians’ professional identity—conflict with core professional values, added professional accountability, and curtailment of professional autonomy—all relate to the fragmentation of work and competing professional values. Our study further reveals that the physicians engaged in identity work through two distinctive responses: identity distinctiveness and identity enrichment. Based on these findings, we develop a theoretical model that highlights the multiple forms of identity work that these professionals simultaneously engage in and through which they encounter changes in roles and practices which, ultimately, affect their existing identities. We contribute to identity theory by showing how professionals customize their identities to make them congruent with changing professional and organizational requirements.
