Executive Coaching, Managerialism, and Coaching as a Profession

In a recent blog post on ADHD coaching, I noted that it is a no-barriers-to-entry kind of occupation. Anyone can hang a shingle as “coach” and there are countless consulting businesses offering executive coaching, ADHD coaching, organizational coaching, and even grief coaching for the bereaved. This got me interested in whether and under what circumstances coaching could be considered a “profession.” The short answer, for a number of reasons, is “no,” but this doesn’t mean that coaching can be dismissed.[1] Indeed, something of what makes it so worthy of investigation is how pervasive it has become.

So I hit the academic databases to look a little more into this “is coaching a profession thing.” One thing I love about going through databases of research is that you get a good “flyover” of how a topic has been approached over time. It’s kind of like how you can see land survey patterns once a plane is high enough: there’s some order to ideas that you might not otherwise see when you are too close and can get at it from one or a couple of angles. Anyway, I found it interesting that the concept of “coaching” comes primarily out of two areas. The first probably won’t surprise you: it’s sports coaching and sports psychology. The second may or may not be a surprise: it’s executive coaching. So, the practices and “norms” associated with coaching for ADHD and other specialty coaching fields are likely to take some of their cues from discourses of managerialism.

Okay so what do I mean by “discourses” and “managerialism?” They are terms that tend to be used in academic work, but their meanings aren’t obscure or difficult. A “discourse” as I use it here (and as it tends to be used in academic work) is a collection of words, ideas, images, people and concerns that are commonly called to mind around a topic. So as a simple example, we could take “discourses” that have developed around the internet and privacy: What comes to mind? Facebook, commercialism, Twitter, the right of state authorities to dig into your personal stuff, over-sharing, and conversely the role of anonymity in how we engage online. You could probably readily add your own ideas here.

Hopefully you can see that the idea of a “discourse” is a very intuitive and useful way to talk about a basket of ideas that in turn can offer a rough-and-ready guide to how we collectively perceive and value some aspect of our society. Another important point to keep in mind is that a lot of these discourses become so normal to us that we take them for granted: We don’t ask why some ideas are important and popular, while others get little or no attention. In other words, some discourses are more powerful than others in terms of their capacity to shape and reflect our thinking.

On to “managerialism,” then. What is that? Managerialism is a discourse — a basket of common ideas and concepts, remember — that pertains to what managers do: continuous personal improvement, which is linked to continuous organizational improvement. Think back to Dale Carnegie’s (1936) “How to Win Friends and Influence People” right through to popular recent organizational improvement strategies like Six Sigma. Because I’ve described this discourse as managerialism, I’m emphasizing that there are a lot of norms built into this body of reading and associated practices. One of them, I’ve already stated: it’s the idea that it is right and good for our self-improvement to be tied to our productivity at work. Books like the ones I just described, curriculum in MBA programs, and executive coaching are all resources that consistently emphasize productivity, extroversion, ambition and strategic thinking are important and worthy personal attributes.

So here is where I’m going with this: If the ideas that accompany “coaching” are mostly determined in organizational and corporate environments —that is, by the practice of “executive coaching,”, the values that align with those environments are more likely to colour or filter the way that we understand coaching relationships (and life) generally. This is the argument made by Western (2012): managerialism, he states, “is a way of thinking and doing that transcends the workplace and enters into all aspects of modern life” (p. 177). What he emphasizes here is that in the context of managerialism, coaching means improving your ability to play a role, so that you can eventually come to see yourself as a collection of “roles” that you perform – that what you do is more important than who you are, that your life only matters when you deliver a good performance in the eyes of others.[2]

Managerialism does not by any means exhaust the ways we can think about and understand a “coaching” relationship. Indeed, Western does a nice job of framing other coaching “discourses,” including the “psy-expert discourse,” and the existentially oriented “soul guide discourse” (Western, 2012). However, when we talk about the legitimacy and value of coaching generally, I believe we have to take the power of that managerial discourse quite seriously. What I learned from my brief foray into the literature about coaching, is that a critical amount of research on the topic is done by “executive coaches” from the perspective of executive coaching, and in the interests of giving executive coaching professional credibility.[3]

