Current challenges for doctors in India: Deprofessionalisation, reprofessionalisation or fragmentation?
Bourdieu
India
deprofessionalisation
profession
Journal
Sociology of health & illness
ISSN: 1467-9566
Titre abrégé: Sociol Health Illn
Pays: England
ID NLM: 8205036
Informations de publication
Date de publication:
22 Oct 2022
22 Oct 2022
Historique:
received:
04
06
2022
accepted:
27
09
2022
pubmed:
23
10
2022
medline:
23
10
2022
entrez:
22
10
2022
Statut:
aheadofprint
Résumé
Western-trained doctors in India struggled to establish themselves as a medical 'profession' in the 1920s and 1930s and these struggles continued into the post-colonial period. The direction of travel is, however, no longer clear. Increasing evidence of a crisis in doctors' collective ability to provide a form of self-regulation since 2000 is highlighted. India's Supreme Court suspended the operations of their country's medical councils in the face of a proliferation of poorly regulated private medical colleges. Practitioners of alternative systems of medicine and unqualified medical practice continue, while new 'short-course' doctors take over tasks previously restricted to fully fledged MBBS doctors. The diversification of the social origins of medical students, with rising numbers of doctors from a wider range of social backgrounds, threatens their aspirations to high status. There is little diminution of the earnings of elite doctors, yet their conditions of work are increasingly constrained by financial targets. Young doctors face uncertain futures. This article analyses the increasingly diverse occupational positions of doctors in India using a Bourdieusian lens and asks whether an alternative, stable form of institutional arrangements is emerging, as some have claimed, or if fragmentation is a more apt description.
Identifiants
pubmed: 36271825
doi: 10.1111/1467-9566.13564
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2022 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.
Références
Amin, Z., Burdick, W. P., Supe, A., & Singh, T. (2010). Relevance of the Flexner Report to contemporary medical education in South Asia. Academic Medicine, 85(2), 333-339. https://doi.org/10.1097/acm.0b013e3181c874cb
Anand, A. C. (2019a). Indian healthcare at crossroads (Part 1): Deteriorating doctor-patient relationship. The National Medical Journal of India, 32(1), 41-45. https://doi.org/10.4103/0970-258x.272117
Anand, A. C. (2019b). Indian healthcare at crossroads (Part 2): Social and environmental influences. The National Medical Journal of India, 32(2), 109-112. https://doi.org/10.4103/0970-258x.275354
Anderson, M. (2018). Becoming employees: The deprofessionalization and emerging social-class position of health professionals. In H. Waitzkin (Ed.), Healthcare under the knife: Moving beyond capitalism for our health (pp. 33-42). Monthly Review Press.
Bajpai, V. (2020). A cure worse than the Malady-National medical Commission act. Economic and Political Weekly, 55(9), 16-18.
Bhat, R. (1996). Regulating the private health care sector: The case of the Indian Consumer Protection Act. Health Policy and Planning, 11(3), 265-279. https://doi.org/10.1093/heapol/11.3.265
Bhattacharya, A. (2021). The alarming rise in violence against doctors in India and its immediate solution. Jurist. [Online]. Available from https://www.jurist.org/commentary/2021/07/bhattacharya-astha-pandemic-violence-doctors-india/. Accessed 16 March 2022.
Bloom, G., Standing, H., Lucas, H., Bhuiya, A., Oladepo, O., & Peters, D. H. (2011). Making health markets work better for poor people: The case of informal providers. Health Policy and Planning, 26(suppl_1), i45-i52.
Bourdieu, P. (1984). Distinction: A social critique of the judgement of taste. Harvard University Press.
Bourdieu, P. (1986). The forms of capital. In J. G. Richardson (Ed.), Handbook of theory and research for the sociology of education (pp. 241-258). Greenwood.
Brosnan, C. (2010). Making sense of differences between medical schools through Bourdieu’s concept of ‘field’. Medical Education, 44(7), 645-652. https://doi.org/10.1111/j.1365-2923.2010.03680.x
Carvalho, T., & Santiago, R. (2015). Professional autonomy in a comparative perspective. In T. Carvalho & R. Santiago (Eds.), Professionalism, managerialism and reform in higher education and the health services (pp. 30-63). Palgrave Macmillan.
Chatterjee, P. (2012). The debate over political society. In A. Gudavarthy (Ed.), Re-Framing democracy and agency in India: Interrogating political society (pp. 305-322). Anthem Press.
