Post-professionalism— Part 3 – Unbundling of goodness and expertise
This is the third installment in the occasional series focusing on one of the ‘posts’.
This series centres on post-professionalism.
You can recap the Introduction to the series here, and read Part 2 on the first main reason why the healthcare professions are becoming de-centred here.
Alongside late capitalism, perhaps the next most important discourse shaping the post-professional era is what Edgar Burns has called the unbundling of goodness and expertise.
Let’s get into that now.
Health professionals are not as altruistic and public-spirited as they would have us believe
‘[w]e are on the brink of a period of fundamental and irreversible change in the ways that the expertise of the specialists is made available in society’ (Susskind and Susskind, 2015).
At the heart of the unbundling claim is the argument that professionals have long believed themselves to be altruistic and public-spirited; that they are disinterested in personal or professional status; that they are models of ethical comportment; bearers of specialised knowledge and affectively neutral.
Since the 1980s, however, authors like Ivan Illich, Eliot Freidson, Terry Johnson, and Magali Larson have challenged that belief.
By contrast, these authors portray the professions as inherently conservative, protectionist, deeply self-interested, disproportionately advantaged, and promoting attitudinal mythologies inherent to maintain them as apex social actors.
They highlight the ‘inverse care failures’ of aged care facilities, mental health institutions, professional training institutes, and workplaces.
They draw attention to the professogenic effects that are ‘systematically produced as part of the social organisation’ of things like healthcare (Wrigley & Dreby, 2005).
And they accuse the professions of being agents of the capitalist state, patriarchal, racist, discriminatory, ableist, ageist, homophobic, and heteronormative (Abbott & Meerabeau, 1998).
What unbundling is doing
What Burns and others show is that;
'there is nothing inherent in goodness or expertise that demands the person be a professional, and there is nothing innate in professionalism that makes the person a good person or knowledgeable practitioner’ (Nicholls, 2022).
In other words, professionals hold no monopoly on goodness and expertise and while these claims might have been the basis for the professions’ claims to prestige and privilege in the past, they are no more.
So those resources, knowledges, roles and responsibilities once held within protective enclosures by the professions are now becoming increasingly democratised.
The social capital that they once controlled is being more widely distributed across a more diffuse network of social actors, such that the historical professions are just one mechanism among many through which people experience health and healthcare.
Inevitably, the professions are seeing their hard-won power and prestige diminish, and many are struggling to come to terms with this. But another factor in post-professionalism is the declining ability of the professions themselves to control events. Leading some to suggest that;
‘trusting the health professionals to bring about reform themselves is akin to the ‘rabbits guarding the lettuce’ (Susskind and Susskind, 2015), particularly given how adept the health professions have been in the past at ensuring their territorial security’ (Nicholls, 2022).
As Edgar Burns suggests;
‘While post-professionalism does not deny that society needs the service of articulate, clever, society-oriented actors and professionals, who can be a human beacon in a world of juridified, formalised, corporatised correctness, it does assume that professionals will be less important than they used to be’ (Burns, 2019).
A new opening
In the 17th and 18th centuries in Britain, common land was increasingly consolidated and privatised. People that used to farm, graze and glean in common with others were increasingly denied access as the land was turned to profit for landowners.
Unbundling makes the same claim about the professions: that they took lucrative aspects of healthcare and colonised them for their own benefit.
Part of the power professionals took for themselves was the ability to control the labour supply, and thereby ensuring demand.
In disability studies, professionals have been called parasites for their willingness to endlessly invent new forms of disability that they are conveniently best placed to address (Swain, French and Cameron, 2003).
But this self-interested privilege has now become a critical weakness for the professions because, ‘If professionals are only able to share their experience and knowledge by advising on a face-to-face basis, then there can be few beneficiaries of the genuinely outstanding’ (Susskind and Susskind, 2015).
Susskind and Susskind continue;
‘Professionals play such a central role in our lives that we can barely imagine different ways of tackling the problems that they sort out for us. But the professions are not immutable… To pick out a few of their shortcomings — we cannot afford them, they are often antiquated, the expertise of the best is enjoyed only by a few, and their workings are not transparent. For these and other reasons, we believe today’s professions should and will be displaced by feasible alternatives’ (Susskind and Susskind, 2015, emphasis added).
Perhaps unsurprisingly, many advocates for post-professionalism would see the capacities, knowledges, and resources that the professions once claimed as their own returned to the people.
And, in truth, this is now happening at a remarkable rate sometimes because, but often despite the professions themselves. I’ll cover some of this in the next instalment when we tackle the third main driver of post-professionalism: digital disruption.
References
Burns, E. A. (2019). Theorising professions: A sociological introduction. Palgrage Macmillan.
Nicholls, D. A. (2022). Physiotherapy Otherwise. Tuwhera Open Access. https://ojs.aut.ac.nz/tuwhera-open-monographs/catalog/book/8
Susskind, R., & Susskind, D. (2015). The future of the professions. Oxford University Press.
Swain, J., French, S., & Cameron, C. (2003). Practice: are professionals parasites? In Controversial issues in a disabling society (pp. 131-140). Open University Press.
Wrigley, J., & Dreby, J. (2005). Fatalities and the organization of child care in the United States, 1985–2003. American Sociological Review, 70(5), 729-757.