Okay well, so what? Why is that a problem? Here it is: There is a pile of money tied up in executive coaching, and much of it is paid for by corporations in the interests of improving the productivity and performance of management elites. This means that a very prominent discourse, or way of thinking about coaching, serves to make it normal for our organizations to watch us, counsel us, and shape our values and interests as workers rather than as people who may not otherwise be interested in a 24/7 psychic dedication to corporate or organizational bottom lines (Garvey, 2014).[4] And we’re not just workers, right? We are parents, friends, sons, daughters, community volunteers, and people who engage in activities for pleasure, growth, and to share the company of others. Not everything we do has an agenda. Executive coaching instructs one that this isn’t okay. Which isn’t okay.

Regardless of its present status as a “profession,” coaching is intended as a helping relationship toward some form of self-improvement. I’ve no doubt that countless dedicated coaches and coachees can attest to the sense of purpose and fulfillment that accompanies this joint work, and that this can be ethically undertaken. Whether coaching “professionalizes” in a direction that reinforces performance and “doing” over better “being” remains to be seen.

[1] If you are right into finding out *why* coaching isn’t a profession or would beg to differ, this chapter provides a useful overview/discussion: Lane, Stelter and Stout-Rostron, 2014. The future of coaching as a profession. In Cox, E., Bachkirova, T and Clutterbuck, D. (Eds.), The complete handbook of coaching, pp. 377-390). London and New York: Sage.

[2] Kind of bleak, huh? “Performativity” is pretty much guaranteed to make you feel like shit about yourself most of the time. It stands in stark contrast to the humanist ideas I much prefer: authenticity, living according to your own values, living with integrity that transcends your life roles, growth for its own sake, healthy (and again authentic) relationships, pleasure in being, not just doing. You get the idea. Also that I’m basically a hippie.

[3] See, for example, Bennett, J. L. (2006). An agenda for coaching-related research: A challenge for researchers. Consulting Psychology Journal: Practice and Research, 58(4), 240–249. http://doi.org/10.1037/1065-9293.58.4.240; Bozer, G., Sarros, J. C., & Santora, J. C. (2014). Academic background and credibility in executive coaching effectiveness. Personnel Review, 43(6), 881–897. Retrieved from

[4] Garvey. R. (2014). Neofeudalism and surveillance in coaching supervision and mentoring. e-Organisations & People, 21, 4, 41-47. Also see Alvesson, M. & Spicer, A. (2012) A stupidity‐based theory of organizations. Journal of Management Studies, 49(7), 1194-1220.


Who Should Discipline Alberta’s Teachers?


Alberta’s new teacher disciplinary process? Okay not really. But there’s an edge of vigilantism in some critics comments on teachers’ professional conduct.

The dust-up between Alberta Education Minister Jeff Johnson and the Alberta Teachers’ Association continues. In the latest chapter of a political fight that shouldn’t be happening in the first place, Minister Johnson made a great show of permanently revoking the licenses of four Alberta teachers who had been suspended through the ATA’s disciplinary hearing process.[1] Publicly, Johnson states that he intends to “work with” the province’s teachers’ union and professional association, but in less public settings, he has expressed the desire to break up the ATA by separating its professional and union functions into separate bodies – a union and a Teachers’ College, the latter of which would be under the direct authority of the province.[2]

First and foremost, then, questions around the discipline of badly behaving teachers should be understood fundamentally as a political battle. Continue reading

Want Excellent Teachers? Let Them Work Together More

A couple of things tweaked me to write this follow-up post on the report from Alberta Education’s Task Force on Teacher Excellence. First was this response to my last blog. The reader commented,

Just a quick question: You say that there a few ( very few) teachers who should be put out to pasture. I agree. But how do we know who that is? What measure should we use? How can the system be changed so those bad apples are weeded out?

Second was yesterday’s episode of The Current on CBC. Alberta blogger and teacher Joe Bower mentioned teacher collaboration as an alternative to “top down” practice assessment, and host Anna Maria Tremonti had no idea what he meant. So I figured she’s probably not the only one who isn’t aware that this possibility for improved teaching exists.

