Occupational Professionalization

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For more than a century, people who study work, occupations, and society more generally have been interested in what distinguishes a profession from an occupation and how an occupation becomes a profession. Over time, theorists have provided different answers to these questions and proposed different processes of occupational professionalization. What underlies all of the theories is the fundamental assumption that professions such as medicine and the law are different from other occupations and that professional status is something desirable and something to be aspired to. This entry reviews five main approaches to the study of professions: functionalist, taxonomic, professionalization, power, and systems. The approaches are presented in chronological order, tracing the historical development of ideas. The entry also discusses more recent trends in research on professions and professionalization and concludes with thoughts about why modern occupations continue to strive for professional status.

Theoretical Approaches to the Study of Professions and Professionalization
The Functionalist Approach
During the late nineteenth century, Emile Durkheim, often cited as one of the fathers of sociology, was interested in the function or purpose of a division of labor in society. He argued that the functional division of labor binds people to one another in a new way and creates a new sense of "solidarity" among people who differ from each other but who are mutually dependent. Durkheim was also greatly concerned with what he perceived as a growing sense of isolation and disconnectedness between individuals in an industrial society. He defined a profession as an occupational group whose members share a body of knowledge and a moral commitment. Professions were important to him because he believed that they provided support for members and linked them to the broader society thereby reducing the experience of isolation and disconnectedness. This functionalist approach does not address the negative or dysfunctional effects professions have on subordinate occupations and the people who seek out professional advice and services. Nor does it describe the process by which an occupation becomes a profession (i.e., occupational professionalization).

The Taxonomic Approach
Research more narrowly focused on the topic of professions emerged in the 1920s and 1930s. Around this time, researchers such as Sir Alexander M. Carr-Saunders and Paul A. Wilson were concerned with differentiating between occupations and professions. To that end, they identified criteria that marked professions. Examples of such criteria include service orientation, technical knowledge, and specialized training. This approach to studying the professions, referred to here as a taxonomic or classification approach, may be overly concerned with what some see as the futile task of determining what is and is not a profession while, like the functionalist approach, being short on ideas regarding the causes and consequences of professions.

The Professionalization Approach
The professionalization approach evolved from the taxonomic approach described above and dominated the American and British literature on professions through the mid-1960s. It focused on the organization of professions and their stepwise progression from occupational group or craft guild to full profession. Theorists in this group, especially Harold L. Wilensky, were among the first to identify an orderly process whereby an occupational group becomes a profession. In other words, they specified a process of occupational professionalization that included creating training schools and professional associations, initiating licensure requirements, and establishing a code of ethics. According to this approach, professional status depends on whether an occupational group has gone through all the necessary steps. This approach to understanding professionalization has been criticized for being unidirectional and more concerned with organizational structure than work. Furthermore, some have argued that the stepwise approach conceptualizes professions as homogeneous and the professionalization process as constant both across professions and over time.

The Power Approach
Research during the 1960s and 1970s moved away from the process-oriented, stepwise professionalization approach and led to the emergence of power theories to explain professional status. These theories focused on the way a few well-established professions (e.g., medicine and the law) dominated and subordinated other occupational groups that did similar work—often to the detriment of the people who sought professional assistance. For example, Eliot Freidson asserted that the dominance of medicine over other occupations such as nursing was potentially harmful to patients and that people in need of health care would be better served by a less hierarchical organization of health occupations. Power theories also tended to describe professions as monopolistic and self-serving. From this perspective, one way to identify a profession is to look at the amount of power an occupational group possesses. Critics of this approach have described it as simply another version of the taxonomic approach that focuses on power, as opposed to organizational structure, as the defining characteristic of professions. Some have suggested that it does not sufficiently forward our understanding of how an occupation achieves professional status.

Andrew Abbott and the Systems Approach
In his effort to understand the nature of expert knowledge and the people and groups that produce, practice, and control it, Andrew Abbott came to understand professions and the process whereby an occupation becomes a profession differently from the way his scholarly predecessors understood them. His predecessors researched individual professions and saw them as evolving independently of one another. They focused on how professions were organized and how much power they had. Abbott, on the other hand, saw professions not as individual and independent entities but as members of an interdependent system where a shift in one impacts the work and boundaries of others. He focused on the work of professionals and the way they compete for jurisdiction over certain types of work. Jurisdiction can be described as the power or right of an occupational group to produce knowledge and claim expertise in a certain area. This focus on work and jurisdiction signified a fundamental departure from the way professions had been studied in the past.

