Competition in the Health Care Professions: A Distant Mirror?

I’ve written at length about sociologist Andrew Abbott’s 1988 book, The System of Professions (Chicago, 1998), and his very astute analysis about how the information professions—all of them, ranging from librarians to MBA consultants—compete with each other, obstruct competing groups when they reach for more power, and so on. He describes what professionals do as offering a “treatment,” which requires special training and knowledge, and the exercise of independent judgment. When a particular group wants to gain the upper hand, moving into an emerging market, for example, they practice “treatment substitution.” Essentially they are saying “I know a lot too, and my strategy is a better one.”

Since we all work together in the information professions, the actual dynamics of treatment substitution can be obscured by good vibrations, collaborative spirit and so on—or at least, we can hope so. However, oftentimes the easiest way to perceive the current of competition in our own field of expertise is to look to other fields and see what is happening there.  With respect to treatment substitution, there is no better example than the medical professions, and Andrew Abbott devoted many pages of his book to the medical fields along with the information professions.

Well, unsurprisingly, the Affordable Care Act (ACA) is stirring up controversy and also creating opportunity. When opportunities abound, professional competition can heat up fast. And next comes treatment substitution!

Nurse Practitioners: Exercising New Muscle

On March 24, 2013, the San Francisco Chronicle reported on the current struggle of nurse practitioners to exercise more independent judgment in health care delivery. NPs already can diagnose acute and chronic illness, are trained in pharmacology and health care ethics, and they have become essential partners in care. They are regulated at the state level, and so what they can actually do varies by region. Chronicle Reporter Shannon Pettypiece describes the overall status of their struggle, which increasingly is playing out in the courts.

Physicians have always seen themselves as the “captain of the ship,” and they and their associations vigorously guard their primacy in the practice of medicine. Yet at the same time, there is a shortage of 13,000 doctors right now, and this shortage is forecast to grow to 130,000 in the coming years. Nurse practitioners argue that they could fill a crucial gap, if they are afforded the privileges needed to diagnose and treat patients. This is particularly true in rural regions.

Closer to Home: Opportunity from Atomization

In the information professions, there has been splintering of major concepts and established roles–you could even say atomization of “skill sets,” as the digital era unfolds. MIS managers, consultants, CIOs, information specialists and librarians all compete to offer the best information “treatments,” but new technology and ideas about social interaction are rewriting the rules. Treatments on offer include digital curation, digital publishing, preservation, digital conversations, reference consultations, and more. As digital convergence pushes us all closer together, we face more moments when we must choose to collaborate or compete.

In the journals marketplace, the emergence of SPARC and new strategies to promote open access scholarship are swiftly changing our expectations and assumptions about the future of information management and delivery. At the same time, technical skills can be learned readily by just about any enterprising person with a dream. These enterprising people can create apps and other tools that become “must-have” functionalities on our smartphones.

In other words:  competition, and treatment substitution, are alive and well in the information professions. We even have litigation over publishing markets and journal pricing, although our version seems a lot less personal than physicians’ assertion that they simply “know more” than nurses.

“A Finch Sang in Berkeley Square….”

I don’t think we have a single issue that defines current competition among the various information handling professions; rather we have a great many, and they are diverse. But for the moment, with the release of the “Finch Report” in the United Kingdom and its mandate to build “Gold Open Access” models to make research available to all, I’d say open access is a illuminating issue that defines what competition looks like. At what point does a publisher need the library, or for that matter, at what point does the library actually “become” the publisher? Or further: at what point do authors become the “agents of change” in an all-new style of writers’ guild, given that technology makes this possible, right now?

These and many other questions will not be answered soon, although the nature of competition may reveal some of the strategies that many of us will surely test. Meanwhile, while we continue to work together, we continue to hone our skill at monitoring the digital environment we work in, and the new opportunities that arise to extend our reach.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s