No struggle, no strength: how pharmacists lost their monopoly

Research accounts of the struggle of professions to attain and maintain a monopoly, strategies of exclusion and usurpation, make for interesting and often exciting reading. The purpose of this article is to present a less frequently reported phenomenon -- the study of a profession that had a monopoly, and then lost it. The authors attempt to answer the question: under what circumstances will a profession support the state in breaking their own monopoly? The study looked at the pharmacy profession in Iceland in the light of the recent change in drug legislation. Interviews with key actors in the pharmacy profession were conducted to gain an understanding of how they interpreted and experienced this change. Three factors contributed to the break in the professional monopoly: (1) political desire to take advantage of new competition and deregulation policy, (2) desire to cut the health budget and (3) internal divisions within the profession. The results of the study revealed at least four internal divisions within the pharmacy profession: (1) urban/rural, (2) employer/employee, (3) lower/higher education and (4) young/old. The article illustrates how a profession weakened by internal strife became prey to the government's cost cutting activities. This study is an example of how internal conflicts not only weakened the profession, but created a climate conducive to losing its monopoly. Our findings raise fundamental questions about the future of professions in society today.