Medical Career Systems and Professional Space. Conceptualising Clinical Autonomy from a Professions Perspective
1University of Helsinki, Finland; 2Finnish Medical Association, Finland
This paper presents the evolving conceptual framework of an ongoing multi-method study of Finnish medical profession that focuses on medical work and clinical autonomy. The study that is conducted in collaboration with the Finnish Medical Association is carried out in two stages, the first of which involved semi-structured interviews with 38 doctors, half of whom were in an early career stage and the second half in a late career stage. The second stage, which is planned to begin in early 2020, builds on the analysis of several different sets of already collected survey data with representative samples of Finnish doctors. Results from the interview study have been reported in a research report and analysed in one article focusing on the early career stage from a gender perspective. This paper develops a conceptual framework based on these analyses. The paper considers insights from the qualitative interviews and from survey data, respectively for developing understandings of how medical career systems structure clinical autonomy. We argue that professional agency is shaped by the ways doctors perceive the professional space available to them in different career stages and organisational positions. We consider examples of unequal career patterns and career paths within the profession and argue for the need to consider intersecting inequality regimes as dynamics underpinning medical career systems.
‘Protected Professionals’? How Well-Connected Professionals Can Remain Autonomous and Authoritative
Utrecht University, Netherlands, The
Traditionally, professionals such as medical doctors, academics and judges are well-protected. They work within well-defined jurisdictions, belong to specialized segments, and are granted autonomies and discretionary spaces. In this way, they can be trained and supervised, case-related considerations can be highly substantive (instead of e.g. commercial), and they can take decisions independently. Ideally, these decisions are authoritative and accepted, both by the clients and society (stakeholders).
This ideal-typical but also ‘ideal’ imagery has always had its flaws; nowadays its shortcomings are increasingly clear. ‘Protected professionalism’ as well as ‘protected professionals’ have become outdated. Due to heterogeneity and fragmentation within professional fields, interdependencies between professional fields, and dependencies of professional actions on outside worlds, professionals can no longer isolate themselves from others and outsiders. This is fuelled by financial-economic pressures (e.g. cost control), socio-cultural transitions (e.g. multi-problems, declining trust), political turmoil (e.g. polarization), and technological innovations (e.g. social media, Google and Facebook, algorithms).
This might lead to a ‘decline’, ‘withering away’ and ‘hollowing out’ of professionalism, stimulating a ‘return to’ professional values and spaces. It might also lead to a ‘reconfiguration’ of professionalism, with more ‘hybrid’, ‘organized’ and ‘connected’ professional identities and actions. This paper contributes to the debate on connective professionalism, arguing that connectivity calls for more fundamental reflections and redefinitions of professionalism/professionals. How can professional action be related to others and outsiders and remain ‘autonomous’ and ‘authoritative’ at the same time?
This can no longer be ‘autonomy’ and ‘authority’ as fixed entities; these dimensions become fluid. They have to be enacted continuously, backed by certain mechanisms that accentuate (instead of ‘protect’) key aspects of professional acts, such as ‘independence’ or ‘integrity’.
The Impact of Workplace Change on Professionals’ Skills and Knowledge: Engineers in Canada
The University of Western Ontario, Canada
Professional workplaces have experienced considerable change over the last several decades, impacting professional work and workers. Although numerous changes have been identified in the literature, it is not clear what impact they have had on the work that professionals do. The proletarianization thesis, prominent in the 1980s, held that professionals were being deskilled by organizational & technological change and managerial control. This thesis was largely rejected and replaced by the now-dominant hybridity thesis, which holds that professionals are increasingly taking on managerial responsibilities, skills and training. The hybridity thesis suggests professional skills are either expanding or changing. An alternative perspective – a stratification hypothesis – argues the impact of change on skills might vary within the profession across structural location, gender, age, and race. Despite these differing accounts, there has been surprisingly little empirical exploration on this topic. Through an analysis of in-depth interviews with engineers in Ontario Canada, this paper explores engineers’ perceptions of how workplace change is affecting them, and what the impact is on what they do and how they do it. Particular attention is paid to structural location, as well as gender, race, and age in their accounts. Findings suggest that trends are complex, and that structural location strongly shapes the impact of workplace change on skills. The implications of workplace change for professional work, and professional skills and knowledge more broadly, are discussed.
Unionism in the Name of Professionalism? On Solidarity, Professionalism and the European Central Bank
Institut für Sozialforschung an der Goethe Universität Frankfurt, Germany
The paper discusses the role of collective action in the field of professional work. A binary approach, distinguishing between unionism and association versus professionalism and social closure has long been refuted. But with regard to the ongoing debate on structural changes of professionalism, hybridization and the frequently discussed phenomenon of situated or organizational professionalism, occupational politics and employees’ interest representation might further amalgamate and develop new patterns. Based on an empirical study the European Central Bank (ECB), which combines a bureaucratic and strictly hierarchical organization with aspects of an epistemic community, will be discussed as an example of emerging unionism in the name of professionalism.