JACD 71-4 - American College of Dentists

This seeming paradox can be
unraveled by observing the distinction
between an explicit body of knowledge
and a tacit one. Explicit knowledge can
be conveyed in journals, PowerPoint
slides, and other formal media. Tacit
knowledge cannot be converted to
words, it is passed on by experience and
observation, and it is often performed
semiconsciously. Entry into a profession
is based on mastery of explicit knowledge
through education and formal licensure
examination. Status and success within
the profession normally come through
mastery of tacit knowledge.
Understanding the difference
between the scientific face that professions
show to the public and the utilitarian
face they show to their individual
patients helps explain why professionals
tend to be conservative. Knowledge is
highly portable and can be leveraged.
A new computer chip or a new mystery
novel can be mass-produced, and the
profit margin on a single item can be
converted into substantial wealth if the
market is sufficiently large. By contrast,
professional services cannot be leveraged.
Lawyers and accountants bill for their
time: physicians and dentists bill by the
procedure actually performed by them.
The individual and personal nature of
professional services means that great
ideas, while appreciated, are never as
valuable as practical routines that can be
effectively and reliably used. Whereas
young mavericks can become the heroes
of manufacturing and service industries,
the elites among professionals almost
always have gray hair.
Because value added among
professionals is grounded in applications
to specific individual patients, it cannot
be easily multiplied by the accumulation
of equipment, auxiliaries, or capital.
Dentists can purchase most of what they
need to operate their personal practices
on their personal credit card. Law
firms and hospitals have fewer layers
Journal of the American College of Dentists
of administrative structure than most
industries do.
There is paradox about professional
knowledge. Publicly professional knowledge
is an immense body of material
that must be mastered to enter a
profession, to drive predictable effective
care, and to create an effective barrier to
lay intrusion. Professionally, knowledge
is the internalized routines and shared
standards of excellence that never leave
the practitioners’ hands and prevent
care from becoming a commodity.
Regardless of its validity, there is a limited
market for evidence-based anything
in the professions, because it challenges
the concept of professional knowledge
being inherently personal.
The Continued Viability of the
Professions
The story about the history of the medical
profession suggests that substantial
changes can occur in practice and in the
relationship between a profession and
the public. Nowhere is it written that the
professions will remain unchanged. The
context in which professions function
continuously evolves. The only way for
professions to remain viable in such a
context in flux is for them to remain
faithful to their essence. Attempting to
preserve the superficial structure of
practice will expose a brittle exterior to
erosion and breaking off of parts by
the forces of social change.
Professions’ strength flows from
their unique character, properly understood
and vigorously practiced. This
character has already been defined as
involving the three-part economic
structure (client, professional, and
professional organization), personal
and private care, customized work,
agency rather than market economy,
and trust. Looking at differences
between established and soft professions
may reveal some of the pressures
currently threatening the foundation
of dentistry as a profession.
Employees are almost never
professionals, except in the sense of a
professional manner of providing courteous
service. Teachers (the largest group
of soft professionals), social workers,
and engineers tend to be identified with
unions as much as professions. Because
they are salaried, they must balance
their allegiance to a profession with
their allegiance to bureaucratic organizations
that have different goals and
different sets of procedures for how
clients are to be treated. Introducing an
outside party with economic or political
motives always disrupts the professional
relationship. The overwhelming majority
of dentists continue to work only for
their patients, themselves, and the
profession at large.
But there are troublesome trends.
For the past twenty years there has been
a small but steady increase in the proportion
of dentists who work for other
dentists. The Indian Health Service,
prisons, and the military do provide
stipends and salaries, but this is to meet
a national service need and does not use
the professional for commercial services.
By contrast, there are new economic
schemes that treat dentists as salable
commodities. Such practices inevitably
erode professionalism.
Like golf pros, piano teachers, and
hair stylists, professionals provide
personal services. Unlike those just mentioned,
the services of professionals are
not just desirable enhancements but are
regarded as necessary for maintaining
personal integrity. Justice, salvation, and
health, for example, are in a different
category from economic gain, personal
self-help, and good looks. It is a core part
of the professions to restore individuals
to effective functioning, and to do so on
a personal basis with dignity.
Leadership
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