So. Here goes:

Collaborative Professional Development to Promote Teaching Excellence

I was actually mildly frustrated when, in the Current interview I just mentioned, Bower went straight to class sizes as an issue. In the case of evaluating teachers’ practices, class sizes aren’t that relevant. But Bower’s brief reference to collaboration is very relevant indeed. Here then, I want to elaborate on what teacher collaboration is, and why it is under-utilized in schools even though it can be very effective route to improved teaching. Continue reading

Dr. Google and the Canadian Real Estate Association: More Tales of Professions

The rise of the internet has not been particularly kind to professionals. Here’s why: you can find out almost anything online.

One thing that makes a professional a professional is that s/he has access to knowledge that is hard to get. That’s what makes a client seek out a professional service: Professionals know stuff you don’t, and you pay them to put that knowledge to work for you. Lawyers and doctors are, of course, classic examples. But what happens when you can find out things for yourself? Do you need to consult a professional after all? Well, sometimes yes, but maybe sometimes no.

You’ve probably heard references to “Dr. Google,” or as I like to call the phenomenon, Googlechondria. That’s where people engage in do-it-yourself diagnosis online. Resources range everywhere from well-reputed and researched public information sites to hacks ‘n quacks selling colon cleansing kits and miracle weight loss supplements [1].

Regardless of the sketchy quality of much of what’s online, and the persistent presence of some people who will believe anything, what we’ll generally call “health information” available on the internet has changed relationships between patients and their doctors. For better or for worse, many patients no longer automatically defer to what their doctors advise. The case may be made that the qualities that distinguish the doctor as a professional are being challenged because the medical professions no longer have exclusive access to diagnostic tools and information.

Of course, it’s not that simple. As this editorial fleshes out, a little information in the wrong hands can be a dangerous thing. Sometimes you’re smartest when you know what you’re not smart about. And I doubt Dr. Google will impact health professionals negatively compared to the fodder it provides for the Darwin Awards.

Instead, what I’m getting at here is the crucial role that information and knowledge play in our recognition of a profession. Importantly, occupational groups that want to benefit from professional status may claim this status on the basis of having exclusive knowledge – that is, again, knowledge that not just anyone has [2]. The questions raised when such knowledge becomes more widely available are these: “Well, should knowledge be controlled anyway? If so, by who? And, when is it in the public’s interest?”

A good case can be made that it is in the public interest to ensure that those who claim to have medical knowledge/skills (that is doctors and other health professionals) do, in fact, know their stuff. This in turn makes it more legitimate to claim that what health professionals know isn’t just for anyone to know. As noted above, a little knowledge can be a dangerous/stupid thing. I’m quite happy that not just anyone can hang a shingle and call himself a doctor, thank you very much.

But here’s another case where the role of knowledge in professionalization is, arguably, a little more suspect…

De-Professionalizing Real Estate

If professionalization describes the process where an occupation tries and/or succeeds in being recognized as a profession, de-professionalization describes the opposite process: an occupation loses its claim on providing an exclusive, important service.  A case may be made that real estate agents are precisely in the midst of this. Here’s why:

The MLS (multiple listing service) as most people know, is a database of properties for sale, and it has long provided real estate agents with a basis for claiming professional status. The argument has been made by real estate service providers that they should be paid well for their services because they have access to exclusive knowledge. And they do know some legal and technical stuff that takes some effort to learn. But a significant part of what makes up a real estate agents’ knowledge is not knowledge per se, but exclusive access to information available via the MLS. The Canadian Real Estate Association (CREA) itself claims, “only a REALTOR®, a member of The Canadian Real Estate Association, has access to the Multiple Listing Service®, Canada’s most powerful real estate marketing system.” [3]

Here’s what’s been happening though: The MLS has been managed online for a number of years now, creating potential for non-exclusive access to the information it contains. So you’ve got other upstarts who see this potential and would like to use the MLS in different ways, providing alternatives to consumers who may want to do more of their own thing when buying and/or selling their home. And the new providers say “Hey, why can’t we access MLS and offer these services to our clients?” The result has been a legal battle between the CREA and the Federal Competition Bureau [4]. The gist of it is that new providers have been challenging the right of the CREA to act as a gatekeeper of the information that the MLS contains.

