1. De-Professionalization of Medicine
Leonardi A. Goenawan
Interactive Lecture

2. 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

3. 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

5. 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

6. 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

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

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

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

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

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

15. 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?

16. 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?

17. Thank You