Medical dominance and power: A rural perspective

Amanda Kenny
La Trobe Rural Health School, La Trobe University, Bendigo VIC

PP: 158 - 165

Abstract

Whilst medicine has historically maintained a position of dominance and power within the health care system, there are suggestions that contemporary social trends such as managerialism, proletarianisation, and the corporatisation of the health care system are resulting in challenges to medicine's traditional power.

In some countries, declining medical power has been attributed to increased interest in alternative health management, intraprofessional competition, and medical oversupply. In Australia, these emerging social trends are having some impact on the dominant position of the medical profession. However, many of these trends are 'metrocentric'. In rural Australia, most doctors are neither corporatised workers nor publicly employed. They retain significant independence as fee-for-service providers whose medical power is strengthened by medical shortages and professional autonomy.

The Australian Health Care Agreement provides for equitable access for public health care irrespective of geographic location. However, in Victoria, it would appear that rural doctors' economic autonomy creates a significant disparity between rural and metropolitan constituents' access to public health services, especially public hospitals.

Keywords

sociology; rural; medicine; power; dominance

View references

References

Alexander J, Morrisey M, Burns L and Johnson V (1998) Physician and clinical integration among rural hospitals, Journal of Rural Health 14(4): 312-326.

Australian Government Department of Health and Ageing (2002) Medicare Benefits Schedule Book, Canberra: Commonwealth of Australia.

Australian Government Department of Health and Ageing (2003) Annual Report, Canberra: Commonwealth of Australia.

Australian Government Department of Health and Ageing (2004) Australian Health Care Agreements, Commonwealth of Australia http://www.health.gov.au/haf/docs/hca/

Australian Government Department of Health and Ageing (2004) Medicare Plus, Commonwealth of Australia http://www.health.gov.au/medicareplus/index.htm

Australian Health Ministers' Conference (1994) National Rural Health Strategy, Canberra : Australian Government Publishing Services.

Australian Institute of Health and Welfare (1998) Health in Rural and Remote Australia, Canberra : AIHW.

Australian Institute of Health and Welfare (2000) Medical Labour Force, AIHW http://www.aihw.gov.au

Australian Institute of Health and Welfare (2002) Rural health, AIHW http://www.aihw.gov.au/ruralhealth/

Australian Medical Association (2003) Stop gap, http://www.ama.com.au

Barnett J, Barnett P and Kearns R (1998) Declining professional dominance? Trends in the proletarianisation of primary care in New Zealand, Social Science & Medicine 46(2): 193-207.

Calnan M and Williams S (1995) Challenges to professional autonomy in the United Kingdom? The perceptions of general practitioners, International Journal of Health Services 25: 219-241.

Clarke J, Gerwitz S and McLaughlin E (2000) New Managerialism, New Welfare? London: The Open University and Sage.

Clarke J and Newman J (1997) The Managerial State: Power, Politics and Ideaology in the Remaking of Social Welfare, London: Sage.

Coburn D, Rappolt S and Bourgeault I (1997) Decline versus retention of medical power through restratification: an examination of the Ontario case, Sociology of Health & Illness 19(1): 1-22.

Commonwealth of Australia and State of Victoria (2003) Australian Health Care Agreement, Canberra.

Cooper R and Stoflet S (1996) Trends in the education and practice of alternative medicine clinicians, Health Affairs 15: 226-238.

Denhardt R (1993) The Pursuit of Significance: Strategies for Managerial Success in Public Organizations, Belmont: Wadsworth Publishing Company.

Duckett S (2000) The Australian Health Care System, Melbourne: Oxford.

Duckett S and Kenny A (2000) Hospital Outpatient and Emergency Services in Rural Victoria, Melbourne: Department of Human Services Victoria.

Easthope G (2002) Alternative medicine, in J Germov (ed) Second Opinion: An Introduction to Health Sociology, South Melbourne: Oxford University Press, 325-342.

Elston M (1991) The politics of professional power: medicine in a changing health service, in J Gabe, M Calnan and M Bury (eds) The Sociology of the Health Service, London: Routledge, 58-88.

Ernst E and White A (2000) The BBC survey of Complementary Medicine use in the UK, Journal of Complementary Therapies in Medicine 8(1): 32-36.

Exworthy M and Halford S (1999) Professionals and the New Managerialism in the Public Sector, Buckingham: Open University Press.

Foreman S (1996) Managing the physician workforce: hands off the market is working, Health Affairs 15: 243-249.

Foucault M (1973) The Birth of the Clinic, London: Tavistock.

Foucault M (1983) The subject and power, in H Dreyfus and P Rabinow (eds) Michel Foucault, beyond structuralism and hermeneutics, Chicago: University of Chicago Press, 208-226.

Friedson E (1970) Professional Dominance: The Social Structure of Medical Care, Chicago: Aldine.

Friedson E (1994) Professionalism Reborn: Theory, Prophecy and Policy, Cambridge: Polity Press.

Gabe J, Kelleher D and Williams G (1994) Challenging Medicine, London: Routledge.

Garpenby P (1999) Resource dependency, doctors and the state: quality control in Sweden, Social Science & Medicine 49: 405-424.

Germov J (2002) Challenges to medical dominance, in J Germov (ed) Second Opinion. An Introduction to Health Sociology, South Melbourne: Oxford University Press, 283-305.

Henderson G (1993) Physicians in China: assessing the impact of ideology and organisation, in F Hafferty and J McKinlay (ed) The Changing Medical Profession: An International Perspective, New York: Oxford University Press, 251-278.

