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Copyright 2012 by Pearson Education, Inc. All rights reserved.

Chapter 11

Physicians

Medical Sociology Twelfth Edition

William C. Cockerham


Professionalization of the Physician

Goodes characteristics of the profession:

Prolonged training in a body of specialized and abstract knowledge

An orientation toward providing a service

To consolidate professional power, must also:

Obtain public acceptance of claims to competence

Gain control over its own membership



Additional features of the profession: 1) Determines its own standards of education and training 2) Student professionals go through a more stringent socialization

experience than the learner in other occupations 3) Professional practice is often legally recognized by some form

of licensure 4) Licensing and admission boards are staffed by members of the

profession 5) Most legislation concerned with the profession is shaped by

that profession 6) As the occupation gains income, power, and prestige, it can

demand high-caliber students 7) The practitioner is relatively free of lay evaluation and control 8) Members are strongly identified by their profession



Prior to the 20th century The medical profession was still developing

Lacked both prestige and many of the characteristics identified by Goode

Service orientation has always been characteristic of physicians

By the 20th century Could claim the main characteristics of a profession

Scientific and technological advances improved claim to specialized body of knowledge


The American Medical Association

Founding of the American Medical Association (AMA) in 1847 eventually organized physicians into a professionally identifiable group

Journal of the American Medical Association (JAMA) contributed to prestige of group and also promoted awareness of allegiance to group

Specific organization of the AMA, in which the local society had considerable control over its members, helped consolidate power


The American Medical Association

Important influence on health policy during the 20th century, but influence is waning

In 1963, 70% of qualified doctors were members, compared to 2007 when less than 30% were

Exercise of power concentrated in the hands of a relatively limited of physicians and there is no effective forum for internal dissent


The Control of Medical Education

Early medical schools marked by low standards of instruction, poor facilities, and lax admission policies

Significant developments in the early 1900s:

1904 AMA established Council on Medical Education to review and implement ways to improve medical education

1910 Flexner Report



Flexner Report

Sponsored by the Carnegie Foundation

Inspected all medical schools in the U.S.

Only 3 medical schools given full approval

Harvard, Western Reserve, and Johns Hopkins

Recommended that schools have a full-time faculty, qualifications of both students and faculty raised significantly, should be associated with a university and taught on a graduate level



The AMA Council on Medical Education and the Flexner Report resulted in a tightening of medical education standards

Increased the professions control over its own education

By the 1920s, physicians had consolidated professional power and acquired most of the characteristics identified by Goode


The Socialization of the Physician

126 accredited medical schools in the United States

In 2009, 18,390 students were selected out of 42,289 applicants

48% of first-year students in 2009-2010 were female, representing a significant increase In the 1970s, only about 10 percent of all first-year

medical students were female

Racial minority students comprised about 39% of medical students, up from 3% in 1969



Most medical students are from upper- and upper-middle-class families

But increasing numbers of lower-middle- and lower-class students are entering medical school



Many medical students choose medicine with the goal of wanting to help people

Socialization by colleagues tended to encourage :

Success-oriented physicians to be less obvious about their ambitions

Less success-oriented to strive for the level of status indicative of their professional group



An established research tradition examines the impact of the medical education experience on students

Emphasizes how students learn to become emotionally detached from patients

Demanding work load and time constraints offered as rationalization for emotional detachment

Appears to be the result of the situational demands of medical school, and more humanitarian concerns return after graduation



The medical student learns how to tolerate three types of uncertainty resulting from: An awareness of not being able to learn everything A realization of limitations in medical knowledge and

techniques Problems distinguishing lack of personal knowledge from

limits of available knowledge

Evidence-based medicine Utilizes clinical practice guidelines based on proven

procedures to provide detailed step-by-step instructions on medical care

Meant as a method to reduce uncertainty among students


The Power Structure of American Medicine

Three factors influence establishing prestige within the medical profession:

1) Affiliation with a prestigious hospital

2) Acquiring and retaining a clientele through both professional and lay referral systems

3) Entrance into the inner core, comprised of specialists who control major hospital positions


The Power Structure of American Medicine

Major groups of physicians:

Inner core

Divided into the knowledge-elite and the administrative elite

New recruits

Likely to enter the inner core at some future point in career

Friendly outsiders

General practitioners linked to the inner core through the referral system

Marginal physicians

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