The bloody contest between capitalism and socialism unexpectedly came to an end in 1989 after a struggle that gripped the world for a century and a half. Of course appearances may prove deceiving; movements and institutions have been known to survive defeat and prosper under new names. Still, the tides of geopolitical fortune have undeniably shifted, giving us good reason to wonder where capitalism, giddy with self-congratulation and unchecked by any formidable opposition, is taking us.
Elliott A. Krause, a professor of sociology at Northeastern University, suggests that we have misjudged both the stakes and the duration of the contest that capitalism is winning. Casting his eyes back over a historical panorama so sweeping that 1848 and the Communist Manifesto recede into minor significance, Krause takes the recent triumphs of capitalism to mark the end of an era of guild power that began in the Middle Ages. In Death of the Guilds: Professions, States, and the Advance of Capitalism, 1930 to the Present, he identifies professions such as law, medicine, and the various academic disciplines as authentic descendants of the medieval guilds; he worries that their power to control the conditions under which their members work is fading, to the detriment of us all.
From this perspective, control over the workplace becomes the great pivot on which history turns. The professions become simply those occupations in which practitioners have managed to establish control and hold on to it most tenaciously. Capitalism and the state, each with its own distinct, if overlapping, interests, become the two most likely antagonists that members of a profession must hold at bay if they are to control their destinies. The traditional guilds lost control centuries ago, but it is only now, at the end of the twentieth century, Krause believes, that control is finally slipping out of the hands of lawyers, doctors, and professors as well. What happened to skilled artisans in the nineteenth century, as factory owners increased profits by de-skilling jobs and routinizing manufacturing processes, is analogous to what he believes is happening to the learned professions today. Posing his thesis as a rhetorical question, Krause asks: “Have capitalism and the state finally caught up with the last guilds?”
By arguing that the modern professions are the “last guilds,” Krause boldly revises the prevailing history of the professions. No one doubts that divinity, medicine, law, and other professions have long histories, but the relevance of events in the eighteenth century and earlier to their current practices seems slight because so much changed in the nineteenth century. New professions emerged, such as electrical engineering; old ones took a new shape as they adapted to an increasingly interdependent world of cities, factories, and cheap transportation, a world of rising per capita income and proliferating expertise. There are good reasons to think of the professions today as offshoots of the modernizing and nationalizing processes of the urban industrial era, rather than as survivals of medieval corporatism. With few exceptions, historians as well as sociologists have taken it for granted that little is to be gained by dwelling on the antiquity of professional pedigree; it risks mistaking resemblances of form for continuities of substance.
Krause’s challenge to received wisdom will be controversial, but there is some plausibility to his account. His story about the growing precariousness of professional control of the workplace in an era of capitalist triumphalism will ring true for many readers because it squares with their personal experience. Budget cutbacks and attacks on tenure give ample evidence that the longstanding public prestige of the university is not what it was. More than a few politicians in the United States are finding it politically advantageous to present themselves as stern critics of the institution that houses the academic disciplines and acts as gatekeeper and educator for all the authentic professions.
Since everyone relies on doctors, an even more conspicuous example of decline in professional power in the United States is the diminished autonomy of the medical profession in recent decades. As recently as twenty years ago the authority of physicians and surgeons to dictate the conditions of their work seemed immune to challenge. The question asked about doctors in the 1970s was not whether they needed greater autonomy, in order to maintain control of the medical workplace and uphold high ethical and therapeutic standards. It was how the autonomy they already had could possibly be justified in a society that aspired to be democratic.
Today, in contrast, doctors working in the major cities have with few exceptions become well-paid functionaries in bureaucracies driven as much by the profit motive as by therapeutic considerations. Fear that doctors control too much has been displaced by fear that they control too little. Increasingly it is the entrepreneurs of the medical care industry who determine who will be treated and how long treatment will continue. Those who now hire and fire doctors have even tried to dictate which of several alternative treatments their employees may or may not mention to patients. In reaction, sixteen state legislatures passed laws last year prohibiting “gag rules” and reaffirming the right of doctors to unrestricted communication with their patients; the federal government followed suit with an order to the same effect. 1
A recent editorial in the New England Journal of Medicine alleged that managed care plans suffer from “an inherent conflict of interest. On the one hand they pledge to take care of their enrollees, but on the other their financial success depends on doing as little for them as possible.” The editorial warned that “the quality of health care is now seriously threatened by our rapid shift to managed care as the way to contain costs.” In late December the federal government stepped in between feuding doctors and HMO managers to set limits on the types of bonuses that doctors can be offered for containing the cost of services for Medicare and Medicaid patients.2 Yet another sign of growing conflict between professional and capitalist priorities can be seen in the fact that in 1994, the latest year for which data are available, the average income of physicians stopped rising and, in fact, declined for the first time in recent memory.3
If medicine, the most powerful and prestigious of all the professions, can be made to scramble for control over its own workplace, what can the future hold for other self-governing professions? We get a clue when we read that giant corporations such as Lockheed, Electronic Data Systems, and Andersen Consulting are competing for the opportunity to administer the entire welfare operation of the state of Texas, with an annual budget of $563 million.4 Squeezing profits from running state welfare systems once seemed an unlikely prospect, to say the least. If welfare can be made to pay, there would seem nothing to prevent capitalists from turning universities—where tuitions have long risen faster than inflation and patentable ideas create occasional windfalls—into profitable enterprises. Viewed as a commodity, a college education for one’s children is arguably the choicest object of consumer desire.
