Professional dominance, autonomy, and control have been consistently emphasized in theories of the medical profession. Recently, however, the professional hegemony that physicians have enjoyed is increasingly being questioned in the light of profound changes that are taking place in the organization of health care in the United States. Debates about the implications of the power of medicine and the means by which it is maintained are being replaced by attempts to understand professional decline. Proletarianization (McKinlay and colleagues) and restratification theory (Freidson) are two prominent and competing predictions for the future of the medical profession. Taking obstetrics as a critical case, this article considers the relative ability of these theories to elucidate the changing organization of maternity care in one state and presents a case study of patient care in one hospital. It suggests a disjuncture between obstetricians' inability to protect their interests as a corporate body and their relative ability to control the organization of everyday medical work. It is concluded that more theoretical clarity is needed on professional behaviors at the macro and micro levels.
Get full access to this article
View all access options for this article.
References
1.
McKinlayJ.StoeckleJ.Corporatization and the social transformation of doctoring. Int. J. Health Serv. 18(2): 191–205, 1988.
2.
FreidsonE.The changing nature of professional control. Annu. Rev. Sociol.10: 101–120, 1984.
3.
FreidsonE.The reorganization of the professions by regulation. Law Hum. Behav.7(2/3): 279–289, 1983.
4.
FreidsonE.The reorganization of the medical profession. Med. Care Rev. 42(1): 11–35, 1985.
5.
FreidsonE.Professional Powers. A Study of the Institutionalization of Formal Knowledge. Chicago University Press, Chicago, 1986.
6.
HarreR.Philosophical aspects of the micro-macro problem. In Advances in Social Theory and Methodology: Toward an Integration of Micro- and Macro-Sociologies, edited by Knorr-CetinaK.CicourelA., pp. 139–160. Routledge & Kegan Paul, London, 1981.
7.
DerberC.Professionals as Workers. Mental Labor in Advanced Capitalism. G. K. Hall, Co., Boston, 1982.
8.
McKinlayJ. B.The business of good doctoring or doctoring as good business: Reflections on Freidson's view of the medical game. Int. J. Health Serv. 7(3): 459–483, 1977.
9.
FreidsonE.The medical profession in transition. In Applications of Social Science to Clinical Medicine and Health Policy, edited by AikenL.MechanicD., pp. 63–79. Rutgers University Press, New Jersey, 1986.
10.
HaugM.The deprofessionalization of everyone?Sociol. Focus8(3): 197–213, 1975.
11.
HaugM.The erosion of professional authority: A cross-cultural inquiry into the case of physicians. Milbank Mem. Fund Q. 54: 83–106, 1976.
12.
HaugM.LavinB.Consumerism in Medical Care: Challenging Physician Authority. Sage Publications, Beverly Hills, 1983.
13.
StarrP.The Transformation of American Medicine. Basic Books, New York, 1982.
14.
LarsonSarfattiM.Proletarianization and educated labor. Theory and Society9(1): 131–175, 1980.
15.
ThayerG.Who Shakes the Money Tree?. Simon & Schuster, New York, 1973.
16.
BravermanJ.Crisis in Health Care. Acropolis Books, Washington, D.C., 1980.
17.
MandelE.An Introduction to Marxist Economic Theory. Pathfinder Press, New York, 1970.
18.
O'ConnorJ.The Fiscal Crisis of the State. St. Martin's Press, New York, 1973.
19.
AltmanD.Two views of a changing health care system. In Applications of Social Science to Clinical Medicine and Health Policy, edited by AikenL.MechanicD., pp. 101–112. Rutgers University Press, New Jersey, 1986.
20.
RenaudM.State intervention in health care. Int. J. Health Serv. 5(4): 559–571, 1975.
21.
GoldsmithJ.The health care market: Can hospitals survive?Harvard Bus. Rev., September/October 1980, pp. 100–112.
22.
SalmonJ. W.Profit and health care: Trends in corporatization and proprietarization. Int. J. Health Serv. 15(3): 395–418, 1985.
23.
RelmanA.The new medical-industrial complex. N. Engl. J. Med.303(17): 963–970, 1980.
