Olivia King, Monash University. Please note, this article was originally published in the online TASA publication Nexus. It has been reprinted here with the Editors’ permission. The article is the 4th of 5 in the Professionalisation series.
Professionalisation is not a finite process with a clear and unchanging end-point but rather an on-going journey characterised by efforts to establish spheres of expertise and achieve aspirational objectives in the face of interprofessional competition [1-3]. Milestones such as national registration, title protection and legislative reinforcement for specific practices (such as prescribing) offer relative security to profession-based statuses and have historically featured as key objectives for the healthcare professions. In spite of these milestones, the healthcare professions are considered as dynamic as the social, political and demographic contexts within which they exist and even the most ostensibly consolidated professions are vulnerable to undermining [1, 2]. There are similarities between historic and contemporary professionalisation campaigns in healthcare, in that the key objectives remain the same for the emerging professions such as natural medicine practitioners . There are also some marked differences due to the vastly altered social and political contexts. There are three major, inextricably linked factors influencing the context within which healthcare professionalisation occurs: shifting demographic trends and disease patterns (such as burgeoning rates of chronic disease), health policy directives and diminishing medical dominance [5-9].
The traditional non-medical healthcare professions, such as nursing, dentistry, physiotherapy, podiatry and the other allied healthcare professions emerged within a hierarchy headed by the medical profession [1, 6]. Medicine’s sovereignty has been challenged by the advent of government policy, oriented towards innovative healthcare practices such as increased role flexibility for all healthcare professions . Over the last three decades several non-medical professions have expanded their role boundaries and scopes of practice to include some tasks traditionally exclusive to medicine, such as surgical and prescribing practices , paving the way for newer types of professionalisation such as post-professional competition and dominance between hierarchically equivalent professions, for example, nursing and allied healthcare professions.
To illustrate this point, the nursing and podiatry professions have both secured limited prescribing rights for appropriately endorsed members. Both professions can work in the interdisciplinary field of diabetes education where there is poor definition of the interprofessional role boundaries at the macro level and role boundary competition at the micro level. It appears that the advances made by these professions with respect to non-medical prescribing have contributed to the ambiguity and competition around the interprofessional role boundaries in the diabetes educator field. While ambiguity around the role boundaries of diabetes educators persists, the longer established nursing profession holds pre-eminence in this clinical area*.
It is easy to conceive of similar inter-professional role boundary ambiguity and post-professionalisation strategies among professions working in clinical areas where new diagnoses, greater awareness of conditions, and novel ways to manage conditions are emerging. For example, in the mental health field, where a number of different professions work with people with mental health conditions using both similar and contrasting treatment approaches.
Contemporary professionalisation strategies among the healthcare professions differ from those observed earlier, in that their focus is not merely on establishing themselves and their role in the context of a clear medical hierarchy, but rather on capitalising on opportunities to work innovatively and flexibly, within a plethora socio-political complexities and challenges. As highlighted, this creates space for competition at the post-professional level, which is arguably characteristic of contemporary professionalisation.
- Nancarrow, S.A. and A.M. Borthwick, Dynamic professional boundaries in the healthcare workforce. Sociology of Health & Illness, 2005. 27(7): p. 897-919.
- Martin, G.P., Interprofessional Boundaries. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society, 2014.
- Fournier, V., Boundary work and the (un) making of the professions. I Malin, Nigel (red) Professionalism, Boundaries and the Workplace. 2000, Florence, KY: Routhledge.
- Bradbury, J., S. Grace, and C. Avila, N-of-1 trials: Building the evidence for natural medicine, one patient at a time. Journal of the Australian Traditional-Medicine Society, 2017. 23(1): p. 14.
- Nisbet, G., S. Dunn, and M. Lincoln, Interprofessional team meetings: Opportunities for informal interprofessional learning. Journal of interprofessional care, 2015. 29(5): p. 426-432.
- Willis, E., Introduction: taking stock of medical dominance. Health Sociology Review, 2006. 15(5): p. 421-431.
- Bacon, D. and A.M. Borthwick, Charismatic authority in modern healthcare: the case of the ‘diabetes specialist podiatrist’. Sociology of health & illness, 2013. 35(7): p. 1080-1094.
- King, O., et al., Contested professional role boundaries in health care: a systematic review of the literature. Journal of foot and ankle research, 2015. 8(1): p. 1.
- Nancarrow, S.A., Six principles to enhance health workforce flexibility. Human resources for health, 2015. 13(1): p. 1.
*Information drawn from my PhD thesis completed March 2018