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A process approach to professions focuses upon diversity and conflict of interest within a profession
and their implications for change. The model posits the existence of a number of groups, called seg-
ments, within a profession, which tend to take on the character of social movements. Segments develop
distinctive identities and a sense of the past and goals for the future, and they organize activities which
will secure an institutional position and implement their distinctive missions. In the competititon and
conflict of segments in movement the organization of the profession shifts.

The "process" or "emergent" approach cuses more pointedly upon conflicting inter-
to the study of professions developed in the ests and upon change.
following pages bears considerable resem- Functionalismsees a professionlargely as
blance to a common-sensepoint of view. It a relatively homogeneouscommunity whose
utilizes commonlanguage to order the kinds members share identity, values, definitions
of events that professionals informally dis- of role, and interests.2There is room in this
cuss among themselves-frequently with conception for some variation, some differ-
great animation. It is even used by sociolo- entiation, some out-of-line members, even
gists in their less professionalmomentswhen some conflict; but, by and large, there is
they are personally challenged by their own a steadfast core which defines the profes-
colleagues or by persons from other fields. sion, deviations from which are but tem-
What is different here is that we shall take porary dislocations. Socialization of recruits
the first steps toward developing an explicit consists of induction into the common core.
scheme of analysis out of these common- There are norms, codes, which govern the
place materials. In addition, it will become behavior of the professional to insiders and
apparent that this approachdiffersfrom the outsiders. In short, the sociology of profes-
prevailing "functionalism" because it fo- sions has largely been focused upon the
mechanics of cohesiveness and upon detail-
' The intellectual origins of this scheme of anal-
ing the social structure (and/or social or-
ysis are both our own research and various writ-
ings of our predecessors and colleagues. Its spe-
ganization) of given professions. Those
cific ideas occurred to us when Miss Bucher, several tasks a structural-functional sociology is
years ago, had occasion to analyze a number of preparedto do, and do relatively well.
specialty journals and interview a sample of pa- But this kind of focus and theory tend to
thologists. Since then we have both been engaged lead one to overlook many significant as-
in a study which brings us much information about
psychiatrists and psychiatric nurses in Chicago,
pects of professions and professional life.
and we have had available also Everett C. Hughes's Particularlydoes it bias the observeragainst
interviews with the medical staff at the University appreciating the conflict-or at least dif-
of Kansas medical school. The writings to which ference-of interests within the profession;
we are most indebted are those of Everett Hughes this leads him to overlook certain of the
on work and professions (cf. Men and Their Work
[Glencoe, Ill.: Free Press, 1958]) and the symbolic-
more subtle features of the profession's"or-
interaction position in social psychology (cf. George ganization" as well as to fail to appreciate
Herbert Mead's Mind, Self, and Society [Chicago: how consequential for changes in the pro-
University of Chicago Press. 1934]). Because the fession and its practitioners differentialin-
materials on occupations, work, and professions are terests may be.
well known and readily available, we have not
cited all references to pertinent literature; the files
In actuality, the assumption of relative
of various specialty journals in all the professions 2Cf. William J. Goode, "Community within a
are useful to anyone interested in further illustra- Community: The Professions," American Socio-
tions. logical Review, XX (1957), 194-200.


