Changing economic conditions and their effects on professional autonomy: An analysis of family practitioners and oncologists

This study examines the effects of dimensions of the social structure on professional autonomy. Little support exists for arguments suggesting professional dominance or professional-bureaucratic confrontation. The study supports a theory of social change that places physicians in their historical, political, and economic context. There are four important findings. First, the degree of autonomy varies across physician specializations, and the social structure affects the autonomy of family practitioners and oncologists in different ways. Second, the Federal Drug Administration constrains the responsibility autonomy of both oncologists and family practitioners, and the innovative autonomy of family practitioners. Third, bureaucracy either has no effect or enhances physicians' autonomy. The fourth, and most consistent, finding demonstrates that profit-seeking corporations external to the work setting constrain physicians' autonomy. Findings suggest that researchers should give more attention to shifts in the loci of power and the effects of organizations external to the work setting, especially corporations, on professions.An earlier draft of this paper was presented at the American Sociological Association annual meeting, Miami, Florida, August 1993.