That today’s capitalists see monetary incentives for converting hitherto professional, governmental, and non-profit activities into competitive businesses gives a jolt of credibility to Krause’s warning that the “guild power” of the professions is eroding.
Another reason for taking Krause seriously (even though he is silent on the subject) is that there exists a long tradition of cultural rivalry between professional people and businessmen. Fear that open warfare would break out between capital and labor has always made the subtle but persistent antagonism between capitalists and the professions seem mild by comparison. As early as 1825 Blackwood’s magazine complained that “the Philosophers… are getting up what they are pleased to call a New Aristocracy—an Aristocracy of Science [which] is to be the enemy and ruler of the old one.”5 Building on Coleridge’s “Clerisy” and Carlyle’s “Aristocracy of Talent,” Matthew Arnold spoke in 1868 of a major split within the British middle class. In addition to businessmen, there was another rising social category that included intellectuals but was made up mainly of professional people. Its members scorned everything associated with the marketplace, identifying themselves instead with values drawn from the aristocracy and the teachings of the Church.
When Ruskin wanted to criticize businessmen, it was the professions he held up as a model. The proper role of the merchant or manufacturer, he contended, was unselfishly “to provide for the nation.”
It is no more his function to get profit for himself out of that provision than it is a clergyman’s function to get his stipend. This stipend is a due and necessary adjunct, but not the object of his life, if he be a true clergyman, any more than his fee (or honorarium) is the object of life to a true physician.6
The professional person’s claim to moral superiority can be seen as a rhetorical weapon in a complex rivalry of classes. This was a contest in which professionals initially spoke for other interests—as lawyers did for rich clients—but by the end of the nineteenth century, they asserted with mounting confidence a social ideal of their own. “Their ideal society,” as the historian Harold Perkin observes, “was a functional one based on expertise and selection by merit.”7 The ideology of of disinterested devotion to functional efficacy that Perkin identifies with the professions is best epitomized by the words of the eminent historian and Fabian socialist, R.H. Tawney. Tawney’s influential 1920 book, The Acquisitive Society, deplored the inability of market culture to sustain any sense of purpose capable of transcending the selfish interests of individuals. The cure he prescribed was wondrously simple: professionalize all occupations.
The application to industry of the principle of purpose is simple, however difficult it may be to give effect to it. It is to turn it into a Profession. A Profession may be defined most simply as a trade which is organized, incompletely no doubt, but genuinely, for the performance of function. It is not simply a collection of individuals who get a living for themselves by the same kind of work. Nor is it merely a group which is organized exclusively for the economic protection of its members, though that is normally among its purposes. It is a body of men who carry on their work in accordance with rules designed to enforce certain standards both for the better protection of its members and for the better service of the public.8
Professionalizing work as an anti-capitalist cultural reform was a more influential force in Britain than elsewhere, but the British experience was not unique. Throughout the West, from the 1870s through the 1930s and beyond, it was commonly assumed among educated people that the professions had claims to a sense of honor and disinterestedness not to be expected from those who merely competed and traded in the marketplace. Not until the 1960s would that assumption come under attack, particularly from critics on the left who saw professionals as wolves in sheep’s clothing, who lived by caveat emptor but lacked the candor to admit it.
