P ROFESSIONAL I DENTITY IN MEDICINE : A PPLYING THE C OSMOPOLITAN -L OCAL C ONSTRUCT - 1 Paper presented at British Sociological Association, Medical Sociology Group, 31 st Annual Conference, University of York 24-26 th September 1999 Aksel Hn Tjora 1 PROFESSIONAL IDENTITY IN MEDICINE: APPLYING THE COSMOPOLITAN-LOCAL CONSTRUCT 2 Abstract Gouldner introduced the cosmopolitan-local construct as latent organisational roles or identities in 1957, in a study of university personnel. Cosmopolitans were hypothesised as persons who are committed to specialised role skills rather than loyal to the employing organisation. Locals were hypothesised as those with an opposite orientation. In health service institutions, the construct may be regarded as relevant to the understanding of professional commitment, recognition, status and ideology. This paper aim to explore this relevance. In a study of interprofessional patient focused health service projects, participants of different professions were interviewed applying a semi-structured approach. Respondents were asked questions about motivation, professional autonomy and interprofessional co-ordination and co- operation during these projects, and how a patient focus was maintained. Interview data were analysed using critical discourse analysis, for example of the different professions' use of terms like "patient focus", to identify how specifically professional ideologies are maintained in the interprofessional projects. Preliminary findings from the study show that the health personnel's orientations and identities are important to the success of the interprofessional projects. The development of an identity related to a specific project make possible commitments from several professional groups. The local-cosmopolitan construct provide a possible understanding of physicians' somewhat reluctant participation in interprofessional local projects, compared to nurses' participation. It is in the paper discussed how Gouldner's theory may prove relevant to questions on the mediation between health professions, and the debate on professionalisation and deprofessionalisation within health care. Key Words: Medicine, Professionalisation, Local-cosmopolitan Introduction There is a growing concern in the public sector in Norway on making the services client friendly and whether professionalisation in the sector hinders the development of such client focused services. The professionals themselves tend to argue that it is in their interest to secure the quality of services for their clients. The study, on which this paper is based, is called “Fragmented Professions and Integrated Services” and was initiated to study whether professionalisation is compatible with increased client focus in the health services. “To put the patient first” has become an important slogan for the Norwegian Ministry of Health, and only projects conforming to these objectives seem to get governmental financial support. In our study 1 The author is Associate Professor in sociology, at the Norwegian University of Science and Technology (NTNU), Department of Sociology and Political Science, N-7491 Trondheim, Norway, e-mail: akselht@svt.ntnu.no 2 The study, on which this paper is based, is supported by the Norwegian Association of Local and Regional Authorities (Kommunenes Sentralforbund). It is managed by SINTEF Unimed NIS Health Service Research, N-7034 Trondheim, Norway. The author would like to thank Researcher Lars Erik Kjekshus for useful discussions of the ideas that are presented in this paper and SINTEF Unimed NIS Health Service Research for financial support for the presentation of the paper.