Kenny A and Duckett S (2004) A question of place: medical power in rural Australia, Social Science & Medicine 58(6): 1059-1073.

Kletke P, Emmons D and Gillis K (1996) Current trends in physicians' practice arrangements: from owners to employees, Journal of the American Medical Association 276: 555-560.

Light D (2000) The medical profession and organisational change: from professional dominance to countervailing power, in C Bird, P Conrad and A Fremont (ed) Handbook of Medical Sociology, New Jersey: Prentice Hall, 201-216.

Mintzberg H (1979) The Structuring of Organisations, Englewood Cliffs: Prentice Hall.

Moscovice I and Stensland J (2002) Rural hospitals: trends, challenges, and a future research and policy analysis agenda, Journal of Rural Health 18(Suppl): 197-210.

National Rural Health Policy Forum and National Rural Health Alliance (1999) Healthy Horizons, National Library of Australia.

New South Wales Government (2004) NSW Health, http://www.health.nsw.gov.au

Noble T (2004) Rural hospitals wrongly charging fees: study, The Age, March 11: 6.

Pfeffer J and Salancik G (1978) The External Control of Organisations: A Resource Dependence Perspective, New York: Harper & Row.

Pinch S (1997) Worlds of Welfare: Understanding the Changing Geographies of Social Welfare Provision, London: Routledge.

Rappolt S (1997) Clinical guidelines and the fate of medical autonomy in Ontario, Social Science & Medicine 44: 977-987.

Ricketts T. C (1999) Rural communities and rural hospitals, Journal of Rural Health 15(2): 168-169.

Russell C and Schofield T (1986) Where It Hurts: An Introduction to Sociology for Health Workers, Sydney: Allen & Unwin.

Scarpaci J (1990) Physician proletarianization and medical care restructuring in Argentina and Uruguay, Economic Geography 6: 362-377.

Shreffler M (1996) An ecological view of the rural environment: levels of influence on access to health care, Advances in Nursing Science 18(4): 48-59.

Shuval J (1995) Elitism and professional control in a saturated market: immigration physicians in Israel, Sociology of Health & Illness 17: 550-565.

Strasser R, Hays R, Kamien M and Carson D (2000) Is Australian rural practice changing? Findings from the National Rural General Practice Study, Australian Journal of Rural Health 8(4): 222-226.

Sullivan R, Watanabe M, Whitcombe M and Kindig D (1996) The evolution of divergences in physician supply policy in Canada and the United States, Journal of the American Medical Association 276: 704-709.

Tousijn W (2002) Medical dominance in Italy: a partial decline, Social Science & Medicine 55: 733-741.

Turner B (1992) Medical Power and Social Knowledge, London: Sage.

Weber M (1978) Economy and Society, Berkeley: University of California Press.

Willis E (1989) Medical Dominance, St Leonards: Allen & Unwin.

Zolman C and Vickers A (1999) Users and practitioners of complementary medicine, British Medical Journal 319: 836-838.

Navigate: Archives | Contents | Top of page

Sign Me Up for latest release updates

*  Email Address:
    First Name:
    Last Name:
*  I am interested in::





 

Web Feed

Latest Articles

Special Issues

Culture, Death and Dying with Dignity
Volume 22/1
Summary

Lifestyle Science: Self-healing, co-production and DIY
Volume 21/3
Summary

Transformations in Health Care: Privatisation, Corporatisation and the Market
Volume 20/3
Summary | Contents

Mental Health and Illness: Practice and Service Issues
Volume 20/2
Summary | Contents

Men's Health
Volume 19/4
Summary | Contents

Food, ethics and identity
Volume 19/3
Summary | Contents

Sociology, Recreational Drugs and Alcohol
Volume 19/2
Summary | Contents

Ageing, Anti-ageing and Globalization: Transitions and limits in the governance of ageing
Volume 18/4
Summary | Contents

Expert Patient Policy
Volume 18/2
Summary | Contents

Social Determinants of Child Health and Wellbeing
Volume 18/1
Summary | Contents

Integrative, Complementary and Alternative Medicine: Challenges for Biomedicine?
Volume 17/4
Contents

Community, Family, Citizenship and the Health of LGBTIQ People
Volume 17/3
Summary | Contents

Re-imagining Preventive Health: Theoretical Perspectives
Volume 17/2
Summary | Contents

Death, Dying and Loss in the 21st Century
Volume 16/5
Summary | Contents

Social Equity and Health
Volume 16/2
Summary | Contents

Medical Dominance Revisited
Volume 15/5
Summary | Contents

Childbirth, Politics and the Culture of Risk
Volume 15/4
Summary | Contents

Revisiting Sexualities and Health: Contributions from Sociological Insights
Volume 15/3
Summary | Contents

Closing Asylums for the Mentally Ill: Social Consequences
Volume 14/3
Summary | Contents

Workplace Health: The Injuries of Neoliberalism
Volume 14/1
Summary | Contents

Rural Health Symposium: Patients and Practitioners
Volume 13/2
Summary | Contents

Symposium on Women's Health
Volume 13/1
Summary | Contents

Symposium on Women's Health: Breast Health - Health and Ageing
Volume 12/2
Summary | Contents

Symposium on Indigenous Health and the Contribution of Sociology
Volume 10/2
Summary | Contents

Research Funding
Volume /

Research Methodology: Theory and Practice
Volume /

Reconstructing Health Knowledge
Volume /

crossref.org - The citation linking backbone



Website by Arrowsmith Websites Sunshine Coast. Business & Government Websites, Social Media, Web Hosting, Domain Names & SEO. Website Design Sunshine Coast, Australia.