Institutional Logics and Institutional Pluralism: The Contestation of Care and Science Logics in Medical Education, 1967–2005

Abstract

Although most studies underscore institutional change as replacement of one dominant logic for another and assume that professions are guided by a single logic, professions that operate in multiple institutional spheres often have plural logics. We focus on medical education, the supplier of medical professionals, which resides at the interstices between academia and healthcare. Using archival sources from 1910 to 2005, we identify two logics central to the profession that persisted over time: care and science. We found that jurisdictional competition with rivals such as public health, contestation among physicians, the rise of managed care, and increasing numbers of women entering medical schools are associated with increased attention to the care logic. Differentiation in the missions of medical schools is associated with reduced attention to the science logic. Our study reveals that plural logics of care and science in medical education are supported by distinct groups and interests, fluctuate over time, and create dynamic tensions about how to educate future professionals.