So from the perspective of the Canadian Real Estate Association, this is seriously bad news. A key source of the legitimacy of the real estate professional – exclusive access to knowledge in the form of the MLS listings – has been compromised. The consequence is that real estate agents lose the status they had as exclusive providers of what the CREA has consistently marketed as a professional service.

See how that works? The CREA does perform some of the functions of a professional association, regulating and certifying the conduct and knowledge base of its members, and this has indeed provided some degree of consumer protection. But exclusive access to the MLS has been a very significant part of what has made being a real estate agent a do-able way to make a living. So the livelihoods of members are suddenly on the line.

And that’s the point I’ve hoped to make here, really: seeing, overall, that there are meaningful links between

  • control over knowledge and information,
  • the interests of the public,
  • perceptions of what counts as “professional,” and
  • the bottom line: the financial rewards of the occupation.

Dr. Google and the unbundling of real estate services are just two examples of how our understandings of “professions” have been shifting in response to the ubiquity of the internet. These shifts will continue to play out in important ways as the Wild West of online information remains unregulated and untamed.


Notes and References

[1] All of these sites will claim they base their stuff on science, and you will see words like “professional” and “scientific” and “evidence” routinely bandied about in alternative medicine sites. Here’s Respectful Insolence, the often entertaining blog of a doctor who loves to expose quackery.

[2] Controlling knowledge is one strategy for occupational closure. The theory suggests that limiting the number of knowledgeable people in an occupation, demand for the services it provides will remain high, and wages and rewards for the people working in that occupation will thus also remain high. If you’re dying to know more about occupational closure, see Weeden, K. (2002). Why Do Some Occupations Pay More than Others? Social Closure and Earnings Inequality in the United States.  American Journal of Sociology, 108(1), 55-101. doi: 10.1086/344121. In Academic Speak, Weeden cites four mechanisms through which occupations work toward closure: “restricting the supply of labor in an occupation, enhancing overall demand for a product or service, solidifying an occupation’s claim to be the sole provider of that service, or signaling to customers that the occupation provides a service of a particular quality” (p. 57).

Keep in mind that theories of occupational and professional closure are only some among many ideas about why some kinds of work have higher status and pay better than other kinds of work. These theories don’t explain everything, but they do, I think, offer some interesting and important ways to “make sense” of work.

[3] If you’re curious and have all sorts of free time, take a closer look at the Canadian Real Estate Association’s write-up on why people should use Realtors. In addition to the closing statement of the document noted above, if you read carefully, you’ll see how ideas like trust, valuable/exclusive knowledge and licenses are used to make the Realtor’s role more legitimate, and to persuade you that you should call upon their services. These are professionalization strategies. (See Evetts, J. (2003). The construction of professionalism in new and existing occupational contexts. International Journal of Sociology and Social Policy, 23(4/5), 22-36.

[4] Steve Ladurantaye (2010, January 29). The battle to unlock the housing market. The Globe and Mail. Retrieved May 7, 2011.  Most recently: CBC News (2011, May 27). Competition Bureau sues real estate board. Retrieved June 1, 2011.

Professional “Status” for Nurses and All Those Other Professions

It was really interesting to read the responses to my recent bit on CBC’s White Coat Black Art. In particular, yikes… did I offend a few nurses! Some respondents were pretty choked that I would suggest that nurses pursue credentials just to gain status, instead of out of a commitment to their patients and their profession.

The only thing is, that wasn’t really what I was suggesting at all. Hence a follow up blog. In the WCBA interview, I talked about the ways in which higher/more education credentials can help professional groups to jockey for status, especially when they are forced to compete for control over a given type of work. It goes something like this:

“We are more qualified to do this kind of work than you are because we learned how in (insert valuable education program here), and here’s the credential to prove it. Do you have this credential? No you do not.”

The response of the rival group is either a) to increase its own credential requirements to prove equal or superior capability; or b) to dismiss the knowledge and skills as something you don’t need to “learn” how to do at school.

