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Professions- Ideology and Performance
Freidson on medicine as a consulting profession- Assumptions
Autonomy is key to understanding model-
In Freidson’s model the medical profession is portrayed as having a monopoly over the provision of health services. We observe a regimented division of labor, ranging from with an exclusive license to practice medicine, to prescribing controlled drugs, admitting patients to hospitals, and performing other critical gatekeeping functions. Those occupations that are subordinate within the hierarchy, paraprofessionals, seek prestige via their obligation to work under the supervision of physicians. (their task being defined for them) Therefore ‘profession’ differs from ‘paraprofessional’ by the place of each in an organized division of labor. Professional is not technically subordinate to any other occupation, paraprofessional occupation is technically subordinate to a profession.
This model, a monopoly model, casts professionalization as the successful pursuit of dominance and authority by a group seeking upward collective mobility. Organizational features such as licensing legislation or codes of ethics enable monopolization of market which turns to prestige wealth and power, enlarges the security of their domination in professional client relationship. Monopolization is achieved through internal organization and control of practitioners and tasks, linkages of skills and services to values and interests of an elite class, corporate capital or the state.
In sum, what is critical for the status of medicine as a consulting profession is its ultimate control over its own work. Control over work need not be total- essential is control over the determination and evaluation of technical knowledge used in work- secondary is control of social and economic terms of work. Freidson makes this clear when he states that a professional can be remain a professional when s/he is socially subordinate to someone who does not belong to her/his profession as long as s/he is not technically subordinate.
Others have commented on Freidson’s unwillingness to concede the profession has changed quite a bit since 1970 and have offered a minimalist revision, offering five characteristics or definitions of a profession*-
Professional and Corporate ‘Values’
‘Professional’ ‘Corporate’ (onset of managed care) Service (to community) Profit Advocacy Competition Altruism Responsibility to stockholders Services of specialized knowledge Market driven Humanism Consumerism Autonomy (standards set internally) Autonomy (standards set externally)
Abbott's Model- Assumptions
Most important feature of profession is its ability to control abstract knowledge. Jurisdiction, complete control over all forms of expertise and work, is key to understanding model. Abbott draws our attention to a profession’s ability to control abstract knowledge. He does not consider control over expert, technical knowledge as key, simply because this can be delegated to others. (Later in the book he argues that too much formalization of expert knowledge makes task vulnerable to routinization and thus are easily usurped by less expensive paraprofessionals) He maintains that the professions together constitute a system that is the proper unit of analysis for sociological theorizing. Inter-professional competition occurs when more than one ‘group’ lays claim to diagnosis, inferential interpretation, and treatment of problems. His model has been called ‘structural’ in that it pays close attention to historical contingencies and actors’ initiative to explain the causes of
In making his case, Abbott
In sum, Abbott would argue that medical sociologists should not question whether or not medicine is a profession but rather why do the professions (medicine, science, law, etc) continue to dominate our world? Why are there occupational groups controlling the acquisition and application of knowledge? Where did groups (such as medicine and law) obtain their power? |
