Health Care Practitioners

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School

North Carolina State University *

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Course

381

Subject

Medicine

Date

Oct 30, 2023

Type

ppt

Pages

20

Uploaded by MinisterJaguar3704

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Healthcare Practitioners
Healthcare Practitioners • So far, we have only mentioned health workers in passing • To explicate the ‘history of doctoring’ we will draw upon the sociology of professions – Competition for legitimacy – Rise and decline of the physician – New challenges and directions
The End of the Golden Age of Doctoring • By McKinlay and Marceau (2002): – “With the golden age of medicine now almost behind us, doctors are huddling in their monasteries (hospitals and medical centers) powerlessly awaiting the next corporate onslaught” (p. 381) • The forces of capitalistic economic development have challenged the privileged position of the physician in the United States
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Professionalism “Professionalism can be defined as a system of values and beliefs and behavior (concerning how things ought to be done) resulting from dedicated commitment usually following a prolonged period of training.” (p. 381) In the case of doctors: – Sanctioned by the state – Protected from view (secrecy) – Supported by strong institutions
Extrinsic Factors Causing Decline 1) Shifting Allegiance of the State: • The government helped facilitate the rise of physicians • However, in recent years: has lost the ability or willingness to act on behalf of doctors • Managed care • Attempts at healthcare reform • WHY? • Neo-Marxists (Serves the Capitalists) • Pluralists (Serves the People) • New Right Perspective (State acts somewhat autonomously = does not do the will of the people)
Extrinsic Factors Causing Decline
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Extrinsic Factors Causing Decline Shifting Allegiance of the State (continued): • Movement toward ‘New Right’ Philosophy has challenged the government and the position of doctors “This now dominant New Right perspective has resulted in an important shift in the primary allegiance of the state – from protecting the interests of the medical profession to advancing the interests of the financial and industrial owners of an ever more corporatized U.S. health care system.” (p. 387)
Extrinsic Factors Causing Decline
Extrinsic Factors Causing Decline
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Extrinsic Factors Causing Decline 2) Bureaucratization (Corporatization) of Doctoring • From 1983-1997: Doctors as ‘employees’ rose from 24% to 43% (no ownership interest) • ‘Assembly-line’ mentality – Success = patients seen, diagnoses and referrals given • Loss of clinical autonomy • Increased scrutiny over decisions • ‘Taylorism’
Extrinsic Factors Causing Decline
Extrinsic Factors Causing Decline
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Extrinsic Factors Causing Decline 3) An Increasingly Crowded Playing Field • Legitimacy through state licensing and regulations • Third-party reimbursement = doctor could order anything and be paid – Equaled a monopoly over a lucrative business • Now: competition by non-physician clinicians: nurse practitioners, midwives, PAs, alternative/ complementary medicine • Increasing competition/rivalry
Extrinsic Factors Causing Decline
Extrinsic Factors Causing Decline 4) Globalization and the Information Revolution: • Increasingly connected outside interests threaten the power of the AMA – Also, the technology of the ‘West’ is desired in impoverished nations – undermining doctors there • Information on the internet undermines the authority of doctors – The gap between doctor and patient in terms of accessible medical information has declined
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Extrinsic Factors Causing Decline 5) The Epidemiological Transition and Changing Concepts of the Body: • The ‘type’ of condition that is pertinent to modern society = age of degenerative and man-made disease – In previous generations, doctors could ‘cure’ (or, at least, this was the perception) – Now, doctors are unable to effectively treat the illnesses of the day • From curing to monitoring
Extrinsic Factors Causing Decline 6) From Relationship to Encounter – The Erosion of Patients’ Trust: “A measure of the change in this relationship lies in the words now used to describe it: “doctor” has become “provider,” the “patient” has become the “client,” and the “relationship” is now an “encounter.” (p. 402)
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Intrinsic Factors Causing Decline 1) Weakening of Market Position Through Oversupply: • Projected oversupply of physicians
Intrinsic Factors Causing Decline 2) The Doctors’ Union – Divide and Conquer • The AMA used to be a very strong group influencing legislation • Specialization has undermined its authority as doctors no longer speak with ‘one voice’ – Only 40% of the nation’s doctors in the AMA – Unable to resist the effects of managed care and commercialism

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