The Professional Autonomy in the Cage of Bureaucratic “Freedom”: General Practitioners in Primary Healthcare in Bulgaria

The article analyzes the changes taking place in the professional autonomy of general practitioners (GPs) in the context of health care reform since the late 1990s. Using the concept of professional jurisdiction of Andrew Abbott and data from an empirical study conducted among GPs in Tryavna and their patients, the analysis shows the change in the three levels of professional autonomy (diagnosis – treatment – follow-up) with bureaucratic principles. The observed changes transformed medical care into services and patient attitudes into client. The article problematizes relationships between the state (reform), the primary care doctors (GPs) and their patients through the prism of professional autonomy and focuses on the question of whether the criticized health reform has not become a convenient routine.