Medical Power and Hierarchy in Australia

This essay explores the dominance of the medical field in Australia over nursing and allied health professions using ideas of social theories. It discusses the biomedical model and the Australian healthcare system in brief before discussing in details the concepts of power and hierarchy.

Running Head: POWER AND HIERARCHY 1
Medical Power and Hierarchy in Australia
Student’s Name
Institutional Affiliation

POWER AND HIERARCHY 2
Health is a multidimensional theory that addresses mental, social and physical wellbeing.
What a health care system does is not only promoting health but also maintaining or restoring
it (WHO, 2009). According to Callahan (2010), the success of a healthcare system is determined
by how the system serves the ailing patients. The reason for authority and power were given to
one professional group is to ensure that the quality of services (care) offered to consumers is not
compromised. Professional hierarchy in medicine comes up when healthcare practitioners realm
work to established how medicine is to be practiced. Theorists in the past have come up with
sociological perspectives and theories that explain the dominance of the medical field. There has
been a debate over the right relationship between professionals in healthcare. The concept of
medical dominance is deeply rooted in the Australian healthcare system. From the clinical
position, doctors take in health in treatment as well as diagnosis, they are able to establish
dominance through political, clinical and economic autonomy (Willis, 1989). This essay will
explore the dominance of the medical field in Australia over nursing and allied health
professions using ideas of social theories. This paper is outlined to first explain about the role
played by sociology and perspectives in healthcare. That will be followed by a discussion of the
biomedical model and the Australian healthcare system in brief before discussing in details the
concepts of power and hierarchy.
Adorno (2018) defines sociology as learning about people in their respective societies
and exploring their social interactions, relationships and culture from micro to macro- level
groups. Health sociology targets to understand the important issues in humans like pain
suffering, and health and even proceeding to examine the impact of the health conditions
Sociology in health examines the occurrence of illnesses and the interventions possible in
specific locational and societal settings. Sociology in health according to Pescosolido, Martin,

POWER AND HIERARCHY 3
McLeo and Rogers (2010), comprises of health and illness, medicalization, cerebral health,
infirmity, and social epidemiology. From a sociological point of view, health and illness have
their roots as social organization, traditions beliefs, culture, and ethnic traditions, in the way they
come about and how they are spread. This, therefore, means that health problems are social
problems. As an example, poor people in the society are likely victims of illness and health
issues as compared to people of a higher social class. Unlike medical insights, sociological
perspectives regard external influences of demographics of those contacting illnesses and
diseases. The patterns of illness and health across societies or within societies is not constant. For
example, mortality is low in developed and industrialized societies and that leads to higher life
expectancy in developed societies over the undeveloped or the developing ones. Heath and
illness are also attributed to inequalities existing in societies. The unequal share of social,
political and economic resources and power link the quality of care patients receive. As a
summation of all these, as biological and natural factors are in determining health or lack of it,
sociological insights also play a role.
There are various approaches to sociological exploration. Sociology provides answers
like the definitions of health relative to peoples’ view, sex, and addictions without limitations to
others. Other issues that are guided by sociological perspectives is the viewing of condition or
infirmities, previously thought to be normal but are now taken for disease and vice versa. The
impact of perspectives is felt by the understanding of issues of this weight. The interactionist
perspective addresses the understanding of personal health and how these health statuses affect
others. An example is having an Ebola patient within a society. The interaction of the patient
with other people in the same society including health providers puts their health statuses at risk
of contracting the fatal and highly communicable disease. A functionalist perspective, for

POWER AND HIERARCHY 4
example, looks at the social aspects and how fundamental they are in addressing societal health
and viability through macro analysis. By so doing, the impact of the healthy population in a
society is examined and how it influences the stability of a society, for example, the recovery of
the sick. A conflict perspective sociological analysis according to Andersen and Taylor
(2012), targets eliminating social inequality between people in healthcare systems. As already
mentioned, a socially disadvantaged background is a socially disadvantaged quality care. Lack of
equality in genders, races, tribes, and other domains according to this perspective, are
contributing factors in poor health. As a result of globalization, health is continuously perceived
differently. The social formation and shaping of diseases have been analytically perceived by
sociologists. Feminists, for example, explain the impact of patriarchy in the medical domain over
other health professions. Marxists’ perceptions are attached to the role of social stratification
while Foucauldians are more of how professionals administer the society.
The Australian healthcare system is a broad economic sector that combines both the
public and private providers. The public sector, however, is more established and widely spread.
All sectors of the system are under supervision from Australia’s three levels of government and
thus AHCS is influenced by political, legal, economic, technical and social structures. From the
primary system being universal, there is an emphasis on equality. The biomedical model takes a
critical position in the Australian healthcare system (Hally, 2008). These model disregards all
social factors relating to health and illness and lays its focus on biological and physical traits of
disease and infections (Mazzotta, 2016). The model also does not consider the psychosomatic
and ecological influences on illness and health. It is a doctor’s centered model and one that can
accurately diagnose and treat most diseases and infections. Some of the practices within the

