Professional dynamics and the changing nature of medical work.

The organization and delivery of health care in the United States is undergoing significant social, organizational, economic, political, and cultural changes with important implications for the future of medicine as a profession. This essay will draw upon some of these changes and briefly review major sociological writings on the nature of medicine's professional status to examine the nature of professional dynamics in a changing environment. To this end, we focus on the nature of medical work and how this work impacts on and is impacted by medicine's own internal differentiation and the presence of contested domains at medicine's periphery. We trace this dynamic through a number of issues including the multidimensional nature of medical work, the role of elites in that work, and how changes in the terms and conditions of work can exert changes at medicine's technical core. We close with some thoughts on the relationship of public policy to medicine's professional status, the role health policy might take in shaping a new professional status, the role health policy might take in shaping a new professional ethnic for medicine, and the role sociologists might play in this process.