1. DEPROFESSIONALIZATION OF MEDICINE
James G. Anderson, Ph.D.
Department of Sociology and Anthropology

2. Factors Affecting the profession of Medicine
Private health insurance l945-l960
Medicare/Medicaid l965
HMO Act 1973
FTC antitrust ruling l979
Monetarization of health care
Rise in for-profit medical enterprises
Increased enrollment in managed care plans

3. Health Care Expenditures (in billions)

4. Health Care Expenditures (% of GDP)

5. Rationalization/Restructuring of Health Care Organizations
Horizontal Integration
Vertical Integration
Cost Controls
Economic Credentialing
Gate Keepers
Prior Approval of Services
Practice profiles
Incentives
Substitution of Allied Health

6. Percentage of Doctors Employed by Age Group

7. Number of Persons Receiving Health Care from HMOs

8. Percentage of Employees Enrolled in Traditional and Managed Care Plans

9. Number of Physicians Who Belong to Unions

10. Commercial Medicine: Potential Hazards
Diversion of Funds
Pricing
Risk Avoidance
Increased Load on Public Providers
Downgrading of Personnel
Loss of Free Speech

11. Commercial Medicine: Potential Hazards
Distortions of Clinical Care and Ethical Dilemmas
Managed Care
Commercial Insurance in the Nonprofit Sector
Physicians as Entrepreneurs
Neglect of Community Responsibility
Monopoly

12. Social Consequences Physician Employees/Subcontractors
Conflicts of Interest
Decline in Access to Care
Decline in Quality of Care
Loss of Physician Autonomy
Erosion of the profession of Medicine
Dispirited Physicians

13. Discussion Questions
Will fewer US students be attracted to medicine as a career?
Will quality of medical students be lower?
Will most physicians work as employees for private care corporations on a salary basis?
Will routine procedures that physicians perform be taken over by nurse practitioners and allied health care workers?

14. Discussion Questions
Are physicians likely to be subjected to more stringent cost containment efforts?
Will doctors join unions?
How will these changes effect doctor-patient relations?
Will there be increased competition for patients by health care organizations and groups of physicians?

15. Discussion Questions
How will these changes affect the ability of professional medical organizations to represent and lobby for physicians?
Will increased corporate control and consolidation of health care reduce the autonomy and influence of community boards and local groups of physicians?