Abstract
In the current economic turmoil embroiling Russia, the health care system is in a particularly precarious position. Physicians have not been able to improve their financial or professional standing. This chapter will examine the underlying causes of the professional predicament that Russian physicians face. Numerous forces are holding physicians back from developing an autonomous political voice to advocate for their profession.1 The legacy of Soviet socialized medicine and the feminization of the medical field are important contributing factors. More recent impediments to professionalism such as lack of institutional capacity and economic resources to support reforms are also contributing to the problem.
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Notes
For the purposes of this paper, a professional occupation is defined as a self-regulating occupation that requires training, specialization, and an orientation toward a code of ethics that entails corporate responsibility. This definition combines a few basic criteria that appear in many Western definitions of professionalism and that have come to be generally accepted. Two books that clearly define the term are Paul Starr, The Transformation of American Medicine (New York: Basic Books, Inc., 1982), 15, and Samuel Huntington, The Soldier and the State: The Theory and Politics of Civil-Military Relations (Cambridge, MA: Harvard University Press, 1959), 8–10.
Barrington Moore Jr., The Social Origins of Dictatorship and Democracy: Lord and Peasant in the Making of the Modern World (Boston: Beacon Press, 1966), and Harold Perkins, The Rise of Professional Society: England Since 1880 (London: Routledge Press, 1989).
There is a small literature on the middle class and its importance in socialist societies. For a discussion of the terms and applicability, see Michael Kennedy, “The Constitution of Critical Intellectuals: Polish Physicians, Peace Activists and Democratic Society,” CSST Working Paper #46 (Ann Arbor, MI: The University of Michigan, April 1990), and Michael Kennedy, Professionals, Power and Solidarity in Poland (Cambridge, UK: Cambridge University Press, 1991). For an in-depth discussion of the history of the middle class in the Soviet Union, see Harley Balzer, ed., Russia’s Missing Middle Class: Professions in Russian History (London: M. E. Sharpe, 1996). Also, the last Open Media Research Institute publication of the journal Transition (21 March 1997) is devoted to the issue of the middle class in Russia.
A few examples include Jeffrey W. Hahn, ed., Democratization in Russia; The Development of Legislative Institutions (New York: M. E. Sharpe, 1996); Nicolai N. Petro, The Rebirth of Russian Democracy; An Interpretation of Political Culture (Cambridge, MA: Harvard University Press, 1995); and David Remnick, “Can Russia Change?” Foreign Affairs (January/February 1997).
L. K. Levashov, et al., Kak zhivesh Rossiya? (Moscow: Russian Academy of Sciences, 1995).
S. Ia. Chikin, “O finansirovanii zdravookhraneniia za gody Sovetskoi vlasti,” Sovetskaia meditsina, no.11 (1990): 41–42. This article provides the following figures for percentage of GNP allotted in the 1930s: between 2.1 and 6.6 percent, in 1940: 5.2 percent, and in the 1960s: between 3.8 and 4.2 percent. This trend of between two and four percent has continued up to the present.
Kendall Bailes, Technology and Society Under Lenin and Stalin: Origins of the Soviet Technical Intelligentsia, 1917–1941 (Princeton, NJ: Princeton University Press, 1978).
From Gorbachev’s speech to the party congress in February, 1986, quoted in Martin Walker, The Waking Giant (New York: Pantheon Books, 1986), xxiv–xxv.
The problem of comparing professions in socialist and capitalist countries is analyzed in Anthony Jones, ed., Professions and the State; Expertise and Autonomy in the Soviet Union and Eastern Europe (Philadelphia, PA: Temple University Press, 1991). The professional power of doctors in the United States and Western Europe is examined in the following works: Elton Rayack, Professional Power and American Medicine (Cleveland, OH: World, 1967); Eliot Freidson, A Study of The Sociology of The Profession of Medicine (New York: Dodd, Mead, 1970); Jeanne Brand, Doctors and the State: The British Medical Profession and Government Action in Public Health, 1870–1912 (Baltimore, MD: Johns Hopkins University Press, 1965); Harry Eckstein, Pressure Group Politics: The Case of the British Medical Association (Stanford, CA: Stanford University Press, 1960); Talcott Parsons, The Social System (New York: Free Press, 1951); Jeffrey Berlant, Profession and Monopoly: A Study of Medicine in the United States and Great Britain (Berkeley, CA: University of California Press, 1975); Deborah A. Stone, The Limits of Professional Power: National Health Care in the Federal Republic of Germany (Chicago: The University of Chicago Press, 1980).