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homogeneity within the profession is not nel); its organizations (the AmericanMedi-
entirely useful: there are many identities, cal Association, the state and county so-
many values, and many interests. These cieties); its recruitmentpolicies; its stand-
amount not merely to differentiation or ards and codes; its political activities; its
simple variation. They tend to become pat- relationswith the public; not to mention the
terned and shared; coalitions develop and professions' informal mechanisms of socia-
flourish-and in opposition to some others. bility and control. All this minimal "struc-
We shall call these groupingswhich emerge ture" certainly exists.
within a profession "segments." (Specialties But we should also recognize the great
might be thought of as major segments, ex- divergency of enterprise and endeavor that
cept that a close look at a specialty betrays mark the profession; the cleavages that
its claim to unity, revealing that specialties, exist along with the division of labor; and
too, usually contain segments, and, if they the intellectual and specialist movements
ever did have common definitions along all that occur within the broad rubric called
lines of professional identity, it was prob- "organized medicine." It might seem as
ably at a very special, and early, period in if the physcians certainly share common
their development.) We shall develop the ends, if ever any profession did. When
idea of professions as loose amalgamations backed to the wall, any physician would
of segments pursuing different objectives in probably agree that his long-run objective
differentmannersand more or less delicately is better care of the patient. But this
held together under a common name at a is a misrepresentationof the actual values
particular period in history. and organization of activity as undertaken
Our aim in this paper, then, is to present by various segments of the profession. Not
some initial steps in formulatinga "process" all the ends shared by all physicians are dis-
model for studying professions. The model tinctive to the medical profession or inti-
can be considered either as a supplement mately related to what many physicians do,
of, or an alternative to, the prevailing func- as their work. What is distinctive of medi-
tional model. Some readersundoubtedlywill cine belongs to certain segments of it-
prefer to consider the process model as sup- groupings not necessarily even specialties
plementary. If so, then there will be a need -and may not actually be sharedwith other
for a further step, that is, for a transcending physicians. We turn now to a consideration
model. But we ourselves are concernedhere of some of those values which these seg-
only with sketching the outlines of a process ments do not share and about which they
approach, suggesting a few potentially use- may actually be in conflict.
ful concepts, and pointing to certain re- Tke sense of mission.-It is characteristic
search problems that flow from our frame- of the growth of specialties that early in
work and concepts. their development they carve out for them-
selves and proclaim unique missions. They
"ORGANIZED MEDICINE"y issue a statement of the contribution that
Medicine is usually consideredthe proto- the specialty, and it alone, can make in a
type of the professions, the one upon which total scheme of values and, frequently, with
current sociological conceptions of profes- it an argument to show why it is peculiarly
sions tend to be based; hence, our illustra- fitted for this task. The statement of mission
tive points in this paper will be taken from tends to take a rhetoricalform, probably be-
medicine, but they could just as pertinently cause it arises in the context of a battle for
have come from some other profession. Of recognition and institutional status. Thus,
the medical profession as a whole a great when surgical specialties, such as urology
deal could be, and has been, said: its insti- and proctology, were struggling to attain
tutions (hospitals, schools, clinics); its per- identities independent of general surgery,
sonnel (physicians and paramedicalperson- they developed the argument that the par-

