Decline vs. retention of medical power through restratification: An examination of the Ontario case

Abstract

Though some argue that medical power is declining, others disagree. In particular, Freidson assets that medicine is being restratified with medical elites retaining control over health care though practitioners are losing their individual autonomy to these elites. We use the case of state-medicine relationships in Ontario to examine the restratification thesis. Our findings indicate that the state partially controls medicine through restratification. There is partial state co-option of medical organisations and elites. This case also implies that control over the context of care and over the content of medical practice is not as separate as assumed, that profession-practitioner relationships are increasingly problematic, that the concept of autonomy itself requires theoretical and empirical specification, and that the existence of self-regulatory and representative organisations cannot be equated with actual professional self-regulation. The contingent nature of medical power is underlined.