Managerial Doctors: Medical Technocracies Revisited

Across European countries, the relationship between professionalism and managerialism indicate new emergent configurations of hybrid professionals and mixed forms of governance in health care. Studies concerning Portuguese case (Serra, 2010; Carvalho, 2012; Correia, 2012; Kuhlmann, et al. 2012) show a specific situation due to the power the medical profession stills to exert over health regulation. Definitely, doctor’s influence on state regulation seems to counter the dynamics that have been described in sociology of professions and organisations, which point out the increasing criticism of medical autonomy, the growing managerial control over medical authority and the state regulation of medical procedures.

In Portugal, the control of technologies is an example of the intersection between state and medical regulation. Serra (2010) had already described different systems of governance based on the physician’s technical skills in a given medical area of expert knowledge (medical technocracies); systems in which medical experts are in control and where decision-makers are selected on the strength of their degree of skill and quali­fication.

Also, the need for public investment coexists with the relative inability to maintain the state’s regulation over the effective control of medical technologies. For hospitals and medical specialties in particular, the domination of a technology is important insofar as it boosts the self-regulation mechanisms of the profession whilst also allowing the organisation to attract investment that brings greater financial sustainability. From the notion of medical technocracies (Serra, 2010) the aim of this paper is to look to key question of technological dependence and the control of management instruments by medical profession, which allows medical procedures to meet the demands of the 3Es – economy, effectiveness and efficiency (Rhodes, 1994) and, simultaneously, boost the self-regulated professional power, defined as medical technocracy. To a certain extent, it is the increasing introduction of NGP criteria that strengthens medical technocracy.