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ticular anatomical areas in which they were men are too much interested in research,
interested required special attention and and in internal medicine there are exhorta-
that only physicians with their particular tions that they should be doctors, not scien-
backgroundwere competent to give it. An- tists. This latter lament is particularly in-
esthesiologists developed a similar argu- teresting in view of the traditional mission
ment. This kind of claim separates a given of the internist to exemplify the finest in the
area out of the general stream of medicine, "art of medicine": it is a real betrayal when
gives it special emphasis and a new dignity, one of them shows too much interest in con-
and, more important for our purposes,sepa- trolled research.
rates the specialty group from other physi- Work activities.-There is great diversity
cians. Insofar as they claim an area for in the tasks performed in the name of the
themselves, they aim to exclude others from profession. Different definitions may be
it. It is theirs alone. found between segments of the profession
While specialties organize around unique concerning what kinds of work the profes-
missions, as time goes on segmental missions sional should be doing, how work should be
may develop within the fold. In radiology, organized,and which tasks have precedence.
for example, there are groups of physicians If, for example, the model physician is taken
whose work is organized almost completely as one who sees patients and carries out the
around diagnosis. But there is a recently diagnosis and treatment of illness, then an
burgeoninggroup of radiologistswhose mis- amazing variety of physicians do not fit
sion is to develop applications of radiation this model. This diversity is not wholly con-
for therapeutic purposes. This difference of gruent with the organizationof practice by
mission is so fundamental that it has given medical specialties, although there are cer-
rise to demands for quite differentresidency tain specialties-like pathology, radiology,
training programsand to some talk of split- anesthesiology, and public health-whose
ting off from the parent specialty. In pa- practitioners for the most part do not ap-
thology-one of the oldest medical special- proach the model. Within a core specialty
ties, whose traditional mission has been to like internal medicine there are many differ-
serve as the basic science of medicine with ent kinds of practice, ranging from that of
relatively little emphasis upon clinical ap- a "family doctor" to highly specialized con-
plications-lately a whole new breed of pa- sultation, a service to other doctors. These
thologists has come to the fore, dedicated to differences in the weights assigned to ele-
developing pathology as a specialized serv- ments of practice do not begin to take into
ice to clinical practitioners and threatening account the further diversity introduced
those who cling to the traditional mission. when professionals assign different weights
The split between research missions and to such activities as research, teaching, and
clinical practice runs clear throughmedicine public service.
and all its specialties. Pediatrics has one of This point can be made more clearly by
the most rapidly growing fields of practice, considering some of the different organiza-
but it has also attracted a number of young tions of work activities that can be found
people, particularly at some centers in the within single specialties. The people who
Northeast, specifically for research. They organize their work life as follows all call
are people who have no conceptionsof them- themselves "pathologists:" (a) time nearly
selves as family pediatricians at all; they equally divided between researchand teach-
are in this field because of what they can do ing, with little or no contact with patient
in the way of research. In the two oldest care; (b) time divided (ideally) equally
specialties, surgery and internal medicine, between research, teaching, and diagnostic
one finds throughoutthe literatureconsider- services to other doctors; (c) administra-
able evidence of this kind of split. One finds tion of a hospital service, diagnostic serv-
an old surgeon complaining that the young ices and consultations with other physi-

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cians, and educational activities. (The ob- acteristic activity; many are not so highly
jects of educational activities are not only identified with a single work activity. But,
medical students and residents but other to the extent that segments develop diver-
practitionersof the hospital. These patholo- gent core activities, they also tend to de-
gists may also actually examine patients velop characteristicassociated and auxiliary
face-to-face and consult on a course of treat- activities, which may introduce further di-
ment.) versity in commitment to major areas, like
Again, consider the radiologist. There is practice, research, or public health.
considerablerange in the scope and kind of Methodology and techniques.-One of
practice subsumed under radiology. The the most profounddivisions amongmembers
"countryradiologist"tends to function as an of a profession is in their methodology and
all-round diagnostic consultant, evaluat- technique. This, again, is not just a division
ing and interpreting findings concerning a between specialties within a profession.
broad spectrum of medical conditions. In Specialties frequently arise around the ex-
the large medical center the diagnostic radi- ploitation of a new method or technique,
ologist either does limited consultation con- like radiology in medicine, but as time goes
cerning findings or else specializes in one by they may segmentalize further along
area, such as neurologicalradiology or pedi- methodological perspectives. Methodologi-
atric radiology.Then there is the radiologist cal differencescan cut across specialty-and
whose work is not primarily diagnostic at even professional-lines with specialists
all but involves the application of radiation sharing techniques with members of other
for therapeutic purposes. This man may specialties which they do not share with
have his own patients in course of treatment, their fellows.
much like an internist or urologist. Insofar as these methodological differ-
These illustrations suggest that members ences reflect bitter disagreements over the
of a profession not only weigh auxiliary ac- reality that the professionis concernedwith,
tivities differently but have different con- the divisions are deep indeed, and communi-
ceptions of what constitutes the core-the cation between the factions is at a minimum.
most characteristic professional act-of In psychiatry the conflict over the biological
their professional lives. For some radiolo- versus the psychological basis of mental ill-
gists it is attacking tumors with radiation; ness continues to produce men who speak
for others it is interpreting X-ray pictures. almost totally differentlanguages. In recent
For many pathologists it is looking down years the situation has been further compli-
the barrel of a microscope; for others it is cated by the rise of social science's per-
experimental research. A dramatic example spectives on mental illness. Focusing upon
of the differencein characteristicprofession- different aspects of reality, psychiatrists
al acts is to be found in psychiatry, which of these various persuasions do different
for many of its practitioners means psy- kinds of research and carry out various
chotherapy, an intricate set of interactions kinds of therapy. They read a variety of
with a single patient. This is what a psy- journals, too; and the journals a man reads,
chiatrist does. Yet many practitioners of in any branchof medicine, tend to reflecthis
psychiatry have as little face-to-face inter- methodological as well as his substantive
action with a patient as possible and con- interests.
centrate upon physical therapies.Still others Social scientists must not suppose that,
may spend a good deal of their time admin- since psychiatry is closer in subject matter
istering or directing the activities of other to the social sciences, it is the only branch
people who actually carry out various thera- of medicinemarredby bitter methodological
pies. disputes (we do not mean to imply that such
Not all segments of professions can be disputes ought to be avoided). Pathologists
said to have this kind of core- a most char- are currently grapplingwith methodological

