I think a lot of doctors can still be thought as small time artisans. If they work for something like a hospital they’re typically on contract rather than full time employees. It’s just more efficient this way since doctors can shared pooled medical equipment and resources with this model
Maybe, but from my loose understanding of the workplace their class character doesn’t seem very strongly working class. They move around and work pretty similarly to how an artisan would
Their relationship seems a lot closer to “renting” out the equipment like how a craftsperson would rent their workshop/studio/storefront nowadays. But instead of paying money, doctors pay a tiny tiny autonomy charge to follow the hospital’s structure of how things work
If we’re talking about specifically America, doctors have essentially positioned themselves as a cartel and are holding the general public hostage for their services and labor, and they collaborate with hospitals and clinics (the government, in this cartel analogy) to fleece us because the hospitals , insurance companies, and the government need doctors to survive and profit themselves
Expert artists in the past being hired by the wealthy and given materials (expensive paints, sculpting materials, etc.) to complete their contracted work may be the closest profession to modern day doctors in terms of class relationships, except doctors are a necessity for the hospitals to make any money
Doctors are being proletarianized as private equity absorbs more and more healthcare. There’s still a lot of private practice and hybrid structures that are petty bourgeoisie or pretty close.
Even with salaried doctors, though, it’d be a mistake, I think, to claim they have the same class interests as most hospital staff or other workers. In the US specifically, and for now.
Professional-managerial still seems to me to be the best signifier to describe the subclass of highly-educated people with high salaries. They have easy access to petty-capitalist and landlordist mechanisms, and benefit from them passively, even for ones that don’t personally meet the definition of petty bourgeoisie. I don’t think their position aligns very well with a typical understanding of artisan.
My point though, is that it is the structures themselves that are producing these reactionary doctors, not that the medical practice itself is inherently reactionary. And it is precisely because they are in the precarious arena of being at risk of losing their protected class status, as they are fully proletarianized. Skilled proletarians, to be sure, but proletarians nevertheless.
I have almost always found more class solidarity within the pediatrics ward of any hospital than most union shops. Not that this means anything for revolution in the U.S., as the structures that bind us are still far too powerful.
I think I agree in the sense that your analysis is becoming the reality. It’s growing out of the dying subclass of doctors as professional-managerial (which I still hold as distinct from other proletarian interests due to colonial and imperial flows). The same deskilling/proletarianization is happening in most professional industries, really.
Fully proletarianized doctors, especially younger ones, are likely to increasingly have revolutionary potential comparable to other workers. That’s at tension with the older aspects of the subclass that still retain petty bourgeois and professionalist interests or ideology.
Hostile interactions with actual capitalists (hospital boards, insurance companies) do seem to be accelerating the potential of a lot of doctors, the ones that have the capacity for it at least.
Notes on your other comment (from memory since in my app I can’t easily reread it while replying here, so I apologize in advance): I imagine the class character of Cuban doctors is gonna be quite different from that of US doctors. Is the education system in Cuba used as a class signifier? I don’t actually know but I suspect not.
And we examine different subsets of classes not to determine purity or morality, but to identify revolutionary potential. A strict two-class model is used for education and explanation, it isn’t meant to reduce analysis. If people are trying to gatekeep “proletariat” for moralist purposes I agree it’s not useful, but especially in the context of multilayered colonial and imperial systems, it’s essential to be able to examine the internal tensions and trajectories contained within any class/subclass.
I am not trying to limit the class structure, I am saying that the proletarianisation of doctors is happening. If it will complete within my lifetime, I don’t know, I doubt it, but the long-term trend is there. Marx was correct, and since he didn’t put a time scale on this stuff (he discussed feudalism in terms of centuries, over a millenia if history), he is correct, and that means that we, as communists, should recognize that solidarity can be obtained from the class of medical practitioners, and we should seek to build that relationship, in spite of their current reactionary disposition.
There are several different classes that exist, but the primary driver of history can only be the proletariat if modernisation is to exist and continue. If you don’t want modernity you will value a different class, but the proletariat comes out of modernity, which means that they are the only class that truely values it’s preservation.
Doctors make up a small fraction of healthcare workers too, so if anything I suspect nurses and wage-workers are still going to be the primary drivers of organization within the medical industry. Threat of proletarianization will push many in the professional subclasses to fascism and some to revolutionary movements, and I suspect that applies to doctors/dentists/etc, for the reasons we’ve both mentioned. Those that are comrades should be welcomed, those that aren’t should be isolated, as with anyone in any class.