Chaturvedi, S., Kumar, N., Tillu, G., Deshpande, S., & Patwardhan, B. (2020). AYUSH, modern medicine and the Covid-19 pandemic. Indian Journal of Medical Ethics, 32546457.
Collyer, F. M. (2015). Practices of conformity and resistance in the marketisation of the academy: Bourdieu, professionalism and academic capitalism. Critical Studies in Education, 56(3), 315-331. https://doi.org/10.1080/17508487.2014.985690
Das, J., & Hammer, J. (2012). Health and health care policy in India: The case for quality of care. In C. Ghate (Ed.), The Oxford handbook of the Indian economy (pp. 420-445). Oxford University Press.
Das, J., Hammer, J., & Leonard, K. (2008). The quality of medical advice in low-income countries. The Journal of Economic Perspectives, 22(2), 93-114. https://doi.org/10.1257/jep.22.2.93
de Carvalho, E. M. (2020). Social affordance. In J. Vonk & T. Shackelford (Eds.), Encyclopedia of animal cognition and behavior (pp. 1-4). Springer International Publishing.
Ecks, S., & Basu, S. (2014). “We always live in fear”: Antidepressant prescriptions by unlicensed doctors in India. Culture, Medicine, and Psychiatry, 38(2), 197-216. https://doi.org/10.1007/s11013-014-9368-9
Ehrenreich, B., & Ehrenreich, J. (1977). The professional-managerial class. Radical America, 11(2), 7-22.
Enders, J., & De Weert, E. (Eds.). (2009). The changing face of academic life. Palgrave Macmillan.
Evetts, J. (2003). The sociological analysis of professionalism. International Sociology, 18(2), 18395-18415. https://doi.org/10.1177/0268580903018002005
Evetts, J. (2011). A new professionalism? Challenges and opportunities. Current Sociology, 59(4), 406-422. https://doi.org/10.1177/0011392111402585
Frankenberg, R. (1981). Allopathic medicine, profession, and capitalist ideology in India. Social Science & Medicine. Part A: Medical Psychology & Medical Sociology, 15(2), 115-125. https://doi.org/10.1016/0271-7123(81)90031-6
Freidson, E. (1970). Profession of medicine: A study of the sociology of applied knowledge. University of Chicago Press.
Gadre, A., & Shukla, A. (2016). Dissenting diagnosis. Penguin India.
Goudar, S. S., & Kotur, P. (2003). Trends in medical education. Indian Journal of Anaesthesia, 47(1), 25-29.
Haug, M. R. (1972). Deprofessionalization: An alternate hypothesis for the future. The Sociological Review, 20(1_Suppl), 195-211.
Haug, M. R. (1975). The deprofessionalization of everyone? Sociological Focus, 8(3), 197-213. https://doi.org/10.1080/00380237.1975.10570899
Haug, M. R. (1988). A re-examination of the hypothesis of physician deprofessionalization. The Milbank Quarterly, 66, 48-56. https://doi.org/10.2307/3349914
Hunter, B. M. (2020). Going for brokerage: Strategies and strains in commercial healthcare facilitation. Globalization and Health, 16(1), 1-13. https://doi.org/10.1186/s12992-020-00578-z
Hunter, B. M., Murray, S. F., Marathe, S., & Chakravarthi, I. (2022). Decentred regulation: The case of private healthcare in India. World Development, 155, 105889. https://doi.org/10.1016/j.worlddev.2022.105889
Jeffery, R. (1977). Allopathic medicine in India: A case of de-professionalisation? Social Science & Medicine, 11(10), 561-573. https://doi.org/10.1016/0037-7856(77)90174-3
Jeffery, R. (1988). The politics of health in India. University of California Press.
Jeffery, R. (2020). Medical education, inclusiveness, democracy and development in contemporary India. In N. V. Varghese & M. Bandyopadhyay (Eds.), Education, democracy and development: Equity and inclusion (pp. 149-164). NIEPA - Shipra Publications.
Jesani, A. (2014). Professional codes, dual loyalties and the spotlight on corruption. Indian Journal of Medical Ethics, 11(3), 134-136. https://doi.org/10.20529/ijme.2014.036
Johnson, T. J. (1972). Imperialism and the professions: Notes on the development of professional occupations in Britain's colonies and the new states. The Sociological Review, 20(1_Suppl), 281-309. https://doi.org/10.1111/j.1467-954x.1972.tb03222.x
Johnson, T. J. (1977). The professions in the class structure. In R. Scase (Ed.), Industrial society: Class, cleavage and control (pp. 93-110). Allen and Unwin.
