PROFESSIONS

The idea of a "profession" did not exist in ancient times. Although there were people who did what is currently denoted as professional work, these "professionals" often labored in dependent positions. For example, physicians in the Roman Empire were slaves in wealthy households, and architects worked as salaried public employees. Lawyers in ancient Greece were merely friends of the litigants who spoke before a gathering of their peers. Neither lawyers nor physicians received formal training (Carr-Saunders and Wilson 1937). By medieval times, the three classic professions—medicine, law, and the clergy (which included university teaching)—began to approximate more closely the modern conception of professions. With the development of universities, then under religious auspices, would-be professionals completed lengthy training in their chosen fields. They also began to constitute a new class of intellectuals. As society increasingly secularized, the professions emerged from under religious control and began to organize professional associations. By the eighteenth century, they had achieved independent status.

In the nineteenth century, middle-class occupations such as dentistry, architecture, and engineering began to professionalize, aspiring to the gentlemanly status of the classic, learned professions (Dingwall and Lewis 1983). "Gentlemanly" was the appropriate description, since the majority of professionals were men. It was not until the 1970s that women began to make significant inroads into these occupations, and even today men predominate in the status professions.

In the nineteenth and early twentieth centuries, professionalism developed in concert with the increasing division of labor and rationalization characteristic of industrializing Europe and the United States. As competitors in market economies, occupational incumbents sought to professionalize to improve their status. In addition, they wanted to better their economic positions by securing occupational niches for their services (Ritzer and Walczak 1986). In the United States, at least, universities played the key role of transferring both the technical know-how and the culture of professionalism to new generations of professional aspirants (Bledstein 1976).

WHICH OCCUPATIONS ARE PROFESSIONS?

Today the term "profession" includes a range of occupations arrayed along a continuum of high to medium levels of prestige. At the high end of the continuum are the classic, or "status," professions of medicine, law, clergy, and university teaching. Incumbents in these occupations usually receive high incomes, exercise job autonomy, and receive deference from the public and those lower in the status hierarchy. Although women have begun to gain entry into some of the professions, most professions remain predominantly male: in 1998, women's representation among physicians, lawyers, and the clergy was 27, 28, and 12 percent, respectively. Women have made more progress moving in to college and university teaching, representing 42 percent of incumbents by 1998 (all 1998 data are from U.S. Bureau of Labor Statistics 1999, Table 11).

Somewhat lower on the continuum are the "newer" professions such as dentistry, engineering, accounting, and architecture, which also command respect and relatively high salaries. Men also predominate in these occupations: 20, 11, and 18 percent of dentists, engineers, and architects, respectively, were women in 1998. Only in accounting have women made significant inroads: 58 percent of all accountants and auditors were women in 1998. This feminization is attributable largely to accounting's dramatic occupational growth in the 1970s (Reskin and Roos 1990, pp. 40–41).

Still lower on the professional continuum are the "marginal professions" (e.g., pharmacy, chiropractic) and the "semiprofessions" (e.g., nursing, public school teaching, social work, librarianship). These occupations exhibit some characteristics of the classic professions but have not acquired full professional status because of opposition from established professions and an inability to convince the public that they command unique expertise. These occupations are less prestigious and their incumbents are paid less than those in either the classic or the new professions. Moreover, because they are concentrated in bureaucratic settings, these professionals exercise less job autonomy than higher-status professionals. An important difference between the marginal professions and the semiprofessions is that males are in the majority in the former (although pharmacy, an occupation that has feminized rapidly in recent years, is now 44 percent female), whereas semiprofessions have long been predominantly female (in 1998 women composed 92, 75, 68, and 83 percent of nurses, public school teachers, social workers, and librarians, respectively).

Paraprofessionals work with, but as subordinates to, members of the other professions. They are generally technicians associated with various professional occupations. Paralegals, for example, work closely with lawyers, and physicians delegate certain tasks and responsibilities to physicians' assistants. As in the semiprofessions, women tend to predominate in paraprofessional occupations. These data clearly show the sex-stratified nature of professional occupations, but these occupations are also stratified by race: in 1998, for instance, 5 percent of physicians were black, 6 percent of college and university teachers, 4 percent of lawyers, and 9 percent of clergy, notably less than their 11 percent representation in the labor force as a whole. Blacks are overrepresented, relative to their labor-force representation, in the following professions: dietitians (18 percent); respiratory therapists (12 percent); prekindergarten and kindergarten teachers (14 percent); educational and vocational counselors (13 percent); social workers (23 percent); recreation workers (16 percent); athletes (13 percent).