The example I used in my earlier blog on this topic was the shoring up of the nursing profession in the face of the growing presence of Physicians’ Assistants in the field. The increasing use of practical nurses is another case in point. Practical nurses perform many of the tasks as nurses do, and are solidifying their educational requirements to prove they can capably do this work. The more it is accepted that PNs can do the work, the less it seems necessary to pay more expensive nurses to do it. The nursing profession as a whole must respond in a manner that protects and hopefully even enhances the importance of RNs to good healthcare.

Although I have focused on nurses, the point of my discussion was never to “dis” the nursing profession, or any one profession for that matter; as I hope will become clear, all professions have incentives to be highly regarded. And of course individual people pursue their occupations (usually) out of passion and commitment and interest, not in order to gain status. But individual people are not the same as the organizations or institutions they are caught up in. And professional organizations, industrial lobby groups, political parties, and chambers of  commerce are diverse examples of organizations that benefit their members by promoting the legitimacy and value of what those members do [1].


So let me explain that person versus organization distinction further. The thing that makes credentialism[2] so interesting is that it is not the consequence of individual motivations, but of what we can call “institutional actors.” This line of thinking comes out of institutional and (to some extent) organizational theory, and examines how institutions “act” in response to other institutions and environmental cues. [3]. It’s sort of like the personification of corporations in the (aptly named) documentary, The Corporation [4]. So we set aside the fact that institutions (companies, schools, professional organizations et al.) are ultimately made up of individual people and treat the institution as a whole. We work with the assumption that the whole is different somehow from the sum of its parts – just like we can’t reduce a person to a catalogue of his or her body parts!

Then we ask questions like, “How does this institution respond to changes in its environment?”  Just like you’d have to meet new people, change your habits and learn new things if you moved to a new city, an organization might have to change in response to, for example, a new policy or a new kind of technology. Think, for example, of how companies have had to change their marketing strategies in response to the growth of the internet.

Here’s another great example: some years ago, Edmonton Public Schools began to operate as a “quasi-market.” This means that schools are still publicly funded and subject to Alberta’s education legislation, but are encouraged to “market” themselves to attract students by offering innovative programs and learning environments. The idea here is that the parent/student “consumers” of public education get the benefits of a market – competition and innovation – without the risks, because the system is still public [5].

So if you want evidence of how this policy change has affected education in Edmonton, Alberta, you just need to attend to the growing proliferation of roadside signs as schools re-invent themselves in order to attract parents and students. One of our neighbourhood schools, for example, has recently niched itself as an all boys academy; another is now offering Spanish bilingual education for elementary school age students. Because boundaries are open, schools are free to attract students, but they are also free to fail and face closure if they can’t keep their numbers up.

The point here is that, under the open boundaries system, schools change what they do if they want to stay open in order to survive. No individual school – its administration, teachers, parents, students and community – is going to “go gently into that good night;” schools, as organizations, are invested in their own survival. So they examine what competing schools are doing, try to discern what parents and students might want, and actively seek out a niche. If they rely on their old ways of being and think of themselves just as neighbourhood schools that serve their geographical communities, there’s a chance they won’t make it. Or at least they’ll find themselves struggling with fewer students and less funding. And hey – who wants less funding?

In my consideration of the professions, we can think about professions in the same way I just discussed schools – as institutions that need to survive. If we return to the question of nursing, we can see that the profession as a whole involves all sorts of institutions and organizations – higher education (where nurses learn and get their degrees), unions, and professional associations. All of these entities have a stake in nurses being valued in their workplaces, so all will maneuver in response to changes that threaten the well-being and welfare of the nursing profession as a whole.

So when I talk about status seeking through more education, I want to make it clear that I’m talking about the way institutions behave – that’s institutionalism – and not, as I think some of White Coat Black Art listeners took it, about status seeking by individuals. Because nursing has historically been treated like “women’s work” and marginalized next to doctoring, it’s always had to work hard to be recognized as a profession. And now nursing is facing new threats as more care work is provided by practical nurses and aides.

