Shifting Patterns of Professional Regulation: Medicine in Comparative International Perspective

Even in a single society, the forms of regulation of occupational groups regarded as professions in the modern world vary considerably at particular points in history as well as in the contemporary context. This paper compares and contrasts shifts over time in professional regulation, with specific reference to medicine, in three very distinct societies – Britain, the United States and Russia. As such, it overviews broad regulatory changes in medicine over two centuries in each of the countries concerned. The analysis is undertaken from a neo-Weberian frame of reference based on defining fully-fledged professions in terms of exclusionary social closure. It shows that the patterns vary historically following relatively early open fields from classic social closure through corporatisation to complete deprofessionalisation in the three very different socio-political systems concerned. Notwithstanding the common claims of functionalist theorists about convergence towards a single highly professionalised destiny for elite knowledge-based occupations in the developed world, it is argued that – for all the methodological issues involved – there is no trend towards one emergent contemporary pattern. Rather, the paper highlights that each particular configuration in medicine has evolved as a result of specific socio-political circumstances in the spectrum of countries considered – based on differing balances between the market and the state. The paper concludes by raising questions as to which of the regulatory patterns concerned might be most desirable in future in the struggle for a better world. In weighing up the advantages and disadvantages, innovative and graphic use is made of animal metaphors – employing the vehicles of zoos, circuses, safari parks and the law of the jungle – to depict the main regulatory models that are available. Each of these has different consequences for the public, not least in relation to the classically ‘top dog’ profession of medicine.