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In the first part of this paper, the significance of the word ‘accountability’ is explored in relation to the employment of hospital doctors, as in‐practice doctors and management attach very different meanings to it. The paper takes the view that, essentially, management views doctors as particularly expensive and difficult senior employees, while doctors see themselves as accountable only to their patients. In the second part, the processes for disciplining doctors are described in relation to the three main types of problem — sickness; personal misconduct; and professional misconduct and incompetence.