In France, Emile Durkheim, one of the founding fathers of the new academic discipline of sociology, proposed reforms as sweeping as Tawney’s, which explicitly called for a revival of the guilds in modern form, as professions. Herbert Croly and other Progressives in the United States had no native tradition of guilds on which to build, but they echoed Tawney’s dismay about the prevailing ascendancy of rights over duties and shared his enthusiasm for elevating disinterested expertise above popular elections as a basis for public policy. In spite of not sharing any of the religious convictions that motivated Tawney, Thorstein Veblen was just as deeply repelled by the pecuniary lust of businessmen. In The Higher Learning in America he construed the university as a fortress of disinterestedness and tried to defend it against those who would divert “idle curiosity” (“the disinterested pursuit of unprofitable knowledge”) to the service of Mammon.9
The collegial, corporate, guild-like character of professional communities held out the hope of a proven remedy for selfishness, one that was immensely appealing to late Victorians who worried about the atomizing tendencies of individualism and saw in the tumultuous market economy of the Gilded Age a threat of moral anarchy. The huge success of Edward Bellamy’s Looking Backward owed much to the book’s denunciation of individualism and its warm advocacy of communal and corporate values. So did the popularity of “collegiate Gothic,” the antimodern architectural style that Ralph Adams Cram originated on the campuses of Princeton and West Point, which spread to college campuses throughout the country, lending an air of contemplative quietism to educational reforms that might otherwise have been seen as an effort by educators to cash in on a rising tide of careerism.
One might even argue that the multifaceted and ever-evolving political persuasion we call “liberalism” is at heart an ideology of professional people (especially those who inhabit the university) and that its fate has therefore always been tied to that of the professions. In 1900 college-educated people accounted for no more than 4 percent of the population, yet they thoroughly dominated the leadership of the Progressive movement, the main source of liberal politics in this century. That movement, which occurred just as the first graduates of the reformed universities and colleges of the 1880s were reaching positions of influence, managed to elect the closest approximation to intellectuals ever to occupy the White House: Woodrow Wilson, whose previous career at Johns Hopkins and Princeton is well known, and Theodore Roosevelt, who in 1912 lost the White House to Wilson but won the presidency of the American Historical Association.
At the very least it can be said that liberalism has always embodied aspirations similar to those expressed by Tawney: to uphold the authority of “brain workers,” or intellectuals, broadly speaking; to put the public interest ahead of individual interests; and to soften the harsh dictates of supply and demand, thereby affording those who do not have capital some shelter from those who do. Liberals have been loathe to admit that 1980 was in its own way a historical turning point as critical as 1989; but the groundswell of rhetoric in favor of laissez-faire enterprise and legislation that swept Ronald Reagan into the White House was arguably as unexpected and as unsettling to liberals as the collapse of communism was to some socialists. “Rugged individualism” and everything that heavily freighted term stood for had been reviled by American intellectuals from the 1880s onward and was assumed by my generation to be a thing of the past. Its shocking reincarnation in 1980 put liberalism on the defensive, where it has remained ever since. Insofar as liberalism reflects the political standpoint of the self-governing professions—of people, that is, who pride themselves on their command over cultural rather than pecuniary capital—its current disarray could be interpreted as one more sign that the “last guilds,” along with the political ideologies they sustain, are indeed in difficulty.
Krause’s contention that the current clashes between capitalism and the professions are episodes in an epochal confrontation over guild power would have been stronger had he related them to the cultural rivalry that Tawney, Ruskin, and the American Progressives exemplify. But Krause attempts nothing of the kind. Although he launches his book with a narrative sketch that tries to connect the medieval guilds and the modern professions, the connection is never adequately supported by evidence or argument. Readers who are accustomed to thinking of the professions as products of the urban-industrial transformation of the nineteenth century are not likely to be persuaded otherwise by anything in his book, for he presents no convincing evidence of continuity with the Middle Ages or the Renaissance.
Krause devotes a few admiring pages in his first chapter to important work by historians such as Katharine Park and Lauro Martines on the guilds within which medicine and law developed in Renaissance Florence. But more than a long stretch of years separates the Florentine Guild of Doctors, Apothecaries and Grocers, established in 1293, from the American Medical Association, which was founded in 1848 and did not become an important voice of the profession for another half century. As their names suggest, the two institutions were distinctive products of what amount to different forms of life. The alliance of medical practitioners with grocers and pharmacists that seemed so natural in thirteenth-century Florence could never have occurred in nineteenth-century America and seems even more arbitrary today. Or so it will seem to anyone of a moderately historical turn of mind.
Indeed, the historical sweep of Krause’s argument, which seems so panoramic on first encounter, shrinks after the first chapter. From then on, his attention narrows to the years between 1930 and the present. In itself, this is unexceptionable; Krause is a social scientist, not a historian, and he wants to test a hypothesis by assembling empirical data. The central question for him is whether “guild power” over the workplace is rising, falling, or remaining steady. Even the years between 1930 and 1990 interest him less as a sequence of changes than as a synchronic “moment”; what he wants is a snapshot, showing major trends. He sets up the snapshot in a way that seems logical, but the result is so crowded and busy that readers must squint and strain to arrive at any coherent impression of the whole.