I wouldn’t propose to offer any solutions to the complex business of providing the right mix of health professionals for a given setting – that one is out of my league. But I do think it is important to look at how professional organizations – and the nursing profession is just one among many – seek to ensure how their own interests are protected in the process.


[1] I want to add a few words about “legitimacy” here. It’s an especially important concept when we are talking about professions, because members of the public come to use professional services on the basis of recognizing that the “professional” exclusively possesses skills and knowledge that not just anybody can get/use. That’s why you’re willing to pay for that person’s services, and it’s the basis for professional’s compensation (like making big bucks); you accept that the person possesses a legitimate combination of knowledge, skills, and experience that you can’t cobble together on your own.

[2] Credentialism, if it isn’t clear, refers to the growth, over time, of schooling required to be recognized as a legitimate worker in a given area. Historically, occupations have required more and more schooling for entrance. One example is school principals. It is increasingly difficult to become a school principal without a master’s degree, but this has not always been the case. Physiotherapists now require a master’s degree, not just a baccalaureate (undergrad) degree.

[3] Institutionalism is a field of study that, much as I described above, studies institutions (instead of people). It asks questions like: why do institutions behave as they do? How do institutions affect each other? What causes institutions to change (or not)? How do institutions affect the way society is organized? For further explanation, here’s the Wikipedia entry.

[4] The premise of The Corporation was that a corporation has the legal status of a “person.” The documentary systematically examines the behavior(s) of a corporation and concludes that if the corporation were in fact a person, it would be a psychopath!

[5] For an explanation of quasi-markets, see J. Kachur (1999), Privatizing Public Choice: The Rise of Charter Schooling in Alberta. In Contested Classrooms: Education, Globalization and Democracy in Alberta.

All About Bedpans: How Credentials Stratify Work

In a September episode of White Coat, Black Art,  host Dr. Brian Goldman attributes burnout among some young nurses to a gap between expectations established in pre-professional training, and the realities of the job. His guest, an early career ICU nurse, described this:

“Nurses really still seem to be in a secondary role to doctors, and I was surprised by the lack of respect that I felt as a nurse, and the stuff I was expected to do as a nurse that I didn’t get taught in nursing school.” The stuff she was expected to do included cleaning up bodily fluids (as the cleaning staff were not allowed to do this), cleaning bedpans, and answering the phone. “I feel like a glorified secretary sometimes,” she said.

This nurse, who at the time of the interview was considering a career change, also described having a great deal of responsibility, but little autonomy in the performance of her work. This is an issue well worth discussing on its own. But I’d like here to focus on what her comments suggest both about how our career expectations are shaped, and about, again, the question of status in the professions1.

First, consider the question of expectations. The nurse interviewed by Goldman recalled the idealism she developed through her nursing education: she described, briefly, feminist influences, and the idea that nursing profession was evolving professionally into realms of greater power and responsibility. Her work experience was rather far removed from what, through her education, she had been taught to expect.2

As college and university degrees are increasingly marketed in terms of “careers,” you have to wonder whether unmet, “great expectations” are also becoming more pervasive. Lots of unis and colleges are developing co-op programs to help bridge learning and practice, but I remain skeptical. It seems to me that once we start marketing education – a phenomenon that has really intensified in Canada in recent years – there can be a nasty, dark underbelly in terms of exploiting students’ (often uninformed and under-researched) aspirations. Does this contribute to unrealistic career expectations? I wouldn’t argue this as an absolute, but I do think it’s a question worth asking.

The second point I’d like to consider is a question that I’d love to put to health professionals. Does the increasing stratification of health care entrench, in some unhealthy and unexamined ways, a form of credentialed elitism? Perhaps I was tweaked to consider this by the nurse’s comments about cleaning bedpans. I couldn’t help but compare this to the stoically cheerful comments by my daughter’s stepmom, a long-practicing nurse, about shifts spent “wiping butts.” Have these two nurses – one newer, one with twenty years on the job – simply learned to think differently about the meaning of their work? Has our younger nurse been trained in an environment where it is expected that the lower status aspects of care will be “downloaded” onto LPNs and nursing assistants?3

It’s not a frivolous question. What I’m thinking about here is something akin to an unrecognized caste system, which is entrenched both through professionalization and, in many cases, unionization. Basically, the more thoroughly we are able to describe work – name positions and place boundaries around the nature of tasks that will and will not be performed – the more opportunity there is to segregate “good work” from “not so good work.”