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issues which raged in some of the biological physicians in its totality, comes closest to
sciences, particularly anatomy, some years being the model for the general practitioner
ago. The central issue has to do with the or his more moderncounterpart,the family-
value of morphology, a more traditional practice internist. It seems to set an ideal
approachwhich uses microscopictechniques for other physicians, who may incorporate
to describe the structure of tissues, as whatever aspects of it are closest to their
against experimentalapproachesbased upon own workingconditions into an image of the
more dynamic biochemical techniques. doctor-patient relationship peculiar to their
While the proponents of the two method- own segment.
ologies appear to understand each other Specialties, or segments of specialties, de-
somewhat better than do the psychiatrists, velop images of relationships with patients
they still do not wholly appreciate each which distinguish them from other medical
other: the morphologists are disposed to groupings. Their own sense of mission and
be highly defensive, and the experimentalists their specialized jobs throw them into new
a little embarrassedby the continued pres- relationshipswith patients which they even-
ence of those purely morphologically in- tually formulate and refer to in idealized
clined. Then, in the primarily clinical spe- ways. Moreover, they do not simply define
cialties, those combiningmedical and surgi- the relationship,but may highly elaborate a
cal techniques offer their own peculiar relation which this particular kind of doc-
possibilities for dispute. Men can differ as tor, and this kind alone, can have with pa-
to how highly they value and emphasize the tients. The pediatricians, for example, have
medical or surgical approach to treatment; created an image of family practitioner to
for example, an older urologist complained whom not only the child but the parents and
in a journal article that the younger men in the whole family group surrounding the
the field are "knife-happy." An analogous sick child are patients. According to a
refrain can be heard among clinicians who spokesman of the pediatricians,the peculiar
frown upon too great a dependence upon involvement of parents in the illness of the
laboratory techniques for diagnosis and ac- child creates the conditions under which
cuse many of their colleagues of being un- the pediatrician can evolve his relationship
able to carry out a complex physical ex- to the family unit. Something similar exists
amination in the grand clinical manner. in psychiatry, where it is not the mentally
Clients.-Characteristically, members of ill patient who may be regardedas the sole
professions become involved in sets of re- or even main client but the family. It is
lationships that are distinctive to their own probably in psychiatry, too, that the most
segment. Wholly new classes of people may highly elaborated doctor-patient relation-
be involved in their work dramawhom other ships exist, since the psychotherapeutic
segments do not have to take into account. practitioneruses his relationship to patients
We shall confineourselvesfor the moment to as a conscious and complex therapeutic tool.
consideringrelationshipswith clients. The most significant point here is that the
We suspect that sociologists may too young psychiatrist, learning the art of psy-
easily accept statements glorifying "the chotherapy, has to unlearn approaches to
doctor-patient relationship" made by seg- the patient that he acquired in medical
ments of the medicalprofessionwho have an school.
interest in maintaining a particular rela- In addition, there are the physicians who
tionship to patients. In actuality, the rela- only in a special sense can be said to have
tionships between physicians and patients patients at all. We are likely to think of
are highly varied. It does appear that an pathologists, anesthesiologists, and radiolo-
image of a doctor-patient relationship per- gists as doctors without patients: they may
vades the entire medical profession, but it have little or no contact with patients, but
is an image which, if it fits any group of they do have a relationship to them. The

