Determinants of professional status of physicians in urban areas of Mexico.

Abstract

While there has been considerable work in medical sociology on the status of the medical profession in relation to other occupational groups, few attempts have been made to study variations in the income, prestige and power among physicians. From the status attainment research are taken three main aspects: (1) the theoretical and empirical expectations that can be applied to the case of the status attainment of a learned profession; (2) the definition of the main sets of variables in this study; and (3) the methodological approach chosen in this dissertation (the use of structural equation models--LISREL) follows the status attainment tradition, namely, the definition of causal models. The results of the dissertation show the great variation within each of the dimensions of professional status. Such a finding gives some support to the argument of the erosion of provider homogeneity. There is evidence that prestige/power and economic status share a similar pattern of determination (generation, gender and work history). However, in the economic dimension, the determinants of the internal stratification of physicians seem to parallel the determinants of the occupational and property stratification structures of social stratification in general. This leaves a complex set of implications for issues of: medical manpower policy, exploring in particular the implications of the determinants and the internal stratification of the medical profession for the state, medicine and the public, as well as the policy implications for physician management in the health system; conceptualizations of professional work, both the theoretical contribution of the findings of the dissertation to the status attainment research, as well as the theoretical contributions to the debate between the proletarianization and the medical dominance theories; and about the changing character of the medical profession, the results of this dissertation are useful to highlight a number of issues that inform about the ways in which a highly stratified medical profession can react and organize to face the introduction of changes in the health care system, and provide some insights about the paths that health care reform can follow in the case of Mexico.