Year : 2016 | Volume
: 5 | Issue : 4 | Page : 745--746
Future of profession
Chief Editor, Journal of Family Medicine and Primary Care, President Academy of Family Physicians of India, Ghaziabad, Uttar Pradesh, India
Chief Editor, Journal of Family Medicine and Primary Care, President Academy of Family Physicians of India, 049, Crema Tower, Mahagun Mascot, Crossing Republik, Ghaziabad - 201 016, Uttar Pradesh
Being a doctor in today's time is a tough experience in many parts of the world. Many young people motivated by the traditional image of profession and desire for service opted for this vocation without anticipating today's challenging environment. Bad press, violence against doctors, tough employment conditions, unemployment, and lack of societal respect have become common phenomenon across the world. It is indeed time to introspect. The institution of medical profession is rapidly transforming not necessarily only under the influence of rapidly changing technology. The presented viewpoint is an analysis on impact of changing global political scenario on the future of medical profession.
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Kumar R. Future of profession.J Family Med Prim Care 2016;5:745-746
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Kumar R. Future of profession. J Family Med Prim Care [serial online] 2016 [cited 2018 Jan 16 ];5:745-746
Available from: http://www.jfmpc.com/text.asp?2016/5/4/745/201158
Doctors as God
During past two centuries, the role of modern medical doctor in society has not only been determined by the scientific and social changes but also been impacted by contemporary political changes. The Godly position - “next to God” or “God on the earth” position within society - was not achieved by doctors or physicians through trade unionism. Rather, the high social status was a bargain deal achieved through negotiations among political ideologies as a protection mechanism toward individuals and population as large. This meant that in the situations of illness, life, and death, only best and appropriate therapeutic intervention would be administered in the best interest of the individuals, and booking profit would not be a primary consideration of the service provider.
Political Evolution of Modern Physician: Legal, Ethical, and Moral Boundaries of Profession
During and after the industrial revolution, the class conflict defined the “role of a physician” within the society; as a noble citizen, educationalist, scientist, rationalist, and healer. Competency skill set were defined and embedded within the modern education system. The doctors were contracted by the society to practice the physician's trade after being awarded a legal license. Apart from the routine responsibilities of dealing with sickness and illness, the physicians were also designated to determine the workman's fitness, compensation, wages, working condition, living condition, and population health.
In plain words, the “role of physician” in society was therefore also a reconciliation position between the capitalist and the socialist schools of thoughts. Due to the support across political spectrum, the position of medical practitioner was elevated to that of “next to God.” Society expected “professionalism” from the physicians which meant he/she should pledge to work in public interest and in best interest of the persons being cared for. This was in contrast to other professionals who used to the pledge their loyalty in favor of King or God (e.g., military, judiciary, administration professionals). Therefore, the societal expectations from the doctors is to maintain high level of ethics; persons only next to God – noble and noncorruptible.
Professionalism – Social Contract between Medicine and Society: Changing Scenario
Doctors never became very rich by practicing their trade however, they were always assured of a decent income and living across all cultures, societies, and service delivery systems. In recent times, their compensation has varied among the political models of service delivery: (a) capitalist – American, private insurance based; (b) socialist – Former USSR (free service for public thereby employed by state); (c) mixed – UK/Canada through National Health System (NHS) (socialist arrangement within capitalist system). Although there is a defined “framework of professionalism,” ethical practice became the hallmark medical profession.
Challenges to Medicine Profession in the Present Times
With respect to the present political context of the world, especially after the cold war period, and with the weakening of socialist governments, world is becoming unipolar and a predominant capitalist globalized economy. Decreased investment in social sector is a global phenomenon. Last two decades have seen countries such as India open up their economies. A large number of developing as well as developed countries are moving toward further privatization of their health systems. India and the UK are best examples of this phenomenon. India which was already one of the most privatized health systems in the world is moving toward further privatization (Americanization). Irrespective of what people may believe and say, the NHS of the UK is moving down spiral toward complete privatization. Allowing profiteering in health sector is no longer a political taboo. Health sector is considered a booming industry. These are not random happenings but the events driven by the strong global political realities of today.
Industry, Physicians, and Underlying Political Process
The recent, current, and ongoing political changes are impacting the social standing, professional position, employment status, and ethical choices of physicians/doctors at large globally. The existing stringent legal framework of “professionalism for medical doctors” were enacted as a protection shield for individuals and population. The ethical choices of medical professionals, however, continue to be determined by political systems.
Although there is a popular perception about shortage of licensed medical doctors in many parts of the world, more and more doctors are being pushed out from the public health systems to seek employment in private sector across the globe. Healthcare industry is promoting a medical care model which is fragmenting human care into body parts faster than ever. Doctors employed at hospitals have turned into technocrats performing medical procedures; losing responsibility for the whole body/person. Their roles as autonomous professionals and regulators of care for “whole person” have largely eroded during past three decades.
Any political system of health service delivery which is governed by profiteering from illness and sickness is likely to corrupt their practitioners the most. As a group of professionals, doctors, if practicing ethical medicine, would become barrier toward the growth of healthcare industry or optimizing the economics of ill health. If doctors are corrupt, industry and political system are equal partner.
Future of Medical Profession
Industry partnering (employing and corrupting them) with physicians is an open secret. Although it may be an exaggeration, future medical doctors are likely to become “technicians” rather than respected physicians. Their roles shall be limited to performing procedures and providing part care, but without any professional autonomy and regulatory role in the health system. Poor depiction in the mainstream media will lead to further erosion in trust and respect for doctors. Medical doctors have been almost stripped off their godly image and position. Violence against doctors, which is more a reflection of frustration by people against health system, is likely to continue as a global phenomenon. Medical doctors will have to learn to work in more hostile and threatening environments. However, their compensation packages shall be replaced with harsher employment terms and conditions. In long term, their practice licenses may be diluted, rendering them dysfunctional. Finally, they may be replaced with an another set of professionals who are not governed by stringent licensing (legality with respect to competency and quality) or ethically bound by Hippocrates oath (moral compulsion to work in public interest). Although the trend is global, due to demographic dividend (potential for industry) and political system, countries such as India are most labile, susceptible, and complying. The institution of medical profession is under threat more than ever. The reason for the same is political more than anything else.
|1||The History of NHS Reform: Nuffield Trust. Available from: http://www.nhstimeline.nuffieldtrust.org.uk/. [Last accessed on 2017 Jan 21].|