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美国医生职业倦怠与美国医生无产阶级化:一种理论重构。

U.S. physician burnout and the proletarianization of U.S. doctors: A theoretical reframing.

机构信息

Center for Advancing Interprofessional Practice, Education & Research (CAIPER), Edson College, Arizona State University, Phoenix, AZ, USA.

National Board of Medical Examiners (NBME), Philadelphia, PA, USA.

出版信息

Soc Sci Med. 2024 Oct;358:117224. doi: 10.1016/j.socscimed.2024.117224. Epub 2024 Aug 10.

Abstract

We delve into the escalating issue of U.S. physician burnout, arguing its roots lie in the proletarianization of the U.S. medical profession-a transition driven by the loss of autonomy and control under the shadow of capitalist systems. This process, aligned with Marx's concept of proletarianization, sees physicians morph from independent practitioners to exploited workers within a wage-labor system controlled by a corporatized U.S. healthcare system. We contend that contemporary factors attributed to U.S. physician burnout-loss of control, emphasis on productivity, increased clerical demands, and a diminishing sense of work's meaning-are not novel but deeply ingrained in the medical profession's socio-historical fabric. By juxtaposing burnout with proletarianization, we highlight macro-level sources of strain and advocate for reevaluating physician work through Marxist theory and, in turn, extend the argument that addressing burnout necessitates moving beyond individual or organizational solutions to encompass broader socio-economic structures as seen through the lens of work exploitation. We conclude by discussing "class consciousness" among U.S. physicians and posit that collective awareness and action could pave the way for substantial reforms for the practice of medicine, the organization of medicine as a profession, and the burnout epidemic among U.S. physicians.

摘要

我们深入探讨了美国医生职业倦怠日益严重的问题,认为其根源在于美国医学职业的无产阶级化——这一转变是在资本主义制度的阴影下,自主性和控制权丧失的驱动下发生的。这一过程与马克思的无产阶级化概念相一致,医生从独立从业者转变为受薪劳动力系统中的被剥削工人,而这个系统由一个公司化的美国医疗保健系统控制。我们认为,导致美国医生职业倦怠的当代因素——失去控制、强调生产力、文书工作需求增加以及工作意义感的减弱——并非新颖,而是深深植根于医学职业的社会历史结构中。通过将职业倦怠与无产阶级化并置,我们强调了宏观层面的压力源,并主张通过马克思主义理论重新评估医生的工作,进而得出这样的结论:解决职业倦怠问题需要超越个人或组织层面的解决方案,而要涵盖更广泛的社会经济结构,这可以从工作剥削的角度来看待。最后,我们讨论了美国医生中的“阶级意识”,并假设集体意识和行动可以为医学实践、医学职业的组织以及美国医生的职业倦怠问题带来重大改革铺平道路。

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