Organizational Powers: Capture of Professional Jurisdiction in the Case of U.S. Retail Clinics

Galperin, Roman V.

doi:10.2139/ssrn.1873545

Cited by 1 publication

(1 citation statement)

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“…Professions theory focuses on how important it is for professionals to construct task boundaries between themselves and competing practitioners (Freidson 1970; Starr 1982); because professional jurisdiction is the means of continued livelihood, professionals fiercely guard their core task domains (Abbott 1988). Environmental changes, like new laws, can disturb the system of professions by opening new task areas that spark jurisdictional battles between existing professions (David, Sine, and Haveman 2013; Dobbin and Kelly 2007; Edelman 1992; Fligstein 1990; Galperin 2014; Hafferty and Light 1995; Zetka 2003). Such jurisdictional battles can negatively affect those who are served by professionals (Heimer 1999; Kellogg 2011, 2012; Timmermans 2005).…”

Section: Current Understanding Of Reform Implementation Involving Promentioning

confidence: 99%

Brokerage Professions and Implementing Reform in an Age of Experts

Kellogg¹

2014

Am Sociol Rev

161

129

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In this comparative ethnographic case study of the implementation of a reform related to the Affordable Care Act in two community health centers, I find that professionals may not compete to claim new tasks (and thereby not implement reform) if these tasks require them to acquire information unrelated to their professional expertise, use work practices that conflict with their professional identity, or do impure or low-value tasks that threaten their professional interests. In such cases, reform may be implemented if lower-status workers fill in the gaps in the division of labor between the professions targeted by the reform, playing a brokerage role by protecting each profession's information, meanings, and tasks in everyday work. When the new tasks represent professionally ill-defined problems, brokers can be more effective if they use buffering practices rather than connecting practices-managing information rather than transferring it, matching meanings rather than translating them, and maintaining interests rather than transforming them-to accomplish reform. By playing a buffering role in the interstices between existing professional jurisdictions, lower-status workers can carve out their own jurisdiction, becoming a brokerage profession between existing professions that need to collaborate with one another for reform to occur. Public health activists argue that because low-income people's health problems often occur long before they get to their doctor, for the Affordable Care Act to be successful, patients need access to primary care physicians and to enabling programs that address the social determinants of health. Activists across the country have received funding for these programs (American Public Health Association [APHA] 2010). KeywordsMLP reform is an enabling program designed to improve the health outcomes of traditionally disadvantaged groups by changing the everyday practices of health center doctors and legal aid lawyers.Health center doctors typically treat low-income patients' medical problems; with the implementation of 3 MLP reform, they also address the social and legal problems that affect patients' health (e.g., if a patient's apartment lacks heat, it will be difficult for the patient to recover from an ear infection). Lawyers, in working with low-income clients, often use individual cases to bring legal reform for large numbers of the poor; with the implementation of MLP reform, they gain new access and treatment points for vulnerable clients by expanding legal screening, and they increase their ability to solve legal problems related to health for large numbers of the poor by getting doctors to assist with reform efforts.To implement MLP reform, both doctors and lawyers need to change how they screen clients, determine their eligibility for treatment, and treat them. Doctors must learn from lawyers to screen patients for unmet social and economic needs in areas such as income, housing and utilities, education, immigration, and personal and family stability; they must also refer ...

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