Negotiating Medical Dominance: The Social Construction of the Care Coordinator within the Tasmanian Coordinated Care Trials

Abstract

State and corporate induced changes to health care systems are occurring globally. These changes are altering the environment, which previously supported the medical profession's dominance over all health matters. Health care occupations, in conjunction with systemic health care changes, also threaten the autonomy of general practitioners through new opportunistic attempts to expand their occupational territory. Using a symbolic interactionist approach in tandem with Bucher's natural history framework to trace the emergence of an occupation, this paper analyses the social processes involved in the construction of the care coordinator occupation within the context of the Coordinated Care Trial in Tasmania. An analysis of both the occupational encroachment and defensive strategies employed by government health agencies, general practitioners, nurses, and pharmacists during the construction of the position description of the care coordinator is undertaken. Specifically, the focus of this paper is on how the general practitioners acted to retain their preeminent position within the health care system when facing a dual challenge from above (the state) and below (nursing, pharmacy).