14 Types of professions

Parsons’ trait theory established an ideal standard against which all occupations could be measured, with medicine being the paradigm case. Alexander Carr-Saunders used this to begin a debate that has run for decades now into whether disciplines like physiotherapy and nursing are true, or semi-professional ^[1]. Carr-Saunders defined the distinction in this way:

• Established professions (medicine, for example);
• New professions — based on ‘fundamental’ studies (engineering and the social sciences);
• Semi-professions — based on the acquisition of technical skill (nursing and social work);
• Would-be professions — ‘occupations which require neither theoretical study nor the acquisition of exact technical skills, but may require facility with modern practices in business administration — for example, hospital managers ^[2].
• The argument against calling nursing or physiotherapy true professions stems from the functionalist claim that they lack ‘sufficient theoretical knowledge or powers of self-regulation’ ^[3], a point of contention within physiotherapy for more than half a century. In the 1961 Mary McMillan lecture to APTA members, for instance, Catherine Worthington argued that ‘Physical therapy has generally been thought of as a therapeutic technique, not a source of new knowledge’ ^[4], and so;

‘To be specific and very blunt — if your objective is to develop physical therapy into a profession — you must give attention to the differences between technicians and professional persons. Historically, you are technicians. You aspire to professional status. You are sensitive to the lack of confidence of the medical profession in your professional competence and judgement and, as a result, are often defensive in your reactions. Many of you failed to realise that to call yourselves professional does not of itself entitle you to such a designation. To be professional, members of the group must possess a body of knowledge that is both identifiable and different from that of other professions. They must also assume responsibility for adding to that body of knowledge and for developing their own standards of education and practice’ (ibid).

Whether it be through moves away from vocational training to degree-level education, research, the pursuit of professional autonomy, legislative protection of title, or increasing clinical specialisation, physiotherapists have worked hard to be judged against the ideal-type functionalist definition of a profession. For physiotherapists, the task has been made somewhat easier by the profession’s adoption of many of Parsons’ professional traits. Physiotherapists’ affective neutrality and universalism, particularly, set them apart from other ‘caring’ professions. And from a purely functionalist point of view, this has historically been to their advantage.

Pamela Abbott and Liz Meerabeau suggest that nursing, midwifery, health visiting, and social work, have all made claims to be professions, but ‘these occupational groups are still striving to demonstrate that caring is work, and to find ways of caring that do not make them subservient, but which demonstrate that they have professional expertise’ ^[5]. As early as 1933, Carr-Saunders and Wilson suggested that masseurs, biophysical assistants, and medical auxiliaries, could not be considered true professions because they worked in service of medicine ^[6]. Eliot Freidson argued that ‘those paramedical occupations which are arranged around the physician cannot fail to be subordinate in authority and responsibility’ ^[7]. William J. Goode argued that ‘no other occupation in the medical sphere will achieve the full professional status of the doctor and dentist’ ^[8]. While physiotherapists like John Mercer, writing in his 1978 doctoral thesis, argued that clinical physiotherapy, ‘cannot equal the professional attributes of the doctor because it is a segment of the medical profession without its overarching leadership function. It can no more become an ‘ideal’ type profession than the arm can become the whole body’ ^[9].

The desire to be judged against ideal-type functionalist definitions of the ‘true’ professions remains strong, however. Professions Australia, for instance, defines a profession as;

‘a disciplined group of individuals who adhere to high ethical standards and uphold themselves to, and are accepted by, the public as possessing special knowledge and skills in a widely recognised, organised body of learning derived from education and training at a high level, and who are prepared to exercise this knowledge and these skills in the interest of others’ ^[10].

Similarly, the latest NHS Allied Health report draws heavily on functionalist language when it argues that;

‘Physiotherapists are autonomous practitioners, with expertise in the use of physical and psychosocial approaches to rehabilitation, optimising independence and quality of life. Physiotherapy is a science-based profession and takes an evidenced approach to ‘whole person’ health and wellbeing’ ^[11].

What these definitions illustrate is the enduring influence of functionalist ideas on all aspects of professional life. Functionalist motifs resonate through many aspects of healthcare, and almost every facet of physiotherapy, past, and present. And it seems this most often happens without the authors’ and instigators’ awareness that their ideas and practices can be understood as functionalist. Functionalism is clearly both a powerful and enduring tool for developing, explaining, and analysing professional practice and thinking.

To briefly summarise, the two main principles of functionalism are that parts of a system contribute to the stability of the whole, and that the different parts of a system can be differentiated by their traits or characteristics. How, then, does this relate specifically to physiotherapy?