Author: Agostina Loreley Gieco
Labour precarization and class boundaries in physicians of General Medicine, under the pacemaker of Evidence-Based Medicine
The 36th International Labour Process Conference 2018
‘CLASS AND THE LABOUR PROCESS’
Faculty of Social Sciences, University of Buenos Aires, 21-23 March 2018
Precarious Work in Comparative Perspective
ABSTRACT
Labour precarization and class boundaries in physicians of General Medicine, under the pacemaker of Evidence-Based Medicine
There is a scattered literature about some aspects of the pauperization process of physicians (based on livelihoods and income as delimitation of fractions and class segments) and about precarization process of these professionals (related to material conditions of the work process such as: work environment, alienation, conditions of employment contract: pension system, provisional security, unstable and temporary forms of hiring, seniority and elements that establish a minimum remunerative amount, absences, substitutions and internship, conditions of designation, etc.). But in these theoretical contributions, the description of these dynamics and their movements (all of them of a quantitative nature) are not related to the processes of proletarization (of a qualitative nature). The discussion about the definition of class boundaries and social position, and the processes of work's transformation forces us to take up the Braverman-Derber debate. According to them, salaried professionals lose power, but there isn't conclusive evidence to support the thesis of disqualification or taylorization, typical of the processes of proletarianization of industrial workers of the nineteenth century supported by Braverman and other Marxist theorists. That is why Derber postulates ideological proletarianization as a loss of control over the ends and uses of work, differentiating it from the technical proletarianization that supposes the loss of control over knowledge and technical decisions concerning work.
The professionals maintain their craft skills and their relative autonomy at work. However, the development of the trend of Evidence-Based Medicine that involves the construction of knowledge and application of medical practice through systematized guidelines for intervention (according to the standardized Clinical Epidemiology framework) forces to rethink the limits between these definitions, and their scope. All this in a process of increasing commercialization and the loss of social conquests linked to public health, which gradually submits services (not without contradictions) to an increasingly commercial logic, overlapping after the pretended public policies of primary health, thought from the international health organisms issued by international credit organizations.
In this context, it is worth asking: How is the control of the work process in its dimension of ideological and/or technical proletarianization?Do job precarization and the strategy of Evidence-Based Medicine constitute a process that benefits management, increases professional individualism and ideological proletarianization? All this embodied in a specialization like General Medicine, deepens the difference between these professionals and other workers in relation to ideological and technical proletarianization? How does Evidence-Based Medicine express tendencies to bureaucratization, and in what sense does it do so? Resorting to efficiency, or as a pivot for capitalist production?