2009-The Physician of the Future English and Catalan

F UNDACIÓN E DUCACIÓN M ÉDICA (FEM) 46 1.9. Working Conditions Medicine used to be a liberal profession but the majority of doctors have become salaried employees of public or private health care corporations. $rough this proletarianisation the entire profession is gradually losing its identity and becoming another occupational group striving for working security of civil servant status with tenure, and as part of this involution adopts the “ complaint culture ” expressed through the burn out syndrome, so frequent nowadays, along with lack of motivation. Moreover, within health care organisations, physicians are "nding it increasingly di#cult to de"ne how to organise their own work and its limits. $e professional assumes the routine associated with working in organisations that establish protocols (explicit knowledge) and delegate responsibilities in teams, but "nds it di#cult to assert his professional expertise (tacit knowledge) in an environment that clearly favours standardised procedures, centralised programming and has little appreciation or is even unaware of the discretionary nature of a job well done. In such working environments, physicians o%en perceive others to be interfering in their work and feel obliged to carry out their tasks under risky conditions for patients. O%en physicians demand to participate in the organisational decision-making processes, even when, in practice, they display only a limited commitment to the organisation, which contributes to increasing the power of managers.