Hierarchy and Power in the Australian Healthcare System

This article discusses the impact of hierarchy and power in the Australian healthcare system with the help of sociological theories and concepts. It explores the dominance of medicine, the role of corporatization, and the strict hierarchy in healthcare organizations. The article also explains the biomedical model and its contribution to the healthcare hierarchy. The conclusion highlights the natural existence of hierarchy in every part of society and the politicization of healthcare.

Running head: HEALTH SOCIOLOGY
HEALTH SOCIOLOGY
Name of the Student
Name of the University
Author note:

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Hierarchy and power are intrinsic to the current health care system in Australia. Discuss this
statement by drawing on sociological theories and concepts. Discuss how this may impact on
you as a health practitioner.
Sociological theories are very important to be applied in the field of healthcare because
this particular field deals with people who are sentient beings and need to be treated with
utmost care. The medical field has its own form of hierarchy and dominance. Many researchers
agree that the present scenario of hierarchy and power relations in healthcare needs to change
in Australia, because these power exchanges affects the relationships between the patients and
the healthcare providers. The process in which the providers of healthcare get the training may
shape and model the way they are providing healthcare in their workplace in context to the
relations of power. There are many aspects in the medical training that are responsible for the
shaping of power sharing within healthcare settings and are abusive in many cases (Green et al.,
2017). Both in case of the patients and the healthcare service providers the idea of sharing
certain power and being in the hierarchical lineage within the system is being gradually shaped
and modelled by certain entities and causes within the medical field (Rodon & Silva, 2015). In
Australia most of the healthcare practices and systems are shaped and regulated by the
government. The universal healthcare system which is also known as the Medicare is the
publicly funded universal healthcare system in Australia.
Dominance, hierarchy and power is prevalent in every field of work, be it social, political
or commercial. In the organizational perspective there is a particular hierarchy which is
followed everywhere and in this particular field of healthcare various hierarchy, dominance and
power can be described. The political dominance in the field of medical practice is evident by
the type of controlled that is exerted by the political administration on the healthcare system of
a particular region. In an organization there is always the play of power. Employees of all levels
use power in the best possible way they can so that the objective they wish to achieve can be
achieved by them remaining within the organizational context. It is observed that the ability of
a particular individual to use and react to power is the basic requirement of the person in being
successful in the organizational background. In the healthcare system it is seen that the
dominance rests in the hands of the doctors and certified nurses or healthcare providers who

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has been for a long time in the field of medical practicing and they tend to dominate the
comparatively newly joined employees and the patients as well. According to () in general
terms however it can be said that medicine has been dominating the healthcare arena since the
longest time. However the trends are changing and recently it has been seen that the
domination of medicine in the social field is changing and the various concepts such as
corporatization and managerialism are giving tough competition to the dominance of medicine
in the field of healthcare. The corporatization of the healthcare sector has resulted in the
growth of medical followership and tribalism. It has been seen that the junior doctors who are
entering into the field of healthcare are usually forced to follow the norms and regulations,
official or unofficial imposed upon them by the seniors, and therefore the medical followership
and hierarchy is thus imposed. There are various theories that have aimed to comprehend the
various ways such hierarchy and dominance works in the society. Some of the theories are
Marxism, Feminism, Functionalism, Social Constructivism and Weberianism. These theories are
social theories that can be used in general explain societal events and also the hierarchy of the
society.
In Australia the present medical system is well developed and many people from various
parts of the world come to Australia for better medical treatment. The facilities in the
Australian healthcare are very professional and well structured. The healthcare organizations in
Australia are very strictly structure with strict hierarchy. The hospital structure is organized
hierarchically and the staff members are expected to follow the structure very strictly. This has
allowed the dominance and power play to be established in the healthcare field of Australia.
The healthcare givers in Australia can be classified into senior doctors, junior doctors, certified
nurses, nurses on training, the medical care givers, administrative staff and the executives
working at the lower level. The medical hierarchy in Australia starts from the senior medical
officers at the top, who can be further divided into General Practitioners, Staff Specialists and
Career Hospital Doctors. The next stage of the hierarchy consists of the Visiting Medical
Officers, then the Registrars, then the Principal House Officer and then the Resident Medical
Officers. The Resident Medical Officers can be further divided into Senior House Officers, Junior
House Officers, and the Interns. This is the whole structure and hierarchy of the medical

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scenario in Australia. It can be said that the Senior Medical Officers are the most senior in this
hierarchy and therefore politically and qualitatively they are the most powerful and they are
often having administrative power given by the government. In the organizational context the
highest decision maker is the person occupying this post and therefore in Australian context the
medical hierarchy is dominated by this person. They direct the total process of patient care. It is
in this position that the further hierarchy in the field of medical care is designed and followed.
The interns and the residents are having the least say in this Hierarchy in healthcare in
Australia. In general it can be stated that medicine still dominates the healthcare in Australia as
it is the case with the rest of the world. However with passing days the system and social trend
is changing and the corporatization is becoming the most dominant part of the medical care in
Australia. Power play is an integral part of every organization. The people at the top of the
organization usually tend to use the power in order to establish their own say in the
organizational context. It is seen that the Senior Medical Officers do the same in the healthcare
organizations on a localized context. On the other hand often the doctors are again controlled
by the corporate directors and owners therefore in the healthcare hierarchy the corporate
heads are gradually gaining more dominance and power in the field of healthcare. However in
the rural parts of Australia most of the doctors work in an independent way, and they have the
ultimate say on their patients, in this case the ultimate power rests in the hands of the
independent doctors and there is no corporate control over them (Carter et al., 2016). The
patients are directly monitored and directed by the doctors themselves. Here the usual power
and hierarchy trends does not occur.
The two theories which can be explained in this regard is Marxism and Social
Constructivism. Marxism is one of the social theories that can be most appropriately used to
explain the hierarchy and power dominance in the healthcare field. Marxism in general relies
on the idea that the society is actually made of two classes of people the ones who exploit and
who rule by using the wealth and power they have, and the section of the society who are
exploited and utilized by the more powerful section (Coburn, 2015). According to David
Mechanic (1990) in an articles in the health affairs “John McKinlay and John Stoeckle present
perhaps the most stimulating essay in the book, in which they review various forces