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pathologist practicing in a hospital has a shared interests and common symbols, it is

well-developed set of obligations to the pa- probably rare that all members of a profes-
tient whom he may never confront, and in- sion are even potentially colleagues. It is
terest groups among the pathologists are more feasible, instead, to work with a notion
concernedwith making the lay public aware of circles of colleagueship. In the past, so-
of the functions of the pathologist behind ciologists have recognized such circles of
the scenes. Practitionersin all three of these colleagueship,but from the viewpoint of the
specialties appear to be concerned with de- selective influence of such social circum-
fining their own relationship to patients. stances as class and ethnicity. The profes-
Colleagueship.-Colleagueship may be sional identity sharedby colleagues, though,
one of the most sensitive indicators of seg- contains far more than the kinds of people
mentationwithin a profession.Whom a man they desire as fellows. More fundamentally,
considers to be his colleagues is ultimately they hold in commonnotions concerningthe
linked with his own place within his pro- ends served by their work and attitudes and
fession. There is considerable ambiguity problems centering on it. The existence of
among sociologists over the meaning of the what we have called segments thus limits
term "colleague." Occasionally the word is and directs colleagueship.
used to refer to co-workers,and other times Identification with segments not only di-
simply to indicate formal membershipin an rects relationships within a profession but
occupation-possession of the social signs. has a great deal to do with relations with
Thus, all membersof the occupationare col- neighboring and allied occupations. We
leagues. But sociological theory is also like- might use the term "alliances" to distin-
ly to stress colleagueship as a brotherhood. guish this phenomenon from colleagueship
Gross, for example, writes about the col- within a profession. Alliances frequently
league group characterized by esprit de dramatizethe fact that one branch of a pro-
corps and a sense of "being in the same fession may have more in common with ele-
boat." This deeper colleague relationship, ments of a neighboringoccupationthan with
he says, is fostered by such things as con- their own fellow professionals.For example,
trol of entry to the occupation, develop- experimentally minded pathologists consult
ment of a unique mission, shared attitudes and collaborate with biochemists and other
toward clients and society, and the forma- basic scientists, while pathologists oriented
tion of informal and formal associations.3 toward practice make common cause with
This conception of colleagueship stresses clinicians of various specialties.
occupational unity. Once entry to the occu- Interests and associations.-to what ex-
pation is controlled, it is assumed that all tent, and under what conditions, can we
members of the occupation can be col- speak of professionalsas having interests in
leagues; they can rally around common common? (Here we mean "interests" in
symbols. However, the difficulty is that the the sense of fate, not merely that they are
very aspects of occupationallife which Gross "interested in" different matters.) Sociolo-
writes about as unifying the profession also gists have been overlookinga very rich area
break it into segments. What ties a man for research because they have been too
more closely to one memberof his profession readily assuming unity of interest among
may alienate him from another: when his professionals. That interests do diverge
group develops a unique mission, he may no within a professionis clear enough when the
longer share a mission with others in the observerlooks for it; not only may interests
same profession. run along different lines, but they may be,
Insofar as colleagueship refers to a rela- and frequently are, in direct conflict.
tionship characterized by a high degree of Pathologists present a particularly strik-
3'Edward Gross, Work and Society (New York: ing illustration of conflict of fateful interest
Thomas Y. Crowell Co., 1958), pp. 223-35. between segments of a specialty. The prac-