The task Krause has set himself is to systematically assess whether there has been, from 1930 to the present, a decline in the autonomy of four professions—law, medicine, engineering, and university teaching—in five countries—the United States, Britain, France, Germany, and Italy. Examining four professions in five countries yields twenty combinations of nation and profession. Since he asks four basic questions about the autonomy of each profession in each nation, his text must thread its way through a labyrinthine grid of eighty topics, and is better sampled than read.
Quite apart from the fragmenting effect that his scheme has on the reader’s attention, the project’s large scale requires Krause to breeze past complexities and rely on only a handful of sources (not always the best or the most recent ones) about each profession and each country. Readers with expert knowledge of French medicine, Italian law, or the German academy are likely to find omissions and oversimplifications that undermine confidence, as I did in regard to American professions. (For instance, the American Bar Association was founded in 1878, not 1868, as Krause twice asserts.)
These reservations notwithstanding, Krause gives a fuller and more revealing comparison of professional lives than any of his predecessors has achieved. And although he tends to neglect the differences between past and present, there is no faulting his sensitivity to differences between ostensibly identical professions as they now exist in different countries. A lawyer in France or Germany is really a public official by comparison with the go-getting private practitioners in the United States. Indeed, Krause makes so much of national differences that the very categories of comparison on which his analysis depends—“law,” “medicine,” and so forth—threaten to evaporate, leaving behind only irreducible variations in national culture.
Near the end of the book he concedes that for lawyers the differences from nation to nation are so great as to make the different legal professions virtually incomparable—a point tellingly illustrated by a sociologist’s paradoxical observation in the early 1970s that there were more lawyers in New York City than in all of Germany, but more judges in Germany than in the entire United States.10 In that comparison we see the difference not only between adversarial and civil law systems but also between national cultures, which subscribe to very different notions of what it is to be a lawyer or a judge or to do justice. Germans accept that a judge will apply the extensive civil code fairly, and they do not depend on lawyers to aggressively make their cases.
It is noteworthy that one of the four professions, engineering, drops out of the analysis altogether. In each of the five countries he surveys, Krause finds that engineers have never had any effective guild power and are never likely to. What he says of the engineering profession in the US—that it attracts people who are “more interested in machines than people” and that they are willing to accept “a subordinate, though middle-level, role”—applies everywhere. Engineers are so deeply enmeshed in lower and middle echelons of capitalist hierarchies, and so lacking in vision or any conception of themselves as having political interests, that the possibility of conflict with the values of profit-making businesses is, for most of them, ruled out in advance.
The most interesting case to follow through this labyrinth of data is that of the professoriate, the educators of all other professions. In Krause’s estimation, the overall trend of the guild power of professors currently slopes downward everywhere except Italy, which is, as we shall see, a case unto itself. Professorial guild power rose in the United States, he believes, between the 1930s and the mid-1960s, but then it leveled off for faculty employed by the most prestigious universities and began declining for the profession as a whole.11
Power shrank as the number of potential practitioners grew, unbalancing supply and demand. There were 82,000 academics in this country in 1930 and 236,000 by 1960. Then came the explosive growth of the 1960s. The arrival in colleges of vast numbers of children born after World War II, and the emphasis on technical education as a requirement of the cold war, were among the factors that combined to make the 1960s the only decade in which the profession has ever enjoyed a seller’s market. The number of potential job holders soared to 474,000 by 1970 and continued to climb at a slower rate after the mid-70s, reaching 695,000 by 1985—more than eight times what it had been in 1930. The predictable result was stratification. The holders of tenured and tenure track positions make up the elite; meanwhile a rising number of “gypsies” with advanced degrees go from school to school, never finding jobs with tenure, and faculties grow mainly by adding part-timers, who accounted for 22 percent of the academy in 1970, and 32 percent by 1980. These trends convince Krause that for many members of the profession the rule is no longer “publish or perish”; instead it has become “publish and perish.” Working conditions have worsened, he reports, restricting access to such amenities as “travel funds, extra summer teaching, supplies, secretaries, and even, in some places, the toilet paper in bathrooms.”
