DEPROFESSIONALIZATION OF MEDICINE James G. Anderson, Ph.D. Department of Sociology and Anthropology

Factors Affecting the profession of Medicine Private health insurance l945-l960 Medicare/Medicaid l965 HMO Act 1973 FTC antitrust ruling l979 Monetarization of health care Rise in for-profit medical enterprises Increased enrollment in managed care plans

Health Care Expenditures (in billions)

Health Care Expenditures (% of GDP)

Rationalization/Restructuring of Health Care Organizations Horizontal Integration Vertical Integration Cost Controls Economic Credentialing Gate Keepers Prior Approval of Services Practice profiles Incentives Substitution of Allied Health

Percentage of Doctors Employed by Age Group

Number of Persons Receiving Health Care from HMOs

Percentage of Employees Enrolled in Traditional and Managed Care Plans

Number of Physicians Who Belong to Unions

Commercial Medicine: Potential Hazards Diversion of Funds Pricing Risk Avoidance Increased Load on Public Providers Downgrading of Personnel Loss of Free Speech

Commercial Medicine: Potential Hazards Distortions of Clinical Care and Ethical Dilemmas Managed Care Commercial Insurance in the Nonprofit Sector Physicians as Entrepreneurs Neglect of Community Responsibility Monopoly

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

Discussion Questions Will fewer US 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 Are physicians likely to be subjected to more stringent cost containment efforts? Will doctors join unions? How will these changes effect doctor-patient relations? Will there be increased competition for patients by health care organizations and groups of physicians?

Discussion Questions How will these changes affect the ability of professional medical organizations to represent and lobby for physicians? Will increased corporate control and consolidation of health care reduce the autonomy and influence of community boards and local groups of physicians?