Feminist accounts of work and learning (which have expanded, appropriately, to consider questions of race), point to the ways in which care of children (education, early childhood education and daycares/dayhomes), and care of the ill and infirmed (hospital and long-term care), are disproportionately assigned to society’s most disadvantaged (on average) members: women, immigrants, and visible minorities.

So as we continue to define increasingly specific forms of work through training and credentialing (dayhome providers, homecare providers, nursing assistants, etc.), some real problems emerge. One is that university degrees may “overqualify” those who, once in the workplace, find themselves changing bedpans, answering phones, or undertaking similar “low status” and low skill work. A second, more serious problem is captured through a feminist take on care work: As a society, we can all too easily perpetuate its low status through education paths. College and training credentials specific to care work ensure that it is always “someone else’s job.”

For me, this last question raises lots more ethical and economic questions about “good” work, “bad” work, and how it ought to be distributed in society. Someone has to clean the bedpans. Who should it be and why? Food for thought, and fodder for another blog. In the meantime, I have to go wash some sheet (a job for which I am grossly overqualified).


1See my blog from last week about Physicians’ Assistants.

2The problem of being “rudely awakened” in practice is one shared by teachers. In our own Faculty of Education at the University of Alberta, present reform efforts in teacher preparation are in part spurred by a recognition that classroom learning and work-based learning (through practicums) needs to be better integrated. The culture shock of shifting from “ideal” to “real” is just intense.

3I want to emphasize that I’m not personally criticizing the nurse in question here. I’m more interested in whether her perceptions of her work are representative of some broader assumptions. The nurse’s comments do deserve to be heard in their context: The White Coat Black Art episode about burnout in the health professions was broadcast September 2, 2009, and is available for download. And WCBA is a terrific show by the way! Check it out.

So You Want To Be a Professional? The Case of Physician Assistants in Health Care

These are certainly interesting times if you are a health care provider trying to figure out where you stand in the “pecking order” of professional designations. We have a health care system fraught with chronic shortages of physicians. Other health care providers are subject to boom and bust cycles in demand for their services.1 These conditions, along with the pressing need to improve the efficiency of health care delivery, are encouraging innovation in human resources: re-allocations of labour, team care models, and new specialization areas. A recent episode of CBC’s The Current  discussed the emergence of one such innovation: the introduction of the Physician Assistant position in Ontario health care settings.

What’s a Physician Assistant? Great question. Add it to the growing list of specializations and sub-specializations that fall under the umbrella of health care providers. The Physician Assistant or “PA” position has been a staple in the military for several decades, but has only very recently been given a place in civilian health care in Canada. According to CAPA, the PAs’ professional organization, a PA works as a “physician extender.” Typical tasks include taking medical histories, ordering and interpreting diagnostic tests, prescribing medications, and assisting in surgery. CAPA President Ian Jones, who was interviewed by The Current, states that the introduction of PAs is a sensible strategy for delivering healthcare more efficiently, and reducing patient wait times.

So what’s the problem here? Doris Grinspun, Executive Director of the Registered Nurses’ Association of Ontario, also appeared on the Current episode, arguing that PAs are inconsistently trained, less trained than RNs, and may potentially compromise care quality.3 In fact both guests define the issue in terms of patient care and patient interests. Regulation of professions, via self-regulation, the state, or some combination of these, is indeed important for protecting public interests in areas that significantly affect their wellbeing. Think, for example, of concerns voiced by some around the unregulated nature of alternative medicine.

The patient-interests based arguments of The Current’s guests are thus not without relevance or merit. However, they obscure the fascinating dynamics of power struggles among established professional groups and “up and comers” competing for legitimacy within a given field. Perspectives that examine conflict, competition and self-interest within and among professions are sometimes designated “neo-Weberian” because they pick up on and extend the work of turn-of-the-century (that’s 20th century) sociologist Max Weber.4 Among his many historical and sociological explorations, Weber took an strong interest in how specialized knowledge brought power and status to the emerging professional class. In other words, he recognized that the idea of “the professional” has what we might call cultural or symbolic worth beyond their defining educational and technical criteria. Professionals have social status; people defer to their authority. This has some cachet, no?