THE PROCESS OF PROFESSIONALIZATION

Given the stratification of the U.S. occupational structure, it is clear why workers desire to professionalize. Professionalization brings higher income, higher prestige, greater job autonomy, and higher job satisfaction. It also protects incumbents from competition. The "process of professionalization" posits a common sequence of development that occupations undergo. Some scholars accept Harold Wilensky's depiction of this process (1964). First, people begin to work full time at a specific set of tasks that will form the new occupation's core jurisdiction. Second, those in the occupation establish a university-affiliated training program, and some incumbents undertake the responsibility for training new generations of practitioners. Third, practitioners and teachers combine to form a professional association that identifies the occupation's core tasks and makes claims regarding skill jurisdiction. Fourth, occupational incumbents seek to protect their jurisdictional claims by political means. Professionals lobby for legal protection, in the form of licensing and certification requirements, to generate labor-market shelters that ensure their monopoly of skills. Finally, incumbents develop a formal code of ethics that embodies rules to protect clients, eliminate the unqualified, and spell out the occupation's service ideal. As we shall see, later theorists have come to question this linear sequence of events.

APPROACHES TO THE STUDY OF THE PROFESSIONS

What distinguishes the professions from other occupations? Theoretical approaches in studying this question have changed over time and remain in flux. Scholars have also developed new methods to address these questions.

The Trait Approach. After World War II, the trait approach was dominant in scholarship on the professions (Freidson 1986). Scholars—mostly American academics—tried to define the professions by generating an exhaustive list of characteristics. These traits, scholars hoped, would distinguish professions from nonprofessions and higher-status professions from those of lower status. The main method used was the case study.

Scholars carefully scrutinized particular occupations to determine how well they approximated the four major criteria, or traits, of the ideal-typical profession (Hodson and Sullivan 1990). First, professionals are experts with abstract, esoteric knowledge and skills that set them apart from others. Second, because of their unique expertise, professionals exercise autonomy on the job. Codes of ethics help to ensure autonomy from outside control by permitting professionals to police misconduct internally. Third, their esoteric knowledge allows professionals to claim authority over their clients and subordinate occupational groups. Finally, the professions are altruistic, that is, service-rather than profit-oriented. Underlying these four traits is a fifth: the public must recognize the occupation as a profession. Regardless of an occupation's claim of unique expertise, if the public does not view the occupation's knowledge as abstract, it is difficult for those working in it to claim professional status and the perquisites that accompany it.

Scholars used these criteria to differentiate among the professions, most particularly in comparing the female semiprofessions to the typically male status professions. While the semiprofessions have a body of knowledge, they lack a monopoly over that knowledge. They also have a difficult time convincing the public that their skills are professional. The public is less likely to recognize their expertise (e.g., teaching children, servicing library patrons) as particularly esoteric. Semiprofessionals typically work in bureaucratic settings and, as a consequence, are subject to heteronomy, or supervision by organizational superiors and professional colleagues. Their ability to claim autonomy is limited.

The Power Approach. In the 1960s, scholars in the United States and Great Britain began to criticize the trait approach as static and ideological. Recognizing the salience of culture and social structure, power theorists also shifted to historical methods to understand the sources of professional power. They argued that occupations we view as professions do not necessarily exhibit the requisite traits, but rather have the power to convince the public that they do. Power theorists viewed the professions as monopolistic organizations intent on gaining and retaining professional control and ensuring their status in the stratification system. Eliot Freidson (1986), for example, focused on how professions establish protected labor markets for their services. Magali Sarfatti Larson (1977) argued that the professions are market organizations in the capitalist economy, explicitly seeking to dominate the market for their expertise.

For these theorists, the so-called objective characteristics of the trait approach are ideological attempts to preserve the professions' status and privilege (Freidson 1986). Rather than being truly altruistic, professional incumbents create the myth of service orientation to gain public goodwill, enhance their status, and minimize external control. According to this view, professionals sometimes abuse their autonomy by failing to police themselves, and incompetent doctors and lawyers fleece the public with little fear of reprisal from their peers. Finally, the professional's authority over clients has also declined in recent years as a more educated public has become active in activities seen as the province of professionals (e.g., getting second opinions on medical recommendations and becoming more educated consumers regarding medical and legal issues).

The historical battles between physicians, on the one hand, and pharmacists and chiropractors on the other, illustrate how an established profession exercises power against competing occupations (Starr 1982). When the pharmacist's traditional task of compounding drugs shifted to pharmaceutical companies, they lost their diagnostic expertise (and hence monopoly over their knowledge). With respect to chiropractors, the American Medical Association restricted access through licensing laws or blocked reimbursement from private insurance companies. As a consequence, pharmacy and chiropractic have yet to become fully professional.

