Health professions: the origin of species

Abstract

Specialization is an important feature of post-World War II health sector development. Its value is indisputable. On the other hand, unchecked specialization also brings problems, notably of cost escalation and service profile twisting. To exploit the potentials of highly specialized medicine without neglecting the everyday problems that constitute the bulk of medicine, one needs a carefully constructed policy. To design such a policy, one needs, among other things, to understand the whys and hows of specialization. This reports discusses three different approaches to the understanding of the process of specialization: the sociological (S is a reflection of the selfish interests of the professions), the medical (S is the natural response to scientific and technological progress), and the economic (S is a result of increased market demand). Much is to be said in favour of the sociological explanation. Occupational groups do pursue interests of their own, centering on the construction and defence of job monopolies. The histories of the professions readily lend themselves to this kind of interpretation, and its gives, beyond doubt, valuable insight into the ways in which occupational groups relate to each other, to clients and to the surrounding society. This report, however, argues that the sociology of the professions is largely concerned with phenomena secondary to the process of specialization. It explains the behaviour of occupational groups, once they have been established. It does not, however, explain why they came into being in the first place. For that purpose, the perspective of medicine and, in particular, that of economy, may be more suitable. I support this position by data on the specialization of the health service system of Norway.