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PubMed1995

Health care reform in Norway: the end of the "profession state"?

From the early nineteenth century until about 1980, a close relationship developed in Norway between the state and the medical profession. Medicine became integrated into the state at all levels of government, and the profession assumed important roles in initiating and formulating health policy. Another, and perhaps also causally related, development has been that health policy--and most strikingly during postwar expansion--tended to be formulated and implemented in its own policy sector, with few links to other parts of the welfare state. Important elements of the "profession state" in Norway have thus been professional integration with the state and institutional isolation from other policy sectors. Health reforms of the 1980s and 1990s brought changes in institutional relations: Other professions have replaced physicians as experts at central and local levels, and health policy making has become more politicized and integrated into welfare state policies. Thus there are clear indications that the profession state is waning.

Cross-Cultural Comparison↗

PubMed2003

[The medical profession at issue (1922): a historical and sociological view].

Can a profession become the subject of historical or sociological study? Such an undertaking can only be possible if one avoids the meaning ascribed to the word profession and begins to give it a conceptual statue. Based on this concern, we present theoretical postulates introduced by several North American sociologists in their attempts to define profession as a concept, distinguishing it from occupation. We are interested in identifying the role played by knowledge and control of the labor market control. We make use of this reference to analyze a specific case, the medical profession, in a particular place, Brazil, and in a given historical context, the early 20th century, specifically at the "National Congress of Practitioners" (1922). From this empirical, historical analysis, we make three comments on our theoretical frame of reference. The first refers to the constitutive heterogeneity of a professional body, the second to the historical meaning of the professional process, and the third to coercion as a means for eliminating competitors and establishing one's self as a professional in the labour market. The purpose is to show that historical and sociological study of the medical profession is legitimate, relevant, and extremely opportune.

English Abstract↗

PubMed1977

Women in male-dominated health professions.

Analysis of survey data on six health professions in Michigan suggests the extent to which sex-role stereotypes are reflected in the distribution of women within and among those professions which typically function as independent practitioners. The particular emphasis of the analysis is the structural or organizational aspects of the professions which facilitate or hinder the recruitment and participation of women. Distribution of women among professions is associated with relative levels of sex-segregation and with the relative availability of career opportunities in nonentrepreneurial settings. Implications of these findings for future trends in the sex structure of the health professions are discussed and a research agenda on women health professionals is proposed.

Adult↗

PubMed2005

Historical perspectives of autonomy within the medical profession: considerations for 21st century physical therapy practice.

As a part of the American Physical Therapy Association's (APTA) vision statement, by the year 2020, physical therapists "will hold all privileges of autonomous practice." This vision statement and the ideals held within it are elemental to the direction of our continued growth as a profession. Many members and nonmembers, however, appear confused and perhaps even intimidated by the concept of autonomous practice. This paper will review and discuss the processes used by other health care professions to gain autonomy within the US health care system. In particular, the processes used by physicians, which were extremely effective and have been used as a template by many other health professions, including physical therapy. Further discussion will focus on the physical therapy profession, emphasizing the parallels with medicine and considering many issues relevant to the goal of autonomous practice. By understanding the past and considering the present, readers will develop an appreciation of (1) the foundation for autonomous practice in health care, (2) the vision of the APTA and why the profession is well positioned to achieve this vision, and (3) the factors we need to consider to hold (and maintain) all privileges of autonomous practice.

Delivery of Health Care↗

PubMed2004

Food animal veterinary medicine: leading a changing profession.

The veterinary profession has gone through periods of profound change in response to economic and social changes. We are currently in another such period: profound change is required in order for the profession to remain relevant in a marketplace where a rapidly expanding knowledge base and new technologies demand an ever-increasing level of expertise in a greater variety of areas. However, the veterinary profession is perceived both internally and by the public as possessing a narrow set of skills that supports a narrow group of careers focused on salvaging ill or injured companion animals. It will be necessary to dramatically change the way veterinary students are recruited and trained, as well as how graduate veterinarians are licensed and provided continuing education, in order for the veterinary profession to capitalize on our historical strengths and provide service and leadership in a greater diversity of career paths. Even though the number of veterinarians needed to provide primary care for livestock is decreasing, both the level of expertise demanded by livestock owners and the value of veterinary involvement on livestock farms are increasing. Colleges of veterinary medicine appear challenged to meet the changing needs for veterinary services in animal agriculture because of the declining percentage of veterinary students interested in food animal careers. Fortunately for animal agriculture, the skill set needed by food animal veterinarians is also needed by several emerging segments of the veterinary profession that have tremendous potential for rapid growth, including employment in all segments of food production systems, environmental monitoring and management, bio-security and disease eradication, laboratory diagnostics, and federal regulatory and bio-defense roles. Like previous periods of profound change, this moment in history will require creative thought, open discussion, and a willingness to step into the unknown.

