This document discusses medical dominance in the Australian healthcare system. It begins by outlining the key learning objectives, which are to understand the concept of medical dominance and how it is achieved and maintained. It then provides context on the structure of the Australian healthcare system and how the medical profession attained power through amendments to the constitution and agreements around Medicare. The document defines medical dominance and strategies doctors use to maintain it, before examining challenges to dominance from deprofessionalization, corporatization, and McDonaldisation. It concludes that while medical autonomy is constrained in some areas, dominance remains strong overall due to being negotiated and constantly contested.

1. SOC108 – TOPIC 7
The Australian Health Care
System and Medical Dominance

2. Learning and teaching objectives
• Understand the notion of ‘medical
dominance’, including how it is achieved and
maintained in health care delivery, health
policy and practice.
• Identify and explain the major challenges to
medical dominance.
• Understand the implications of these
challenges for the professional autonomy of
medicine in Australia.
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3. The Australian Health Care System
• The Federal government plays a leadership role
as well as being the major source of health
funding.
• States and territories deliver and manage a range
of health services and are responsible for
regulation of health professionals.
• However, there is some overlapping of
Federal/State government responsibilities.
• A public/private division of responsibilities also
exists.
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4. The Australian Health System and
the Medical Profession
• The Australian health system is characterised by politics
and power relations.
• The most powerful group in the health system are the
medical profession (i.e., doctors).
• This power came about in Australia through two key
changes:
 An amendment to the Constitution in 1946 which granted
the medical profession freedom from civil conscription.
 In return for the medical profession’s support for Medicare
(which the AMA opposed), the Federal Labor government
in 1984 agreed to allow doctors to treat private patients in
public hospitals.
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5. Explaining the Medical Profession’s
Power: Medical Dominance
• A term used to describe the power of the medical
profession over “the content of medical work and
also clients, other health care professions, and
the context within which health care is given
(health care policy)” (Friedson, 1970 in Coburn
and Willis, 2000, p.380).
• Consists of:
– economic autonomy
– political autonomy
– clinical autonomy
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6. How do the Medical Profession
Maintain their Dominance?
• Willis (1989) proposed four strategies through
which medical dominance is maintained:
– Subordination – ensuring that other health care
workers work under the direct authority of doctors.
– Limitation – restricting the occupational territory of
other health workers.
– Exclusion – denying legitimacy to alternative
practitioners.
– Incorporation – absorbing the territory of other
health occupations into medical practice.
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7. Challenges to Medical Dominance
Health sociologists note three challenges:
• Deprofessionalisation – evident through decreasing
public trust in medicine as a consequence of improper
clinical practice and fraud.
• Corporatisation – evident through growing corporate
control over health care, and especially general
practice.
• McDonaldisation – evident through the growing
emphasis on strategies to improve the transparency
and accountability of medical practice.
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8. Is Medical Dominance in Decline?
• While the autonomy of doctors is constrained in
some areas, and the medical profession is
increasingly fragmented, medical dominance in
general remains strong. Why might this be the
case?
• Nevertheless, it is important to note that
“medical dominance has always been the subject
of contest and resistance” (Germov, 2014, p.402),
and is the product of a negotiated order.
Examples?
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9. Useful references
Allsop, J. (2006) ‘Medical Dominance in a Changing World: The UK Case’,
Health Sociology Review, 15(5): 444-457.
http://search.proquest.com.ezproxy.csu.edu.au/docview/203159309/136660
4FAEF6B748988/5?accountid=10344
Coburn, D. and Willis, E. (2003) ‘The Medical Profession: Knowledge, Power,
and Autonomy’, in G. Albrecht, R. Fitzpatrick and S. Scrimshaw (eds), The
Handbook of Social Studies in Health and Medicine, London: Sage. (available
through the CSU library as an e-book)
Benoit, C., Zadoroznyj, M., Hallgrimsdottir, H., Treloar, A. and Taylor, K. (2010)
‘Medical Dominance and Neoliberalisation in Maternal Care Provision: The
Evidence from Canada and Australia, Social Science and Medicine, 71: 475-
481. http://ac.els-cdn.com.ezproxy.csu.edu.au/S027795361000314X/1-s2.0-
S027795361000314X-main.pdf?_tid=f431c118-1bdd-11e2-8e5b-
00000aab0f26&acdnat=1350865267_a1391f139d0114a9d79046d28e270495
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