Do case managers enjoy professional autonomy?
December 1, 1997 3 minutes read
Do case managers enjoy professional autonomy?
By Mark E. Meaney, PhD
Health Care Ethicist
Center for Ethics in Health Care
St. Joseph’s Health System, Atlanta
Case managers stand at the center of a heated debate. In the November issue of Case Management Advisor, this column explored two differing views of case management: the commercial view and the professional view. If case management is a profession, it is important to understand why before we launch our discussion of the special moral obligations professional status entails.
The discipline of sociology provides five characteristics that distinguish professions from professional occupations. Individuals who work in professional occupations do full-time, with a certain degree of expertise, work that others may do in their spare time. Examples of individuals who work in professional occupations include plumbers, carpenters, mechanics, and electricians.
In addition, some professional occupations do what others do at an amateur level. In that category fall such individuals as actors, athletes, and writers.
The basic five
Conversely, members of professions perform tasks that cannot be performed by amateurs. The witch doctor is the sociologists’ classic example of a member of a profession. The argument goes like this:
• The witch doctor possesses obscure skills and knowledge.
• The witch doctor initiates his successors to the role and regulates access to the knowledge.
• The witch doctor performs an essential service to the community.
Sociology uses five essential characteristics to distinguish professions from professional occupations: element of skill, specialized knowledge, formal education and accreditation, professional autonomy, and social function.
The relation of skill to knowledge is critical. There must be a body of theoretical knowledge to support the skills of members of a profession. Preparation for membership in a profession involves formal education in an organized, standard, body of knowledge.
Why is it so important to establish whether case management is a profession? Society grants members of professions a greater degree of autonomy than professional occupations, because of the specialized nature of their skills and knowledge. Members of professions establish their own standards and accreditation processes, regulate entry into the field, and operate with relatively few social constraints. These powers and privileges constitute a form of monopoly granted by society to members of professions.
Facing responsibility
There is a trade-off that takes place between society and members of professions that constitutes an "implied contract." In exchange for autonomy, society expects members of professions to serve the public good and to self-regulate and discipline their members. Professional associations must set higher standards of conduct than those required of others in society. Society entrusts a professional association with the regulation of the profession. Professional ethical development becomes a moral obligation of the association and its professionals.
Case management differs in significant respects from professional occupations like auto repair or plumbing. Let’s look at case management in terms of the five characteristics sociologists assign to professions. Case management involves a high degree of skill and knowledge. However, to qualify as a profession, it must also have a sufficient body of theoretical knowledge that is a necessary prerequisite for practice.
In fact, this systematic theory is developing in the case management literature. It may be too early to determine whether case management fully meets this requirement. Nevertheless, case managers have met many of the requirements for true professions. Those include:
• Case managers have established their own standards of practice and accreditation processes. (For discussion of current accreditations and other emerging issues in the professional development of case management, see story on p. 201.)
• Case managers have developed guidelines to regulate entry into the field and to discipline members.
• Case managers require a specialized knowledge and skill that allows greater degree of freedom to exercise authority than in the trades, the arts, or in business.
If society does formally grant these powers and privileges to case managers, it will constitute a form of professional monopoly. Case management appears to have assumed the five essential characteristics of a profession. In return, society expects case managers to serve the public good. In addition, the "implied contract" between the professions and society places a moral obligation on case management associations, such as the Case Management Society of America in Little Rock, to ensure that members of the case management profession live up to professional standards of conduct. In our next column, we will begin discussing what this "implied contract" means for case managers.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content