Prevention or Production. Autonomy and Subordination in Occupational Medicine (France, 1970-2010)
This doctoral essay studies the professional autonomy of occupational physicians in France between 1970 and 2010. It explores how, although they are expected to be independent in their work, these doctors are bound to their employers by a work contract, i.e. a relationship of subordination. It also sheds light on the failure of occupational hazard prevention in France. The study of historical documents combined with an ethnographic study of currently active physicians shows how the issue of autonomy varies according to the setting. The apparent coexistence of autonomy and subordination is possible only inasmuch the " medical " side of professional activity (on which the physician is entitled to complete independence) is distinguished from its " administrative " side (which allows for a legitimate degree of subordination). I show that this distinction is the unstable product of continuous negociations between occupational doctors and their counterparts (e.g. other professionals in the medical service or the company, other doctors...). Furthermore, even the definition of the work that has to be done - that is, all the tasks that can be performed legitimately in the name of occupational medecine - appears to be the precarious result of continuous negociations in each medical service. The issue of autonomy is settled not only in the professional's control over his work, but also in the process which leads to the definition of this work. Hence, this work shows the shortcomings of the classic definition of professional autonomy as control over routine activites, which is problematic when the nature of the work to be done is not given in advance, but at the center of conflicts. On a more general scale, it gives a perspective on the tension between legitimate and illegitimate dependency, consent or resistance to subordination, which is at the heart of work relationships in wage society.