Chapter 3: The Consolidation of Professional Authority (1850 - 1930)

a. I was surprised to learn of the mutual hostility among practitioners. I suppose this should not be surprising, given the competition of the time, and the surplus of practitioners, but it does offer a contrast to today's world where many practitioners work with one another and benefit from networking, coordinating care, and making and receiving referrals.

b. One point that I agree with is that the structure of society does not remain fixed throughout time. Most aspects of society are dynamic, and experience changes, whether cyclical or linear in direction. This has been seen in professions other than medicine. The rise of the technology boom along with the internet in the late 90s resulted in growths in the industry, which experienced rapid decline in the early 2000s, with the dot-com crash. While more sudden in growth and more extreme in its rapid decline, it provides one example of how professions and social structures are constantly evolving. I also agree that common identity is imparted along with prolonged training, as this is certainly true among other professions and training.

c. One point I disagree with is the author's statement that "internally divided, it was incapable of mobilizing its members for collective action." I do not think it is necessary or even ideal for all members of a profession or group to agree on everything. Internal division can actually help mobilize members. Indeed, internal division is what initiated the medical community to make many changes, including the formation of authoritative medical associations, which also brought important organizational changes. Even today, there is some division among the medical community, such as the division of specialties into emerging specialties or sub-specialties, which can drive change and even collective action.

d. Reading about how inequalities among doctors parallel class structure applies to an experience I have had as a patient, because wealthier doctors tend to live in areas where wealthier people in general live. For example, there are not very many physicians or health care professionals in rural areas, which tend to be poorer. In this way, the social class structure of the two groups parallel one another.

e. One way the Starr book will influence my view on a topic is when thinking about interest groups. For example, in another public health course on politics and policy development, we are learning about interests (as in interest groups). The Starr book discusses how interest group organizations tend to produce generalized benefits. This is somewhat different than what I have learned in my other class, in that interest groups don't necessarily. For example, highway development interest groups, which are focused on building, expanding, or improving roads, may not necessarily strive to build roads which the general public needs. The Starr book specifically mentions organizational benefits in the form of "selective incentives" for participants in professional organizations. This is a new type of interest group which we have not studied, and it will be interesting to apply the concept of selective benefits to other types of interest groups.