Post-professionalism – Part 6 – Diagnosis
How do we know that post-professionalism is taking hold in healthcare? Where would we look to find signs of the atomisation of the body, late capitalist expansion, the unbundling of goodness and expertise, and digital innovation? And, if we found them, would they represent a genuine break with the everyday incremental kinds of change that people in healthcare seem to have experienced all of their lives?
Given how complex health care is, it’s hard to be absolutely definitive about the degree to which post-professionalism is becoming the dominant discourse. However, although one could point to innovations and healthcare reforms as evidence of post-professionalism, perhaps the paradigmatic sign of a new philosophy of healthcare can be found in the professions and disciplines themselves, and the way they are reacting to this new epoch.
In Physiotherapy Otherwise, I set out four broad archetypes to explain the ways that the physiotherapy profession internationally appears to be responding to post-professionalism. Although these archetypes relate directly to physiotherapy, I think there are many commonalities across the entire healthcare spectrum.
Here are the four archetypes:
1| Watching and waiting
Perhaps the hardest to locate, this approach is the most conservative response with the profession trusting in its stability, and arguing that reactive change might endanger the profession's future prospects. Innovations are sometimes described as trends or fads, or threats that the profession has faced down before. And the profession is reassured that people have nothing to worry about and that the future won’t be that dissimilar to today.
Pros: the profession promotes a sense of confidence amongst its members and reassures people that the profession is here for the long haul.
Cons: the profession gets left behind and becomes obsolete, replaced by more agile competition, or what Susskind and Susskind call ‘viable alternatives’.
2| Modern heritage
This approach sees the profession return to its founding values; its most grounding ontological presuppositions. As a way of actively resisting the threat of radical reform, people within the profession call for a return to core values. New ways of thinking and innovation become the target of critique, and the profession’s history is mobilised to remind members how the profession got here in the first place.
Pros: this is a very straightforward professional identity to ‘sell’ to members, the public, funders and regulators. It is often very familiar, particularly to elite members of the profession who have prospered because of their mastery of the same core values. And it is often easy to consolidate in a curriculum or revisionary scopes of practice.
Cons: the biggest danger here is that the profession is actively marginalised because it fails to address changing social priorities. It might be seen to serve the interests of the profession’s elite, or the kind of population that the profession was suited to in the past. In both cases, the profession may be seen as arcane and increasingly irrelevant.
3| Renaissance
This approach involves throwing the baby out with the bathwater, radical professional reform, the subversion or inversion of traditional values, and a desire to profoundly redesign the profession's identity and purpose.
Pros: this is perhaps seen as the most responsive of the four archetypes because it shows that the profession is attuned to shifting social dynamics, as well as being agile enough and willing to adapt when the need arises.
Cons: the biggest danger of this approach is that it can be extremely unappealing to those people within the profession who have built their professional identity on an earlier image that has now been rejected. This can make it very difficult to change curricula or scopes of practice because the very people who have to instigate the change are the ones that don’t want it to happen.
4| Hybrid
The fourth and final archetype is, perhaps, the one that has the broadest appeal and the one that has so far had the widest impact in healthcare. The hybrid approach attempts to take the best of the profession's past and incorporate the best of the new. In many cases, this opens up the possibility of a new ‘holistic’ professional identity in which traditional professional boundaries become much more porous.
Pros: for many within the profession, the hybrid approach creates the possibility for a much more diverse and inclusive understanding of the profession. It can liberate many people to finally acknowledge aspects of the profession that were previously latent or sublimated. It may open up the possibility for territorial expansion and justify the expansion of the profession into new markets and new territories.
Cons: the biggest danger with a hybrid approach is that it embraces such a wide set of beliefs about the nature of the reality of healthcare (that it is biologically based, experientially based, culturally based, environmentally based, spiritually based, socially based, or all of the above) that people can no longer see clearly what the profession believes or stands for. In trying to be all things to all people, the professional loses the distinctiveness and has to operate at a much more superficial level that, in the end, doesn’t require the kinds of depths of training that conventional approaches demand. Similarly, the curriculum now takes 17 years to complete and teaches the student one thing in the morning, and it’s direct obverse in the afternoon. All is confusion.
We are seeing some or all of these archetypes being played out in the different healthcare disciplines today. But as can be seen, there isn’t any one approach that does not come with some significant flaws.
As diagnostic tools, though, they do show the degree to which all of the professions are now asking fundamental questions about their ongoing viability.
And whereas in the ‘golden age’ of the health professions the question was really only how the orthodox and legitimate state-sanctioned professions could work most efficiently in an otherwise stable and unchanging field, the professions are all now asking whether the field even exists in the same way does it used to.
One of the features of this new field is a change in the ability of the professions themselves to influence the future.
In the previous post in this series (Link), I argued that one of the two main features of post-professionalism is the degree to which the professions are having their own agency de-centred, suggesting that even if the professions do adopt a modern heritage, renaissance or hybrid approach, it will have little impact on the relentless turn away from the professions as a governing principle in western healthcare today.
So, what might be a more viable way forward for people within the professions, if their future is going to be increasingly marginal?
This will be the subject of the last substantive post in the series looking at the future for the professions in a post-professional world.
Reference
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.