In addition, Abbott's concept of professionalization was different from earlier accounts, namely the step-wise professionalization approach. Abbott rejected the idea of unidirectional movement from an occupation toward full professional status. For him, going through a series of steps did not necessarily make an occupational group a profession. Rather, an occupational group became a profession as a result of gaining jurisdiction over certain types of work (e.g., childbirth or mental health). Jurisdiction was achieved via competition and settlement with competing occupational groups. For example, the turn of the twentieth century revealed midwives in stiff competition with physicians for jurisdiction over childbirth in the United States. Physicians, with their scientific knowledge, arguably won the dispute for control over childbirth. However, midwives (both lay and nurse-midwives) continued to attend a small percentage of births in the United States and have been mounting an organized effort since the 1970s to regain legitimacy and jurisdiction over at least some, namely "normal" or "low-risk," births. According to Abbott, such disputes result in the continuous construction and reconstruction of jurisdictional boundaries over time.

Four concepts are central to Abbott's systems theory: work, jurisdiction, competition, and system. When more than one profession tries to claim expertise with respect to a certain type of work, jurisdictional disputes arise and must be settled. Rarely can jurisdiction be equally shared. Thus professions compete to have their work acknowledged as legitimate and their knowledge recognized as dominant. A shift in one profession's jurisdictional boundaries affects others, and as this process unfolds over time, the entire system of professions is impacted. Such is the nature of this amoeba-like system of interlocking professions—constantly shifting, swelling, and contracting. Much of the recent literature on professions and professionalization tests, extends, or illustrates shortcomings in Abbott's work.

Recent Developments in Professions Research
Since Abbott published The System of Professions in 1988, no researcher has undertaken so systematic and comprehensive a project aimed at introducing a new and groundbreaking theory of professions. At the same time, the professions literature has not stagnated. Theoretical and empirical research on professions has continued to flourish by (1) testing and augmenting existing theories and (2) describing the changing environment in which professions negotiate jurisdiction and the new professionalization strategies such changes have inspired. New and interesting areas of inquiry in the study of professions and professionalization include intraprofessional relations, workplace size and degree of bureaucratization, gender, and unconventional professionalization strategies.

Intraprofessional Relations
Sydney A. Halpern was interested in why some professions are better than others at subordinating competing groups. Using comparative and historical methods to analyze data gathered from medical publications and professional association meetings, she explored the degree to which American medicine has had control over adjacent occupational groups such as radiologic technology, physical therapy, laboratory technology, and nurse anesthesia over time. She tested the professionalization, power, and systems theories and found that none fully explain American medicine's pattern of domination. Rather, she suggested that intraprofessional relations (e.g., between two medical specialties like radiology and internal medicine) significantly affect interprofessional boundary negotiation (e.g., between radiology and X-ray technology). She found that a subsection of a profession (e.g., radiology), not the profession as a whole (e.g., medicine), embarks on an effort to challenge a competing group (e.g., X-ray technology). Her data revealed that for a subsection to be successful in its efforts to subordinate a competing occupation, it must have support from other subsections of the profession. In light of her findings, Halpern suggested that Abbott's theory should be extended to explain not only interprofessional relations but intraprofessional relations as well.

Workplace Size and Degree of Bureaucratization
Cecilia Benoit criticized researchers' tendency to universalize findings from studies of American and British professions and professional boundaries to other countries. She reviewed historical data on midwifery in Sweden, the Netherlands, and Canada and found that the concepts of medicalization of birth and deprofessionalization (i.e., loss of professional status) of midwives as a result of the rise and dominance of obstetrics are not as relevant in Sweden, the Netherlands, and some Canadian provinces as they are in the United States and Britain. Rather, in the countries she studied, birth continues to be understood as a natural process, and midwives have attained a level of professional status not seen in the United States and Britain. Most important, she argued that workplace size and degree of bureaucratization are important factors for whether an occupational group becomes a profession. She asserted that midwives in Sweden, the Netherlands, and Canada may have achieved professional status, at least in part, because they work in small, relatively nonbureaucratic settings.

Gender Perspective
Kristin Barker built on Abbott's systems theory and presented evidence of a gendered system of professions. She focused on the dispute between the American Medical Women's Association and the American Medical Association regarding the 1920 Act for the Promotion of the Welfare and Hygiene of Maternity and Infancy, popularly known as the Sheppard-Towner Act. She analyzed discourse on Sheppard-Towner between 1921 and 1929 as recorded in the Medical Women's Journal and the Journal of the American Medical Association. She found that shared gender both divided and united women in their efforts to gain jurisdiction over pregnancy and birth. Intraprofessional (i.e., within the medical profession) and interprofessional (e.g., among medicine, nursing, and social work) collaboration helped women gain initial jurisdiction. However, the interprofessional coalition did not include midwives and, in the end, served to undermine midwifery's historic claim to jurisdiction over childbirth. Due to these and other circumstances, women, regardless of professional status and affiliation, lost the battle over childbirth to the predominantly male medical profession. Barker urged fellow researchers to pay careful attention to the gendered nature of jurisdictional disputes, both intra- and interprofessionally.