POWER AND HIERARCHY 5
model are medication, chemotherapy surgery, and x-rays. Much focus in the model is laid on the
solution (treatment) and not the conditions leading to illness.
Medical dominance has been a topic of interest by social theorists in the past since the
19th century. Interests of the medical doctors are always paramount and therefore medicine is the
dominating class in healthcare systems of many nations. Doctors, therefore, exercise power as
they occupy the highest hierarchal position in healthcare. Nursing and allied professions have
partial decision-making roles. This dominance is more of a clinical boundary that separates the
clinical knowledge of both fields. There are two views of medical dominance distinguished from
the comprehension of autonomy and the degree of applicability of the autonomy in
healthcare (Ovretveit, 1985). According to Willis (1989), autonomy is expressed also in political
and economic fields. This is done by incorporation, exclusion subordination, and even limitation.
In Australia for example, doctors show dominance political means. In Australia, doctors have
joined in associations that entice the government to limit how the other professions. The medical
profession is also legitimized in Australia. This is enhanced by political and legal structures
(Furze, 2014). One field in health that has been dominated by doctors is medicalization of
childbirth. (Naidoo & Wills, 2016). Historically, only doctors had the authority from the
Australian government to sign death certificates, hold appointments with the government among
other advantages (Furze, 2014). According to the functionalist theory, the relationship between
doctors and patients is complex and consequently demands complexity in analyses.
Medical dominance according to Michael Foucault is a historical concept that defined the
professionalism of the medical domain (Barry & Yuill, 2011). How dominance of medicine
came about was through the sheer increase in the demand for healthcare and the profitable
market for medicines. In Australia, professionalism is one of the reasons why there is

POWER AND HIERARCHY 6
dominance. From the power of the medical doctors, the other health occupations are restricted to
opportunities available. The domination of medicine is monopolistic. One thing about the
medical profession is that it maintains legal and formal rules and principles to control the other
healthcare fields without subjecting to them. Actually, Willis (1989), suggests that the state
benefaction to the occupation of medicine is the reason medicine is more powerful than the allied
health professions and nursing. This was the reason why Freidson prayed for the formation of a
distinct kind of medical sociology that would put into practice structural perspectives to the
medical institutions and still remain a distance away from the assumptions of medicine and its
perspectives.
Division of labor is a particular case of the distinguished power and hierarchy of the
medical domain. How labor is divided in Australia is from the hierarchal nature and dominance
of medicine occupation and it is done using a capitalistic approach. Nurses are often held
submissive to doctors. In Australia, there have been claims that nursing has been devalued by
medicine and has been nicknamed “women’s work”. Labour division is categorized into two;
sexual and occupational divisions. It is out of these two bases that a hierarchal structure that
results into the serious disparity in the earnings and standing of nurses and doctors. This disparity
in status and income and the limitation of nurses as decision makers is what was captured by the
conflict approach theorists. The duty of a qualified doctor is diagnoses and treatment of
problems, however, Conrad and Leiter (2003) suggest that categorizing social problems as
medical issues is a monopolization of treatment and an ignorance of the significant social causes
of the conditions. However, this continues to be the case in Australia where the biomedical
model is over-relied upon. It has actually been noted that as much as the model is praised to be
accurate, it is not completely perfect.

POWER AND HIERARCHY 7
Still, on the division of labor, Henslin, Possamai, Possamai-Inesedy, Marjoribanks and
Elder (2014) maintain that the health profession is gendered as most males are doctors and most
females are nurses. Historically, this is Australia can be implied to mean that women are
regarded as inferior to men and thus cannot take manage the more advanced medicine career.
This is the concept of patriarchy that has been addressed by Greig, Lewins, and White (2003).
Feminists are also against inequalities between nursing and medicine based on gender. Despite
the recent improvements in the health sector in Australia towards the inclusion of many women
in the medical career, total equality is still far from attainment as not many women are included
in leadership positions. Statistics show that Australia has only 12.5 %women in CEO positions in
the healthcare sector (The Conversation, 2016). This is actually an improvement as the statistics
were even worse before 1980. It has been found out that, at interactive level, chauvinistic micro-
aggressions, insentient biases, and club culture are the major influences towards the antagonistic
environment for women in the general healthcare setting. Again at structural levels, the
traditional social customs and male chauvinism in career paths are stumbling blocks for women
who have tight motherhood schedules like maternity leaves or giving care to families to
acquiring higher positions of power that require more dedication and longer stays in duty.
There is a notable change however and the intensity of “inequality” is not as much as it
used to be in the past. This from the fact that the government and many organizations have been
pushing for more women into the dreaded medical fields and the high positions of power within
these careers. The contribution of the government particularly in the healthcare setting goes in
allowing for equality in the opportunities for all genders in their admission to medical schools.
The number of women in formal leadership positions and areas of specialty practice, though low,
is still an improvement in the present day. The reason for putting “inequality” in these quotation

