HSC210: Power and Hierarchy in the Australian Healthcare System

This essay delves into the intricate concepts of hierarchy and power within the Australian healthcare system, with a specific focus on medical dominance. The study employs sociological theories, including feminist and conflict approaches, to analyze the dynamics between medical professionals, particularly doctors, and other healthcare workers like nurses and allied health practitioners. It begins by providing a foundation in sociological perspectives relevant to healthcare, including functionalism, conflict theory, social interactionism, Marxism, and feminism, and then outlines the structure of the Australian healthcare system, including the biomedical model and the influence of government. The core of the essay examines how doctors hold a dominant position, influencing decision-making, autonomy, and economic, clinical, and political power, often at the expense of other professions. The essay highlights the impact of gender inequality, patriarchy, and the division of labor on the healthcare system, and it explores the limitations of the biomedical model. The analysis also considers the historical context of medical dominance and its implications for the nursing profession. The essay concludes by discussing how sociological perspectives can offer insights into the distribution of power and the impact of these dynamics on healthcare outcomes and professional roles.

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Hierarchy and Power in Australia Health Care System
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In Australia, the concepts of hierarchy and power (medical dominance) are firmly
grounded and other healthcare careers like nursing being subjective to it. Theories and
perspectives like functionalism, conflict theory, social interactionism, Marxism, and feminism
have all explained these two concepts and some of them criticizing it. Doctors take a very
critical position in health and during health assessments (diagnosis) and management. It is from
this characteristic that they dominate the health sector. Medical power is not under any
direction by other professions in health. This is an aspect of autonomy that was described by a
sociologist called Willis, (1989). Doctors have economic, clinic and political autonomy. They
autonomy is exercised over nurses and allied healthcare practitioners in different ways:
limitation, exclusion, subordination and incorporation (White, 2016). Doctors are therefore are
held with so much stature in Australia (Braithwaite et al., 2016). This study will explore aspects
of hierarchy and power, particularly in the Australian healthcare system using the feminist and
conflict approach sociological theories in a detailed reflection on medical dominance and its
effect on nursing and other allied healthcare professions. The implications of the theories will
also be highlighted. To achieve these objectives, this paper is outlined in a way that it will first
explain about sociology the role of perspectives in health care. The Australian healthcare
system will also be discussed together with the valuable biomedical model. Finally, the paper
will discuss power and hierarchy in details using the feminist and conflict approach theories.
Sociology is a scientific study of the society and its patterns of social interaction,
relationships and culture (Adorno, 2018). It is commonly termed as studying humans in their
societies. Sociology study all aspect in small or extensively large groups; macro and micro level
societies. Components of the sociology of health are disease, medicalization, mental health,
disability and social epidemiology (Pescosolido, Martin, McLeo & Rogers, 2010). The reason for
health sociology is to understand the issues of much importance to human beings like pain,
health, and suffering but also going into details of how health and illness affect the working of
society incorporation (White, 2016). Sociologists argue that the occurrence of health or illness is
from the contribution of the societal organization. In simpler terms, diseases are socially
formed and spread. Also, from Germov (2014) argument, health and illness have social origins
and health problems are social issues. This as an example, is when poor people living and
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working in similarly poor conditions and environments are much more predisposed to illness
and thus dying much earlier than their counterparts occupying the top social system
incorporation (White, 2016). Sociologists explore many issues of day to day living in the society
like the inequalities based on gender, ethnicity, race, and class (Livesey, 2014). Disease and
health are thus linked to inequalities in the society. This inequality in the way resources of
economic, political and social are distributed is the social gradient on which health lies.
Sociological perspectives are very significant in the way society tackles epidemics and disaster
outbreaks.
The way health is perceived is evolving as a result of globalization and technological
advancement within societies (Brooker & Waugh, 2013). This technological determinism is what
has been used to examine the development of the medical field to a position of dominance. The
medical power has not evolved from its scientificness or technical advances but from its
occupational organization into groups that lead and control other workers in the health field.
The medical knowledge is shaped by the society and is thus not 100% scientific (White, 2016).
