Clinicians are increasingly being required to take on additional management duties in today's National Health Service. The framework of social defences provides one way of understanding the role-conflict for these clinician-managers. It is proposed that clinicians cope with the anxieties of health-care work by projecting unacceptable aspects of themselves into managers and that managers develop defensive social structures involving projection into clinicians. The current NHS culture and the associated increased anxiety exacerbates the reliance on these defensive structures. This makes collaboration between clinicians and managers particularly difficult, and results in increased anxiety for those who occupy the dual role.