Second Opinions: Why Canadian Doctors Do Not Always Defend Medical Dominance
Bibliographic record
Abstract
Organized medicine is a uniquely powerful political force in Canada, with physician colleges and associations exerting extensive influence over healthcare provision. Their influence has contributed to what social scientists describe as medical dominance, or the exceptional power of the medical profession within the healthcare system and wider society. However, Canadian medical organizations do not consistently defend this dominance; rather, they have occasionally lent support to policy changes that, on their face, would appear incompatible with traditional conceptions of medical power and authority. Typically, these instances are explained as a simple matter of strategic retreat: medicine conceding defeat on a particular issue in an effort to save face or conserve resources, without any change in underlying beliefs. This dissertation questions that assumption, asking if at times organized medicine’s support for threats to medical dominance is instead a function of more fundamental shifts in core policy beliefs. Through a series of interviews exploring how organized medicine responded to the re-emergence of midwifery and expansions of pharmacy scope in four provinces (Alberta, Ontario, Quebec and Nova Scotia), the analysis determines that, while medicine only supported expanded pharmacy scope out of strategic retreat, there are signs of more substantive shifts in belief with respect to midwifery. This suggests that the relationship between organized medicine and traditional medical dominance is more flexible and dynamic than has been assumed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.030 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.024 | 0.014 |
| Scholarly communication | 0.009 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.013 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".