Different sociologist draws different perspectives in their explanations of how the diseases are
shaped and produced socially (White, 2016). Marxists, for example, put more weight on the
role of social stratification (formation of distinct classes and categories), feminists draw on the
role of patriarchy in the medical field and matriarchy in the nursing field, ethnicity sociologists
focus on the impact of racism, and Foucauldians are of the perceptive that the society is
administered by the professionals (White, 2016). The functional perspective encompasses the
analysis of the broad society (macro-level) as it gives a broad picture of the aspects within the
society that influence the stability of health and viability of the society as a whole (Stolley,
2005). The conflict point of view is that eliminating societal inequalities is a boost to the
healthcare system. Lastly, the perspective of the interactionist theorists is that the
understanding of health is a personal issue and one's health status affect others in the society.
Healthcare systems are complex and uniquely different from other work environments.
A health system consists of people, institutions, and resources all organized in a systematic way
in order to deliver healthcare services that satisfy a specific target population. Healthcare
systems are developed by nations such that they are limited to the needs of the population and
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the resources at hand. Through a health care system, health can be promoted or restored. In
Australia, the health care system is a large economic sector comprising both private and public
sectors. It is said to be an important factor towards better health outcomes of all Australians as
it delivers all health initiatives in the country. The dominating sector, however, is the universal
health care (public). The three-level of the Australian government are the watchdogs over the
system making AHCS an influence from social, technical, economic, political and legal
structures. The dominating system being a universal health care emphasizes the equality of
care despite discrepancies between clients.
Apart from the social model of health in Australia, there is the biomedical model which
is a key perceptive in health. According to Germov (2014), the biomedical model has certain
limits and it is necessary to rediscover the social medicine and public health. The model is
concerned about the physical and biological characteristics of disease and infections (Mazzotta,
2016). The model is used to diagnose and treat illness and conditions on the onset of
symptoms. The model is centered on doctors, health providers, and the hospital setting. It
encompasses practices such as stitches to facilitate the healing of laceration, surgery,
chemotherapy, medication, and x-rays. The biomedical model is not so much concerned about
the etiology of disease/illness but the presenting condition and the solution to the condition is
primary treatment. Since the biomedical intervention is primarily attached to biological
determinants of illness, social and behavioral causes are not considered. Medical science and
technologies prove very crucial in the accurate diagnoses of disease within the model. The
biomedical approach to health is the first consideration and the dominating intervention as far
as health care is concerned in Australia (Hally, 2008). It has played a pivotal role in extending
life expectancy in Australia. The model is criticized on the grounds that it ignores the role of
social factors and thus may not always be the solution to promoting good health. Again the
model is costly (reliant on professionally trained personnel), does not treat all conditions, and is
not readily affordable for all people.
A theorist called Michael Foucault explained medical dominance as a historical concept
that defined the professionalism of the medical field (Barry & Yuill, 2011). Doctors are the
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highest ranked professionals in the Australians health system’s hierarchy. In most cases, the
nursing and allied professions have limited and subjective decision making roles. This makes the
dominance look like a boundary of clinical knowledge and proficiency between professional
doctors and nurses (Bradby, 2012). Nurses’ role as decision makers is limited by the medical
power and Medical dominance and hierarchy are integrated by the conflict approach theorists.
Variables of gender, race, tribe, and class are linked to medical dominance (Andersen & Taylor,
2016). This is the same concern by feminist theorists even though they are primarily focused on
gender imbalances in the medical career. The nursing occupation is far from reaching a
complete professional status in Australia. This does not consider the advancement in the
alteration of the occupation’s structures. How labor is divided I healthcare is based on the
hierarchal nature and dominance by the medical career. The labor is further differentiated into
2 bases that actually relate to each other. One of the bases is occupational division while the
other one is sexual (gender) division. From these two bases, a hierarchal structure leads to a
serious variation in the income and status between nurses and doctors. According to Furze
(2014), the medical field is justified or legitimized by political and legal systems.
