ABSTRACT
The institutional and technical character of medical work has become so complex that it threatens to make physicians an appendage to rather than master of their technology. This chapter presents an historical overview that shows how the profession’s long campaign for autonomy and dominance contributed, ironically, to a reversal in its fortunes. A provocative effort to understand the institutional changes affecting physician’s centers on the debate between some Marxists, Weberians, and liberal intellectuals about the nature of professional work in advanced economies. Instituting health insurance along professional lines and defeating prior efforts to legislate national forms of social insurance completed “the professional project”. The profession’s emphasis on elaborated techniques and specialization led to more complex organizations of work and finance, with a given physician only part of a larger complex. In order to manage large hospitals and health centers, administrators became more professionally qualified and powerful.
