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Dialogues@RU is published annually
by the
Writing Program at
Rutgers, The State
University of New Jersey
Volume One
Spring 2002
The Routinization
of Health Care
and the Professional Calling -
Page 1
by Megan H. Johnson
Through the years, the "culture of work" has been altered in many occupations. One clear illustration of a type of work that has faced transitions over time is that done by workers in the health care industry, specifically doctors and nurses. Recent changes in the health care industry have greatly impacted the work of health care professionals. Two of the most pressing issues currently affecting the work of doctors and nurses are 1) the role of the HMO (Health Maintenance Organization) in health care, and 2) the impact of the present nursing shortage. In the article "Finding Oneself," Robert N. Bellah shares his views on the role of the individual in society, specifically making pertinent connections between individuals and the work they do, making classifications according to "job," "career" and "calling" that can be applied to the work of doctors and nurses. In the article, Bellah defines a calling in the following terms:
In the strongest sense of a "calling," work constitutes a practical ideal of activity and character that makes a person's work morally inseparable from his or her life. It subsumes the self into a community of disciplined practice and sound judgment whose activity has meaning and value in itself, not just the output or profit that results from it. But a calling not only links a person to his or her fellow workers. A calling links a person to a larger community, a whole in which the calling of each is a contribution to the good of all. (66)
In this description of qualities that characterize work as a calling, Robert Bellah stresses the importance of one's work being a connection with people outside the workplace. In this sense, work should involve a "give and take" between workers and those they serve. Beyond that, Bellah asserts that in order to truly practice a calling, one must morally integrate work into one's life, investing it with one's own values and a sense of purpose. This moral connection of work to a person's sense of self will then serve as a driving force, urging the practitioner of a calling to perfect his or her craft and take pride in it. Doctors and nurses do a type of work that many people might consider characteristic of a calling, as the word is defined by Robert Bellah, but changes in the industry may be modifying this designation by impeding personalized human interaction between health care providers and patients. By examining their current work roles in terms of Bellah's definition, one can gain insight into how the routinization of medical care is challenging doctors' and nurses' ability to experience their work as a "calling" in the present day.
Health maintenance organizations are undoubtedly driving forces behind many changes in the health care industry, most notably its economic transformation. The fiscal reform of health care has played a key role in altering the work performed by doctors and nurses, as it has forced them to consider costs when delivering care to patients. The controversial system of managed care arose in the 1980s, as insurance companies noticed trends of medical excess. Researchers conducted studies on how many "inappropriate" surgeries were being performed each year, and insurance companies decided something had to be done to hold down costs (Anders 23). Whereas physicians could once charge unchecked "fees for service" on any treatments deemed appropriate, companies began placing doctors on the capitation system of flat monthly salaries. Many hospitals were subject to similar plans involving "case rates" for treatment of specific illnesses, an approach that rewards providers for keeping patients out of costly intensive care units and internists' offices. The sickest patients, once viewed as lucrative sources of revenue, became the biggest financial drain on hospitals' fixed capitation checks (Anders 26). As a result of these changes, doctors can no longer order unnecessary tests to increase revenue, hospitals must control services or absorb the costs, and patients are forced to leave hospitals sooner. These HMO-instituted compromises have changed not only how health care providers are paid, but also how they are able to interact with patients.