The United States medical profession: an abnormal form of the division of labour

Abstract

During the last century, the US medical profession, once dominated by general practitioners, has been transformed into a body of highly specialised physicians. Sweeping technological advances have fueled this evolution in which broadly trained primary care physicians who provide relatively inexpensive comprehensive medical care have become a professional minority. This country's specialty-oriented system of medical education has produced far more specialised doctors than are required to meet the need for their services among the general population. As a result, medical specialists have invaded the province of primary care physicians. They now compete with generalists for patients who do not have conditions requiring sophisticated specialised medical procedures. Their intrusion into the field of primary care, for which they have not been trained, is bitterly resented by general physicians. This largely unregulated division of labour has been insensitive to patient need and has disrupted the collaboration between general and specialty physicians which previously served the public interest.

Extending the authority for sickness certification beyond the medical profession: the importance of ‘boundary work’

“…Science narrowly conceived is, however, not static. Increasing sub-specialisation in medicine is perhaps one manifestation of this [ 16 ]. In any event, such practices always have ‘discursive’ characteristics.…”