POWER AND HIERARCHY 8
marks is because social theorists missed on some points in their discussion about the “gendered”
medical field. The point missing consideration of factors within women especially related to
motherhood that limit the women in taking the demanding medical paths or withstanding the
leadership positions in this position. Moreover, most are the times when women have the skills
(are intelligently capable) needed for certain jobs but lack confidence in themselves or rather
hold back in making moves to taking these top positions or extending their studies to gain
promotion to certain specialty areas of practice. This confirms that it is not always inequality as
it is perceived from the outside. Having fewer women in the medical field should therefore not
be interpreted to mean inequality. In Australia, there has been an alteration of structures in a
move to improve the professional status of nursing, but there is still much left to do. According
to Freidson (1988), hierarchy is grounded on the putatively loftier knowledge of professionals.
However, Willis (1989) argues that hierarchy should include negotiated power. Bureaucratic and
collegial relationships are what define teamwork in the framing of a perfect labor division. This
is, however, not the case in Australia as the position doctors take does not allow for negotiated
power or team working. Nurses and allied health professions only act in subordination.
To sum up, power and hierarchy are well positioned in Australia’s healthcare system. The
superiority of the medical field is primarily based on its autonomy or rather its independence.
Theorists in the past have studied the concept of medical dominance and some even criticized it.
The division of labor and gender inequality are among the major concerns highlighted in this
study based on conflict and feminist theories. The inequality in nursing is actually disputable on
the grounds of limitations within women based on balancing duties and motherhood. There is a
need to review medical dominance and balance it with other healthcare filed in a move to
improve the service delivery to patients.

POWER AND HIERARCHY 9
References
Adorno, T. W. (2018). Introduction to sociology. John Wiley & Sons.
Andersen, M. L., & Taylor, H. F. (2012). Sociology: the essentials. Nelson Education.
Barry, A. M., & Yuill, C. (2011). Understanding the sociology of health: An introduction. Sage.
Callahan, P. M. (2010). Power Allocations and Professional Hierarchy in the Illinois Health Care
System. DePaul J. Health Care L., 13, 217.
Conrad, P., & Leiter, V. (2003). Health and health care as social problems. Lanham: Rowman &
Littlefield.
Freidson, E. (1988). Profession of medicine: A study of the sociology of applied knowledge.
University of Chicago Press.
Furze, B. (2014). Sociology in Today's World - with Student Resource Access 12 Months.
Melbourne: Cengage Learning Australia.
Greig, A., Lewins, F., & White, K. (2003). Inequality in Australia. Cambridge, UK: Cambridge
University Press.
Hally, M. B. (2008). A guide for international nursing students in Australia and New Zealand.
Elsevier Australia.
Henslin, J., Possamai, A., Possamai-Inesedy, A., Marjoribanks, T., & Elder, C.
(2014). Sociology Down to Earth Approach VS (2nd ed.). Sydney: Pearson Education
Australia.
Hughes, D., & Allen, D. (2017). Nursing and the division of labour in healthcare; Sociology
and Nursing Practice. Basingstoke: Macmillan International Higher Education.

POWER AND HIERARCHY 10
Mazzotta, C. (2016). Biomedical approaches to care and their influence on point of care nurses: a
scoping review. Journal Of Nursing Education And Practice, 6(8). doi:
10.5430/jnep.v6n8p93
Naidoo, J., & Wills, J. (2016). Foundations for Health Promotion-E-Book. Elsevier Health
Sciences.
Ovretveit, J. (1985). Medical dominance and the development of professional autonomy in
physiotherapy. Sociology Of Health And Illness, 7(1), 76-93. doi: 10.1111/1467-
9566.ep10831370
Pescosolido, B. A., Martin, J. K., McLeod, J. D., & Rogers, A. (Eds.). (2010). Handbook of the
sociology of health, illness, and healing: a blueprint for the 21st century. Springer
Science & Business Media.
The Conversation (2016) Female doctors in Australia are hitting glass ceilings –
why? Retrieved 10th October 2018, from http://theconversation.com/female-doctors-in-
australia-are-hitting-glass-ceilings-why-51325
White, K. (2016). An Introduction to the Sociology of Health and Illness. SAGE.
WHO. (2009). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety
Challenge Clean Care Is Safer Care; Definitions of health-care settings and other related
terms. Retrieved 10th October 2018 from
https://www.ncbi.nlm.nih.gov/books/NBK144006/
Willis, E. (1989). Medical Dominance Revised. Allen & Unwin.