What Is New in Professions Theory? Contributions from Actor Perspective(s)

The impact of neo-liberal and New Public Management (NPM) health reforms on medical profession has undergone comprehensive changes. Although the underlying reasons are similar across western countries, concerning the Portuguese case the outcomes diverge, particularly due the influence of medical profession on shaping professional practices and regulatory mechanisms. In Portugal, doctor’s influence on state regulation seems to counter the dynamics that have been described in sociology of professions, which points out the increasing criticism of medical autonomy, the growing managerial control over medical authority and the state regulation of medical procedures. Doctors have succeeded in developing strategies to protected their professional position in the workplace, by reconfiguring their jurisdictions and influencing organizational structures and decision-making processes.

The purpose is to provide a comprehensive explanation of how NPM health reforms impact on micro-level relationships on health organisations, namely the interplaying of doctors with other health professions, managers and patients. New questions arise concerning the understanding of how cooperation between different health professions is construct as they work together in the best interest of patients. As teamwork is a network of semi-independent professionals who tend to repre­sent their professional organisations and groups, the impact of managerialism in healthcare may not improve the situation and brings new challenges to sociology of professions. Research on professions tends to analyse tension/cooperation problems among health professions ignoring the fact that multi-professional cooperation as the same character as mono-professional cooperation, to preserve collegiality through co-existence. This idea challenges the three stands on professions theory: service ideal, discretionary power and professional dominance. My argument is that these three stands allow us only to explain part of the tensions/cooperation problems and that professionals are strongly influenced but not determinate by their professional logics. The actor perspective offers a useful interpretation in understanding individuals’ cooperation problems among health multi-professional teamwork.