Animals↗

PubMed1985

Nationally speaking. The challenge for research in a practice profession.

We have suggested that certain research challenges now face the profession. In summary, these challenges may be seen as part of the dual mission of research in a practice profession. Research must contribute to the development of a body of knowledge: some research is academic and theoretical in nature and other research helps to sustain and improve clinical practice. In either case, theory in a practice profession differs significantly from that in more traditional sciences. It is, in fact, more sophisticated and complex than the theory utilized by nonpractice professions, because it must provide the means to state intended outcomes and identify the methods required to achieve the prescribed results (5). This is known as "prescriptive theory" and represents the ultimate research challenge to the practice profession. Prescriptive theory cannot rest on studying what is and what has been; it must anticipate what might be--indeed, what must be--if patients are to achieve their greatest potential as functional members of society.

Ethics, Professional↗

PubMed1997

Why the profession of occupational therapy will flourish in the 21st century. The 1996 Eleanor Clarke Slagle Lecture.

The use of occupation as a therapeutic method is the essence of the profession of occupational therapy. This core of therapeutic occupation is flexible across cultures, times, health care environments, and different philosophies of the nature of the human being. Given this adaptability, the profession espouses diverse models of practice--the multiple frames of reference that guide therapeutic occupation for different populations in different settings. Across the history of the profession, therapeutic occupation has been the common core of otherwise different approaches to intervention. Although each of the many past and current models of practice has a different viewpoint, the common factor is the synthesis of occupational forms designed to elicit meaningful and purposeful occupational performance. Occupational synthesis is the essential act of the occupational therapist. It is necessary that occupational therapists confirm the power of therapeutic occupation through research that examines the profession's central principles. Occupational therapists are also urged to use the term occupation consistently and proudly in their interactions with recipients of therapy, fellow health care professionals, and each other. The profession of occupational therapy will flourish because occupation, its core, is so basic to human health yet so flexible, depending on the needs of the individual human being.

Activities of Daily Living↗

PubMed2002

Chiropractic: a profession at the crossroads of mainstream and alternative medicine.

Chiropractic is a large and well-established health care profession in the United States. In this overview, we briefly examine the development of chiropractic from humble and contentious beginnings to its current state at the crossroads of alternative and mainstream medicine. Chiropractic has taken on many of the attributes of an established profession, improving its educational and licensing systems and substantially increasing its market share in the past two decades. The public increasingly uses chiropractic largely for spinal pain syndromes and appears to be highly satisfied with the results. Of all the so-called alternative professions, chiropractic has made the largest inroads into private and public health care financing systems and is increasingly viewed as an effective specialty by many in the medical profession. Much of the positive evolution of chiropractic can be ascribed to a quarter century-long research effort focused on the core chiropractic procedure of spinal manipulation. This effort has helped bring spinal manipulation out of the investigational category to become one of the most studied forms of conservative treatment for spinal pain. Chiropractic theory is still controversial, but recent expansion in federal support of chiropractic research bodes well for further scientific development. The medical establishment has not yet fully accepted chiropractic as a mainstream form of care. The next decade should determine whether chiropractic maintains the trappings of an alternative health care profession or becomes fully integrated into all health care systems.

Chiropractic↗

PubMed1985

The PA credentialing process--the Bureau of Health Professions' role.

The widespread use of credentialing mechanisms has been an important trend among health professions in recent years. The PA profession is one of several that has undergone a multi-stage credentialing process designed to promote individual competence and relevance of the field. The goal was to establish a national credentialing program involving clearly delineated roles, competency requirements, and criterion-referenced examinations. Several organizations participated in the process to produce a variety of assessment tools and continuing competence models. The article discusses the role of these organizations (including that of the Bureau of Health Professions), examines the initial development of the credentialing process, and outlines the four major phases of the program. The author cites that while the entry-level competence of PAs can be assured through the credentialing process, the profession's continuing competency program remains the subject of controversy, partially because of the newness of the profession and its re-certification program. The author feels, however, that the experience gained in the initial credentialing process will assist in the resolution of this matter.

Credentialing↗

PubMed2000

Do new roles contribute to job satisfaction and retention of staff in nursing and professions allied to medicine?

