Professions, Work and Careers

Anselm L. Strauss

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138530874
• eBook ISBN: 9781351307949
• Topic: Business
• Subtopic: Business General
• Index: Business

Professions, Work and Careers addresses some of the central themes that preoccupied the eminent sociologist Anselm Strauss. This collection is directed at sociologists concerned with the development of theory and graduate and undergraduate students in the sociology of work and the sociology of medicine. His approach is both thematic and topical.Straus examines organization, profession, career, and work, in addition to related matters such as socialization, occupational identity, social mobility, and professional relationships, all in a social psychological context. Because medicine is considered by many to be the prototype profession, Strauss effectively illustrates many of the points by allusion to nurses, chemists, hospitals, wards, and terminal care. The progression of ideas in these essays are a befitting source for the study of structure, interaction and process, other themes that occupied Strauss in his other research enterprises.As Irving Louis Horowitz noted at the time of Anselm Strauss's death in 1996: "Anselm was and remained a social psychologist of a special sort. He appreciated that what takes place in the privacy of our minds translates into public consequences for the social fabric. His statements on personal problems are invariably followed in quick succession by intensely sociological essays on close awareness, face-to-face interaction, and structured interactions. The subtext distinguishes sociological from psychiatric conventions, seeing everything from daydreams to visions in interactionist frames rather than as pathology. The implications of his explorations into the medical profession are stated gently, but carry deep ramifications, for the act of people treating each other compassionately, not less than professionally, is also an act of awareness. Treating the human person as a creature of dignity, when generalized, becomes the basis for constructing human society."The late Anselm Strauss was a pioneer in bridging the gap between theory and data in sociology. This collection of his works, available in paperback for the first time, will be a valuable resource for professionals and students interested in grounded social theory.Anselm L. Strauss was professor of sociology and chairman of the graduate program in sociology, University of California, San Francisco. He is the author of numerous books including Creating Sociological Awareness and editor of Where Medicine Fails, both published by Transaction.

PART I
IDEOLOGIES AND PROFESSIONS

Professions In Process¹

(With Rue Bucher)

The “process” or “emergent” approach to the study of professions developed in the following pages bears considerable resemblance to a common-sense point of view. It utilizes common language to order the kinds of events that professionals informally discuss among themselves — frequently with great animation. It is even used by sociologists in their less professional moments when they are personally challenged by their own colleagues or by persons from other fields. What is different here is that we shall take the first steps toward developing an explicit scheme of analysis out of these common-place materials. In addition, it will become apparent that this approach differs from the prevailing “functionalism” because it focuses more pointedly upon conflicting interests and upon change.

Functionalism sees a profession largely as a relatively homogeneous community whose members share identity, values, definitions of role, and interests.² There is room in this conception for some variation, some differentiation, some out-of-line members, even some conflict; but, by and large, there is a steadfast core which defines the profession, deviations from which are but temporary dislocations. Socialization of recruits consists of induction into the common core. There are norms, codes, which govern the behavior of the professional to insiders and outsiders. In short, the sociology of professions has largely been focused upon the mechanics of cohesiveness and upon detailing the social structure (and/or social organization) of given professions. Those tasks a structural-functional sociology is prepared to do, and do relatively well.

Reprinted by permission from
The American Journal of Sociology
Vol. LXVI, January 1961, pp. 325-34
Copyright 1961 by the University of Chicago

But this kind of focus and theory tends to lead one to overlook many significant aspects of professions and professional life. Particularly does it bias the observer against appreciating the conflict — or at least difference—of interests within the profession; this leads him to overlook certain of the more subtle features of the profession’s “organization” as well as to fail to appreciate how consequential for changes in the profession and its practitioners differential interests may be.

In actuality, the assumption of relative homogeneity within the profession is not entirely useful: there are many identities, many values, and many interests. These amount not merely to differentiation or simple variation. They tend to become patterned and shared; coalitions develop and flourish — and in opposition to some others. We shall call these groupings which emerge within a profession “segments.” (Specialties might be thought of as major segments, except that a close look at a specialty betrays its claim to unity, revealing that specialties, too, usually contain segments, and, if they ever did have common definitions along all lines of professional identity, it was probably at a very special, and early, period in their development.) We shall develop the idea of professions as loose amalgamations of segments pursuing different objectives in different manners and more or less delicately held together under a common name at a particular period in history.

Our aim in this paper, then, is to present some initial steps in formulating a “process” model for studying professions. The model can be considered either as a supplement of, or an alternative to, the prevailing functional model. Some readers undoubtedly will prefer to consider the process model as supplementary. If so, then there will be a need for a further step, that is, for a transcending model. But we ourselves are concerned here only with sketching the outlines of a process approach, suggesting a few potentially useful concepts, and pointing to certain research problems that flow from our framework and concepts.