Johnson, T. J., & Caygill, M. (1972). Community in the making: Aspects of Britain's role in the development of professional education in the commonwealth. University of London, Institute of Commonwealth Studies.
Kanchan, M. (2015). Business of hospitals. Economic and Political Weekly, 50(30), 25-27.
Karan, A., Negandhi, H., Hussain, S., Zapata, T., Mairembam, D., De Graeve, H., Buchan, J., & Zodpey, S. (2021). Size, composition and distribution of health workforce in India: Why, and where to invest? Human Resources for Health, 19(39). https://doi.org/10.1186/s12960-021-00575-2
Karthikeyan, D. (2011, 5 September). Suicide by Dalit students in 4 years. The Hindu.
Kay, M. (2015). The unethical revenue targets that India’s corporate hospitals set their doctors. BMJ, 351, h4312. https://doi.org/10.1136/bmj.h4312
Keshri, V. R., Sriram, V., & Baru, R. (2020). Reforming the regulation of medical education, professionals and practice in India. BMJ Global Health, 5(8), e002765. https://doi.org/10.1136/bmjgh-2020-002765
Killmer, J. (2018). Village doctors and vulnerable bodies: Gender, medicine, and risk in North India. PhD, Syracuse University.
Kumbhar, & Sambhaji, K. (2022). Healing and harming: The “noble profession” of medicine in post-independence India, 1947-2015. PhD Diss., History of Science, Harvard University.
Lange, I. L., Bhadauria, S., Singh, S., & Penn-Kekana, L. (2021). Care’s profit: Precarity and and professionalizsation of of health workers in private maternal clinics in Rajasthan and Uttar Pradesh, India. In C. Jullien & R. Jeffery (Eds.), Childbirth in South Asia (pp. 188-209). Oxford University Press.
Last, M., & Chavanduka, G. L. (Eds.). (1986). The professionalisation of African medicine. Manchester University Press.
Legge, D. G. (2019). Capitalism, imperialism and class: Essential foundations for a critical public health. Critical Public Health, 29(5), 624-631. https://doi.org/10.1080/09581596.2018.1478067
Lisam, S. (2015). Meeting the primary health care needs of rural Assam through introduction of a mid-level health worker: Lessons from India’s experience with rural health practitioners. Indian Journal of Forensic and Community Medicine, 2(1), 13-22.
Lockwood, D. (1958). The black coated worker. Allen and Unwin.
Lum, K. (2019). The Dalit closet: Managing Dalit identity at an elite University in India. Journal for Critical Education Policy Studies, 17, 1.
Madhiwalla, N. (2021). Protocols and set-ups: Producing professional obstetrical knowledge in the periphery of Mumbai, India. In C. Jullien & R. Jeffery (Eds.), Childbirth in South Asia: Old challenges, new paradoxes (pp. 210-239). Oxford University Press.
Marathe, S., Hunter, B. M., Chakravarthi, I., Shukla, A., & Murray, S. F. (2020). The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India. BMJ Global Health, 5(2), e002026. https://doi.org/10.1136/bmjgh-2019-002026
Maurya, R. K. (2018). In their own voices: Experiences of Dalit students in higher education institutions. International Journal of Multicultural Education, 20(3), 17-38. https://doi.org/10.18251/ijme.v20i3.1627
McDonald, R. (2014). ‘Bourdieu’, medical elites and ‘social class’: A qualitative study of ‘desert Island’ doctors. Sociology of Health & Illness, 36(6), 902-916. https://doi.org/10.1111/1467-9566.12121
Nagarajan, R. (2015). Doctors with conscience speak out. 22 February. Times of India.
Nagarajan, R. (2018). Healthcare corruption. In S. Nundy, K. Desiraju, & S. Nagral (Eds.), Healers or predators? Healthcare corruption in India (pp. 293-310). Oxford University Press.