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titionerpathologists are intent upon promul- can Medical Association over governmental
gating an image of the pathologist that un- ventures into child health legislation, the
derminesthe identity of the research-orient- pediatriciansfavoring the Shepherd-Towner
ed pathologist. The more the practitioners Act. The pediatricians, recognizing a need
succeed in promoting the notion of the pa- for an organization which would represent
thologist as a person who performsinvalua- their own interests independentof the Amer-
ble services to the clinician, and succeeds in ican Medical Association, eventually formed
enlargingthe area of service, the more do the the American Academy of Pediatrics. The
pathologists who want to do research have big professionalassociations in the specialty
to ward off demands from their institutions of pathology are all dominatedby, and exist
for more and more service. Fee-splitting in for, practitioners in pathology. Therefore,
surgery is an example of another kind of when leading research-orientedpathologists
conflict of interest: many surgeons can recently became concerned with increasing
make a living only by engaging in fee-split- research potential in the field, and inci-
ting relationships.The more successful sur- dentally with capturing some of the funds
geonswho dominatethe professionalassocia- which the National Institutes of Health
tions see the practice as tarnishingthe repu- were dispensing to pathology, they formed
tation of the specialty as a whole and committees especially for this purpose to
attempt to discredit it in codes of ethics, function as temporary associations. Recent-
but they cannot, and even dare not, attempt ly, a Society of Medical Psychiatry has been
to stamp it out. formed, undoubtedly in response to the
Probably the areas in which professionals growingpower of psychoanalytic psychiatry
come most frequently into conflicts of inter- and to the lessening importance, in many
est are in gaining a proper foothold in in- academic settings, of somatic psychiatrists.
stitutions, in recuitment, and in relations Looking at professionalassociations from
with the outside. Here there are recurrent this perspective, it seems that associations
problems which segments and emerging must be regardedin terms of just whose fate-
specialties have with their fellow profes- ful interests within the professionare served.
sionals. In order to survive and develop, a Associations are not everybody's associa-
segment must be representedin the training tion but represent one segment or a par-
centers. The medical-school curriculum to- ticular alliance of segments. Sociologists
day is crowded as the medical specialties may ask of medicine, for example: Who has
compete for the student's time and atten- an interest in thinking of medicine as a
tion, seeking to recruit or, at least, to so- whole, and which segments take on the role
cialize the budding professional into the of spokesmen to the public?
correct attitudes toward themselves. (Some Spurious unity and public relations.-
specialties regard themselves as having so There remain to be considered the relations
little lien on the student's time that they
of professionsto the lay public and the seem-
use that time primarily, in some medical
ing unity presented by such arrangements
schools, to impress upon him that only
specialists can safely do certain procedures as codes of ethics, licensure, and the major
-in short, how important and necessary is professional associations. These products
the particular specialty of the instructor. of professional activity are not necessarily
Then, too, segments require different un- evidence of internal homogeneity and con-
derstandings, even different contractual re- sensus but rather of the power of certain
lations, with clients and institutions. Many groups: establishedassociationsbecomebat-
a professional association has arisen out of tlegrounds as different emerging segments
just such conflicts as this. In the 1920's there compete for control. Considered from this
was a great deal of ferment between the viewpoint, such things as codes of ethics and
rising specialty of pediatrics and the Ameri- procedures of certification become the his-

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torical deposits of certain powerful seg- SEGMENTS AS SOCIAL MOVEMENTS

