Two Cultures: Two Ships: The Rise of a Professionalism Movement Within Modern Medicine and Medical Sociology’s Disappearance from the Professionalism Debate

Hafferty, Frederic W.; Castellani, Brian

doi:10.1007/978-1-4419-7261-3_11

Cited by 12 publications

(4 citation statements)

References 123 publications

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“…Much recent research argues that individual emotive and cognitive states are central to predicting employee reactions to organizational change (Choi, 2011;Hodson, 1997;Hoff & McCaffrey, 1996;Jones et al, 2008;Oreg et al, 2011;Piderit, 2000). While accounting for these attributes is undoubtedly vital to painting a more complete portrait of worker responses to organizational change, our findings signal the enduring significance of professional affiliation for shaping how employees attempt to demonstrate their competence and reaffirm their clinical jurisdiction amid seismic organizational shifts (Abbott, 1988;Hafferty & Castellani, 2011). Given the interconnected nature of work in most workplace settings, it is essential to understand how institutional change is perceived and experienced by all members of an organization.…”

Section: Resultsmentioning

confidence: 69%

Occupational Heterogeneity in Healthcare Workers’ Misgivings about Organizational Change

VanHeuvelen

Grace

2020

Work and Occupations

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Past research on organizational change has explored how workers embrace change in some scenarios, resist it in others, and in some cases, subtly circumvent change efforts by feigning conformity. What remains unclear is the role of occupations in explaining workers’ responses to change. Using survey data ( N = 226) and in-depth interviews with workers ( N = 33) in a neonatal intensive care unit as it transitioned from a multiple-occupancy ward design to single-patient rooms, this study examines occupational discrepancies in reactions to the change. Findings reveal that misgivings about the move vary considerably across groups and illustrate the enduring significance of occupational identity.

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Section: Resultsmentioning

confidence: 69%

Occupational Heterogeneity in Healthcare Workers’ Misgivings about Organizational Change

VanHeuvelen

Grace

2020

Work and Occupations

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“…Professional dominance has long been an important and relevant topic in medical sociology. While professionalization theorists have largely fallen out of professional conversations in medicine (Hafferty & Castellani, 2011), the ongoing evolution of Advanced Practice Nurses provides new opportunities for understanding professional dominance. Here, we applied four classical theories of professional dominance to a contemporary development in the health‐care workforce, namely occupational differentiation and corresponding changes in APN autonomy.…”

Section: Discussionmentioning

confidence: 99%

“…In other states, however, policies are more lenient, granting APNs and other nursing specialties more independence. Extant research regarding physician dominance has largely overlooked state‐level variations, focusing instead on micro‐level interactions among health‐care professionals (Jenkins & Hernandez, 2020) or encounters between health‐care providers and patients (Hafferty & Castellani, 2011; Lian et al, 2021; Stivers & Timmermans, 2020). Gains in autonomy by once‐subordinate health care workers are very closely related to discussions of physician dominance over other health‐care workers, as increases in subordinate workers' functional autonomy may signal a decline of physician dominance (Freidson, 1970b).…”

Section: Introductionmentioning

confidence: 99%

Physician dominance in the 21st century: Examining the rise of non‐physician autonomy through prevailing theoretical lenses

Feyereisen

McConnell

Thomas

et al. 2021

Sociology Health & Illness

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Theories of physician dominance are a foundational contribution of medical sociology to the study of health care, but must be revisited in the light of ongoing changes in medicine. As non‐physician specialists like nurse practitioners grow in number and acquire more autonomy, increasing medical profession differentiation presents a challenge for traditional physician dominance theories. After evaluating potential theoretical explanations for subordinate occupations' autonomy gains, we conduct a state‐level quantitative analysis of variation in nursing policies across U.S. states. We construct our dependent variable, nursing autonomy, using seven state‐level advanced practice nursing policies adopted from 2001–2017. Using an ordered scale, we code nurse practitioner, nurse anaesthetist, nurse midwife and clinical‐nurse‐specialist practice and prescription polices according to each policy's autonomy level. We then use time‐series regression to examine theory‐driven propositions regarding nursing autonomy change. Nursing autonomy has increased over time, signalling a general erosion of physician dominance. However, we find differential patterns of policy adoption, indicating that erosion is not uniform. Physicians have maintained dominance in relatively prestigious specialties (e.g. anaesthesiology) while dominance declined in others (e.g. obstetrician). Factors external to the profession, such as consumer power, continue to influence within‐profession dynamics. Examining ongoing professional differentiation in medicine illustrates how physician dominance depends on shifting social and professional contexts.

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“…The development of medicine as a profession was key to these claims of cultural authority, which resulted in a significant increase in autonomy for medical practitioners (Abbott 1988;Freidson 1998;Butler et al 2012). The consequent development of professional medical organizations, which claimed jurisdiction over the education and credentialing of new physicians, meant that medical schools became important sites for the socialization of medical students into professional physicians, and this continues in the present (Good & Good 1993;Good 1994;Good 1995;Hafferty & Castellani 2011;Monrouxe et al 2011;Holmes et al 2011;MacLeod 2011;Craig et al 2018).…”

Section: Introductionmentioning

confidence: 99%

A Tale of Two Shitties

Robertson

2020

JEA

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Based on 12 months of ethnographic data collection in an anal cancer prevention clinic, this article uses the extreme examples of patients involuntarily defecating through the anoscope during the procedure to highlight the relationship between the extreme and the everyday. Despite the rarity of this occurrence, I argue that these extreme examples shed light on the ways the daily clinical routines are embodied as an expert habitus. High Resolution Anoscopy procedures are specialized, highly routinized practices that are performed hundreds of times per month at the clinic. These routines result in the development of a clinical habitus that guides physicians in deploying techniques to efficiently conduct the invasive examination. Exemplary examples of ordinary procedures certainly help explain how this expert habitus is enacted through routine clinical practices; however, this expertise becomes especially observable in moments when habituated practices are disrupted, forcing clinicians to react and respond in unscripted ways. I discuss the only two instances of patients defecating through the anoscope that occurred while conducting my research, each with a different clinician. These extreme examples provide rich opportunities to analyze how clinicians with similar procedural habits navigate extraordinary situations in expert and professional but idiosyncratic ways. Whereas exemplary examples of everyday routinized procedures can show the process of developing an expert clinical habitus, these extreme examples more clearly demonstrate how this habitus enacts expertise and professionalism by highlighting the clinicians’ abilities to deftly navigate the technical and sociocultural aspects of such extraordinary disruptions.

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Two Cultures: Two Ships: The Rise of a Professionalism Movement Within Modern Medicine and Medical Sociology’s Disappearance from the Professionalism Debate

Cited by 12 publications

References 123 publications

Occupational Heterogeneity in Healthcare Workers’ Misgivings about Organizational Change

Occupational Heterogeneity in Healthcare Workers’ Misgivings about Organizational Change

Physician dominance in the 21st century: Examining the rise of non‐physician autonomy through prevailing theoretical lenses

A Tale of Two Shitties

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