The American Journal of Bioethics 4.2 (2004) 28-31
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Toward the Operationalization of Professionalism:
Delese Wear and Mark G. Kuczewski's characterization (2004) of professionalism as a "movement" is both apt (the activities taking place within organized medicine to establish professionalism as a core medical value fit the sociological definition of a "social movement") and timely (given American medicine's current state of institutional evolution). Over the past 30-plus years a variety of social forces have buffeted organized medicine's status as a profession, including:
- an economy in the 1970s that held the country hostage to the scourge of "runaway inflation," including "skyrocketing healthcare costs";
- followed by, the longest running (1980s-1990s) bull market (stock) in U.S. history;
- the advent of research by Wennberg (1973, 1985) and colleagues demonstrating large variations in physician practice behaviors and that the practice of clinical medicine was governed more by local customs and mores than by scientific research and knowledge—something that would spawn, among other things;
- the quality-of-care, evidence-based medicine (EBM), and patient safety movements;
- the evolution of information technologies that would allow medicine to mine clinical and operational data; and
- the political defeat of the Clinton health plan initiative, which imploded squarely within the aforementioned bull market and therefore at a time when investors were looking to invest in what would become one of the hottest sectors (healthcare) of the so-called dot-com era.
All of these forces—and others—helped to create an overall sociopolitical and economic environment that would first challenge the professional prerogatives and privileges of organized medicine and then serve as a backdrop for organized medicine's announcement that "professionalism" would be its solution to the ever-enveloping shroud of medical commercialism and the commodification of healthcare.
The appearance of "big business" and "corporate medicine" at the city gates of organized medicine was greeted by the inhabitants with a mixture of distain and fear. First-tier medical journals such as JAMA, The New England Journal of Medicine, and the Annals of Internal Medicine published a barrage of articles and commentaries about what one authoring team labeled "[an] epic class of cultures between commercial and professional traditions in the United States" (McArthur and Moore 1997). Battle lines were drawn and sides labeled. Within this milieu of physician disillusionment and organizational consternation, a variety of groups within organized medicine (see below) began to identify "professionalism" as the horse that would carry medicine out of its valley of death by commodification. What is key—as Wear and Kuczewski note—is that the various activities and actions pursued by organized medicine constitute a new social movement and that the eventual paths that this movement will take in the future have defining implications for both healthcare in general and organized medicine in particular.
As organized medicine's newly-found fascination with professionalism began to unfold in the 1980s, two broad orientations toward professionalism appeared. The first was a "prodigal son" form of argument where medicine had fallen from grace or lost its professional bearings and therefore needed to reconnect with, reestablish, or recommit to "core professional values." The second "call" to professionalism stressed more the sociopolitical and economic changes in society (and medicine) and argued for a "new professional ethic" (Irvine 1999; Mechanic 2000). Regardless of one's analytical proclivities, the "popularization of professionalism" within organized medicine revealed a rather embarrassing fact—at least for an occupational group that had long claimed the professionalism high ground. There was little consensus about how the term professionalism was to be defined (Swick 2000) and measured (Arnold 2002). This definitional and operational lacunae notwithstanding, a number of groups—including trade associations (e.g., American Medical Association, Association of American Medical Colleges), specialty societies (e.g., American Board of Internal Medicine or ABIM, American College of Surgeons), accrediting bodies (e.g., Liaison Committee on Medical Education, Accreditation Council for Graduate Medical Education), and organizations involved in occupational licensure (e.g., National Board of Medical Examiners)—began to organize...