Comparing national patterns of medical specialization: a contribution to the theory of professions

Abstract

This paper examines the causal factors behind the increase of medical specialization in Great Britain, Germany and the U.S. Current research into professions usually explains the phenomenon of growing specialization by referring to innovations in medical science and technology, competition among physicians, the differentiation of research institutions and medical schools, government intervention and organizational changes in the delivery of health care, but it does not pay sufficient attention to the mediating impact of institutional contexts on these independent variables.The analysis shows first that the causal relevance of these independent variables varies considerably across countries, and second that this variance can be explained by examining the role of institutional contexts as an intervening variable.Regulatory systems affecting the growth of medical specialization are given particular emphasis.