Healthcare’s huge body of knowledge is a major source of the industry’s power. Medical professionals have the power to start life, sustain life, ease pain, or even prevent death. Such great power comes with great responsibilities (Raimi dir. 2002): longer study, longer working hours, continuous professional updates (Khayat 2001), more demanding professional ethics and greater demand on professionalism. Perhaps, due to this great power, at least in the case of doctors, they are perceived as arrogant by some patients.
What the outsider-looking-in can also usually see are just the perks associated with the profession mainly due to higher compensation. The medical professional stereotype has a beautiful and spacious flat, fancy cars, designer clothes, Rolex watches, etc. These economic objects become status symbols that generally represent the profession’s great power in society. A different view likewise point to this highly privileged economic status as the source of the medical professional’s arrogance (Johnson 2005) rather than as a result of compensating the medical professional’s power over life and death.
Again, this is another classic which-comes-first-the-chicken-or-the-egg phenomenon. However, what non-medical professionals cannot directly see are the countless hours of study, practise and deep concentration that medical professionals need to keep mistakes at zero level. Without a patient’s consent, a minor mistake is often not acceptable (Grubb ed 2004). Professional licenses can be revoked. Medical professionals can be sued for malpractise. They can go bankrupt.
They can even cause several deaths that can lead to professional ruin or personal humiliation. Obviously, the medical profession of today has one of the greatest risks and responsibilities among all other professions. We will assert that this intense mix of great power and great responsibilities affects healthcare policy and management. Moreover, this very same premise can be related to the decline or achievement of new heights in the medical profession’s great power.
Aside from presenting evidence on the decline of the medical profession’s power, we will also attempt to answer the question: Can the medical profession’s power decline in this time when medicine’s great body of knowledge continues to expand with continuous medical research, constantly evolving diseases (Murray & Lopez 1996) and exponential growth in the creation of new drugs? Baselines on Power Nearly 16% of the overall US economy can be attributed to the Healthcare System. It is also responsible for nearly 25% of its annual growth. It triggers a considerable amount of technology and pharmaceutical development.
The US spends nearly $2 Trillion on health care averaging around $6,700 per person (Phillips 2005). Hence, in terms of economics, the medical profession wields such great power and influence in American society. The people that depend on this industry could expect stronger representation in the political system. And this is without regard if they actively participate in policy-making or not. US politicians have sufficient motivation to satisfy a great number of voters generating such considerable amount of wealth. But, can a huge amount of knowledge really generate that much amount of wealth?
Yes, it can. US economist Douglas A. Ruby (2002) states that: “Economic growth is …the sum of the rate of growth in technology in addition to a weighted average of the rate of population growth and the rate in which capital accumulates. ” He further explains that all other things constant, a 1% population growth results to a less than 1% growth in output, representing a fall in the standard of living. Ruby therefore concludes that in order to maintain or improve living standards, capital must be accumulated or technology should progress (Ruby 2002).
This effectively indicates that a developed country like the United States has a higher standard of living, and therefore wealth, compared to most countries. This is precisely because of the United States’ well-managed population growth, strong capital formation and rapid technological advances. Of course, progress in technology equates to an expanding body of knowledge. Here now is evidence on how much power does the medical profession have in terms of wealth in the US economy.
This also proves that the medical profession does not only have the power over life or death but more importantly, it has the power of wealth due to its constantly expanding huge body of knowledge. On the contrary, in poorer countries where people cannot afford healthcare, death becomes cheap. Naturally, the demand for the medical profession as we know it is low. This is unless sufficient world attention has been gained to help out in terms of medical missions and the funneling of international funds for healthcare in the depressed area.
In this case, demand would rise due to free healthcare. But consider this: a poorly educated native might still consider fire dancing as a medical profession and a fee in kind, maybe a sacrificial goat or a flavourful bean, could be the basis of the local economy. In this context, lack of knowledge, a primitive economy or crude technology does not in any way diminish the medical profession’s prestige and power. The medical professional, fire dancer or not, still has the power over life or death.
Thus, could any decline in the overall economy, not only in terms of growth rates, but also in terms of declines in actual spending as in the case of the Great US Depression mean a corresponding decline in the medical profession’s power? Could declines in standards of living mean a corresponding decline in the power of the medical profession? When all other industries have also declined, the medical profession’s power could still remain the same except of course for the power to purchase more and certain kinds of economic objects.
In the same light, we also note that the medical professional in the US is more powerful compared its counterparts in other countries like France which only spends 10% of its GDP (Khayat 2001) on healthcare. Compare the sample scenario with a theoretical decline in the contribution of the Healthcare Industry from nearly 16% down to 10% in the US economy. Likewise, let us assume a negative growth rate of 20% instead of a real world positive growth rate of 25% annually. Let us further assume that only the US Healthcare Industry experienced such a decline while other US industries are having robust growth.
