Understanding professional stratification and hybridisation in the medical profession: exploratory evidence from Brazilian federal university hospitals

Abstract

This paper explores drivers, implications, and trends of professional stratification and hybridisation in the medical profession employed in Brazilian substituir por: federal university hospitals (HUFs). Drawing on exploratory findings, we examine some repercussions of the migration of university hospitals to EBSERH, a public company established by the federal government to manage and organise HUFs integrated into the Unified Health System (SUS). Our research shows that transferring hospital administration to EBSERH has led to further internal stratification of the medical workforce. The shift from the logic of medical-academic professionalism to the new logic of business-like healthcare, with the adoption of distinct job contracts and more managerial logics of work and control, may well be changing subjective and formal links established between professionals, universities, and hospitals. We identify and discuss trends towards hybridisation and dehybridisation. These findings are relevant because this shift can have profound implications for the academic nature of HUFs and for the future of professionalism within these health and teaching organisations.

Residências em saúde em hospital universitário: cenário potente de formação para a prática colaborativa interprofissional

“…Caracterizado pela centralização da categoria médica na tomada de decisões do cuidado, e direcionado pelo foco na doença, o modelo biomédico reduz a concepção do cuidado na perspectiva diagnóstica e curativa 25 . Historicamente, a estrutura que coloca os médicos em uma posição dominante no ambiente hospitalar interfere no estabelecimento de relações mais horizontais entre os profissionais de saúde 26 e contribui negativamente para a participação de outras áreas profissionais igualmente necessárias para responder às necessidades dos usuários, família e comunidade. Considerando que as relações entre os profissionais de saúde refletem a estrutura onde estão inseridos 26 , as características do contexto de pesquisa repercutiram nas relações entre os sujeitos envolvidos na PCI no HU.…”

Health residency programs in a university hospital: a potent training setting for interprofessional collaborative practice

“…One of the barriers highlighted by the interviewees was the predominance of the biomedical care model, characterized by centralized decision making in favor of doctors and cure-oriented and disease-centered care 25 . An organizational structure that favors medical dominance hampers the establishment of horizontal relationships between health professionals 26 and adversely affects the participation of other types of professionals who are equally necessary to respond to the needs of patients, their families and the community. Considering that relationships between health professionals are a reflection of organizational structure 26 , the characteristics of the study setting had an impact on the relationships between the subjects involved in ICP.…”

Residencias sanitarias en un hospital universitario: un potente escenario de formación para la práctica colaborativa interprofesional

“…Caracterizado por la centralización de la categoría médica en la toma de decisiones del cuidado, y dirigido por el enfoque en la enfermedad, el modelo biomédico reduce la concepción del cuidado en la perspectiva diagnóstica y curativa 25 . Históricamente, la estructura que ubica a los médicos en una posición dominante en el ámbito hospitalario interfiere en el establecimiento de relaciones más horizontales entre los profesionales de la salud 26 y contribuye negativamente para la participación de otras áreas profesionales igualmente necesarias para dar respuesta a las necesidades de los usuarios, la familia y la comunidad. Se considera que las relaciones entre los profesionales de la salud reflejan la estructura en la que están insertos 26 , las características del contexto de investigación repercutieron en las relaciones entre los sujetos involucrados en la PCI en el HU.…”