Professors in Britain, France, and Germany receive less attention from Krause, but in his view they all have followed the same path upward from the depths of the Great Depression, and then declined in recent decades. Britain best conforms to the pattern. The plan of the economist Lionel Robbins was to double the size of the academy in the 1960s, but in the 1980s the concerted counterattack on higher education by the Thatcher government rolled back budgets and discontinued the practice of granting tenure.
Italy has a strikingly different situation. Drawing on the work of others, Krause depicts it as a “nation of contrasts, of puzzles, and of institutions that do not work as they do in most other western European nations.” Italy, he says, is “an almost totally ‘politicized’ social environment” that the Italians themselves characterize with terms such as partitocrazia, or rule by parties. Made up of members who are bound together by both ideology and personal loyalties, the Italian parties colonize everything within reach. Thus the cleavage that exists everywhere between medical specialists and general practitioners has been sharply exacerbated in Italy, since a specialist until not long ago would normally have been a Christian Democrat (and by now would presumably be attached to one of the parties that have taken over from the discredited DC) while general practitioners tend to have Socialist or Communist sympathies. Exploiting regional and institutional networks, personal friendships, and lavish use of patronage, parties colonize not only the professions, but also the economy and the state.
Partisanship so pervasive immobilizes rational reform. It left the upper courts in the hands of Fascists as late as the 1960s and kept the standards of medical care low, even though Italy has one of the highest ratios of doctors to patients in the world. But partitocrazia leaves the professoriate sitting pretty—or so it seems at first glance.
Perhaps no other profession has as much power in Italy as the university professoriate…. As in France and Germany, the Italian professors are the peak of a pyramid, one in which personal patronage and guild power count for more than membership in a discipline-wide profession. In Italy, modern professional forms are still quite weak, and fiefdoms are built up by professors who are at the same time directors of their own research institutes and editors of their own unrefereed journals. Some sit on research committees that vote the money to support their institutes, and some are even members of Parliament, where they serve on education committees that vote on changes in the university system…. The politics…of a hiring committee will usually tell more about the finalists for a position than the number of articles published by the candidate[s].
Quoting Burton Clark, Krause identifies suppression of competition as the defining feature of the Italian academy:
The Italian fusion of academic oligarchy and state bureaucracy is virtually the ideal system for suppressing competition among operating units…. In economic terms, higher education in Italy may be seen as a system strewn with barriers to competition: a monopoly controlled by an oligarchy through a bureaucracy.
If Krause’s portrait is accurate, Italian academics do indeed function much as members of a guild would, but with an ironic consequence: the more extravagant their exercise of guild power, the less they look like professionals. Here the limits of Krause’s thesis are exposed to view. Though he seems not to notice it, the Italian case is an embarrassment to his argument. By acknowledging the chasm that, in his own words, separates the “monopolies” or “fiefdoms” of the Italian academy from the impersonal, functionally organized disciplinary associations, peer review practices, and other “modern professional forms” that exist elsewhere, especially the United States, he calls into question the easy and anachronistic equation between profession and guild upon which his entire analysis is founded.
The crucial difference between modern professions and medieval guilds lies in changing attitudes toward competition—or, rather, toward conflict in all its forms. The medieval societies that spawned guilds abhorred the sin of pride and had little tolerance for the perpetual rivalry and self-assertion that we today accept—even encourage—under such labels as “competition,” “free speech,” and “upward mobility.” Their citizens were traditionalists who valued order and feared disorder far more than we do. Unable to imagine how anything good could possibly come from ceaseless turmoil and dissension, they deliberately suppressed competition by means of guilds and other grants of monopoly power, and did so with a clear conscience.
But monopoly power—the power to exclude outsiders for the sake of securing insiders against competition—is only an incidental feature of the modern professions, not a defining one. Every authentic profession does, of course, set standards for admission that discourage competition from “amateurs” or “irregulars” or practitioners of “alternative therapies.” Lawyers and doctors and accountants, among others, also enlist the licensing power of the state, putting the force of law behind an exclusive monopoly.
But apart from setting high standards, professions seldom expend much energy in excluding outsiders. They don’t need to because exclusion can be expected as the incidental consequence of intensifying competition among insiders. Professionals shrug off most threats of competition from amateurs, not out of highmindedness, as Tawney might have claimed, but because the pecuniary benefits of suppressing competition from outsiders are trivial by comparison with the increase in professional authority that is achieved by fostering competition among insiders. American doctors worry little about losing business to faith healers; they worry much more about their reputation in the eyes of professional colleagues. Their self-respect depends on it, as do consulting fees, patient referrals, and access to the best-equipped and most prestigious hospitals.