StevensR.The changing hospital. In Applications of Social Science to Clinical Medicine and Health Policy, edited by AikenL.MechanicD., pp. 80–99. Rutgers University Press, New Jersey, 1986.
26.
RheinW.Hospitals in trouble: Crisis for doctors?Med. World News21: 59–68, 1980.
27.
WhiteisD.SalmonJ. W.The proprietarization of health care and the underdevelopment of the public sector. Int. J. Health Serv. 17(1): 47–64, 1987.
LightD.Surplus versus cost containment: The changing context for health care providers. In Applications of Social Science to Clinical Medicine and Health Policy, edited by AikenL.MechanicD., pp. 519–542. Rutgers University Press, New Jersey, 1986.
30.
AllgaierA.Alternative birth centers offer family centered care. Hospitals62: 97–114, 1978.
31.
DeVriesR.Responding to consumer demand: A study of alternative birth centers. Hospital Progress60:48–51, 1979.
32.
McKinlayJ. B.ArchesJ.Towards the proletarianization of physicians. Int. J. Health Serv. 15(2): 161–195, 1985.
33.
RoemerM. I.Proletarianization of physicians or organization of health services?Int. J. Health Serv. 16(3): 469–471, 1986.
34.
MechanicD.From Advocacy to Allocation: The Evolving American Health Care System. Free Press, New York, 1986.
35.
SullivanD.WeitzR.labor Pains. Modern Midwives and Home Birth. Yale University Press, New Haven, 1988.
36.
RuzekS.The Women's Health Movement: Feminist Alternatives to Medical Control. Praeger, New York, 1978.
37.
GoreA.Comment made at hearing on restraint of nurse-midwife practice, Oversight and Investigations Subcommittee of the U.S. House of Representatives December 18th. Quoted in Krause, N. Legislative exchange. J. Nurse-midwifery26(3): 61–63, 1980.
38.
Trenowski. Editorial.Inquiry20: 199–200, 1983.
39.
IglehartJ.Health care and American business. N. Engl. J. Med.306(2): 120–124, 1982.
40.
WashawL.Does it fit corporate plans for cost containment? Issue 5 in Forum on Health Policy Issues of Free-standing Birth Centers. Nat. Assoc. Childbearing Centers News2(1): 3–5, 1984.
41.
BeazleyJ.The active management of labor. Am. J. Obstet. Gynecol.122(2): 161–168, 1975.
42.
SchlichtingF.Position statement read at the meeting of the Alternative Birthing Methods Study Committee, California Department of Health. Report to the 1978 Legislature on Alternatives in Health Care, prepared pursuant to Assembly Bill 4492, State of California Health and Welfare Agency Department of Health, 1977.
43.
GinzbergE.The restructuring of health care. Inquiry12(3): 272–281, 1985.
44.
KinzerD.Physicians and hospitals: Tensions in the relationship. In Physicians and Hospitals: The Great Partnership at the Crossroads, edited by YaggyD.HodgsonP., pp. 29–50. Duke University Press, Durham, N.C., 1985.
45.
NavarroV.Medicine Under Capitalism. Prodist, New York, 1976.
46.
WeissK.Corporate medicine, what's the bottom line for physicians and patients?New Physician9: 19–25, 1982.
47.
ArneyW.Power and the Profession of Obstetrics. Chicago University Press, Chicago, 1982.
48.
DonnisonJ.Midwives and Medical Men. Schocken Books, New York, 1977.
49.
GinzbergE.OstowM. (eds.). The Coming Physician Surplus: In Search of a New Policy. Rowan and Allan Held, New Jersey, 1984.
50.
SalkeverD.BiceT.The impact of certificate-of-need controls on hospital investment. Milbank Mem. Fund Q. 54(2): 286–315, 1976.
51.
DevriesR.Midwifery and the problem of licensure. In Research in the Sociology of Health Care: A Research Annual, Vol. 2, edited by RothJ., pp. 77–120. JAI Press, Greenwich, Conn., 1982.
52.
RayackE.Professional Power and American Medicine. The World Publishing Company, New York, 1967.
53.
KrauseE.The political context of health services regulation. Int. J. Health Serv. 5(4): 593–607, 1975.
