In 1983 there were more than 41,000 active civilian physicians in Canada. The demand for their services was generated by a population of nearly 25 million, more knowledgeable about and with higher expectations in health matters than ever before. In order to help meet this demand, these physicians called upon the services of more than 300,000 other health personnel with a wide range of paramedical skills developed to apply the rapidly expanding body of medical knowledge. Often this application takes place in the doctor’s office, but mainly it occurs in the hospital, where the vast array of complex technical equipment...

Three conditions are necessary if professionalization is to occur: 1 / legal or political privilege protecting practitioners from encroachment on their area of expertise by other occupations; 2 / control by the profession of the production as well as the application of knowledge and skills to its tasks; and 3 / formal demonstration to the public by the profession of its trustworthiness, such as a code of ethics (Freidson 1970a: 75). An understanding of the way in which the medical profession met these conditions and attained professional status requires an examination of the historical development of the regulatory bodies that...

This chapter will examine some of the significant issues that are related to physician demand and supply. It is not another attempt to provide a forecast for medical-manpower planning purposes. This problem seems to be a perennial one, particularly since Judeks authoritative 1964 study for the Royal Commission on Health Services. Numerous studies undertaken since then have attempted to forecast physician demand and supply. Many of them have made a contribution to medical-manpower planning, but few have escaped critical assessment.¹

Current assessments of physician-manpower needs usually rest upon a number of shortcomings. These have been examined in an excellent paper...

The medical profession’s reaction to the social changes it faces is influenced by the socialization process that its members undergo as medical students and, later on, as practitioners. Socialization takes place in every society; it is the process through which human beings become social beings. It is a learning process that is most influential in childhood, but continues throughout life, and during each stage of the life cycle. The major agents of socialization are the home, the school, peer groups, the job, and the mass media. Through interaction with other group members a person learns appropriate behaviour and the cultural...

The most important socializing influence on the student physician is the medical school, where two crucial processes operate that will shape the student into the mould of a physician. The first of these is the formal preclinical and clinical curriculum requirements, which include a knowledge of the formally prescribed professional interests, values, and goals. The second is the influence of teachers and peers, from whom the medical student learns the appropriate norms, values, and attitudes that are an essential element of the practising physician’s perspective. Bullough (1966:2) claims that ‘one of the chief purposes of such training is to initiate...

Paralleling the growth of medical knowledge and technology in the postindustrial society is a proliferation of specialization in the health-care system. Such specialization takes four forms. The first is the division of labour between the dominant professional groups such as physicians and dentists. The second is the internal segmentation of these major groups into specialties, such as internal medicine, neurology, and surgery in medicine, and oral surgery, orthodontics, and periodontics in dentistry. Next is the formation of other health professions and occupations, such as dental hygienists, nurses, physiotherapists, and occupational therapists. Last is the specialization within these groups, such as...

The development of Canada’s health system, with particular reference to the dominance of the medical profession, was outlined in chapter 2. It briefly described the continual struggles between physicians and other heterodox practitioners, and the attempts by medical associations to persuade legislatures to pass statutes that would suppress the irregular healers and thereby help to establish a unified, homogeneous profession. As the medical profession became more science oriented, the disagreement between the irregular practitioners and organized medicine widened. These struggles constituted a drive to professionalize medicine through the establishment of a collegial, self-regulating model of occupational control similar to the...

The decision by the Canadian government to implement a national medicalcare insurance program resulted in the passage of the Medical Care Act of 1966. The act was founded on five major principles: 1 / comprehensive coverage for all physicians' services; 2 / reasonable access; 3 / universal availability; 4 / portability of benefits; and 5 / administration on a nonprofit basis. With financial support from the federal government, the provinces launched their medicare programs based on these principles. As indicated in chapter 2, by the end of 1970 all provinces, and by the end of 1972 Yukon and the Northwest...

In terms of the theoretical model outlined in chapter 1, communal control is another form of occupational control. Under it a community, or a community organization such as a consumers’ group, rather than an occupational group, such as physicians, or a third party such as the government, seeks to define the needs of its members and the manner in which they will be satisfied. The gradual development of communal control is a feature of the socio-economic changes that are occurring in modern industrial societies. One of these is the rise of consumer power. It is evident in the rise of...

A crucial element in the claim to professional status is the degree to which a profession has control over the producer-consumer relationship in terms of the definition of the consumer’s needs and the manner in which they are to be met. This element of professional control, or power, has been the major analytical variable that has organized the foregoing analysis.

An essential foundation of the physician’s authority is the provincial government’s delegation to the appropriate provincial body representing the medical profession of the authority to license those individuals who meet the standards set by the profession for entry into its...