BACKGROUND: Studies have suggested that job dissatisfaction is a major factor influencing nurses' and occupational therapists' intention to leave their profession. It has also been related to turnover of qualified nurses. However, literature relating to these factors among nurses and professions allied to medicine in innovative roles is scarce. AIMS: This paper considers the views of 452 nurses and 162 professionals allied to medicine (PAMs) in innovative roles, on job satisfaction, career development, intention to leave the profession and factors seen as hindering and enhancing effective working. METHODS: A self-completion questionnaire was developed as part of a larger study exploring new roles in practice (The ENRiP Study). FINDINGS: Overall there was a high level of job satisfaction in both groups (nurses and PAMs). Job satisfaction was significantly related to feeling integrated within the post-holder's own professional group and with immediate colleagues, feeling that the role had improved their career prospects, feeling adequately prepared and trained for the role, and working to protocol. Sixty-eight percent (n = 415) of respondents felt the role had enhanced their career prospects but over a quarter of respondents (n = 163; 27%) said they would leave their profession if they could. Low job satisfaction was significantly related to intention to leave the profession. CONCLUSIONS: The vast majority of post-holders in innovative roles felt that the role provided them with a sense of job satisfaction. However, it is essential that the post-holders feel adequately prepared to carry out the role and that the boundaries of their practice are well defined. Career progression and professional integration both being associated with job satisfaction.

Adult↗

PubMed2001

Comparison of multicultural literature in three health professions: physical therapy, nursing & social work.

All health professions' education programs are mandated by their accrediting agencies to include diversity and multicultural content within their curricula. This article reviews literature from the three professions of nursing, social work, and physical therapy that indicates that they accomplish this at different places on the continuum of curricular integration and transformation as identified by Banks. An examination of the complexity of each profession's standards, and a comparison of the depth of cultural competency within each profession is included. Even with the more 'experienced' professions of social work and nursing, there appear to continue to be inconsistencies in the structuring and teaching of multicultural content.

Cultural Diversity↗

PubMed2004

Is dentistry a profession? Part 1. Professionalism defined.

Individual dentists and organized dentistry alike invariably claim to be (members of) a profession. This label is cherished because it suggests special social, moral and political status. However, almost every self-respecting occupation nowadays claims to be a profession. Hence, the question arises as to what exactly is meant when dentists claim to be professionals and, more important, whether they can justifiably lay claim to this label. Rather than reviewing the manifold and divergent discussions in the literature about professionalism, the author proposes--in this first of 3 consecutive articles--a definition of the term "profession" that is based on the literal origins of the word. Next, it is argued that a profession arises out of a social contract between the public and a service occupation that professes to give priority to the existential needs of the people served. In the second article, the author deduces several professional responsibilities. The third and final article examines whether and to what extent dentistry fulfills these responsibilities and outlines some future challenges.

Clinical Competence↗

PubMed2004

The professions.

The professions have been described in terms of their prestige and income, specialized skills and knowledge, protected markets, control over entry and discipline of members, common identity and values, long careers, managed relationships with nonprofessionals, licensure, ethics, and service to clients and the public. As useful as these characteristics are, they fail to capture the essence of the professions, especially the classic ones such as medicine and dentistry. A five-part definition is proposed, consisting of a community (including patient, professional, and peers), treating individuals in a customized private and personal fashion based on diagnosis, in a trusting relationship where the professional acts as an agent rather than engaging in economic exchanges. The evolution of the medical profession is discussed as an illustration of the way professions evolve and to reveal some of the historically "taken-for-granted" aspects of professionalism. The fact professional knowledge is both public and scientific and personal and unsusceptible to objective reduction is a paradox. The continued viability of professions such as dentistry depends on protecting against threats to the five essential characteristics that define professionalism.

Ethics, Professional↗

PubMed2005

Stress in health professions students: myth or reality? A review of the existing literature.

The purpose of this literature review was to determine the extent to which health profession students experience counterproductive stress and to examine the existing gaps in the literature concerning all health profession students and stress. The literature search process included using Eric, Education Abstracts, Psyc INFO, ABIN, WebSpirs Databases, FactSearch, Biological Sciences, International Pharmaceutical Abstracts, MEDLINE, Lexis-Nexis, CINAHL and Registry of Nursing Research. Key articles were identified that documented stress, the causes of stress or "stressors," and psychiatric symptoms as a result of counterproductive stress in the disciplines of medicine, dentistry, nursing, and allied health. Findings from this analysis of the literature indicated that the highest incidence of stress occurred in medical students followed by dental and then nursing students. There was, however, a dearth of studies related to stress in pharmacy students alone, despite the fact that pharmacology requires a rigorous educational process that is similar to that of the other health professions. While it may be argued that pharmacy students may not be experiencing the detrimental levels of stress that affect other medical students, a study by Henning Ey, & Shaw (1998) found a disproportionately high level of distress in pharmacy students. The Henning study also compared the stress levels of medical, dental, nursing, and pharmacy students. This literature review documents that health profession students suffer from high levels of stress during their training. A comprehensive list of "stressors" is delineated for the health education profession students. However, there appears to be a lack of emperical evidence with regards to stress and stressors in pharmacy students. Although it can be extrapolated that pharmacy students may be suffering from similar levels of stress, there is a definite need for research in pharmacy students specifically.