The competitive pressures of an adversarial legal system are even more apparent than those at work in medicine. Lawyers who aspire to high professional status and the wealth that goes with it must not only know the law but anticipate an opponent’s strategy and take steps to deflect unfavorable lines of argument in advance. Once in the courtroom, mental stamina and rhetorical agility are tested publicly, as rival attorneys compete not only for the immediate approval of judge and jury, but also for the approbation of a broader audience of fellow professionals who follow the case through “shop talk,” the medium in which reputations take shape. To “think like a lawyer” is to internalize a social landscape of potential critics. It is to render habitual certain ways of thinking, talking, and acting that are calculated not only to maximize income but also to match or surpass the craftsmanship of one’s peers, thereby earning their respect.
The occupations that rank as authentic professions today are those that most fully embrace the rule of competition, not (as Krause supposes) merely those that held onto guild power most tenaciously. The difference emerged early in history. Most medieval guilds concerned themselves only with the character of prospective matriculants, but in fourteenth-century Florence there were three that departed from tradition by examining candidates for competence as well as character. Two were among the seven “greater guilds” that dominated the town’s economy: the Guild of Doctors, Apothecaries, and Grocers and the Guild of Lawyers and Notaries. Competence could be demonstrated either by practical examination or, in the case of doctors and lawyers, by possession of a doctoral degree from a university.
No effort was made to test the competence of grocers, apothecaries, or the gaggle of other occupations such as barbers and gravediggers who were also admitted to the doctors’ guild. Nor was competence an issue in the other eighteen guilds. By 1349 admission of prospective doctors, lawyers, and notaries was entirely in the hands of their peers and regular occasions for subjecting practitioners to critical appraisal among themselves had become routine. Surgeons were required to consult colleagues about gravely ill patients; physicians rendering judgments about cause of death were required to seek a second opinion from surgeons. Physicians were expected to attend regular human anatomical dissections and go to the university for twice-monthly disputations sufficiently vigorous that they sometimes ended in “brawls or scandals.”12
These measures to make performance public and assess competence undoubtedly heightened competitive pressures among guild members. They may also have made it harder for nonmembers to compete, but that is not why they were adopted and it is not why similar tests of competence have become so ubiquitous in modern times.
Today professions are sometimes said to be monopolies. But monopolies, like medieval guilds, maximize pecuniary gain by minimizing competition through the exclusion of outsiders. In contrast, as we have seen, professions tend to be quite cavalier about the danger of competition from outsiders. What preoccupies today’s professionals is competition among insiders in non-pecuniary kinds of achievement, such as recognition, reputation, and the technical quality of the work performed. Instead of fleeing competition, professions intensify it as a means of encouraging individual practitioners to live up to whatever standards of conduct and technical performance may be thought important within a particular community of practitioners. This mutual criticism is motivated by a tacit understanding of the long-term interests of the profession, not self-abnegation.
Tawney and other intellectuals of his generation, deeply influenced by the Christian ethical tradition, loathed the self-aggrandizing ways of the capitalist marketplace and idealized professional people for their restraint and selfless devotion to function. But being a doctor, a lawyer, an engineer, or a scholar entails making strong claims of competence, and competence presupposes self-assertion within a competitive field; without competition, claims of merit and distinction sound hollow and become unconvincing. It is because professionals are presumed to be immersed in a subculture of competing practitioners who expose and correct one another’s errors that their opinions possess greater authority than those of amateurs. Critical oversight by peers is obviously an ideal of professional life, pursued more vigorously in some circles than others and realized only imperfectly at best. But professionals acquire authority in the modern world to the extent that they stand ready to criticize their peers and to be criticized in return. Broadly speaking, the more intense the competition the greater the authority of those who compete.
The importance of competition in modern medical training is illustrated by Jerome Lowenstein, a physician with the NYU Medical Center, who describes the “clinico-pathologic conference,” a monthly exercise that teaches medical students what it means to “think like a doctor.”
