Beyond decline: consumerism, managerialism and the need for a new medical professionalism.

ABSTRACT

In the health care occupational sector powerful social changes have been involved in challenging two of its core features: the centrality of professionalism and medical dominance. This article proposes that factors internal to the health care system, such as health care reforms, can be explained by factors associated with large-scale social developments such as neo-liberalism and post-modernity. The most significant of these have been consumerism and managerialism. The impact of both is assessed by relying on theoretical insights and empirical evidence from recent studies in several countries. Finally, the need for a new medical professionalism will be considered as an adaptive response to the challenges coming from social change.

KEY WORDS

Sociology, medical profession, consumerism, managerialism, medical dominance, professionalism

Introduction

The growth of employment in the health care sector during the 20th century has reached considerable proportions in all industrialised countries. Its incidence of overall employment, which ranged from 1% to 3% during the 1960s, rose to between 4% and 7% during the 1990s (Moran 1999:9). In some countries, such as Australia, health care has experienced the highest employee growth-rate of all industries. From a sociology-of-work perspective, this growth was marked by two main features that differentiate it from all other industries: the importance assumed by the professions and the unique power attributed to the medical profession, often referred to as medical dominance'. The first feature refers to the fact that in this sector there is a high number of organised professions at work: they operate as collective actors with strategies that often bring them into conflict with one another. This situation contrasts with the rest of the working world where, since the end of the 19th century, the occupationally-based division of labour was progressively destroyed by the spread of the large factory and large office work organisation. In relation to the second feature, in no other industry is there a single profession that exercises so much power over such a large number of different occupations, as the medical profession does in the health care sector.

In the last two or three decades, both features have been challenged by powerful forces of change. Among the most frequently mentioned factors of change are health care reforms, which in many countries have strengthened managerial control over professionals, the spread of health consumerism, the autonomy of many health care occupations and the internal segmentation or fragmentation of the medical profession. This paper addresses two main issues raised by such changes: