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. 2002;80(2):185-235.
doi: 10.1111/1468-0009.t01-1-00010.

A loss of faith: the sources of reduced political legitimacy for the American medical profession

Mark Schlesinger  1
Affiliations

A loss of faith: the sources of reduced political legitimacy for the American medical profession

Mark Schlesinger. Milbank Q. 2002.

Abstract

The political legitimacy and policymaking influence of the medical profession have greatly declined in American society over the past 30 years. Despite speculation about the causes, there has been little empirical research assessing the different explanations. To address this gap, data collected in 1995 are used to compare attitudes of the American public and policy elites toward medical authority. Statistical analyses reveal that (1) elites are more hostile to professional authority than is the public; (2) the sources of declining legitimacy are different for the public than they are for policy elites; and (3) the perceptions that most threaten the legitimacy of the medical profession pertain to doubts about professional competence, physicians' perceived lack of altruism, and limited confidence in the profession's political influence. This article concludes with some speculations about the future of professional authority in American medicine.

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Figures

fig. 1
fig. 1
Loss of public faith in the authority of the medical profession. These survey results show the percentage of the American public expressing confidence in medical leaders. For the Harris and NORC results, confidence is the percent responding “a great deal”; for the Gallup results, it is “a great deal” and “quite a lot. ” █ = NORC; ▒ = Harris; ░ = Gallup.
fig. 2
fig. 2
Loss of elite faith in the authority of the medical profession. Faith is measured by the prevalence of professional service frames in congressional hearings. ░ = number of references; ▒ = proportion of all legitimizing frames.
fig. 3
fig. 3
Interview-based measures of the efficacy and agency of the medical profession. These attitudes were assessed using the levels of support for each of these statements reported by elite (█) and public (▒) subjects.
fig. 5
fig. 5
Survey-based measures of the efficacy and agency of the medical profession. These attitudes were assessed using the levels of support for each of these statements reported by elite (█) and public (▒) respondents.
fig. 4
fig. 4
Interview-based measures of countervailing authority and boundary violations. These attitudes were assessed using the levels of support for each of these statements reported by elite (█) and public (▒) subjects.
fig. 6
fig. 6
Survey-based measures of countervailing authority and boundary violations. These attitudes were assessed using the levels of support for each of these statements reported by elite (█) and public (▒) respondents.
fig. 7
fig. 7
Attitudes about professional efficacy, by political sophistication of respondent. █ = low-knowledge public; ▒ = moderate-knowledge public; ▒ = high-knowledge public; ░ = policy elites.
fig. 8
fig. 8
Attitudes about boundary violations, by political sophistication of respondent. █ = low-knowledge public; ▒ = moderate-knowledge public; ▒ = high-knowledge public; ░ = policy elites.
fig. 9
fig. 9
Attitudes about professional agency, by political sophistication of respondent. █ = low-knowledge public; ▒ = moderate-knowledge public; ▒ = high-knowledge public; ░ = policy elites.
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