Organization and Subjectivity in the US Medical Profession: Physician Responses to Structural Changes within Advanced Capitalism

The medical profession in the United States has had a long history of privilege and status. Throughout much of the 20th century, physicians possessed a distinctive advantage in relation to other occupational groups within the economy for their ability to sustain a monopolistic influence over healthcare practices and policy. Control over the technical core of medicine, the capacity to tightly regulate entry into the profession, and the achievement of autonomy in the production of medical services led to the recognition of medicine as the quintessential profession (e.g. Freidson, 1970, 1980, 1994). In recent years, however, the medical profession in the US has experienced a downward shift in its dominant position. The reasons for this change have been the subject of considerable debate and speculation (Anderson, 1992; Hafferty and Light, 1995; Scott et al., 2000; Schlesinger, 2002) as have the interpretive schema used to explain its current status (Haug, 1973, 1975; Derber, 1983; McKinlay and Arches, 1985; Light and Levine, 1988; Derber et al., 1990; Hafferty and Wolinksy, 1991; McKinlay and Marceau, 2002).