Expanding beyond a strict two-class model isn’t just about acknowledging the existence of feudalism and other modes of production, but about examining the intricacies within the classes. We can claim the proletariat to be the driver of history all we want, but to actually engage with them as revolutionaries we need to understand all of their active parts, analyze them, categorize them, so we can isolate/disempower the backward, unite/empower/organize the forward, and agitate/educate the intermediate.
These nuances can be brushed over when radicalizing/educating the intermediate, but are absolutely essential when discussing among communists because we have finite energy and power. Do we organize around college students? Factory workers? Food service workers? Healthcare workers? Educators?
Are we certain that labor organizing within the imperial core isn’t still fundamentally reactionary?
What about tenants? Immigrants? College graduates? Socially marginalized? People with disabilities? Housing unstable?
All of these segments have unique class character, trajectories, and social/political/economic power, and all require different praxis. And they all exist as microcosms within macrocosms, the interplay of which can fundamentally and unexpectedly alter the class character being examined (like how the macrocosms of global imperialism and settler colonialism can turn segments of proletarian microcosms reactionary).
Expert artisans were not usually given the tools of their trade. They were given money, and then their apprentices would source their materials, much like a head chef sources food for a fancy restaurant. And yes, often the agreement would stipulate that the the materials bought were the property of the patron, not the artist. However, they owned the tools of their trade. They usually (not always) had their own pencils, brushes, scrapers, chisels, and hammers.
A modern car mechanic with a personal Snap-on tool chest has more in common with an artisan than a modern doctor does, which is why you can still find a mechanic in a town of less than a thousand people, but not a doctor.
Certification boards made up of doctors have created the cartel, but most doctors, especially young doctors, are fleeced of their time and money in the pursuit of attaining the medical practitioner status, and have absolutely no control over those larger processes.
And doctors and nurses will be the first to tell you that more often than not it is the universities, hospitals, and insurance companies that are the major obstacles getting in the way of cheap medical care, with the doctors themselves being an outcome of those systems. If the greed of medical doctors were the root the problem, then Cuba wouldn’t create so damn many of them.
If you keep excluding people from the proletariat based on rental agreements and not who actually owns the tools and means of production, you will have an extremely confused set of definitions on your hands.
I think a lot of doctors can still be thought as small time artisans. If they work for something like a hospital they’re typically on contract rather than full time employees. It’s just more efficient this way since doctors can shared pooled medical equipment and resources with this model
I absolutely disagree. If they do not own their own means of production, therefore they are not artisans, it’s literally the definition.
By your definition, the X-ray technicians are also artisans.
The hospital owns the equipment and employs the doctors. How they employ them is not how class distinctions are made.
Maybe, but from my loose understanding of the workplace their class character doesn’t seem very strongly working class. They move around and work pretty similarly to how an artisan would
Their relationship seems a lot closer to “renting” out the equipment like how a craftsperson would rent their workshop/studio/storefront nowadays. But instead of paying money, doctors pay a tiny tiny autonomy charge to follow the hospital’s structure of how things work
If we’re talking about specifically America, doctors have essentially positioned themselves as a cartel and are holding the general public hostage for their services and labor, and they collaborate with hospitals and clinics (the government, in this cartel analogy) to fleece us because the hospitals , insurance companies, and the government need doctors to survive and profit themselves
Expert artists in the past being hired by the wealthy and given materials (expensive paints, sculpting materials, etc.) to complete their contracted work may be the closest profession to modern day doctors in terms of class relationships, except doctors are a necessity for the hospitals to make any money
Doctors are being proletarianized as private equity absorbs more and more healthcare. There’s still a lot of private practice and hybrid structures that are petty bourgeoisie or pretty close.
Even with salaried doctors, though, it’d be a mistake, I think, to claim they have the same class interests as most hospital staff or other workers. In the US specifically, and for now.
Professional-managerial still seems to me to be the best signifier to describe the subclass of highly-educated people with high salaries. They have easy access to petty-capitalist and landlordist mechanisms, and benefit from them passively, even for ones that don’t personally meet the definition of petty bourgeoisie. I don’t think their position aligns very well with a typical understanding of artisan.
My point though, is that it is the structures themselves that are producing these reactionary doctors, not that the medical practice itself is inherently reactionary. And it is precisely because they are in the precarious arena of being at risk of losing their protected class status, as they are fully proletarianized. Skilled proletarians, to be sure, but proletarians nevertheless.
I have almost always found more class solidarity within the pediatrics ward of any hospital than most union shops. Not that this means anything for revolution in the U.S., as the structures that bind us are still far too powerful.
