The position of the Soviet physician: the bureaucratic professional

The social position of the Soviet physician is a paradoxical combination of corporate powerlessness and bureaucratic power. As employees of the state, physicians are subject to its discipline and directives; they lack the control over their own work that is essential to a profession. In contrast to Western physicians, however, individual clinicians exercise enormous power over patients and subordinates by virtue of their position in the bureaucracy. The Soviet case suggests that as medical care in the West becomes increasingly bureaucratized and the profession loses autonomy, individual physicians may gain rather than lose authority in clinical decision making.