Medical dominance in Britain: image and historical reality.

Both proponents and critics of the professional dominance explanation for changes in the social position of physicians base their arguments on the effects of social and economic events occurring over a few decades. Although this time period may be adequate for assessing changes in the position of physicians in the United States, judgments about the relative dominance of the British medical profession must be based on the history of its development over the entire century. Analysis of this history shows that, over the long term, state patronage and intervention have both extended and curtailed medical dominance in the British health care system. Medical dominance is not necessarily inversely related to state intervention; under certain circumstances a more rationalized and bureaucratic health care system may actually promote an expansion of medical hegemony.