“GPs Are Just Registrars!”: The Formation of Professionalism Among General Practitioners in Kazakhstan

Abstract

One of the key challenges of the healthcare system in Kazakhstan remains the underdeveloped institutional potential of general practitioners (GPs). The GP was expected to be a universal specialist combining preventive, diagnostic, and therapeutic work, serving as a central figure in primary healthcare. However, this model faced a number of systemic obstacles: declining professional prestige, staff shortages, and lack of stable institutional support. Within the medical community and among patients, the perception of GPs as intermediaries—“registrars” who do not treat but merely refer patients to so-called specialists—became entrenched. The article is based on interviews and materials from nonparticipant observation in clinics in Almaty and Astana (Kazakhstan). The authors analyze how, under institutional pressure and professional vulnerability, GPs strive to maintain and redefine their understanding of professionalism. In their interpretation, medical expertise extends beyond purely clinical autonomy to include bureaucratic and administrative functions. Routine tasks (processing referrals, patient routing, working with digital platforms) are understood not as obstacles but as an important part of professional identity. Bureaucratic workload becomes a basis for symbolic authority. GPs are rethinking their professional role and adopting new strategies: cooperating with other physicians while maintaining control over patient pathways, and acquiring additional specializations (especially in private clinics, where employment arrangements are more flexible). Thus, the conception of GP professionalism in post-Soviet Kazakhstan is associated not with “universality,” as envisioned by reforms, but with the appropriation of bureaucratic functions and the hybridization of employment. Control over the content and organization of one’s work, even when primarily administrative, becomes a source of professional autonomy and a way to resist external management.

Article in Russian