Medical specialization and medical genetics in Canada (1947 and after)

I examine the social history and evolution of medical genetics in Canada from a marginal activity in medicine in 1947, when the first genetic services were institutionalized at the Hospital for Sick Children in Toronto, to its recognition as a free-standing medical specialty in 1989 by the Royal College of Physicians and Surgeons (Canada). Furthermore, I examine the organization of genetic services since 1989, and the work that medical geneticists do as medical specialists. I draw on four sources of data: written materials on medical genetics and genetic services, interviews with sixty seven key persons, observations at eleven post-clinic review meetings at the Division of Clinical Genetics (Hospital for Sick Children, Toronto), and non-confidential information concerning referral source locations and reasons for referral for patients seen in the Division. I use a segmentalization theoretical perspective to analyse the successful adaptation of Canadian medical geneticists to the professional environment in which they developed as specialists and continue to practice.

There are clear similarities between the medical specialists examined in previous research using a segmentalization theoretical perspective and the medical geneticists examined in this dissertation. The individuals appearing in all of these studies are self-directing, self-regulating, generating a common set of ideological constructs together with a set of functions, interacting by means of socially defined actions and behaviour, possessing a high degree of generalized or systematic knowledge, and exercising a monopoly of expertise in an area of health care delivery. They are medical professionals and the kind of work they do conforms to the organization of patterns of work described in the sociology of the professions literature.

But, at the same time, I focus on the patterned and temporal features of interjurisdictional relations between specialty areas, a matter which has not been discussed at length by sociologists of the professions. Using Strauss's concept of “trajectory,” I show that medical geneticists' work as medical specialists is inextricably linked to a continuum of complex and individuated networks of trajectories of patient care. The events which have engaged my attention are the observable points of the continuum. I have concentrated on information flows and personnel movements that are, on the one hand, “routine,” and, on the other, “complex.” In each instance, information flows and personnel movements can be studied insofar they exhibit invariances, which in this case are diagnostic procedures and outcomes. The self-maintaining clinics and service areas give us the concept of “specialty work;” in addition, those individuals who have observable properties associated with “doing” the work furnish the referent of “specialists.” Individual medical cases, whether they are “routine” or “complex,” represent the singularities of information flows and movement of personnel in the continuum of an overall organizational schema associated with “genetic services.” In the final analysis, it is the organizational schema of “genetic services” which orders itself, bringing about and supporting an array of resources (human and otherwise) in a multiplicity of clinics and service areas both inside and outside of the genetics centres.