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Medical Doctors of the People's Copyright Undertaking This thesis is protected by copyright, with all rights reserved. By reading and using the thesis, the reader understands and agrees to the following terms: 1. The reader will abide by the rules and legal ordinances governing copyright regarding the use of the thesis. 2. The reader will use the thesis for the purpose of research or private study only and not for distribution or further reproduction or any other purpose. 3. The reader agrees to indemnify and hold the University harmless from and against any loss, damage, cost, liability or expenses arising from copyright infringement or unauthorized usage. IMPORTANT If you have reasons to believe that any materials in this thesis are deemed not suitable to be distributed in this form, or a copyright owner having difficulty with the material being included in our database, please contact [email protected] providing details. The Library will look into your claim and consider taking remedial action upon receipt of the written requests. Pao Yue-kong Library, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong http://www.lib.polyu.edu.hk MEDICAL DOCTORS OF THE PEOPLE’S REPUBLIC OF CHINA: THE PROFESSION, PROFESSIONALIZATION, PROFESSIONALISM AND PROFESSIONAL COMMITMENT BELINDA TIN YAN CHOW M. Phil The Hong Kong Polytechnic University 2011 THE HONG KONG POLYTECHNIC UNIVERSITY DEPARTMENT OF MANAGEMENT AND MARKETING Medical Doctors of the People’s Republic of China: The Profession, Professionalization, Professionalism and Professional Commitment Belinda Tin Yan Chow A thesis submitted in partial fulfillment of the requirements for the degree of Master of Philosophy August 2009 CERTIFICATE OF ORIGINALITY I hereby declare that this thesis is my own work and that, to the best of my knowledge and belief, it reproduces no material previously published or written, nor material that has been accepted for the award of any other degree or diploma, except where due acknowledgement has been made in the text. _________________________________ (Signed) _____Belinda Tin Yan Chow__(Name of student) 0 Dedicated to My Family, Dr. Hongxing Hu, Prof. Keli Zheng and PYNEH Renal ward 1 ABSTRACT From a planned economy to a market economy, medical practitioners in China have moved back to the track of being professionals, after served as ordinary state workers for decades. Mao‘s romantic ideology of ―popularity‖ and ―simplicity‖ has now been replaced by the pragmatic idea of professionalism to meet the need of healthcare reform and the growing demand of healthcare services in the post-Mao era. This has put Chinese medical doctors back to the track of professionalization. The purpose of the current research is to investigate the extent to which medical doctors have been professionalized in the People‘s Republic of China and how far the process of professionalization has been institutionally constrained. A theoretical framework was developed in the review of literature on professionalization with focusing on linking the concepts of profession, professionalization, professionalism, and professional commitment. All these have to be considered under the rubric of state-profession relation which is particularly relevant in the Communist authoritarian setting of China. With heavy reference to Friedson‘s ideal model of profession, this study sets to examine the medical profession in China from an institutional perspective. This is a qualitative study with in-depth interviews of medical doctors and related stakeholders as the main research tool for data collection. Guangzhou was selected as the location for this study given its relatively advanced development. A total of thirty medical doctors aged between 25 and 75 in three different age i groups from major hospitals in Guangzhou were interviewed in 2007. To allow an objective assessment of the medical profession and its professionalization, 17 different stakeholders consisting of 11 patients, 3 medical association representatives and three hospital presidents were interviewed in Guangzhou in May, 2008. All the interview records were categorized and analyzed to address the theme of professionalization. The interviews with medical doctors in three different age groups in Guangzhou provided solid evidences of how institutional constraints affected the professionalization of each generation under the growing influences of Western professional values. Their opinions provided an overview on how the profession has followed the path of professionalization under a top-down hierarchical political setting. Under the strong state influence, the profession has enjoyed limited professional autonomy which hindered the pace of professionalization. Though this somehow has arrested their professional commitment, especially the younger ones, medical doctors still held a positive attitude toward the future prospects of the medical profession. The market economy did create different kinds of challenges to the profession, especially their roles in and attitudes to healthcare provision. However, it has also given rise to opportunities for further improvement of their professional competences and for greater achievement of resource enrichment. The interviews of major stakeholders highlight their expectations from the medical doctors, namely, the provision of extensive individual care, better outcome, and quality service. The current tense doctor-patient relation has negatively affected the professionalization as the lack of trust from patients and the public has undermined the morale and the ii enthusiasm of medical doctors. In some respects, the professionalization of medical doctors in China has had elements in common with the West. However, medical doctors have only been granted limited autonomy under the dominance of the Communist state. The State-driven professionalism has focused mostly on the professional standards and service quality without much concern over developing the profession for itself. To align with international norms, the State has basically followed the institutional roadmap adopted by Western countries for the professionalization of the medical profession in China. The professionalization of the medical profession in China is by no means straight-forward when one considers the institutional constraints from the hierarchy, community and the market: Hierarchical constraints. Though the top-down approach of organizing the medical profession has been liberalized as the process of professionalization progresses, it still imposes a lot of hierarchical constraints from the state machinery on moving the medical profession toward independence, autonomy and self-regulation. Community constraints. The interests of the profession itself are effectively subordinated to the community medical well-being. The profession and the professionalization cannot be detached from the community from which they should derive their professional identity. The gap between market value and community value may not be easily bridged. To balance the interest (and power) between the medical profession on the one hand, and that the State and society on iii the other hand, the empowerment of the medical associations as the guidance of medical doctors may be a way out. Market constraints. As a whole, the healthcare reforms have restricted market autonomy and hence the professional autonomy of medical doctors in the pursuit of their market and professional value. How to handle the problematic relationships with tremendous pressure from both the State and the patients while keeping the professionalization progress has constituted the major challenge to the medical profession. From what have been mentioned, unless the three parties, namely, the State, the medical doctors and the patients, can interact with each other in harmony within the healthcare system, it is difficult for the medical profession to progress smoothly in the professionalization process which is beneficial to the society as a whole. Thus, only with strong institutional settings could the medical profession be granted with authority in terms of its professional locus and status; the community should engage themselves in knowledge advancement and maintain the professional morale through the building of trust with patients which can serve as an intrinsic motivation for professional innovation and professional well-being; and the market should regulate the profession and provide them with necessary extrinsic motivations through the use of the pricing system. To conclude, the Western model of medical professionalization might not be fully applicable to the medical profession in China under different institutional settings. The role of the State is still salient in future development of the medical iv profession though under a marketized economy. With the rising power of the public and patients, the medical profession needs to put more efforts in striving for professionalism. Rather than mimicking from the West, the medical profession should work out its own way to professionalization, under the State‘s guidance with market as a stimulating force. This study has provided a snap-shot of professionalization of medical doctors in China with a lot of insights and sound observations. However, its small scale with one-city focus may limit the generalizability of its findings. Much research has to be done in the future to provide a stronger empirical basis for a more conclusive understanding of the medical profession in China. v ACKNOWLEDGEMENT This thesis could not have been completed without the guidance
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