What enables professions to wield power? Theorists point to the occupational characteristics indeterminancy and uncertainty (Ritzer and Walczak 1986). The professions that have achieved and maintained power are those whose tasks cannot be broken down or otherwise routinized (indeterminancy). Similarly, those that deal with areas of uncertainty are also likely to preserve their power. As Wilensky (1964) described it, professional knowledge involves a "tacit" dimension, in Polanyi's (1967) terminology. Their lengthy training and years of practical application ensure that physicians "know" what treatments to use for which symptoms. Similarly, lawyers "know" what legal strategies work best and college professors "know" what instructional strategies are most effective in enhancing student learning. Reading a textbook or consulting computerized data bases is not equivalent to tacit knowledge. This kind of knowledge—expertise refined by years of experience—is not easily routinized. Physicians and lawyers also deal with areas of high uncertainty for their clients, the former with physical health and the latter with legal affairs. Clients need these professionals to translate medical and legal jargon into everyday language they can more readily understand.

The System of Professions. Andrew Abbott's (1988, 1995) theory of professions critiqued the notion that professions undergo a common process of development. Employing historical and comparative methods, Abbott provided a wealth of evidence that the history of the professions is much more complicated than that represented in a linear process of professionalization. Rather than a history of professions that established systems of control (e.g., schools, professional associations, licensing and certification), Abbott's account is of ongoing interprofessional competitions, squabbles over jurisdictions, and professional births and deaths.

Abbott contended that professions make up an interdependent "system of professions." Understanding modern professions entails articulating their histories of conflict with other professions. Comprehending the realities of modern medicine, for example, depends more on investigating its historical conflicts with closely related professions such as psychiatry and chiropractic than on the particulars of medieval or nineteenth-century medicine.

Recognizing the interdependence of professions is important because it clarifies that professions emerge, grow, change, and die within the historical context of competition with other professions. This competition takes the form of jurisdictional disputes over the control of abstract knowledge. Professionals can use their abstract knowledge to define a core set of tasks (their jurisdiction), defend that jurisdiction from others, or appropriate the tasks of others. Interprofessional boundary wars reflect professions' attempts to "enclose" jurisdictional tasks within the boundaries of their profession's sphere of influence (Abbott 1995, p. 553; see also Witz 1992). One recent example of such a jurisdictional dispute was pediatric medicine's partially successful attempt to expand their sphere of influence to include children's psychosocial disorders (Halpern 1990). Whether professions succeed or fail in such jurisdictional disputes, any changes reverberate throughout the system. The professions reequilibrate, with some occupations accepting a subordinate or advisory role, some agreeing to split jurisdictions or clients, and others exiting the professions altogether. To adequately theorize and model jurisdictional disputes, Abbott (1993, p. 205) advocated a multilevel analysis that links micro-level information on careers, to meso-level data on the network structure of careers and jobs, to the macro-level work and occupational structures.

SEX DIFFERENCES IN THE PROFESSIONS

In 1998, women composed 46 percent of the employed labor force and 53 percent of professionals, suggesting that women do quite well in the professions. However, a closer look reveals a different story. As noted, women are heavily concentrated in the semiprofessions (as nurses, public school teachers, social workers, and librarians) and men in the higher-status professions (as physicians, lawyers, and engineers). Incumbents in the former earn less and exercise less autonomy than in the latter. As in the occupational structure as a whole, the professions are highly segregated by sex.

Even within the higher-prestige professions, women work in different, lower-paying, and less prestigious jobs than men. Women lawyers, for example, work in government jobs, in research rather than litigation, and in certain specialties such as trust and estates; women physicians are more likely than men to specialize in pediatrics and to work in health maintenance organizations (HMOs); female clergy specialize in music or education (Reskin and Phipps 1988; see also Tang and Smith 1996).

Part of the reason for this differential job distribution by sex has to do with a characteristic unique to the professions. The high level of uncertainty inherent in prestigious professional jobs means that employers are careful to choose recruits who "fit in" with those already on the job. Thus, as Rosabeth Moss Kanter (1977) suggested, employers tend to recruit people much like themselves, a process she calls "homosocial reproduction." The predominance of males in the status professions thus helps to reproduce sex segregation.

Other factors reducing women's access to high-status professions are entrance restrictions such as certification and licensing. Physicians, for example, consolidated their control over medical jurisdictions by successfully pressing for legislation to outlaw midwives and prohibit the licensing of those trained at "irregular" schools, activities that disproportionately affected women. In 1872, the Supreme Court restricted women's ability to practice law, arguing that "the natural and proper timidity and delicacy which belongs to the female sex unfits it for many of the occupations of civil life" (Reskin and Phipps 1988, p. 192). Male professionals were thus able to establish labor-market shelters to protect themselves from competition from women as well as other "undesirables."

