Transformation of Medical Professionalism in Turkey: Erosions and New Divisions in the Wake of Reforms

This paper aims to examine the impact of recent market reforms in the Turkish health care system on medical professionalism and identifies new divisions within the medical profession.  The research team carried out 60 interviews in the summer of 2010 in Istanbul, Turkey, at two different public hospitals. The findings suggest that the new economic and social context of medicine, which is marked with marketization, consumerism and managerialism, is significantly transforming medical professionalism in Turkey. Physicians indicate growing frustration as the reforms such as introduction of pay-for-performance methods or practice of full-time employment of physicians in public hospitals are being implemented and public hospitals are reorganized as autonomous entities. Physicians report lower levels of professional status, lack of respect on the part of the patients and policymakers and increased violence from patients and their relatives. Many physicians blame the government for erosion of the public trust in physicians and growing violence, claiming that the reformers undermined the credibility of the physicians by defining them as “service providers”. Institutional complaint mechanisms that have recently been established as part of the reforms appear to strain the doctor-patient relationship even more. On the other hand, physicians who occupy managerial positions in the same hospitals provide a somewhat different assessment of the reforms. The discourse of these physician-managers include contradictory elements: while they complain about the inefficiencies in the public hospitals and view some steps like pay-for-performance payments as useful incentives to get their colleagues work more efficiently, they hesitate to embrace the reforms aimed at granting autonomy to public hospitals. They also agree with their colleagues that the patient complaint mechanisms are not working properly. The paper highlights serious threats to erosion of professional status of physicians and emergence of new hierarchies among the practicing physicians and physician-managers in Turkey.