This traditional teaching exercise presents students with a description of selected details of a patient’s history, physical findings, laboratory results, and course of illness. By tradition, the case history presented is that of an actual patient. The students are expected to study the details and arrive at a diagnosis, which they submit, in writing, before the CPC conference. Several students are called upon to defend the diagnoses they have submitted. The CPC invariably generates a great deal of intellectual activity among students and house staff. Journal references are tracked down and read with care, statistics are quoted, and heated discussions take place among students, house staff, and attending physicians. All agree that the CPC is very instructive and seems to engage the minds of the students and house staff more than most other conferences.13
The kind of intense involvement that personal rivalry generates in the “clinico-pathologic conference” is duplicated in the moot courts of law schools and in the research seminars, qualifying exams, and dissertation defenses of the universities. Every authentic profession stages competitive exercises to socialize novices, and competition does not end when students leave the classroom and enter the world of mature practitioners. Mock contests like the CPC or the moot court are the means by which students get a sense of the values and habits of mind they will need throughout their careers; this is what enables them to hold their own and keep their poise under criticism in what the sociologist Alvin Gouldner called “cultures of critical discourse.”14
Gouldner had in mind mainly the world of intellectuals and scholars, in which the duty to criticize and be criticized is probably more deeply ingrained than anywhere else. But in varying degrees all the authentic professions partake of this inherently combative culture, for all are characterized by perpetual rivalry. Paradoxically, competition between professionals is nowhere more evident than in the notorious tendency of experts to arrive at conflicting judgments. Notwithstanding the glib judgment of folk wisdom, disagreement among experts usually attests not to the vacuity of professional knowledge but to the difficulty of the questions experts address—and to the competition they must put up with if they are to speak as authoritative members of a community of the competent.
The intramural competition that professions cultivate is far from foolproof as a means of sustaining high levels of proficiency and ethical conduct among practitioners, but our reliance upon it is far-reaching and by no means misplaced; competition does constrain individual conduct in useful ways. In effect, professions are markets in which competing practitioners try to acquire not only income and assets, but also a good reputation—a stock of favorable impressions of one’s self and one’s work in the minds of others, especially fellow practitioners, who are better equipped than anyone else to pass judgment. Each individual practitioner ultimately depends on the patronage of paying consumers, of course, but patronage presupposes trust and, when it comes to the high-stakes questions that experts have to address, trust can best be elicited collectively by requiring all practitioners systematically to submit to the critical appraisal of their peers. The result is an occupational subculture that tends to be acutely status conscious, but which also tolerates greater candor and higher levels of criticism and conflict than would be thought acceptable in most human communities.
The grain of truth in the Victorian myth of professional disinterestedness is that in the course of fostering competition every authentic profession must fashion for its members a fairly elaborate array of inducements and sanctions that take the path of self-interest out of the rut of simply maximizing income. That does not make the members of a profession unselfish, as Tawney and Ruskin optimistically imagined—far from it. But it does compel them to calculate self-interest twice—first in monetary terms, just like practically everyone else in a market society, but also in quite different terms dictated by the struggle for recognition and distinction within a community of peers whose standards derive from the work they perform. The two calculations sometimes converge, but they can also clash, usefully complicating the motives of the calculator. The result is an angle of vision subtly different from that of people who mainly compete in the everyday market of profit making and for whom the sole “rational” standard is the bottom line.
Because professionals compete for honor and recognition as well as income, they can appear to be acting altruistically even when they are resolutely advancing their interests. When the distinguished chemists Richard Smalley and Robert Curl chose to announce their discovery of a new and potentially lucrative branch of chemistry in an academic journal, one that pays nothing for the articles it publishes, they were not throwing self-interest to the winds. Immediate monetary compensation was irrelevant; they knew that by announcing their discovery in the field’s most prestigious journal they would attract the attention of chemists all over the world, potentially making themselves candidates for the Nobel Prize—which they won in 1996. Similarly, it is not a spirit of self-denial that prompts historians, literary scholars, and philosophers to pass up royalty income in order to publish with a more prestigious press noted for its selectivity.
Outside the university, opportunities to advance one’s own interests at the expense of clients who are vulnerable or confused are a daily occurrence in the lives of doctors, lawyers, and other fee-for-service professionals; and of course some of these practitioners succumb to temptation, prescribing unnecessary treatment or misappropriating assets entrusted to their care. But if doctors, in particular, were not on the whole effectively restrained by concern for their reputation, we patients would have learned long ago through bitter experience to be far less trusting than we are. As for lawyers, the lesson has been learned and the level of trust is correspondingly lower.
To argue, as I have been doing, that competition has a function in the modern professions scarcely less vital than in a modern market economy, where it is relied on to allocate goods and resources, is not to say that it is a panacea in either sphere. There are family doctors who rape patients, surgeons who perform dubious operations, and lawyers who botch their clients’ cases. Concern for reputation will not stop them, but every occupation has its thugs and unscrupulous opportunists, and its fools. Precisely because status achieved in competition counts for so much in the careers of professional people, the professions are notoriously reluctant to impose on their least reputable and most incompetent members the ultimate penalty of expulsion from professional ranks. Relegating the offender to a low rank in the pecking order is generally thought to be punishment enough—even when that means leaving predatory or incompetent practitioners free to continue doing serious harm. Professionals make themselves most vulnerable to criticism today when they allow internal competition and peer review to become empty formalities, lacking substance.
