De-Professionalization of Medicine Leonardi A. Goenawan Interactive Lecture

A Profession under threat De-professionalization is characterized by the transformation of physicians into persons of self-interest, unionized employees, entrepreneurs and business managers A loss of the dedication to service, competence, caring and altruism that has characterized physicians from the beginning An erosion of trust by society

Social Consequences Physician Employees/Subcontractors Conflicts of Interest Decline in Access to Care Decline in Quality of Care Loss of Physician Autonomy Erosion of the profession of Medicine Dispirited Physicians

6 Elements Unionization of the Medical Profession Bureaucratization and Politics Commoditization and Commercialization Failures of Self-regulation (autonomy) Choices of Life-style Modern Medical Education

1. Unionization Market-driven policies that compromise the quality of care and negatively affect physicians' autonomy and personal satisfaction Collective bargaining Adversarial relationships and negotiations Contrasts and deliverables Withdrawal of service

2. Bureaucratization Licensing Insurance plans Approval of care Allocation of resources Acceptance of increased commercial and managerial responsibility

3. Commoditization & Commercialization Volume of services becomes the driving force Medicine as “business” Advertising

4. Failures of Self-regulation Competence and quality Error Ethics Distribution and service Social responsibility

5. Choices of Life-style The “soft” discipline Distribution Gender

6. Modern Medical Education Lack of curriculum The “Hidden” curriculum Lack of assessment

Discussion Questions Will fewer Indonesian students be attracted to medicine as a career? Will quality of medical students be lower? Will most physicians work as employees for private care corporations on a salary basis? Will routine procedures that physicians perform be taken over by nurse practitioners and allied health care workers?

Discussion Questions How will these changes effect doctor-patient relations? Will there be increased competition for patients by health care organizations and groups of physicians? Will increased corporate control and consolidation of health care reduce the autonomy and influence of community boards and local groups of physicians?

Thank You