At this context, we then put forward this question: Could there be a decline in the power of the medical profession when medical professionals still have the power over life or death? Naturally, when we equate power with influence, a decrease in social influence can be considered a decline in power. Power and Influence Power and process determine the contents of a nation’s healthcare policy. The distribution of power in a society directly impacts healthcare policy content at any given time and ultimately, its management.
Meanwhile, political systems and the active participation of people in the making of such policy play major roles in the process component (Walt 1994). An extreme example would be the incident at the Bristol Royal Infirmary Hospital here in the UK. The children’s heart surgery unit had a high death rate in the 1980s and 1990s. This prompted an inquiry resulting to a 12,000-page report with 198 recommendations. Compared with 12 other major specialist centers, Bristol was at the bottom of the league. Between 1991 and 1995, Bristol’s death rate for open-heart surgery on 181 babies less than one year old was 43 or around 23. 75%.
The average for other units was at around 13. 26%. This meant that Bristol had 19 more deaths compared to the average. In the mid-1980s, statistics indicate a 25% death rate. This fell to around 12% in the mid-1990s due to improvements in diagnosis, bypass technology, post-operative intensive care and some advances in surgical techniques. Hence, the Bristol Inquiry notes in Chapter 20, paragraph 22: “We note a failure to progress, rather than necessarily a deterioration in standards” (Fitzpatrick 2001). In this case, the power of the medical profession for self-regulation (Huber 2002) in the UK has been threatened by the Bristol incident.
This is mainly due to the loss of prestige by the Bristol surgeons placed in the hot seat and on the other hand a gain in influence by the Bristol Inquiry Chairman, UK General Medical Council, the UK Minister of Health, the British media and patients to clamor for a new mode of medical practise and regulation. The Bristol incident has also effectively rippled into the emergence of new institutions like the Constructive Dialogue for Clinical Accountability and the National Committee relating to Organ Retention as part of the new framework of regulation of the medical profession (Fitzpatrick 2001).
Here then is evidence on the breakdown of power and influence that were later on redistributed in other forms. Another area worthy of notice is the stigma of being stuck with old knowledge and/or performance. The Bristol incident clearly shows that a mid-1980s performance no longer has room in a profession operating at a mid-1990s performance level. In this case, failure to progress due to the retention of the status quo resulted in the loss of prestige and influence of a group of medical professionals.
Unfortunately, this loss of prestige and influence has not been limited to the Bristol surgeons but has had also a profound rippling effect on the entire British medical profession. We present another example, this time on the growing influence of the pharmaceutical industry on medical professionals. European and North American leaders of the medical profession demand a critical re-evaluation of their relations (“dances with the porcupine”) with the pharmaceutical industry (Wager 2003).
Its growth in size, power and influence alarms doctors to confront certain issues that may eventually affect the medical profession’s power and influence with the general public (Breen 2004). Alarmed with the apparent lack of action of Australian medical profession leaders compared with their North American and European counterparts, Australian gastroenterologist, Kelly J. Breen (2004), lists evidence on the prescribing habits of doctors. This is to gain support in the medical profession to change or improve Australian medical profession policy towards pharmaceutical industry interactions. The list strongly suggests the following: . Most doctors deny that gifts from the industry influence their prescribing (Watkins, Moore, Harvey, et al 2003). 2. The number of gifts received correlates with the belief that seeing representatives does not influence prescribing (Watkins, Moore, Harvey, et al 2003). 3. 80%–95% of doctors see industry representatives regularly (Moynihan 2003). 4. More frequent contact is linked to unnecessary prescribing and to increased use of new drugs (Watkins, Moore, Harvey, et al 2003), (Jureidini & Mansfield 2001). 5. Attendance at sponsored conferences is associated with increased prescribing of the sponsor’s product.
This increase can be seen for the next 6 months (Watkins, Moore, Harvey, et al 2003). 6. It is estimated that the pharmaceutical industry spends about $21 000 per year per practising doctor on drug promotion (Moynihan, Heath & Henry 2002). Here is evidence of the medical profession’s exercise of its great power from a perceived threat: curbing the rising power and influence of the pharmaceutical industry. Certain medical professionals have made actions to gain strong footholds and naturally influence with the general public to counter the growing power of the pharmaceutical industry (Mercola 2004).
