JACD 71-4 - American College of Dentists

Leadership
58
The boundaries are distinct and ritualized.
A physician and a lawyer may be best of
friends in social contexts, but their roles
change dramatically—who can initiate
which conversations, whose opinion is
most respected, and what one wears—
depending on whether a lawsuit or a
serious illness is at stake. Goode also
notes that language changes in the
professional context. Each profession
develops its own way of talking that is
designed, to a certain extent, for clear
communication within the profession,
but to a very large extent, to signal who
belongs to the profession and to prevent
those who are not in the profession from
understanding what is being discussed.
The technical term for language that
signals group membership is argot. The
true masters of argot in American culture
are our teenagers. They constantly
reinvent language that even they may
not understand in order to serve as
social markers and to keep authority
figures at a safe distance.
The last two of Goode’s characteristics
of a profession are related. These are
control over current members of the profession
and control over potential future
members. For thousands of years, both
the church and the military have sought
to maintain a judicial system distinct
from the civil process. These tensions
are still headline news today. Every
profession, through proactive codes of
ethic to peer review panels and internal
sanctions, covets first right of refusal to
discipline its own members. The irony
that the law is among the most revered
professions and at the same time has
such an objectionable odor comes from
the fact that among all professions it is
the only one that can be used to pierce
the veil of self discipline enjoyed by its
sister professions.
Professions also control who can
practice and how, with the highest professions
exercising the greatest control.
Lawyers determine who can join the
prestigious firms that have access to the
prestigious clients and who can argue
cases under various jurisdictions such as
the U. S. Supreme Court. Hospitals determine
who has privileges. To a significant
extent, the high professions determine
who is eligible to enter the profession in
the first place. For example, dental
schools admit only about half of the
individuals interested in the profession
to study. Another 5% are selected out of
the profession during the educational
process. State boards of examiners deny
licenses to approximately 2% of applicants
at initial licensure and perhaps
another half of 1% of dentists lose their
practice privileges.
Professions are also concerned with
markets, specialized knowledge, and
public service. An essential task for professions
is creating a protected market.
Professions seek monopolies, almost
always through political means rather
than through relations with customers.
Clever groups go further than protecting
their markets; they seek to enlarge their
markets by encouraging legislation to
require extended services. For example,
morticians in many states have succeeded
in passing laws that require that the
remains of ones dearly departed be
buried whether they are cremated or
not. Engineers vigorously lobby for
increasingly restrictive regulations that
happen to require the use of an engineer.
Market formation among the
professions also extends to the elimination
of counterveiling forces among clients.
Paul Star, in his Pulitzer Prize-winning
study of the medical profession, describes
the brutal ostracizing of those physicians
during the first half of the twentieth
century who were salaried employees of
companies or groups of employees.
Today, in the province of British Columbia,
Canada, veterinarians are in court,
seeking to restrict the licenses of their
colleagues who perform services under
the fee schedule established by the
profession. Lawyers and real estate
agents in some states collect a fee for
having their secretaries complete simple
forms that customers could as easily
complete except for legal prohibitions.
Formation of a monopolistic market
may be a characteristic of many professions,
but it is not a defining quality.
Many labor groups, especially unions,
are more vigorous in limiting markets
than are professionals. Garbage collectors
in New York City and the Mafia would
certainly have something to show the
American Dental Association about
market formation. On the other hand,
the oldest profession in the world
certainly has entry and exit barriers.
More than market protection is involved
in professions.
Some have said that professions are
built around licenses—state-recognized
authority to perform certain actions,
typically connected with an examination.
The argument that licensure is a
foundation for professionalism crumbles
quickly. Real estate licenses are plentiful;
almost anyone who drives a car has a
license to do so. Years ago, I wanted a
bedroom and bathroom added to my
house in San Francisco and arranged for
a very talented handyman whom I knew
to perform the work. The problem was,
he did not have a contractor’s license
and I wanted the work done to code.
The solution was for me to purchase a
book on electrical codes and a book on
plumbing codes and to study them. After
an hour with each, I passed the county
contractor’s license and sub-contracted
the work to my friend. I had the license
but he was the professional.
Some critics of the professions
recognize the important role played by
licensure, educational qualification,
certification, bonding, regulation, and
liability to law suits as necessary demonstrations
of professional competence and
countervailing power for consumers.
But, as Lieberman notes, “because regu-
2005 Volume 71, Number 4