Physicians as a Professional Group: Production and Maintaining of Medical Professionalism

Abstract

The status of the medical profession as a ‘moral profession’ is one reason to single it out as a special calling with its own professional codes and values. The question of how its core values are passed from older, experienced doctors to younger people entering the professional body is at the heart of this study. This can be referred to as ‘social control’; a mechanism for the self-regulation of the professionalization of doctors. Often, research has shown this practise to be extremely diverse due to the great deal of autonomy given to doctors in carrying out their work duties. This article seeks to analyse physicians’ attitudes in Russia toward current practices used for the "fine tuning” of young physicians and their colleagues to the required professional level. The central aim is to determine whether the social control in the medical profession in Russia tends to be more horizontal or vertical in nature and how correction of practices in young doctors is achieved. It is based on in-depth interviews with 57 doctors from three regions (Moscow, Vologda and Kaluga regions) in the Russian Federation. Questions are raised as to whether the practice of tutorship or the model of competition is preferred in the passing on of values. What emerges is a great deal of diversity in the practice of the reproduction of the medical profession. In Russia, adherence to older, Soviet methods is a key, differentiation factor among doctors. Across the country we see the subculture of each medical institution strongly influencing this reproduction process, in effect these are hidden norms that drive standards and values. The study shows that vertical control mechanisms exist alongside horizontal control mechanisms in the reproduction of the physician community. For some doctors horizontal control is more preferable than the vertical one. In this choice, the deciding role is often played by the personal morality of the senior doctor in question.