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April 15, 1988

The Deprofessionalization of Medicine

Author Affiliations

American Medical Student Association Reston, Va

American Medical Student Association Reston, Va

JAMA. 1988;259(15):2238. doi:10.1001/jama.1988.03720150020019

To the Editor.  —The article entitled "The Deprofessionalization of Medicine" by Drs Reed and Evans1 asserts that diminished physician autonomy is the principal reason for the loss of medical professionalism in the United States. Although the changing economic milieu clearly has reduced physician independence in decision making, we disagree with the authors that this is the primary cause of medicine's deprofessionalization.Of the ten components of professionalism delineated by Drs Reed and Evans, three seem to distinguish a profession from a trade. First, there is a code of ethics governing those practices whose tenets are more stringent than legal controls. Second, a service orientation supersedes the proprietary interests of the professional. Third, the profession is largely free of lay control. However, Drs Reed and Evans themselves state that the necessary underlying support for autonomous rule consists of the first two components of professionalism noted previously. They note that a