Introduction/ Chapter One

I was struck throughout the preface with how familiar the struggle for professionalism in the physician community echoes the current struggle of a number of professions, public administration being the one with which I am most familiar. In our field, we speak often about becoming more professional. Unlike the physicians of the early 20th century, we in PA often possess a significant amount of social authority. We struggle, however, to respond to claims that this authority should not be vested in us. "Good enough for government" and "bloated bureaucracy" are just two examples of barbs regularly hurled at us. What would be the impact of following the example of the physicians, then? Should we institute a certification test to be a public administrator? One governing body, the International City and County Managers Association (ICMA), has started giving out certifications indicating that certain City and County Managers are considered the "best of the best." Similarly, the Masters of Public Administration (MPA) has become the rubber stamp without which you cannot get a job.

A similar transformation has occurred in the physical therapy community. As recently as ten years ago, a BS plus clinical was sufficient to practice. It then required a masters. In the last two years, it shifted to requiring a PhD. This incredible amping up of education requirements can be construed as an attempt to infuse more professionalism into PT and also a declaration of deserved authority.

I also found it interesting to trace the evolution of medicine along major societal shifts. Much like other aspects of American life, the end of the agrarian lifestyle for many people served as the impetus for many large scale societal shifts. As people moved away from the family-centric farms, where self-sufficiency was paramount, to urban centers, where specialization abounded. As we think about some of the qualities of the Industrial Revolution and concommitent rise of Taylorism, it is unsuprising then, that while the medical profession was creating societies and entrance exams, there was also a rise in the number of specialties for physicians. As we would find out later in the century, these specializations would become a complicated calculus with the rise of managed health care.

Overall, the chapter was fascinating because I had previously assumed that physicians always enjoyed the prestige that they do now. The connection between education and organization is also fascinating. If I were to list the professions that immediately come to mind as prestigious, all share similar processes to medicine: extensive education, certification, professional organizations, tightly controlled information etc...It will be interesting to watch which professions join medicine and law over the next century.