An evaluation of physicians' perceptions of proletarianization

Proletarianization refers to the loss of control of professional occupations over the content of work, working conditions, remuneration of labor, labor objects, professional education, means of production, and similar aspects. In the context of the sociology of professions, the process of proletarianization involves bureaucratization, alienation, devaluation, commercialization, loss of status and/or stratification, deskilling, and the erosion of professional autonomy. In this context, physician proletarianization can be defined as the loss of a physician's control over healthcare production tools, the content of work, working conditions, medical education, patients receiving care, and the remuneration of physician labor. It is believed that physicians are increasingly becoming bureaucratized, alienated, devalued, commercialized, and losing professional control. This thesis aims to evaluate the dimensions and extent to which physician proletarianization is perceived. To achieve this goal, a scale was developed to measure the perception of physician proletarianization, and the perceptions of physicians were assessed through the dimensions of loss of control, bureaucratization, devaluation, alienation, and commercialization. More than 900 physicians working in public, private, and university hospitals across various provinces in Türkiye's seven regions contributed to the research. The data collection tool consisted of a draft scale form refined through literature reviews, interviews with physicians, and expert opinions. The research employed exploratory factor analysis (EFA) for construct validity, first- and second-level confirmatory factor analyses (CFA) to test the identified construct, convergent and divergent validity tests to reveal the relationships between statements and other dimensions, and criterion validity by correlating the scale with the Intention to Leave the Profession Scale and the Professional Commitment Scale. Reliability analyses were conducted using Cronbach's alpha coefficient and CR values, and test-retest reliability was also performed. All analyses demonstrated that the scale developed by the researcher is valid and reliable. As a result, physician proletarianization was found to occur through the dimensions of loss of control, bureaucratization, devaluation, alienation, and commercialization. It was determined that the perceptions of physicians regarding proletarianization were high in the dimensions of loss of dominance (3.74±0.898) and bureaucratization (3.79±0.922), very high in the dimensions of devaluation (4.40±0.635) and commercialization (4.27±0.740), and finally at a moderate level in the dimension of alienation (2.60±0.967). It can be said that physicians have a strong perception of proletarianization and that physicians' perception of proletarianization is shaped by health policy tools such as TİG/DRG, SUT, PDEÖS, SDP, AHS, YKİ.