I think I agree in the sense that your analysis is becoming the reality. It’s growing out of the dying subclass of doctors as professional-managerial (which I still hold as distinct from other proletarian interests due to colonial and imperial flows). The same deskilling/proletarianization is happening in most professional industries, really.
Fully proletarianized doctors, especially younger ones, are likely to increasingly have revolutionary potential comparable to other workers. That’s at tension with the older aspects of the subclass that still retain petty bourgeois and professionalist interests or ideology.
Hostile interactions with actual capitalists (hospital boards, insurance companies) do seem to be accelerating the potential of a lot of doctors, the ones that have the capacity for it at least.
Notes on your other comment (from memory since in my app I can’t easily reread it while replying here, so I apologize in advance): I imagine the class character of Cuban doctors is gonna be quite different from that of US doctors. Is the education system in Cuba used as a class signifier? I don’t actually know but I suspect not.
And we examine different subsets of classes not to determine purity or morality, but to identify revolutionary potential. A strict two-class model is used for education and explanation, it isn’t meant to reduce analysis. If people are trying to gatekeep “proletariat” for moralist purposes I agree it’s not useful, but especially in the context of multilayered colonial and imperial systems, it’s essential to be able to examine the internal tensions and trajectories contained within any class/subclass.
I am not trying to limit the class structure, I am saying that the proletarianisation of doctors is happening. If it will complete within my lifetime, I don’t know, I doubt it, but the long-term trend is there. Marx was correct, and since he didn’t put a time scale on this stuff (he discussed feudalism in terms of centuries, over a millenia if history), he is correct, and that means that we, as communists, should recognize that solidarity can be obtained from the class of medical practitioners, and we should seek to build that relationship, in spite of their current reactionary disposition.
There are several different classes that exist, but the primary driver of history can only be the proletariat if modernisation is to exist and continue. If you don’t want modernity you will value a different class, but the proletariat comes out of modernity, which means that they are the only class that truely values it’s preservation.
Doctors make up a small fraction of healthcare workers too, so if anything I suspect nurses and wage-workers are still going to be the primary drivers of organization within the medical industry. Threat of proletarianization will push many in the professional subclasses to fascism and some to revolutionary movements, and I suspect that applies to doctors/dentists/etc, for the reasons we’ve both mentioned. Those that are comrades should be welcomed, those that aren’t should be isolated, as with anyone in any class.
Expanding beyond a strict two-class model isn’t just about acknowledging the existence of feudalism and other modes of production, but about examining the intricacies within the classes. We can claim the proletariat to be the driver of history all we want, but to actually engage with them as revolutionaries we need to understand all of their active parts, analyze them, categorize them, so we can isolate/disempower the backward, unite/empower/organize the forward, and agitate/educate the intermediate.
These nuances can be brushed over when radicalizing/educating the intermediate, but are absolutely essential when discussing among communists because we have finite energy and power. Do we organize around college students? Factory workers? Food service workers? Healthcare workers? Educators?
Are we certain that labor organizing within the imperial core isn’t still fundamentally reactionary?
What about tenants? Immigrants? College graduates? Socially marginalized? People with disabilities? Housing unstable?
All of these segments have unique class character, trajectories, and social/political/economic power, and all require different praxis. And they all exist as microcosms within macrocosms, the interplay of which can fundamentally and unexpectedly alter the class character being examined (like how the macrocosms of global imperialism and settler colonialism can turn segments of proletarian microcosms reactionary).
Expert artisans were not usually given the tools of their trade. They were given money, and then their apprentices would source their materials, much like a head chef sources food for a fancy restaurant. And yes, often the agreement would stipulate that the the materials bought were the property of the patron, not the artist. However, they owned the tools of their trade. They usually (not always) had their own pencils, brushes, scrapers, chisels, and hammers.
A modern car mechanic with a personal Snap-on tool chest has more in common with an artisan than a modern doctor does, which is why you can still find a mechanic in a town of less than a thousand people, but not a doctor.
Certification boards made up of doctors have created the cartel, but most doctors, especially young doctors, are fleeced of their time and money in the pursuit of attaining the medical practitioner status, and have absolutely no control over those larger processes.
And doctors and nurses will be the first to tell you that more often than not it is the universities, hospitals, and insurance companies that are the major obstacles getting in the way of cheap medical care, with the doctors themselves being an outcome of those systems. If the greed of medical doctors were the root the problem, then Cuba wouldn’t create so damn many of them.
If you keep excluding people from the proletariat based on rental agreements and not who actually owns the tools and means of production, you will have an extremely confused set of definitions on your hands.