Post-professionalism

Western healthcare has always been capitalistic — Being responsible — The future or empathy and care — The centrifugal effects of late capitalism — Professions under fire — Unbundling goodness and expertise — Complexity — Implications for physiotherapy — Closing words

In this chapter, I want to bring the study of the professions up to date by examining post-professional healthcare. Although the idea that we are now entering a post-professional era goes back to the 1980s in sociology, only a handful of writers have so far discussed it specifically in relation to healthcare ^[1][2][3]. Post-professionalism refers to the decentralised role professionals are now playing as governing powers in society.

Although Ivan Illich was perhaps the first person to use the term ‘post-professional’ in an academic context ^[4], the ideas and principles it encompasses developed significantly in the earlier work of Eliot Freidson and Terry Johnson ^[5][6]. In sociological terms, post-professionalism refers not to the end of the professions, but rather a world in which the professions are seen as one actor amongst many in the organisation of social fields like education, business, engineering and design, healthcare, entertainment, the law, and government itself ^[7]. And so, while post-professionalism does not deny that ‘Society needs the service of articulate, clever, society-oriented actors and professionals’ ^[8], who can be a ‘human beacon in a world of juridified, formalised, corporatised correctness’ (ibid, see also, ^[9]), it does assume that professionals will be less important than they used to be.

Post-professionalism works on the basis that professionals will see their power and prestige diminish over the coming years, as social capital becomes more widely distributed amongst a much more diffuse set of social agents: from individual and communal, to public and private, real and virtual, informal and formal. This chapter considers three important questions that arise from this shift: who is now acquiring this more widely distributed social capital, how is it being distributed, and what role will the professions — especially physiotherapy — play in the process?

What makes this analysis more relevant and prescient for people in healthcare, is the belief that there is something qualitatively different about the present moment; that healthcare is in the midst of a transformation unlike anything we have seen before. This is a bold claim and one that is open to challenge. Surely, Western healthcare has experienced enormous ruptures before, not least with the imposition of managerialism and neoliberal economics in the 1970s and 80s? And what of the discovery of antibiotics, or the birth of the welfare state? Were these not as significant as today’s disruptions?

In one respect they are. But the economic reforms of the last 50 years have been insufficient, on their own, to radically transform Western healthcare, with the orthodox professions showing remarkable resistance to reform, (at least by comparison with other industries like manufacturing, coal mining, banking, and tourism) ^[10]. Edgar Burns suggests that, ‘A lot of effort is required in repositioning professions’ ^[11]. And perhaps because of this, there have been explicit attempts in high-income countries to restructure health services by ‘bypass[ing] resistance from the medical profession’ ^[12]. And then, secondly, many of the other social disruptions (war, drug discoveries, public health crises, reform of the healthcare system, etc.), seem to have been disruptive largely in the health professions’ favour, and have only served to consolidate orthodox professional power.

What makes this moment different, and so important, then, is the confluence of two forces that are now acting together to reshape healthcare. These forces are late capitalism and the growing critiques of the professions, and together they are giving shape to post-professionalism.