A. When is an occupation a profession? There appears to be no absolute definition, but only different ways of looking at the issue, from historical, cultural, sociological, moral, political, ethical or philosophical viewpoints. It is often said that professions are elites who undertake specialized, selfless work, in accordance with ethical codes, and that their work is guaranteed by examination and a license to practice. In return, however, they request exclusive control over a body of knowledge, freedom to practice, special rewards and higher financial and economic status.

B. The public needs experts to offer them specialist advice, but because this advice is specialized they are not in a position to know what advice they need: this has to be defined in conversation with the professional. Professional judgement could be at odds with client satisfaction since the latter cannot then be “the chief measure of whether the professional has acted in a trustworthy fashion.” Professional elites have negative potential: to exploit their power and prestige for economic goals; to allow the search for the necessary theoretical or scientific knowledge to become an end in itself; to lose sight of client well-being in the continuing fragmentation of specialist knowledge.

C. Professions in different cultures are subject to different levels of state intervention, and are shaped by this. In England, our relatively weak state and the organic growth of professional groups, many of them licensed by Royal Charter, means that regulation became an arrangement among elites. Similarly, in the US. where liberal market principles have had a free rein, academic institutions have had more influence than the state in the development of the professions. By contrast, in many European countries, the state has defined and controlled the market for the professions since the late eighteenth and early nineteenth centuries. In all cases, the activities of the professions affect the public interest, and so the state has a legitimate interest in them.

D. In general, the higher the social status of a profession the greater the degree of public trust in it, and the more freedom to operate it enjoys. There are, however, certain features which appear to be common to most, if not all, professions. In addition to a specialized knowledge base, it appears that there is an agreed set of qualifications and experience which constitutes a license to practice. There is also frequently an agreed title or form of address, coupled with a particular, often conservative, public image, and an accepted mode of dress. Standards are maintained mainly through self-regulatory bodies. Also, financial rewards may be increased through private practice.

E. Within different cultures, and at different times, the relative status of different professions may vary. For example, in Western Europe, the status of politicians has been in long-term decline since the middle of the twentieth century. Teachers would appear to have the higher status in France and Italy than in the UK, where medicine and the law have traditionally been the ‘elite professions’.

F. The higher a profession’s social status the more freedom it enjoys. Therefore, an occupation wanting to maintain or improve its status will try to retain as much control as possible over its own affairs. As in so many other areas, socio-cultural change has affected the professions considerably in recent years. Market forces and social pressures have forced professionals to be more open about their modes of practice. In addition, information technology has enabled the public to become much better informed, and therefore more demanding. Moreover, developments in professional knowledge itself have forced a greater degree of specialization on experts, who constantly have to retrain and do research to maintain their position.

G. Self-regulation then becomes an even more important thing for a profession to maintain or extend. But in whose interests? Is self-regulation used to enable a profession to properly practice without undue interference, or is it used to maintain the status of the profession for its own ends? Is it used to enable those with appropriate education and training to join the profession? Another question that needs to be answered is whether self-regulation restricts access so that the profession retains its social and economic privileges? Or again is it used to protect clients by appropriately disciplining those who have transgressed professional norms or to protect the public image of the profession by concealing allegations that would damage it?

H. These are all questions which the medical profession in the UK has recently had to address, and which remain the subject of continuing debate. One thing is clear, however: the higher a profession’s status, the better equipped it is to meet these challenges.