Most people alive today would find it hard to imagine a healthcare system that wasn’t underpinned by a small group of elite and established professions.
To even imagine that a person might engage in healthcare without the mediating influence of doctors, nurses, midwives, occupational therapists, physiotherapists, psychologists, and others, would seem incomprehensible.
But this is exactly what post-professionalism tries to imagine.
Over the course of the next few weeks. I want to try to set down some of the key principles of post-professionalism, and examine:
What it is;
What its main theories and ideas are;
How it is shaping and disrupting healthcare;
And why it’s been largely absent from the professional literature to date.
So, here’s a bit of a taster of what’s to come.
What is post-professionalism?
Post-professionalism is a relatively new term in healthcare.
The term was first used in the 1980s in the work of Ivan Illich, Terry Johnson, and Eliot Freidson, and has been applied to a wide range of other sectors but has only recently been applied to healthcare.
Post-professionalism does not refer to the complete disappearance of the professions, but rather their increasing decentralisation.
It argues that the established, traditional, orthodox, and legitimate professions will become increasingly marginal social actors, and people will make use of increasingly diverse resources to meet their healthcare needs.
Post-professionalism provides a set of conceptual tools to analyse today’s atomised, digitally disrupted, globalised, neoliberal, and postmodern zeitgeist.
Where once people said, “The doctor knows best”, in the post-professional era they are more likely to say, “The patient will see you now” (Topol, 2016).
What has made post-professionalism possible?
There are many reasons for the post-professional turn, here are two of the biggest:
The late, or advanced, capitalist shift from the pursuit of unlimited growth and surplus value through the ‘external’ colonisation of people and land, to the ‘inward’ atomisation of the body and health. Bodies and health are the new, almost limitless, frontier for commodification, innovation, and market expansion.
The critical unbundling of the orthodox professions’ claims to goodness and expertise (Burns, 2019), underpinned by the belief that the professionalisation project of many healthcare professions is coming to an end after 150 years of notable successes but also some significant failures.
Where can we see post-professionalisation at work?
The challenges now facing the professions are many and varied. Consider this list, for example:
The increasing demands for holistic healthcare for ageing populations of increasingly complex, co-morbid, chronically ill people;
Digital technologies and the rapid rise of AI and digital data;
People’s appetite for personalised healthcare demanding more choice, greater flexibility, and more control over the services they receive;
Demands for ever-increasing levels of professional expertise and specialisation, married to the publics’ progressive loss of faith in once-powerful — often professional — authorities;
The pressure to remain up-to-date with the latest evidence-based findings;
The loss of control of knowledge that was once ‘ours’ (with most of the information contained within a health curriculum now openly available online);
Threats of encroachment from other professions looking for competitive advantage and greater social prestige;
The rising cost of healthcare matched with the desire by governments to cut and contain healthcare expenditure; the rapid privatisation and atomisation of health and the growing social gradient between those who can afford professional care and those who cannot;
The downstream costs of unhealthy lifestyles;
The growing critique of the regulated professions for their intransigence, stubbornness, and resistance in the face of change.
We can add to this list some very ‘local’ anxieties that many of the healthcare professions are expressing individually, including that:
The profession is spread too thin;
Our professional status is in decline, and there doesn’t appear to be a clear plan for how to get it back;
We lack the skills to be creative and innovative;
Evidence-based research repeatedly undermines what we know to be good about our work;
Our many healthcare professions are engineered for curative approaches towards acute, episodic illness and injury, in a world that needs sustained, long-term care where no ready fix is possible;
Our remuneration is not keeping pace with rising student debt, making our professions less and less attractive to new graduates;
Our care model was always individualistic, meaning we have no scaleable, population-level approach to healthcare.
To date, the professions have seen themselves as sovereign entities that must outlive these problems to survive. Post-professionalism inverts this belief, seeing the professions instead as contingent responses, effects, or achievements of biopolitical and governmental rationalities.
In post-professionalism, the professional era is seen as a recent historical invention (a largely Victorian middle-class prestige project) that served society well — mostly — during the 20th century, but is now coming to an end.
Post-professionalism is concerned with what follows.
Over the coming weeks I will try to unpack the arguments around post-professionalism in more depth and, as with the post-humanism pieces, try to provide resources and readings for further study.
References
Burns, E. A. (2019). Theorising professions: A sociological introduction. Palgrage Macmillan.
Topol, E. (2016). The patient will see you now: The future of medicine is in your hands. Basic Books.
All images my own.
Thank you for the series, looking forward to the other parts 👌👌
Thank you Dave, this is great, you write so clearly & accessibly & you are opening a whole new genre of theory for me... so stimulating 👍🏻💕