Professionalism THE END OF THE GOLDEN AGE OF DOCTORING

Eight interrelated reasons for the decline of the golden age of doctoring are discussed in this article. Major extrinsic factors (generally outside the control of the profession) include (1) the changing nature of the state and loss of its partisan support for doctoring, (2) the bureaucratization (corporatization) of doctoring; (3) the emerging competitive threat from other health care workers; (4) the consequences of globalization and the information revolution; (5) the epidemiologic transition and changes in the public conception of the body; and (6) changes in the doctor-patient relationship and the erosion of patient trust. Major intrinsic factors are (7) the weakening of physicians ’ labor market position through oversupply; and (8) the fragmentation or weakening of the physicians, union (AMA). Despite the recent sociopolitical trans-formation of modern U.S. medicine, our thinking remains wedded to a now inadequate theoretical approach. A future sociology of the professions can no longer overlook now pervasive macrostructural influences on provider behavior (corporate dominance). Until these influences are appropriately recognized and incorporated in social analyses, most policies designed to restore the professional ideal have little chance of success. If we want things to stay as they are, things will have to change. Giuseppe di Lampedusa (1) There are striking similarities between the rise and fall of religious monasticism during the Middle Ages and the rise and still continuing decline of professionalism around the turn of the 21st century. During the medieval period, groups of monks (religious orders) clustered together in functionally dependent units (monasteries), eschewed worldly interests (commerce), and professed through values, beliefs, and actions their adherence to another world. Monks considered themselves “called ” to their special vocation and embarked on a period of sacrifice and training as novices, during which they learned appropriate forms of behavior an