Emerging from the shadow of medicine: allied health as a 'profession community' subculture.

ABSTRACT

The authority relationship between medicine and the allied health professions has been conceptualised as one of subordination. The research that underpinned the subordination thesis was largely based on pre-1980 studies of interprofessional interaction and struggle. This article presents data from a comparative longitudinal case study analysis of Australian allied health professions employed in three distinct organisational models in urban acute care general hospitals during the 1990s. The article discusses the emergence of a distinct allied health 'profession community' subculture associated with the emergence of new organisational structures in Australia. A model to account for subculture development under different organisational conditions is proposed. A key concern is the way in which a 'profession community' is created, structured and maintained in the complex organisational settings of the acute-care hospital. The findings challenge the notion that subordination is an inevitable consequence of medical dominance and calls for a re-formulation of our understanding of the relationship between medicine and allied health professions in light of contemporary health service reforms.

KEY WORDS

Sociology of professions, allied health professions, medical dominance, subculture, hospital structure, organisational restructuring

Introduction

International trends in health care reform show that industrialised countries are attempting, with varying degrees of success, to fundamentally restructure the nature of health care. A major focus of studies on health sector reform has typically been on institutional locations such as the hospital, and on professions such as medicine (Degeling et al. 2001). The study reported in this article concentrates on the largely unexplored dynamics of the 'invisible' health professions, that is, the allied health professions, in the context of the organisational reform of hospitals in Australia. Studying the changing nature of inter-professional relations during a concentrated phase of hospital restructuring is likely to reveal important shifts in authority relations.

The key change that has occurred in the organisational arrangements of hospitals nationally and internationally has been the transformation of the sites of clinical care into key operational sub-units of strategic importance to resource management and organisational viability (Packwood et. al. 1991; Boyce 1993a; Degeling et. al. 1999). Although these reforms were not specifically aimed at the allied health professions they have opened up the possibility of new structural options for the professions (Boyce 1991). The purpose of this paper is to examine how the implementation of structural options resulted in the development of a new identity, increased organisational influence and greater independence from medicine for the diverse, numerically small, feminised and loosely-coupled disciplines known as allied health.