Doctors and Professional Dominance

By the 1920s, doctors had become the premiere example of a profession. Although definitions of a profession vary, sociologists generally define an occupation as a profession when it has three characteristics:

1. The autonomy to set its own educational and licensing standards and to police its members for incompetence or malfeasance;

2. Technical, specialized knowledge that is unique to the occupation and learned through extended, systematic training; and

3. Public confidence that its members follow a code of ethics and are motivated more by a desire to serve than a desire to earn a profit.

During the first half of the 20th century, doctors clearly met this definition of a profession. Most doctors worked in private prac- tice (whether solo or group) and set their own hours, fees, and other conditions of work. Those who worked in hospitals or clinics were typically supervised by other doctors, not by nonmedical administrators. And even in these settings, only doctors had the authority to review other doctors’ clinical decisions, and this authority was rarely exercised. Similarly, only doctors served on boards that evaluated medi- cal schools and granted or revoked medical licenses. Finally, the public placed great trust in doctors, believed most doctors worked selflessly to serve their patients, and routinely ranked medicine as the most prestigious occupation. These expectations were confirmed by doctors’ adoption of a professional code of ethics. “Ethical Debate: A Duty to Provide Care?”

As this suggests, as the leading profession in the health care world, doctors enjoyed—and to some extent still enjoy—an unusually high level of professional dominance: freedom from control by other occupations or groups and the ability to control any other occupations working in the same economic sphere. Although doctors often supervised, taught, or set licensing standards for members of other health occupations, those other occu- pations rarely had any say over doctors’ work.