Ritchey F J, Pinkston D, Goldbaum J E, Heerten M E
Department of Sociology, University of Alabama, Birmingham 35294.
Soc Sci Med. 1989;28(1):69-80. doi: 10.1016/0277-9536(89)90308-0.
From an interprofessional role boundary maintenance perspective, this paper traces the historical development of physical therapy relative to physicians. Then, using survey data of 206 physicians in a metropolitan area of the United States, two hypotheses are tested regarding the prospects of physical therapy expanding its role to include highly autonomous skills. The first, from a set of structural-functionalist assumptions about role differentiation, posits that role expansion will precede status enhancement. The other, from conflict-theory assumptions about status politics, posits the opposite. A panel of physical therapists rated 24 procedures as requiring high, moderate and low skills. There was no significant difference in frequency of physician referral for the three levels; referral was associated with patient needs rather than physicians' perceptions of practitioner competency and status. The structural-functional hypothesis was supported, and two policy implications are noted: (1) an expanding physical therapy role is not likely to stimulate 'turf battles' with physicians, and (2) currently, greater professional autonomy is likely to be acquired by physical therapists making physicians aware of the extent of therapists' capabilities (role expansion), rather than through legislating more stringent curricular and license standards (status enhancement). The study is preliminary due to a small response rate.
从跨专业角色边界维护的角度来看，本文追溯了物理治疗相对于医生的历史发展。然后，利用美国一个大都市地区206名医生的调查数据，对关于物理治疗扩展其角色以纳入高度自主技能的前景的两个假设进行了检验。第一个假设基于一组关于角色分化的结构功能主义假设，认为角色扩展将先于地位提升。另一个假设则基于关于地位政治的冲突理论假设，得出相反的结论。一组物理治疗师将24种程序评定为需要高、中、低技能。这三个技能水平的医生转诊频率没有显著差异；转诊与患者需求相关，而非医生对从业者能力和地位的看法。结构功能主义假设得到了支持，并指出了两个政策含义：（1）物理治疗角色的扩展不太可能引发与医生的“地盘之争”；（2）目前，物理治疗师更有可能通过让医生了解治疗师的能力范围（角色扩展）来获得更大的专业自主权，而不是通过立法制定更严格的课程和执照标准（地位提升）。由于回应率较低，该研究只是初步的。
