Doctors in trouble: professional autonomy, physician discipline, and occupational (re)closure
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
The dual components of professional regulation typically include licensure and discipline. Much sociological research has examined licensure as a mechanism by which occupational closure is achieved. Less attention has been given to discipline in this regard. This research explores physician discipline as a form of occupational (re)closure used by US state medical boards and regulatory physician elites to preserve professional autonomy at both the level of the individual physician and the medical profession. It develops the concept of occupational (re)closure to include the processes by which professions, once established, (re)secure control over the expertise required to perform their work and their structural location in the marketplace. It further discusses how factors other than physician misbehavior influence physician discipline, with implications for improving the physician discipline system in the United States. For a sample of 2,014 state medical board-years spanning the years 1985–2017, data include information about the autonomy of US state medical boards (structural independence, type of legal counsel, member composition), information about the profession-state relationship (state-level physician prescribing/dispensing policies), and measures of the frequency and severity of physician discipline. Fixed effects regression analyses are used to examine patterns in the frequency and severity of disciplinary actions taken by US state medical boards against physicians for problematic behavior. Results reveal three main findings. First, physician discipline has declined over time. Second, more autonomous US state medical boards tend to engage in less physician discipline than less autonomous ones. Third, in places with less state control, US state medical boards tend to engage in less physician discipline. These findings suggest that when the medical profession is threatened by external influence, physician discipline may be a response used to preserve the profession’s independence, a scenario consistent with aspects of the restratification thesis of medical dominance.
Description
Keywords
Autonomy, Discipline, Medical Regulation, Professions, Sociology