Proletarianization or Restratification of the Medical Profession? The Case of Obstetrics

Abstract

Professional dominance, autonomy, and control have been consistently emphasized in theories of the medical profession. Recently, however, the professional hegemony that physicians have enjoyed is increasingly being questioned in the light of profound changes that are taking place in the organization of health care in the United States. Debates about the implications of the power of medicine and the means by which it is maintained are being replaced by attempts to understand professional decline. Proletarianization (McKinlay and colleagues) and restratification theory (Freidson) are two prominent and competing predictions for the future of the medical profession. Taking obstetrics as a critical case, this article considers the relative ability of these theories to elucidate the changing organization of maternity care in one state and presents a case study of patient care in one hospital. It suggests a disjuncture between obstetricians' inability to protect their interests as a corporate body and their relative ability to control the organization of everyday medical work. It is concluded that more theoretical clarity is needed on professional behaviors at the macro and micro levels.