ments. Our mode of presentation might lead the
Groups that control the associations can reader to think of segments as simple differ-
wield various sanctions so as to bring about entiation along many rubrics. On the con-
compliance of the general membership with trary, the notion of segments refers to organ-
codes which they have succeeded in enact- ized identities. A position taken on one of
ing. The association concernedwith the prac- the issues of professional identity discussed
tice of pathology, for example, has recently above entails taking correspondingpositions
stipulated specific contractual relations along other dimensionsof identity. Segments
which the pathologist should enter into with also involve shared identities, manifested
his hospital and is moving toward denying, through circles of colleagueship. This allows
critical services of the association to non- one to speak of types of pathologist or types
complying members-despite the fact that of pediatrician-groups of people who or-
a goodly proportion of practicing patholo- ganize their professional activity in ways
gists neither have such contractual rela- which distinguish them from other members
tions nor even consider them desirable. But of their profession.
more or less organized opposition to the Segments are not fixed, perpetually de-
code-writing of intrenched groups can lead fined parts of the body professional. They
to revision of codes from time to time. tend to be more or less continually under-
Changes occur as the composition of criti- going change. They take form and develop,
cal committees is altered. Thus, since the they are modified, and they disappear.
clinically oriented pathologists have gained Movement is forced upon them by changes
power, they have succeeded in making cer- in their conceptual and technical apparatus,
tification examinations more and more ex- in the institutional conditions of work, and
acting along applied lines, making it steadi- in their relationship to other segments and
ly more difficult for young pathologists occupations. Each generation engages in
trained for research to achieve certification. spelling out, again, what it is about and
Certification procedures thus shift with the where it is going. In this process, boundaries
relative power of segments, putting a pre- become diffuse as generations overlap, and
mium on some kinds of training and discrim- different loci of professional activity articu-
inating against others. late somewhat different definitions of the
Those who control the professionalassoci- work situatiton. Out of this fluidity new
ations also control the organs of public rela- groupings may emerge.
tions. They take on the role of spokesmen to If this picture of diversity and movement
the public, interpreting the position of the is a realistic description of what goes on
profession,as they see it. They also negotiate within professions, how can it be analyzed?
with relevant special publics. The outsider As a beginning, the movement of segments
coming into contact with the profession can fruitfully be analyzed as analogous to
tends to encounter the results of the inner social movements. Heretofore, the analysis
group's efforts; he does not necessarily be- of social movements has been confined to
come aware of the inner circle or the power religious, political, and reform movements,
struggles behind the unified front. Thus, in to such problems as the conditions of their
considering the activities of professional origin, recruitment, leadership, the develop-
associations the observer must continually ment of organizational apparatus, ideolo-
ask such questions as: Who handles the gies, and tactics. The same questions can be
public and what do they represent? Whose asked of movements occurring within pro-
codes of ethics are these? What does the fessions. Professional identitiy may be
certification stand for? We should also ask, thought of as analogous to the ideology of a
wherever a profession seems to the general political movement; in this sense, segments
public to be relatively unified, why it seems have ideology. We have seen that they have
so-for this, too, is a pertinent problem. missions. They also tend to develop a broth-

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erhood of colleagues, leadership, organiza- ments. It is probably impossible to study
tional forms and vehicles, and tactics for one segment in movement adequately with-
implementing their position. out taking into account what is happening
At any one time the segments within a to others. Third, the leaders are men who
professionare likely to be in differentphases recognize status within the field, operate
of development and engaging in tactics ap- from positions of relative institutional pow-
propriate to their position. In pathology, er, and commandthe sources of institution-
for example, the clinically oriented segment, alized recruitment.Finally, it must be point-
which one of its antagonists termed "evan- ed out that not all segments display the
gelistic" and which is still expanding, has character of a social movement. Some lack
already created strong organizations, cap- organized activities, while others are still
tured many academic departments,promul- so inchoate that they appear more as a kind
gated codes of ethics, and is closing in on of backwash of the profession than as
the battle to secure desirable status for pa- true segments.
thologists in hospitals. The more scientif- In any case, the existence of segments,
ically oriented segment, on the other hand, and the emergenceof new segments, takes on
finds itself in a somewhat defensive posi- new significancewhen viewed from the per-
tion, forced to reaffirmsome aspects of its spective of social movements within a pro-
identity and modify others and to engage fession. Pockets of resistance and embattled
in tactics to hold its institutional supports. minorities may turn out to be the heirs of
Possibly the acme for some expanding seg- former generations, digging in along new
ments is the recognized status of specialty battle lines. They may spearheadnew move-
or subspecialty. Certainly, this is the way ments which sweep back into power. What
specialties seem to develop. But the condi- looks like backwash, or just plain deviancy,
tions under which segments will become may be the beginnings of a new segment
formalspecialties is in itself a fascinatingre- which will acquire an institutional place
search problem. (So also is the whole ques- and considerableprestige and power. A case
tion of relative development, degree of in point is that of the progenitorsof the clin-
change, influence, and power-matters ex- ical pathologists, who today are a threat to
pressively alluded to when professionals the institutional position of research-ori-
speak of "hot" areas and dead ones.) ented pathologists but who were considered
We have said that professions consist of the failures, or poor cousins, of the specialty
a loose amalgamationof segments which are thirty years ago.
in movement. Further, professions involve We have indicated what new kinds of re-
a number of social movements in various search might originate from the conception
kinds of relationshipto each other.Although of professionsthat we have presented. How-
the method of analysis developed for study- ever, this perspective has implications for
ing political and reformmovementsprovides several quite traditional areas of research.
a viewpoint on phenomena of professional
1. Work situation and institution as
life neglected in contemporary research,
arenas.-The work situation and the institu-
some differencesmust be noted between pro-
tion itself are not simply places wherepeople
fessional movements and the traditional
subject matter of analysis. First of all, pro- of various occupations and professionscome
fessional movements occur within institu- together and enact standard occupational
tional arrangements, and a large part of roles, either complimentary or conflicting.
the activity of segments is a power struggle These locales constitute the arenas where-
for the possession of them or of some kind in such roles are forgedand developed.Work
of place within them. Second, the fates of situation and institution must be regarded
segments are closely intertwined: they are in the light of the particular professional
possibly moreinterdependentand responsive segments represented there: where the seg-
to one anotherthan are other kinds of move- ments are moving and what effect these

