Dissertation Abstracts

Harmonizing, standardizing and hierarchizing work: the medical profession and its labor market in the private sector. The case of surgeons from Monterrey

Author: Antoine Lejault, antoinelejo@gmail.com
Department: Escuela de Negocio y Ciencias Sociales
University: Tecnológico de Monterrey, Mexico
Supervisor: Anne Fouquet
Year of completion: 2021
Language of dissertation: Spanish

Keywords: surgeon , work , profession , labor market
Areas of Research: Professional Groups , Work , Health


The profession is a category of occupation that is distinguished from others by the ability of its members to control their work, to have authority over their field of expertise and autonomy in defining their work. Such is the case of physicians, who have exclusive control over the definition and organization of all technical aspects of disease and patient management. In the 1980s a structural reform of the health sector, characterized by a privatization of public services and an encouragement of private sector participation, took place globally and more particularly in Mexico. One aspect of privatization can be seen in the application of management logics concentrated on medical work. To this end, we witness the promotion of methodologies for evaluating the quality of medical services using non-medical criteria. In addition, in order to sell their services, physicians must partner with other institutions. Today, the challenge is to negotiate with insurance companies and private hospitals, both now omnipresent institutions, in order to establish their place in the private sector, where the medical profession was used to having the upper hand in the organization of health services and in the definition of their work. The objective of the thesis is to study the changes in the way of finding a job and working in medicine based on the observation of the work organization of surgeons in the private sector in Nuevo León, Mexico, starting from a historical review of the operationalization of medical knowledge, followed by a qualitative research (in-depth interviews and direct observation). The main results emphasize a deepening of the internal fragmentation of the profession, both in the division of labor and in the conditions of access to the patient. Also, a corporate governance of medical work emerges through the action of standards acting on the medical work process.