For better or worse, then, the professions share the same values of universal competition and rationalization that characterize the capitalist marketplace itself. In spite of Krause’s fear that the days of the university and the professions may be numbered, the three-way struggle he describes between the professions, the state, and capitalism is likely to continue indefinitely without any party gaining the upper hand for long. Although capitalism and professionalism put competition to quite different uses, both depend vitally on its disciplinary power to govern human conduct; neither could make war on the other without putting its own fundamental commitments in peril. Professionalism is best construed not as an atavistic survival from the age of guild organization, antithetical to the competitive spirit of capitalism, but as yet another modern offspring of the historical tendency that both fascinated and troubled Max Weber, whereby calculations of least cost and maximum efficiency enter and finally disenchant every sphere of life. Far from being the antithesis of capitalism, professionalism (again, both for better and worse) is more plausibly viewed as its sibling.
That is not to say that Krause is wrong in calling attention to the rising tensions between professionalism and capitalism. Volatile as sibling relations often are, it would not be surprising if the culture of the professions were looked to once again as a force that could rein in the excesses of a market economy, now that the regulatory powers of the state have come under a cloud. Such a prospect does not depend on the late Victorian premise that professional people are morally superior or more disinterested than business people; nor does it assume that competition can be counted on to protect consumer interests. It depends only on the observation that the university-based professions can, at their best, impose upon their members a competitive discipline more thorough, more multifaceted, and therefore more compatible with the public interest than that of the business world, where choices and actions are too seldom held to any competitive standard other than profitability.
December 4, 1997
The New York Times, September 17, 1996, p. D12. ↩
The New York Times, December 25, 1996, p. A1. ↩
The New York Times, September 3, 1996, p. D9. ↩
“Giant Companies Entering Race to Run State Welfare Programs,” The New York Times, September 15, 1996, p. 1. ↩
Quoted in Harold Perkin, Origins of Modern English Society 1780-1880 (1969; reprinted by University of Toronto Press, 1972), pp. 265-266. ↩
Quoted in Martin J. Wiener, English Culture and the Decline of the Industrial Spirit, 1850-1980 (Cambridge University Press, 1981), p. 38. ↩
Perkin, Origins of Modern English Society, p. 258. ↩
R.H. Tawney, The Acquisitive Society (Harcourt Brace, 1920), p. 92. ↩
Thorstein Veblen, The Higher Learning in America (1918; reprinted by Hill and Wang, 1957), p. 7. ↩
Dietrich Rueschemeyer, Lawyers and Their Society: A Comparative Study of the Legal Profession in Germany and the United States (Harvard University Press, 1973). Compare p. 49, where the author mentions that there are more lawyers in private practice in New York City than in all of Germany, with table 1 (p. 32), which shows that there are 12,000 lawyers in judicial office in Germany and only 8,180 in the entire US. ↩
Krause has little confidence in the American Association of University Professors, which since 1915 has energetically advanced the interests of professors as members of a profession by its steadfast defense of academic freedom. In a crude oversimplification of torturous controversies over academic freedom that occurred during WWI, the McCarthy era, and Vietnam, he glibly asserts that the AAUP “has always caved in before wider political pressure.” To show how frail professional autonomy is, he also claims that the AAUP regards “political bias in lectures” and the open-ended charge of “moral turpitude” as adequate grounds for dismissal even of tenured faculty (p. 70). Having recently completed a three-year term on the AAUP’s Committee on Academic Freedom, I can testify from personal experience that on these issues Krause simply does not know what he is talking about. Again and again the AAUP has challenged the dismissal of teachers on political grounds and it has succeeded in reversing such decisions or obtaining compensation in many cases. ↩
Katharine Park, Doctors and Medicine in Early Renaissance Florence (Princeton University Press, 1985), pp. 7-21, 23, 38. ↩
Jerome Lowenstein, The Midnight Meal and Other Essays about Doctors, Patients, and Medicine (Yale University Press, 1997), p. 61. Lowenstein goes on to lament the failure of doctors to devote to actual patients the same high level of energy they devote to the hypothetical patient of the CPC. The lament is appropriate. But it is worth noting that the standard he advocates was formulated in the competitive exercise of the CPC. ↩
Alvin W. Gouldner, The Future of the Intellectuals and the Rise of the New Class (Continuum, 1979), pp. 19, 27, 28-44. ↩