Chapter 20. Sociology of medical profession
20.1. Methodological aspects of medical profession
The state and the coming changes in the professional structure of society as well as people’s attitudes to different skills and trades manifested in appraisals and social behavior constitute the subject matter of sociology of professions, which is closely related to sociology of labor in the study of common boundary problems such as occupational adaptation and the attitude of the employees to professional work, professional skills, and economics and organization of the enterprise where they work (G.V. Osipov, 1998).
Sociology of professions had been formed in the 20th century as an individual branch of the sociological knowledge with its specific subject field. It developed in close relations with such scientific branches as sociology of labor, industrial sociology, and sociology of education as well as general sociological theories of social structure, social stratification, and social mobility (Thompson J., Priestley J., 1998; Kryshtanovskaya O.V., 1991). The road to sociology of professions had been paved by such founding figures in the field of sociology as Herbert Spencer, Karl Marx, Émile Durkheim, Max Weber, Werner Sombart, and Pitirim Sorokin. Sociology of professions was also examined in the works of Georg Simmel, Talcott Parsons, Pierre Bourdieu, et al.
The term ‘profession’ originated from Latin professio meaning ‘declare my occupation’. According to Collins Dictionary of Sociology (2005), professions are presented by the individual groups of middle class, characterized with occupation, practice, or vocation requiring mastery of technical skills, intellectual knowledge, and experience as well as with relations to the state service and certain independence in the matter of employment and labor discipline. The ‘traditional’ learned professions are exemplified by law, medicine, theology, and military forces.
Generally, the social institution of medicine can be analyzed by the set of skills, which characterize the profession. Along with law, technology, and education, medicine serves to entire society and help people to attain their social goals. In this context, the medical system is a typical social contract aimed to cope with diseases.
Similar to science of law, medicine became one of the first occupations that had been termed as ‘profession’. It is a common knowledge that the first professions had been advanced not by technological, but social differentiation of labor caused by isolation and individualization of mental work (physicians, priests, lawyers, artists, sculptor, etc.), followed by similar functional isolation of control and organization (officials and supervisors), and finally by isolation of defense function against internal and external enemies (mercenary army, military leaders, jailers, and police officers). These professions were not directly associated with production, but they provided the common conditions for performance of society.
According to Karl Marx, profession is a form of activity. He assumed that differentiation of labor started with isolation of professions. In the system of labor differentiation, K. Marx distinguished profession and specialty as individual and unitary levels. Profession and specialty are historical concepts, which were delineated and specified with the progress and complication of public work. However, the boundaries between profession and specialty are rather variable (Model I.M. and Model B.S., 1997). The basic parameters of specialty are the social ones: social importance of profession, demand for specialty, types and forms of official contacts, and the prospects of professional and career advancement. The modern world distinguishes five types of professions on the methodological basis of interaction between a human being (subject of work) and the objects of labor:
1. Human — living nature;
2. Human — hardware (non-living nature);
3. Human — symbolic system;
4. Human — artistic image;
5. Human — human. In this type of interaction, the objects of interest, recognition, service, and transformation are the social systems, communities, population groups, and the various age groups. These subdivisions are presented by the managers, sociologists, physicians, teachers, etc.
In profession type with ‘human-human’ interaction, further subdivisions can be made according to the aim criterion:
1) Gnosiological (cognitive and recognizing) professions such as sociologists and medicolegal examiner;
2) Transforming professions exemplified by teachers and physicians;
3) Surveyor profession of educationalist and production manager.
P. Sorokin (1993) defined profession as ‘usual continuing occupation of a person which provides the means of livelihood’. In the framework of social stratification theory, P. Sorokin distinguished (1992) ‘lower’ and ‘higher’ professions. By its social importance, medical profession occupies one of the top places in the hierarchy of professional groups being generally considered as the ‘higher’ profession. The work of medical personnel cannot be reduced to material and industrial labor, because the physicians do not produce the material welfare and goods. However, the medical workers create the prerequisite conditions for the growth of national wealth. The work of physicians affects the development of material production. It is socially necessary and useful labor aimed to maintain and improve public health.
The foundations of the modern theory of not only social, but also professional stratification had been laid by P. Sorokin in 1920s. Two conditions are essential for inter-professional stratification16: