Sources of countervailing power in medicine

In recent years a substantial literature has emerged on the alleged deprofessionalization and proletarianization of physicians. The contention is that corporatization is transforming the practice of medicine, divesting physicians of control over many features of their work, consistent with the needs of advanced capitalism. I examine the hypothesis skeptically, differentiating between the cultural role of medicine, the political and social legitimacy of medical concepts, and the personal autonomy of the individual physician. I suggest that while physicians are less autonomous than they used to be, the constraints imposed on them fall within a medical paradigm. From a cultural or social perspective, medicine is more central to the economy and more powerful than ever before. As its centrality and importance increase, there is more at stake, and interests compete more aggressively. I conclude that there is little evidence in support of the hypothesis.