Tracey L. Adams also contributed to the literature on the gendered nature of professions and professionalization processes. She presented a case study of dental hygiene in Ontario to explain how some female-dominated occupations attempt to gain professional status. Her data consisted of articles published in Canadian dentistry journals between 1945 and 2000, government documents, legislation, research reports, dental hygienists' MA and PhD theses, and interview transcripts. Adams found that ideas about (1) women having equal access to historically male-dominated work and (2) women being inherently more caring and better communicators play a significant role in the relatively successful professionalization of dental hygienists in Ontario. She raised questions about whether claims to jurisdiction and professional status based on feminine gender will prove successful in the future as dentistry, among other professions, becomes increasingly populated by women.

Unconventional Professionalization Strategies
As described above, dental hygienists in Ontario used feminine gender as a strategy for gaining professional status and autonomy from historically male-dominated dentistry. This strategy, mobilizing gender-specific arguments when making claims to professional status, is not new. Women physicians in the United States during the late nineteenth and early twentieth centuries used this strategy to enhance their status within medicine. They argued that women have a special capacity for caring and healing and are uniquely suited, perhaps even better suited than men, for medical practice. Although this is not a new strategy, it is still considered unconventional—mainly because prior research on professions rarely addressed gender and, therefore, gendered professionalization strategies have only recently been described.

Martin Laffin and Tom Entwistle wrote about another unconventional professionalization strategy. They began by describing typical professionalization projects and went on to suggest that new conditions (e.g., changes in how policy is made and globalization) are forcing occupational groups and existing professions to experiment with new approaches. They identified three major shifts in occupations' approaches to professionalization: (1) from exclusive jurisdiction to interdisciplinarity and overlapping jurisdictions, (2) from an "insider" approach to affecting policy to public advocacy, and (3) from standalone professions to interprofessional collaboration and the formation of "strategic alliances." They argued that such changes in professionalization strategies force us to reconsider what it means to be a professional and what it looks like when occupational groups undertake professionalization projects.

Conclusion
This entry has described five approaches to understanding professions and the process of professionalization: functionalist, taxonomic, professionalization, power, and systems. Each approach contributes to our understanding of what a profession is and the process by which an occupation becomes a profession. Recent research points to a number of areas ripe for further inquiry such as intraprofessional relations, workplace size and bureaucratization, gender, and emerging professionalization strategies. Regardless of focus or temporal location, all of these studies share an under­lying assumption. They assume that professions are different from and more desirable than "ordinary" occupations. This leads to the question: Why is professional status desirable or, in other words, why do occupations aspire to professional status? First, at the level of the individual, professionals may make more money, exhibit more autonomy, and experience higher status and more control over their work than people who do similar work in nonprofessional adjacent occupations. Second, there is some evidence that professionalizing improves services and the quality of work done by members of the occupational group. Thus a commitment to quality service may serve as motivation. Third, professions and professional organizations exercise a considerable amount of power in the public and legal spheres. Together, these benefits of professional status may contribute to improved quality of life for members of professions, to continued interest by occupational groups in professionalization, and to continued relevance of occupational professionalization as an area of academic inquiry.

References:
Abbott, A. 1988. The System of Professions: An Essay on the Division of Expert Labor. Chicago, IL: University of Chicago Press.
Adams, T. L. 2003. "Professionalization, Gender and Female-dominated Professions: Dental Hygiene in Ontario." Canadian Review of Sociology and Anthropology 40:267-289.
Barker, K. 1998. "Women Physicians and the Gendered System of Professions: An Analysis of the Sheppard Towner Act of 1921." Work and Occupations 25:229-255.
Benoit, C. 1992. "Midwives in Comparative Perspective: Professionalism in Small Organizations." Current Research on Occupations and Professions 7:203-220.
Carr-Saunders, A. M. and Wilson, P. A. 1933. The Professions. Oxford, England: Oxford University Press.
Durkheim, Ё. [1893] 1984. The Division of Labor in Society. New York: Free Press.
Freidson, E. 1970. Professional Dominance: The Social Structure of Medical Care. Chicago, IL: Aldine.
Halpern, S. A. 1992. "Dynamics of Professional Control: Internal Coalitions and Crossprofessional Boundaries." American Journal of Sociology 97:994-1021.
Laffin, M. and Entwistle, T. 2000. "New Problems, Old Professions? The Changing National World of the Local Government Professions." Policy Press 28:207-220.
Wilensky, H. L. 1964. "The Professionalization of Everyone?" American Journal of Sociology 70:137-158.


Source: Occupational Professionalization