So if we apply this kind of thinking to the discussion on the Physician Assistant accreditation, the opposition expressed by nurses takes on a new dimension. Registered Nurses have historically specialized in similar capacities, so a PA is essentially a new kid on their block, competing with nurses for “ownership” over the bodies of knowledge required to support physicians in various settings. The rarity and breadth of knowledge involved (“expertise”), along with the overall necessity of the services offered, impacts the demand for the work, and the compensation for the work. Simply put here, PAs and RNs may be competing for the same jobs, and they do so by trying to persuade others (including the public) of the legitimacy, importance, and usefulness of what they know.

Turf Wars: Implications for Career Planning

I find these conflicts among professional bodies fascinating in their own right,5 but they can have important consequences for students attempting to establish career paths. Professional turf struggles can translate into competing accreditations, designations, and programs of study that can be bewildering for students entering the field. As provinces and provincial level bodies tend to regulate and license forms of education and work, standards and designations can differ from one end of the country to another, making it difficult for students to move to other provinces with assurance that their credentials will be recognized. In the case of PAs, for example, it’s a graduate-level degree in Manitoba,6 whereas in Ontario a student may enter a PA program after two years in any undergraduate degree program.

Fields in the process of professionalizing – fitness trainers and massage therapists come to mind – can be fraught with risk for those entering them. Credentials with weak or questionable recognition value can make it tough to find work in the chosen field, and the road to such recognition is often long. (Midwifery is a great example of an uphill battle to achieve professional status and recognition.) Emerging fields often can’t promise the same compensation as established fields. Being a “professional” is no guarantee of income or job security.

So if you or someone you know is thinking about career routes, it’s not a bad thing to recognize that a “professional” designation isn’t always a straightforward thing. Some professions like RN, LLB, or CGA (among many others) are well established and well recognized. Where newer and less recognized fields are laying claim to professional status, it is a good idea to do some investigation and determine which programs of study are recognized where. Professionalization generally serves public interests, but it’s important to recognize and remember that professional organizations and professionalizing areas have a stake in selling the public on their legitimacy and credibility.


1 Health Canada (2004). Health human resources: Balancing supply and demand. Health Research Bulletin, 8.

2 Health care provider designations include registered nurses, doctors, licensed practical nurses, registered psychiatric nurses, nursing assistants, nurse practitioners, lab techs, radiation techs, respiratory therapists, psychologists, physiotherapists, and occupational therapists… among others! See Health Canada (2004), above. Also Salhani & Coulter, 2009, The politics of interprofessional working and the struggle for professional autonomy in nursing.

3 More detail on the OARN’s position on PAs is available here.

4 Neo-Weberian or critical accounts of professionals and professionalism take the perspective that many aspects of professional organization and professional regulation are self-serving because they bar entry by competitors. The status of the profession is upheld when its exclusiveness is maintained. Weber didn’t talk about this stuff directly himself, but his work serves as a foundation for it. Weber is best known for his work “The Protestant Ethic and the Spirit of Capitalism,” which looked at (like the title suggests) the historical conditions that led to capitalism being more successful in some places than others (i.e. England and North America). The work famously cites Ben Franklin as an exemplary early capitalist, emphasizing frugality, hard work, and self-control. For a quick and dirty overview, here’s the Wikipedia entry.

5Competition for legitimacy can occur in any professional field. For an interesting account of…well, accountants, see Macdonald, L. & Richardson, A. (2004). Identity, appropriateness and the construction of regulatory space: the formation of the Public Accountant’s Council of Ontario. Accounting, Organizations and Society, 29(5-6), 489-524. It’s a historical overview of competing professional accreditation bodies. And hey, who knew there was a field of academic study called “Critical Accounting?”

6Nurses oppose the Ontario government’s physician assistant role…