The health sector in Australia has been characterized by patriarchy and inequality
(Greig, Lewins & White, 2003). The health occupation is gendered in that many male doctors
dominate the medical field with many females are nurses (Henslin, Possamai, Possamai-
Inesedy, Marjoribanks & Elder, 2014). At an interactive level, a club culture, insentient biases,
and chauvinist micro-aggressions are the contributors towards antagonistic environment for
females in healthcare settings. At structural levels, the conservative social norms, and male-
dominated career lines can be a barricade for females to stand the pressures of motherhood
like caregiving and maternity leaves and leadership positions. Even with the recent
improvements in the last 3 decades towards gender equity in Australia, and the rise in the
number of women taking the medicine courses, and the government providing for equal
opportunities for both males and females in gender parity promotion in medical schools, the
number of women with formal leadership positions and specific specialty areas is still low.
According to The Conversation (2016), even with the significant rise in the medical female
workforce in hospitals all over Australia, only 12.5 % or less are women chief executive, with
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only 28% of schools of medicine having women deans and only 33 % of state and federal chief
medical officers as female. This has been a rise from the 1980’s when the percentages were
even smaller, however, it can be considered as a case of equality when doctors are dominating
every field. This is often perceived as an “inequality” that see women medical professional
being channeled to specific fields and statuses that attract weaker wages while the high profile
roles being dominated by males who receive huge amounts of salaries.
However, this cannot be said to be an explicit case of gender inequality because of some
reasons. In most cases, it is not men excluding women from the leadership positions but a
range barricades around insights of credibility, capacity, and capability. Women are
intellectually capable of taking the high profile roles but sometimes lack the confidence to put
themselves forward for these positions. Again, their capacity to serve is perceived to be even
more than that of men, however, balancing manipulating leadership and long hours in specialty
fields of practice with motherhood limits them to certain roles. Sometimes, there are further
studies that are required in order for one to hold certain specialty positions of power which is
also becomes a challenge for many women struggling with motherhood. The barrier of
credibility is when women can be trusted solemnly as leaders or lead surgeons (Zhuge,
Kaufman, Simeone, Chen, & Velazquez, 2011). The conflict theory and the feminist theorists,
therefore, fail to consider these factors and therefore an alienation of women to high profile
role is. The reason for patriarchy in the medical field, therefore, is not primarily an externally
imposition on females by males and could be within women but through the organizational
(workplace) culture and values. The conflict approach and feminist theorists, therefore, should
have also considered mentoring the women to have beliefs within themselves that they can
take the masculine roles and perform well.
A sociologist by the name Friedson (1988) viewed hierarchy as organizational
subservience to senior officers. His view was criticized by Larkin, to be a case of dominance and
not hierarchy. Larkin believes that hierarchy is a case of delegated power and not occupational
subordination to the senior officers or professional experts (Willis, 1989). According to Willis
(1989), how labor is divided into the health sector proves medical dominance over nursing.
Labor in Australia is divided from a capitalist approach. Were it not for the state patronage ---
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according to Willis--- the medical sector would not have such dominating power over nursing
and other health professions. In healthcare facilities in Australia, how labor is divided is in a way
that nurses are always submissive to doctors. Social theorists argue that the power of medicine
is from the male chauvinistic society that degrades nursing as a female career. This is also not a
valid truth as the number of male nurses has increased from the1970’s. However, the extent of
equality in this case, which is actually true, is that male nurses are better placed to occupying
leadership roles and advancement of their careers into specialized areas by furthering their
nursing knowledge through more studies. Willis, therefore, believed that many males could not
eliminate the notion of nursing as “women’s work” as that did not bring equality in leadership
and specialization. However, owing to the earlier argument that the women are mostly limited
to factors internalized within themselves in charming the leadership positions and specialty
practices, Willis argument lack s total solid weight that indeed dominance of medicine over
nursing is a gender imbalance case.
In conclusion, medical dominance (power and hierarchy) is deeply rooted in the
Australian healthcare system. Sociological theorists like Willis and Friedson among others have
tried explaining the autonomy of the medical dominance criticizing its structure as
discriminative in terms of sex and others ways. The feminists and the conflict approach
theorists, in particular, are concerned about the gender inequality in the healthcare and the
medical domains. However, the theories do not consider the fact that gender imbalance in
health is not primarily from men excluding women but also the nature of women roles outside
work particularly motherhood which limits most of them to stepping forwards for top
leadership positions and specialty fields like surgery.
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