Since 1970, women have gained greater entry into some of the professions, including occupations such as medicine, law, and pharmacy. Indications are, however, that internal differentiation within the professions perpetuates job segregation by sex (Reskin and Roos 1990). For example, Polly Phipps (1990) found that women's representation in pharmacy nearly tripled (from 12 to 32 percent) between 1970 and 1988, and has continued to increase since then, reaching 44 percent by 1998. However, women pharmacists concentrate in the lower-paying hospital sector, while men predominate in the higher-paying retail sector. Similar ghettoization exists in other professions that are admitting more women (see, for example, Reskin [1990] on book editors; Donato [1990] on public relations specialists; Roos and Jones [1993] on academic sociologists; and Roos and Manley [1996] on human resource managers and professionals).

THE CHANGING PROFESSIONS

Some view the future of the professions as bleak, predicting that ongoing proletarianization or deprofessionalization will eliminate the professions' unique traits. The proletarianization thesis argues that an increasing division of labor and a bureaucratization within the professions are routinizing knowledge and transferring authority from professionals to organizational superiors. The deprofessionalization thesis documents declines in the professions' monopolistic control over their knowledge, their exercise of autonomy on the job, their ability to protect their jurisdiction from encroachments, and the public's deference to professional authority (Ritzer and Walczak 1986).

Some occupations, of course, have lost some of their professional status. As noted, as pharmaceutical companies increasingly absorbed the compounding of drugs, and as chains replaced independent pharmacies, pharmacists lost some of their autonomy and monopoly of their knowledge to physicians. Taking a broad view of the professions, however, Freidson (1984; 1994, p. 9) argued that professionalism has been "reborn" in a hierarchical form in which bureaucratization and professionalization are often quite compatible. Working in organizations, he argued, has been the norm for many professions from their inception, with engineers the most obvious example. In addition, organizations that employ professionals tend to diverge enough from the ideal-typical bureaucracy to protect professional privilege. For example, professionals in organizations often exercise a lot of autonomy, working under senior members of their own profession rather than nonprofessional managers. Freidson thus portrayed most organizations as working to accommodate professionals, and operating under an "occupational principle" of authority, as opposed to an "administrative principle" of organizing and controlling work (1994, p. 61). Wallace (1995) also described how some bureaucratic work systems—specifically a "corporatist" model of control—can be quite compatible with professionals' self interests.

Like Freidson and Abbott, Brint (1994) viewed the professions as social forms that evolve historically in conjunction with other occupations and work organizations. Rather than look to professions interacting through jurisdictional disputes, however, Brint contextualized changes in the professions within the workplace itself, in the occupationally and organizationally based ties professionals have, and the markets in which they work (see also Leicht and Fennell 1997). He described the ascendance of a new, organizationally based profession—expert professions—that relaxes traditional assumptions about professional work. Pursuing profits, closer interconnections with business, and lesser attention to larger public interests, are all hallmarks of "expert professionalism" (Brint 1994, p. 8), which Brint juxtaposed with "social trustee professionalism," the traditional conception of professions as the trustees of socially important knowledge (p. 4). In Brint's view, the professional class has splintered into highly skilled experts in resource-rich organizations as opposed to professionals with less marketable skills in resource-poor organizations, especially in the public and nonprofit sectors (p. 11). These differing organizational locations have predictable consequences for incumbents' political and social views. Even with such changes, Freidson (1984, 1994) found no evidence that the prestige of the professions as a whole has declined. Nor did he find that public trust in professionals has deteriorated relative to other American institutions. Moreover, the professions' continuing ability to erect labor-market barriers to competition is important evidence of their enduring power. Professionals today remain strong enough to exert their will against others lower in the occupational hierarchy. Professional privilege remains intact in the American occupational structure.

As the professions change, theorizing must evolve as well. Some have begun to call for a broader, synthetic theory of occupations, one that situates the professions in a comparative way within the larger occupational structure (e.g., Abbott 1993; Freidson 1994). Central to such a broader theory is a method that sets occupations not only in their historical, comparative contexts, but also in the organizational and market context in which occupational incumbents work (e.g., Brint 1994). Freidson (1994, p. 21) has argued for moving beyond a theory that defines professions by fiat, to one that recognizes the professional aspirations of a variety of other nonprofessional occupations. In Freidson's terminology, how do ordinary occupational incumbents invoke their day-to-day work activities so as to claim professional status, regardless of whether the larger public would recognize them as professionals? Such a conceptualization opens up the possibility that other occupations can organize in their own self-interest to generate their own "professional projects." Claiming a unique expertise or specialized knowledge, developing professional associations, and convincing the state that certification is appropriate are first steps toward claiming professional status. Ultimately, the true test of professional status will be to convince others that the expertise one has entitles one to professional privilege, and to the right to establish labor market shelters. Only then will professional status and earnings rise to accompany claims of professional privilege.

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Patricia A. Roos