Understanding medical professionalism in Italy—welfare regimes, regulatory models, paths to medical professionalization/professionalism, and gender inclusion

This article proposes a theoretical interpretation of the transformation of medical professionalism in Italy by integrating four analytical dimensions that are often examined separately: welfare regimes, healthcare regulatory models, professionalization pathways/models of professionalism, and gender inclusion. Drawing on comparative welfare state theory and the sociology of professions, the study argues that medical professionalism in Italy has historically developed within a complex institutional configuration characterized by the interaction of state, market, and community coordination mechanisms. Using a historical-figurational perspective, the article shows how the relative weakness of both state regulation and healthcare markets fostered the emergence of clan-based forms of professional coordination, as conceptualized by Ouchi. These relational networks-rooted in academic, political, associative, and community ties-have played a central role in structuring access to careers, economic and political resources, and professional status. The creation of the Italian National Health Service in 1978 introduced a universalistic institutional framework. Still, subsequent reforms, austerity policies, and the expansion of private healthcare have reinforced rather than displaced these particular governance arrangements. At the same time, the progressive feminization of the medical profession and generational change are reshaping professional hierarchies and leadership patterns. The Italian case thus offers a useful lens for understanding how historically stratified institutional contexts influence the contemporary transformation of medical professionalism.