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arenas have on their further development. 5. Public Images.-We have seen that
Since professions are in movement, work images beamed to the public tend to be con-
situations and institutions inevitably throw trolled by particularsegments of the profes-
people into new relationships. sion. However, sometimes segments reject
2. Careers.-The kinds of stages and the these public images as inappropriate-either
locales through which a man's career moves to themselves, specifically, or to the profes-
must be consideredin terms of the segment sion at large. If only the former, then they
to which he "belongs."Further, the investi- may require that the public acquire spe-
gator must be prepared to see changes not cialized images for themselves. In any case,
only in stages of career but in the ladder it- segments from time to time must engage in
self. The system that the career is moving tactics to project their own images to the
through can change along the way and take public. The situation is more complicated
on entirely new directions. The fate of indi- when the whole profession is considered as
vidual careersis closely tied up with the fate a public for particularspecialties or for seg-
of segments, and careers that were possible ments of specialties. Segments may be at
for one generation rarely are repeatable for pains to counteract the images which other
the next generation. people in the profession have of them, and
3. Socialization.-An investigator should attempt to create alternative images.
not focus solely upon how conceptions and 6. Relations with other professions.-
techniques are imparted in the study of Different segments of the profession come
socialization; he should be equally interested into contact with different occupations and
in the clash of opinions among the social- professions. They might have quite special
izers, where students are among the prizes.
problemswith other occupationswhich they
Segments are in competition for the alle-
giance of students: entire schools as well as do not share with other members of their
single departmentscan be the arena of, and profession. In considering the handling of
weapons in, this conflict. During their pro- relations with other professions, it is thus
fessional training, students pick their way necessary to ask such questions as: Who in
through a maze of conflicting models and the profession is concerned with this prob-
make momentouscommitmentsthereby. lem and what difference does it make to
4. Recruitment.-The basic program of them? Who does the negotiating and in
recuitment probably tends to be laid down what ways?
by powerful segments of the profession. Yet 7. Leadership.-Most leadership is asso-
different segments require different kinds ciated less with the entire profession than
of raw material to work upon, and their sur- with restricted portions of it. Certainly, it
vival depends upon an influx of candidates is linked with intellectual movements, and
who are potential successors. Thus, recruit- with the fates and fortunes of certain seg-
ment can be another critical battleground ments. Leadership,strategies, and the fates
upon which segments choose candidates in of segments deserve full focus in our studies
their own image or attempt to gain sufficient of professionalization.
control over recruitment procedures to do
so. Defection by the recruitedand recruiters, MICHAEL REESE HOSPITAL, CHICAGO

by the sponsored and the sponsors, is also AND

well worth studying, being one way that UNIVERSITY OF CALIFORNIA MEDICAL CENTER
new careerstake form. SAN FRANCISCO

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