This chapter explores two main issues related to the experience of becoming a manager in healthcare: first, it has identified the wide range of orientations to management found amongst healthcare managers and examined how that relates to and reflects their clinical-managerial hybridity; second, it has examined what it means to act as a hybrid manager in the quite distinct settings found across the organizations explored in this research. It examines managers' goals and expectations in the light of changes occurring within their organizations and to managerial work across the sector more generally. The chapter explores in more depth the identity of healthcare managers, paying particular attention to the importance of hybridity among the cohort of managers. It excavates into managers' identity narratives to explore the very different sorts of career development trajectory associated with aspirational, ambivalent or conflicted views about management, as well as more deliberate or accidental progression into management roles.