Burnout, Professional↗

PubMed1992

Results of a summer academy to increase minority student access to allied health and other health professions.

To promote interest among incoming ninth grade students at two specialized high schools for health professions, and to help these students prepare for the upcoming high school experience and for pursuit of education and careers in allied health and other health professions, a three-week Summer Health Professions Academy was established. Students, 82.8% of whom were African American or Hispanic, participated in relevant didactic and experiential activities, with emphasis on allied health. Science, problem solving, communications, health career counseling, and allied health career exploration activities are described. Results of instruments administered both prior to and following the Academy indicated that students improved their abilities to analyze and solve science problems, and increased their knowledge of the nine primarily allied health professions emphasized during the program. Students also demonstrated heightened awareness of the factors that could impede their pursuit of allied health professions and other health careers.

Adolescent↗

PubMed1996

The importance of state regulation to the promulgation of the athletic training profession.

States regulate professions to protect the public from harm by unqualified practitioners. Without regulation of athletic trainers (ATs), there is no legal way to assure quality health care to athletes because there is no legal definition as to what an AT can and cannot do. Problems exist, however; 1) ATs nationwide may not be adequately familiar with state regulations; 2) without regulation, legal support is given to high schools to use less qualified persons to care for student-athletes; 3) more education is needed to familiarize the public and the health care industry with the functions and qualifications of a certified AT; and 4) without uniformity of regulation, athletes may continue to suffer as untrained and/or unqualified persons continue to be perceived as members of the profession and as certified and noncertified ATs continue to practice without legal sanction, perhaps beyond their area of expertise. This article encompasses both a literature review and an opinion survey (of ATs) with regard to state regulation of the athletic training profession. The intent of this article is to help ATs understand the implications of state regulation on our profession. A survey was mailed to 500 ATs across the country soliciting opinions on state regulation and its implication of the profession of athletic training. The intent of the survey results are not to verify the literature review nor to infer information regarding other ATs, but merely to be a gathering tool to solicit information from fellow ATs.

Journal Article↗

PubMed1991

The impact of AIDS on recruitment in the health professions.

The occupational risk of AIDS has been identified as a possible factor in the decline of applicants to health professions programs. This study examined data obtained from 914 Philadelphia public and parochial high school students concerning their knowledge and attitudes about AIDS, and their knowledge and attitudes toward the health professions. The survey revealed that the majority of respondents demonstrated a good, basic understanding of the transmission of the virus. While fear of exposure to the virus may negatively impact some prospective students, the majority in this study did not express this concern. Rather, the results indicated that the respondents' lack of knowledge and understanding of the health professions is a major reason that they may not be selecting health careers. Notably, more than 50% of those surveyed responded that high schools do not provide enough information about the health professions. These findings reinforce the need for creative recruitment and career counseling programs that will foster an interest in the health professions.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

[The medical profession in urban areas of Mexico: demographic composition and social origin].

The medical profession in Mexico has experienced deep changes during the last decades. One of the most prominent has been the rapid growth in the number of physicians, who have tended to concentrate in the urban areas. In order to examine the sources of such increase, this paper analyzes the composition of the medical profession by age, sex, and social origin. The data come from the National Survey of Medical Employment, carried out in 1986, in which 604 physicians from a representative sample of households were interviewed in 16 of the main Mexican cities. The results show that the medical profession in Mexico is marked by a clear predominance of young people, which in turn is a sign of the recent explosion of graduates from medical schools. At the same time, there is a growing proportion of women. In contrast, the social origin of physicians has not experienced major changes, since most of them continue to come from the middle classes. The interpretation of these findings indicates that the growth in the number of physicians has not been due to a diversification of the social base of the profession, but to a greater demand for medical education among the middle classes and women. The changes experienced by the medical profession have a basic significance for the present and the future of health in México.

Adult↗