Should the medical profession succeed worldwide in curtailing the power and influence of the pharmaceutical industry through a professional tool called `influence,’ then we can safely say that the power of the medical profession has risen in this aspect. Otherwise, it would have declined. Cycles and Changes A sharp decline in medical school applications in the US started in 1996. This continued until 2003 where it finally recovered, gaining a 3. 4% increase over 2002’s medical school applications. According to Robert Jones, Ph. D. AAMC’s associate vice president for faculty and institutional studies, this gain can be attributed to two factors: One, a lagging economy, and two, an increase in the number of college-age students. Jones explains that a lagging economy often prompts a larger number of persons to return to school. Moreover, 2003 also marks the first time that, since the Association of American Medical Colleges (AAMC) began to keep gender records, women consisted the majority of applicants at 51% (Howell 2003). In terms of gender, this trend in the US is likewise being felt in UK’s medical profession.
Professor Carol Black, President of the Royal College of Physicians, echoed an alarm over the rising number of female doctors in British medicine (Christian Medical Fellowship 2004), (Phillips 2004). Women now comprise more than 60% of new doctors and are expected to outnumber men in the medical profession in less than 10 years (Phillips 2004). Black feels that with a greater number of women in the medical profession, the profession will lose its influence. This is because women often sacrifice career moves in favor of family concerns, Black elaborates.
Unlike men who can work long hours and thus accumulate more experience necessary for promotion, Black says that working mothers work fewer hours. She explains that working mothers shy away from more time-consuming specialties like heart surgery, sitting in government committees, doing research, or influencing the Department of Health (Phillips 2004). She further asserts that, in the case of Russia, gender affects pay scales, influence with the government, competency, skills, and professional ethics. With these concerns, Black hopes to correct the gender imbalance in British medicine and pushes for more child support and flexibility of work.
This is to allow women to rise up in the ranks of the medical profession (Christian Medical Fellowship 2004). Presented here are two examples that show the interplay of cycles and changes. One aspect presented the end of a six-year decline in medical school applications and another, a rise in the number of women doctors. While no substantiated explanations can be offered for the decline in medical school applications or the alarming increase of women doctors both in the US and UK, it is worth noting that a complete cycle in medical school applications have occurred in the US.
After a steady decline, a rise was finally experienced. Again, this is evidence that the power of the medical profession has indeed declined for six continuous years. Likewise, it is noteworthy to examine the motivations of an influential leader like Black. She leverages on the purported loss of influence of the profession due to the higher number of women in medicine. Black is essentially advocating for a significant change in British healthcare policy and management in relation to working mothers.
She wanted more perks for working mothers without necessarily working longer hours than their male counterparts in the medical profession. If Black succeeds, she would have gained more power and influence for working mothers in the medical profession at the expense of their male counterparts who would naturally make up for the gap in lesser working hours. In this example, while the power and influence of women doctors are gaining ground, the male medical professional’s power is seeing a marked, consistent decline. Conclusion How could one measure an abstract concept like power?
Where do we start a baseline to measure its rise or fall? Could we be more accurate in the area of wealth generation where statistical data can be quantified? Or could it be in the area of knowledge where its rapid explosion can be fairly validated in the Internet? Is there really truth to the statement: the more knowledge we have, the more power we gain? In the area of healthcare policy and management, determining the average from which to tie certain baselines can have its drawbacks. In the case of the Bristol Inquiry, the top performers and median performers placed an unnecessary pressure on the bottom performer.
Bristol has to keep up when the data from which its performance is to be based is only available after a certain period of credible substantiation (Fitzpatrick 2001). This could ultimately lead to a culture of witch-hunting. This is one culture that puts additional pressure on everyone to beat last year’s performance at the risk of failing to keep up with the average. Unfortunately, the average in this case constantly improves. Thus, in this specific regard, the more knowledge the medical profession gains, the lesser power it has to make a stress-free living.
Would it be safe then to have a list of the medical profession’s various perks and that any subtractions in or future omissions of such perks can be equated to a loss of power? Arguably, in this respect, there is evidence showing that the power of the medical profession is in decline. However, it is also worth noting that some aspects of its power have achieved greater heights. For one, it has become more efficient. Two, greater demand for healthcare have also increased with the corresponding increase in population and wealth in developed countries.
And three, it has become more advanced specially in the areas of biotechnology and biomedicine. Life can now be duplicated and certain parts of it regenerated. Really, what greater power can be had more than the power over life or death? Therefore, we should be strongly aware that the world and humans follow a cycle of rises and falls. The same thing can also be said true of the medical profession. What is most certain is that with rapid population growth and dwindling world resources, the medical profession’s power continues to rise like the stock market does.
If there’s a Dow Jones Industrial Average or S&P 500 that tracks the bear and bull runs on the power of the medical profession, the trend would indicate a continuous rise as several cycles of ups and downs are completed. Economists call this phenomenon simply: the law of supply and demand. In the medical profession, we can call it the process of technological and economic change. Thus, we therefore conclude that in any system, healthcare or otherwise, when the old has to be replaced by the new, a marked decline in certain aspects of the system can be noted. Of course, this decline is immediately followed by a rise in another aspect.