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transforming the work of physicians, such as the growth of regulation, more aggressive
physician administration, the increasing influence of other health workers, the oversupply of
physicians, and the emergence of physician unions. Using a Marxist perspective, they critically
examine Eliot Freidson's concept of physician professional dominance, maintaining that this
concept no longer applies.” The Marxist approach mainly delineates that the hierarchy in
healthcare is dominated by a particular section of the society who are in the powerful positions
either politically or administratively. The section which are dominated and on whom such
power is being displayed are either the patients or the lower executive and nurses who are not
as powerful or dominant position in their workplace (Malatzky & Bourke, 2016). Power politics
in the society or in the organizational contexts are explained in the Marxist theory in terms of
politics of proletariat and bourgeois. These theories are increasingly becoming important in the
field of healthcare and hierarchy within healthcare systems.
Social Constructivism is the theory which delineates that the order in the society and the
knowledge creation is constructed through the interaction of the human beings with each
other. Therefore the theory mainly deals with the interaction of human beings with each other
and how this gives rise to the social construction and the norms. The social norms and what is
considered to be the society as a whole is a construction of the human beings at a social level.
The human society works together and they aim to achieve similar goals, and this is true in
terms of making different artefacts, architectural buildings, or social theories and ideas. Ideas
actually shape the human society and the ideas are constructed by human beings themselves
which lead to social innovation and construction. In the hierarchy in the field of medicine and
healthcare the hierarchy is actually constructed, the senior doctors are occupying the senior
position in terms of the idea of their superiority in comparison to the other employees working
in the healthcare organizations or the patients (Eisenberg, 2017). The superiority is in terms of
the knowledge which the doctors are having which is greater than the staffs and employees.
The corporate owners and the doctors on the superior positions have constructed the idea that
they are hierarchically superior. Social constructivism is one of the most efficient methods of
explaining the making of the different concepts of social hierarchy (Kauppi, 2018). Medical

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hierarchy in Australia as already described is very much strictly imposed and everyone has to
follow the norms.
The Biomedical model is the model in the field of healthcare which states that the
physical reasons are the main factors which causes problems in the body of the individual. All
the health problems that exist in the body of the individuals are because of the physical causes
which exists (Lane, 2014). This particular model actually does not accredit the mental and
psychological reasons behind the various health complications that exist in the human beings.
The particular model states that the doctors are the most eligible individuals and the only ones
who has the right to treat the patients. This model also gives utmost importance to the usage of
medicine in the treatment of the patients. The model is often criticized for altogether ignoring
the psychological aspect of health complications and that the experts dealing with the mental
health of the patients also play an important role in the holistic treatment of the patients. The
biomedical model is responsible for the excessive sales of medicines and the over dependence
on the medical physicians for even small problems. Therefore this theory has contributed to the
hierarchy in the healthcare as it has placed the senior doctors and physicians at the supreme
position in the scenario of healthcare in the country and all over the world. The biomedical
model can be also related to the functionalist theory which views the different parts of the
system as separate entities. The theory states that everyone in the social order has their
responsibility of maintaining the good health of the society and that the social hierarchy plays
an important role in determining the overall quality of health of the society and the doctors
play the most important part in such maintenance. Without the doctors and the medicines the
ill health of the sick individuals cannot be recuperated and therefore they are invincible part of
the holistic health system of the society. The biomedical model is therefore important to be
described in this regard.
As conclusion it can be stated that hierarchy exists in every part of the society. It is the
nature of man to be a part of the system that is hierarchical. Either in the field of politics or in
the field of religion, either in the field of healthcare or in the field of technology, men needs
their leaders. Leaders show the way to the followers and the next generation of leader or
leaders can be selected from the followers themselves. It is often stated that a good leader is

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also a good follower. In the field of healthcare therefore similar hierarchy exists. This hierarchy
comes naturally with the senior doctors and the senior officials taking a superior position in lieu
of their position. The people occupying the higher position in the healthcare organization are
also given more power which they exercise on their juniors and also on the patients who come
to visit them. Whether or not such utilization of power corrupts with time or it can be made
useful in improving the health care given to the patients differs from organization to
organization. However it can be said that the general scenario comprises of the senior officials
exercising power to shape the operation of the organization in their own interest. The
politicization of healthcare is a known concept and often this becomes a hurdle to good
healthcare.

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Green, B., Oeppen, R. S., Smith, D. W., & Brennan, P. A. (2017). Challenging hierarchy in
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care. British Journal of Oral and Maxillofacial Surgery, 55(5), 449-453.
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