For more on problems in Soviet health care see Mark Field, Doctor and Patient in Soviet Russia (Cambridge, MA: Harvard University Press, 1957); Kate Schecter, “Professionals in Post-Revolutionary Regimes: A Case Study of Soviet Doctors,” Ph.D. dissertation, Columbia University, 1992; Michael Ryan, Doctors and the State in the Soviet Union (New York: St. Martin’s Press, 1990); and William A. Knaus, M.D., Inside Russian Medicine (Boston: Beacon Press, 1981).
See Timothy J. Colton and Robert Legvold, eds., After the Soviet Union: From Empire to Nations (New York: W. W. Norton and Company, 1992); David Lane, ed., Russia in Transition: Politics, Privatisation and Inequality (London: Longman, 1995); and Gail Lapidus, ed., The New Russia: Troubled Transformation (Boulder, CO: Westview Press, 1995).
K. P. Foley, “Russia: American Medical Association Offers Aid To Physicians,” RFE/RL, Washington, D.C., 5 March 1997.
In interviews conducted for a comparative study of Russian immigrant physicians in three countries, we found that this issue of narrow specialization hindered doctors from practicing or retraining in their new country. See Judith Shuval and Judith Bernstein, et al., Immigrant Physicians: Former Soviet Doctors in Israel, Canada, and the United States (Westport, CT: Praeger Press, 1997).
Sue Bridger, Rebecca Kay, and Kathryn Pinnick, No More Heroines? Russia, Women and the Market (London: Routledge, 1996), 51. See also Valerie Sperling’s chapter in this volume.
For more on the rise in prostitution and pornography, see Igor Kon, The Sexual Revolution in Russia (New York: The Free Press, 1995); Igor Kon and James Riordan, eds., Sex and Russian Society (Bloomington, IN: Indiana University Press, 1993); and Mary Buckley, ed., Perestroika and Soviet Women (Cambridge, UK: Cambridge University Press, 1992).
Swanee Hunt, “Women’s Vital Voices; The Costs of Exclusion in Eastern Europe,” Foreign Affairs (July/August 1997): 4, 5.
Christine Johansen, “Medical Courses for Women,” in The Modern Encyclopedia of Russian and Soviet History, ed. Joseph L. Wieczynski, vol. 21, 1981, 174.
I have borrowed this term from Gregory Massell, The Surrogate Proletariat: Moslem Women and Revolutionary Strategies in Soviet Central Asia, 1919–1929 (Princeton, NJ: Princeton University Press, 1974).
Annette Bohr, “Resolving the Question of Equality for Soviet Women—Again,” Radio Liberty: Report on the USSR 1, no. 14 (7 April 1989): 11.
Zoya Pukhova, For a Better Life and More Good Will (Moscow: Novosti Press Agency Publishing House, 1988), 7, cited in Kathleen Mihalisko, “Women Workers and Perestroika in the Ukraine and Belorussia—A Problematic Relationship Unfolds,” Radio Liberty: Report on the USSR 1, no.15 (14 April 1989): 31.
For more on women during revolutionary crises or massive social change, see Darline Gay Levy and Harriet Branson Applewhite, “Women and Political Revolution in Paris,” pp.279–308; Laura Levine Frader, “Women in the Industrial Capitalist Economy,” pp.309–334; and Richard Stites, “Women and the Revolutionary Process in Russia,” pp.451–472, all in Renate Bridenthal, Claudia Koonz, and Susan Stuard, eds., Becoming Visible: Women in European History (Boston: Houghton Mifflin Company, 1987). See also Joan Kelly, Women, History and Theory (Chicago: University of Chicago Press, 1984), 1–18.
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© 2000 Mark G. Field and Judyth L. Twigg
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Schecter, K. (2000). The Politics of Health Care in Russia: The Feminization of Medicine and Other Obstacles to Professionalism. In: Field, M.G., Twigg, J.L. (eds) Russia’s Torn Safety Nets. Palgrave Macmillan, New York. https://doi.org/10.1007/978-1-349-62712-7_5
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