“Organized Medicine”

Medicine is usually considered the prototype of the professions, the one upon which current sociological conceptions of professions tend to be based; hence, our illustrative points in this paper will be taken from medicine, but they could just as pertinently have come from some other profession. Of the medical profession as a whole a great deal could be, and has been, said: its institutions (hospitals, schools, clinics); its personnel (physicians and paramedical personnel); its organizations (the American Medical Association, the state and county societies); its recruitment policies; its standards and codes; its political activities; its relations with the public; not to mention the profession’s informal mechanisms of sociability and control. All this minimal “structure” certainly exists.

But we should also recognize the great divergency of enterprise and endeavor that mark the profession; the cleavages that exist along with the division of labor; and the intellectual and specialist movements that occur within the broad rubric called “organized medicine.” It might seem as if the physicians certainly share common ends, if ever any profession did. When backed to the wall, any physician would probably agree that his long-run objective is better care of the patient. But this is a misrepresentation of the actual values and organization of activity as undertaken by various segments of the profession. Not all the ends shared by all physicians are distinctive to the medical profession or intimately related to what many physicians do as their work. What is distinctive of medicine belongs to certain segments of it — groupings not necessarily even specialties — and may not actually be shared with other physicians. We turn now to a consideration of some of those values which these segments do not share and about which they may actually be in conflict.

The sense of mission.—it is characteristic of the growth of specialties that early in their development they carve out for themselves and proclaim unique missions. They issue a statement of the contributions that the specialty, and it alone, can make in a total scheme of values and, frequently, with it an argument to show why it is peculiarly fitted for this task. The statement of mission tends to take a rhetorical form, probably because it arises in the context of a battle for recognition and institutional status. Thus, when surgical specialties, such as urology and proctology, were struggling to attain identities independent of general surgery, they developed the argument that the particular anatomical areas in which they were interested required special attention and that only physicians with their particular background were competent to give it. Anesthesiologists developed a similar argument. This kind of claim separates a given area out of the general stream of medicine, gives it special emphasis and a new dignity, and, more important for our purposes, separates the specialty group from other physicians. Insofar as they claim an area for themselves, they aim to exclude others from it. It is theirs alone.

While specialties organize around unique missions, as time goes on segmental missions may develop within the fold. In radiology, for example, there are groups of physicians whose work is organized almost completely around diagnosis. But there is a recently burgeoning group of radiologists whose mission is to develop applications of radiation for therapeutic purposes. The difference of mission is so fundamental that it has given rise to demands for quite different residency training programs and to some talk of splitting off from the parent specialty. In pathology — one of the oldest medical specialties, whose traditional mission has been to serve as the basic science of medicine with relatively little emphasis upon clinical applications — lately a whole new breed of pathologists has come to the fore, dedicated to developing pathology as a specialized service to clinical practitioners and threatening those who cling to the traditional mission.

The split between research mission and clinical practice runs clear through medicine and all its specialties. Pediatrics has been one of the most rapidly growing fields of practice, but it has also attracted a number of young people, particularly at some centers in the Northeast, specifically for research. They are people who have no conceptions of themselves as family pediatricians at all; they are in this field because of what they can do in the way of research. In the two oldest specialties, surgery and internal medicine, one finds throughout the literature considerable evidence of this kind of split. One finds an old surgeon complaining that the young men are too much interested in research, and in internal medicine there are exhortations that they should be doctors, not scientists. This latter lament is particularly interesting in view of the traditional mission of the internist to exemplify the finest in the “art of medicine”: it is a real betrayal when one of them shows too much interest in controlled research.

Work Activities.—There is great diversity in the tasks performed in the name of the profession. Different definitions may be found between segments of the profession concerning what kinds of work the professional should be doing, how work should be organized, and which tasks have precedence. If, for example, the model physician is taken as one who sees patients and carries out the diagnosis and treatment of illness, then an amazing variety of physicians do not fit this model. This diversity is not wholly congruent with the organization of practice by medical specialties, although there are certain specialties — like pathology, radiology, anesthesiology, and public health — whose practitioners for the most part do not approach the model. Within a core specialty like internal medicine there are many different kinds of practice, ranging from that of a “family doctor” to highly specialized consultation, a service to other doctors. These differences in the weights assigned to elements of practice do not begin to take into account the further diversity introduced when professionals assign different weights to such activities as research, teaching, and public service.

This point can be made more clearly by considering some of the different organizations of work activities that can be found within single specialties. The people who organize their work life as follows all call themselves “pathologists:” (a) time nearly equally divided between research and teaching, with little or no contact with patient care; (6) time divided (ideally) equally between research, teaching, and diagnostic services to other doctors; (c) administration of a hospital service, diagnostic services and consultants with other physicians and educational activities. (The objects of educational activities are not only medical students and residents but other practitioners of the hospital. These pathologists may also actually examine patients face-to-face and consult on a course of treatment.)

