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

Barret Michalec, Monica M. Cuddy, Yvonne Price and Frederic W. Hafferty

Social Science & Medicine, 2024, vol. 358, issue C

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.

Date: 2024
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DOI: 10.1016/j.socscimed.2024.117224

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