Medical Sociology: Chapter 11 Physicians Flashcards
Professionalization of the Physician
• Goode’s 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
Professionalization of the Physician
• Prior to the 20th century:
– The medical profession was still developing
– It 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
The Control of Medical Education(• 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
FlexNER Report
(The Control of Medical Education)
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 Control of Medical Education(FlexNER Report)
• The AMA Council on Medical Education and the Flexner Report resulted in a tightening of medical education standards
– Increased the profession’s 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
The Socialization of the Physician
- 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
The Socialization of the Physician
• 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
The Socialization of the Physician
• 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 Socialization of the Physician
• 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:
•knowledge-elite & 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