Again, consider the radiologist. There is considerable range in the scope and kind of practice subsumed under radiology. The “country radiologist” tends to function as an all-around diagnostic consultant, evaluating and interpreting findings concerning a broad spectrum of medical conditions. In the large medical center the diagnostic radiologist either does limited consultation concerning findings or else specializes in one area such as neurological radiology or pediatric radiology. Then there is the radiologist whose work is not primarily diagnostic at all but involves the application of radiation for therapeutic purposes. This man may have his own patients in course of treatment, much like an internist or urologist.

These illustrations suggest that members of a profession not only weigh auxiliary activities differently but have different conceptions of what constitutes the core — the most characteristic professional act — of their professional lives. For some radiologists it is attacking tumors with radiation; for others it is interpreting X-ray pictures. For many pathologists it is looking down the barrel of a microscope; for others it is experimental research. A dramatic example of the difference in characteristic professional acts is to be found in psychiatry, which for many of its practitioners means psychotherapy, an intricate set of interactions with a single patient. This is what a psychiatrist does. Yet many practitioners of psychiatry have as little face-to-face interaction with a patient as possible and concentrate upon physical therapies. Still others may spend a good deal of their time administering or directing the activities of other people who actually carry out various therapies.

Not all segments of profession can be said to have this kind of core — a most characteristic activity; many are not so highly identified with a single work activity. But, to the extent that segments develop divergent core activities, they also tend to develop characteristic associated and auxiliary activities, which may introduce further diversity in commitment to major areas, like practice, research, or public health.

Methodology and techniques.—One of the most profound divisions among members of a profession is in their methodology and technique. This, again, is not just a division between specialties within a profession. Specialties frequently arise around the exploitation of a new method or technique, like radiology in medicine, but as time goes by they may segmentate further along methodological perspectives. Methodological differences can cut across specialty — and even professional — lines with specialists sharing techniques with members of other specialties which they do not share with their fellows.

Insofar as these methodological differences reflect bitter disagreements over the reality that the profession is concerned with, the divisions are deep indeed, and communication between the factions is at a minimum. In psychiatry the conflict over the biological versus the psychological basis of mental illness continues to produce men who speak almost totally different languages. In recent years the situation has been further complicated by the rise of social science’s perspectives on mental illness. Focusing upon different aspects of reality, psychiatrists of these various persuasions do different kinds of research and carry out various kinds of therapy. They read a variety of journals, too; and and the journals a man reads, in any branch of medicine, tend to reflect his methodological as well as his substantive interests.

Social scientists must not suppose that, since psychiatry is closer in subject matter to the social sciences, it is the only branch of medicine marred by bitter methodological disputes (we do not mean to imply that such disputes ought to be avoided). Pathologists are currently grappling with methodological issues which raged in some of the biological sciences, particularly anatomy, some years ago. The central issue has to do with the value of morphology, a more traditional approach which uses microscopic techniques to describe the structure of tissues, as against experimental approaches based upon more dynamic biochemical techniques. While the proponents of the two methodologies appear to understand each other somewhat better than do the psychiatrists, they still do not wholly appreciate each other: the morphologists are disposed to be highly defensive, and the experimentalists a little embarrassed by the continued presence of those purely morphologically inclined. Then, in the primarily clinical specialties, those combining medical and surgical techniques offer their own peculiar possibilities for dispute. Men can differ as to how highly they value and emphasize the medical or surgical approach to treatment; for example, an older urologist complained in a journal article that the younger men in the field are “knife-happy.” An analogous refrain can be heard among clinicians who frown upon too great a dependence upon laboratory techniques for diagnosis and accuse many of their colleagues of being unable to carry out a complex physical examination in the grand clinical manner.

Clients.—Characteristically, members of professions become involved in sets of relationships that are distinctive to their own segment. Wholly new classes of people may be involved in their work drama whom other segments do not have to take into account. We shall confine ourselves for the moment to considering relationships with clients.

We suspect that sociologists may too easily accept statements glorifying “the doctor-patient relationship” made by segments of the medical profession who have an interest in maintaining a particular relationship to patients. In actuality, the relationships between physicians and patients are highly varied. It does appear that an image of a doctor-patient relationship pervades the entire medical profession, but it is an image which, if it fits any group of physicians in its totality, comes closest to being the model for the general practitioner or his more modern counterpart, the family-practice internist. It seems to set an ideal for other physicians, who may incorporate whatever aspects of it are closest to their own working conditions into an image of the doctor-patient relationship peculiar to their own segment.

Specialties, or segments of specialties, develop images of relationships with patients which distinguish them from other medical groupings. Their own sense of mission and their specialized jobs throw them into new relationships with patients which they eventually formulate and refer to in idealized ways. Moreover, they do not simply define the relationship...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Preface
• PART I IDEOLOGIES AND PROFESSIONS
• PART II CAREERS
• PART III WORK AND ORGANIZATION