Nahar, P., Kannuri, N. K., Mikkilineni, S., Murthy, G., & Phillimore, P. (2017). At the margins of biomedicine: The ambiguous position of ‘registered medical practitioners’ in rural Indian healthcare. Sociology of Health & Illness, 39(4), 614-628. https://doi.org/10.1111/1467-9566.12521
Nicholls, D. A. (2020). After the love has gone: Generalists, specialists and post-professional healthcare. In T. Pernecky (Ed.), Postdisciplinary knowledge (pp. 215-234). Routledge.
Nicholls, D. A. (2022). Physiotherapy otherwise, Tāmaki Makaurau (Auckland), Aotearoa (New Zealand). Tuwhera Open Books, Auckland University of Technology.
Nundy, S., Desiraju, K., & Nagral, S. (2018). Healers or predators? Healthcare corruption in India. Oxford University Press.
Olsson, C., Kalén, S., & Ponzer, S. (2019). Sociological analysis of the medical field. Advances in Health Sciences Education, 24(3), 443-457. https://doi.org/10.1007/s10459-018-09872-3
Pandhi, N. (2021). Behind the violence against healthcare workers in India lies A failed system. The Wire. [Online]. Available: https://thewire.in/health/behind-the-violence-against-healthcare-workers-in-india-lies-a-failed-system. Accessed 16 March 2022.
Prime Minister’s High Level Committee. (2006). Social, economic and educational status of the Muslim community in India (Sachar committee report). Cabinet Secretariat, Government of India.
Rao, M., Rao, K. D., Kumar, A. S., Chatterjee, M., & Sundararaman, T. (2011). Human resources for health in India. The Lancet, 377(9765), 587-598. https://doi.org/10.1016/s0140-6736(10)61888-0
Rudra, S., Kalra, A., Kumar, A., & Joe, W. (2017). Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014. PLoS One, 12(5), e0176916. https://doi.org/10.1371/journal.pone.0176916
Savage, M. (2016). The fall and rise of class analysis in British sociology, 1950-2016. Tempo Social, 28(2), 57-72. https://doi.org/10.11606/0103-2070.ts.2016.110570
Scott, J. (2006). David Lockwood. In J. Scott (Ed.), Fifty key sociologists: The contemporary theorists (pp. 162-165). Routledge.
Sen, G., & Basant, R. (2010). Who participates in higher education in India? Rethinking the role of affirmative action. Economic and Political Weekly, 45(39), 62-70.
Sharma, D. C. (2015). India still struggles with rural doctor shortages. The Lancet, 386(10011), 2381-2382. https://doi.org/10.1016/s0140-6736(15)01231-3
Sharma, R. (2001). Head of the medical council of India removed for corruption. BMJ, 323(7326), 1385. https://doi.org/10.1136/bmj.323.7326.1385
Singh, A. K. (2013). Defying the odds: The triumphs and tragedies of Dalit and Adivasi students in higher education. In S. Deshpande & U. Zacharias (Eds.), Beyond inclusion (pp. 186-216). Routledge India.
Singh, C. B. (2017). Multilevel exclusion of Dalit students in professional elite colleges of India. Social Change, 47(3), 359-372. https://doi.org/10.1177/0049085717712814
Sood, R., & Adkoli, B. (2000). Medical education in India-problems and prospects. Journal, Indian Academy of Clinical Medicine, 1(3), 210-213.
Srinivasan, S. (2018). Vyapam. In S. Nundy, K. Desiraju, & S. Nagral (Eds.), Healers or predators: Healthcare corruption in India (pp. 549-559). Oxford University Press.
Thorat, S., Shyamprasad, K. M., & Srivastava, R. K. (2007). Report of the committee to enquire into the allegation of differential treatment of SC/ST students in All India Institute of Medical Science. All-India Institute of Medical Sciences.
Willis, E. (2006). Taking stock of medical dominance: Introduction. Health Sociology Review, 15(5), 421-431. https://doi.org/10.5172/hesr.2006.15.5.421
Yadav, J., Menon, G. R., & John, D. (2021). Disease-specific out-of-pocket payments, catastrophic health expenditure and impoverishment effects in India: An analysis of national health survey data. Applied Health Economics and Health Policy, 19(5), 769-782. https://doi.org/10.1007/s40258-021-00641-9
Zodpey, S., Sharma, A., Zahiruddin, Q. S., Gaidhane, A., & Shrikhande, S. (2018). Allopathic doctors in India: Estimates, norms and projections. Journal of Health Management, 20(2), 151-163. https://doi.org/10.1177/0972063418763651