Must Read: “The Future of the Professions”

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In 1540 a legendary union took place in England, in which the Guild of Surgeons agreed to merge with the Guild of Barbers to form the Company of Barbers and Surgeons and so give birth to the first professional association in the West. Since that moment, it has been commonplace for “professionals” to try to find each other and associate in such a way as to validate their special standing in society. That special standing, and its future in a world of big data and artificial intelligence, is the subject of one of the most insightful business books I have read in some time: The Future of the Professions by Richard and Daniel Susskind.

The authors start by asking two basic questions: what exactly is a “profession” and why do they have such special standing in society? To answer to the first question, they propose four criteria that must be met:

  1. Professionals have knowledge that other people do not; moreover, professionals are expected to both keep that knowledge current and, whenever possible, advance it for the good of the profession’s members and society as a whole.
  2. Professionals must possess specific credentials in order to be admitted into the profession.
  3. Professions are regulated in two ways. First, they have exclusive (or almost exclusive) control over certain activities; second, their work is expected to comply with standards and (often ethical) codes of conduct and behavior.
  4. Lastly, professional are, in the authors’ words, “thought to be bound by a common set of values over and above and formal regulations that apply to them.” Depending on the setting, professions may also be expected to serve a social function or provide a common good.

In return for meeting and upholding these criteria, say the authors, society agrees to what they call “the grand bargain,” in which society grants professionals great powers in return for their promising to behave in a certain way. So it is that doctors are given the power to open people up and lawyers are given the power to ask that society kill a citizen. Of course, ever since professions have existed, with these powers came prestige, high social standing, and often great wealth. The justification for the grand bargain, claim the authors, was that for centuries it was simply impossible for any one person to know everything, and so professionals agreed to acquire and maintain great stores of specialized knowledge (often at great cost and effort) in return for status and remuneration above what most people enjoyed. Quoting the philosopher Donald Schön, they repeat his succinct explanation of this arrangement:

In return for access to their extraordinary knowledge in matters of great human importance, society has granted them [professionals] a mandate for social control in their fields of specialization, a high degree of autonomy in their practice, and a license to determine who shall assume the mantle of professional authority.

Having presented their definitions of what a profession and professional are, and the social compact that created today’s professional world, the authors ask if the conditions that created and necessitated the grand bargain still apply in today’s world? In other words, given what has happened since the advent of the Internet, is it still necessary for us to grant special powers and status to distinct classes of experts? As the authors put it: “Is the grand bargain actually working? Are our professions fit for purpose? Are they serving our societies well?” The answer to these questions, claim the authors, is overwhelmingly no.

In presenting their case against the grand bargain, the authors lay out six failures of the current professional model:

  1. Economic Failure: “Most people and organizations cannot afford the services of first-rate professionals; and most economies are struggling to sustain most of their professional services, including schools, court systems, and health services…For some time, the harsh reality, broadly speaking, is that only the rich or robustly insured can engage many top-flight professionals.”
  2. Technical Failure: “…by and large, the arrangement presupposes a model of professional work, especially advisory work, that rests on increasingly antiquated techniques for creating and sharing knowledge,” which are “out of step with the ways in which most information and knowledge is shared in a technology-based “Internet society.”
  3. Psychological Failure: “Excluding people from understanding their problems and from engaging in their resolution can be disempowering. To outsource an important personal issue to another can be diminishing, and conducive to doubts about one’s on self-sufficiency.”
  4. Moral Failure: “…if we have the technological means to spread expertise in society far more widely at much lower cost, we believe we should strive to make this happen.”
  5. Performance Failure: “The fifth problem with the professions is that they underperform. This is not to suggest that the professions invariably achieve low levels of attainment. Rather, we maintain that in most situations in which professional help is called for, what is made available may be adequate, good, or even great, but rarely is it world-class.”
  6. Accountability Failure: “We believe the professions are unacceptably inscrutable…Sometimes, of course, the problem being solved or the work being undertaken is so complex that no lay person could hope to grasp what is going on. But there are occasions, no doubt, when there is intentional obfuscation, to justify high fees, perhaps, of for straightforward self-aggrandizement. Where there is opacity and obfuscation, there will be mistrust and lack of accountability.”

It is hard to imagine anyone reading these indictments and questioning their general validity. In far too many situations, the grand bargain has become an unnecessarily unequal one, in which professions take much more from society than they return. After all, what good to society is a medical system that produces a few brilliant doctors who are available only to its richest members? What good is a professional legal class that makes it impossible to receive a fair day in court without spending millions on a first-rate defense team? What good is it to create a cadre of great accountants whose highest-paid members serve only to slip wealth through the tax code cracks their legal brethren leave open? What good is an academic profession that turns out millions of graduates who are unable to find a good job in order to pay back the crushing levels of debt incurred in acquiring their degrees?

For all these reasons, and more, argue the authors, the age of the grand bargain is slowly coming to a close. We see this all around us, of course. Take for example, just one profession: medicine. In 1950, there were two major medical professional classes: doctors and nurses. Today, that number has climbed to (at least) seven:

  • Medical Doctor (1950) = Medical Doctor, Physician’s Assistant, and Medical Assistant (2017)
  • Nurse (1950) = Advanced Practice Registered Nurse, Registered Nurse, Licensed Nurse Practitioner,  Certified Nursing Assistant, etc. (2017)

Similar changes have have occurred in other professions such as law and engineering, as access to a profession’s body of knowledge and skills is continuously segmented and made more accessible. These changes have been driven by technology, of course, but also, more importantly, by the failures that the authors note. If these failures did not exist, sites such as WebMD or Coursera would not have grown the way they have. Moreover, it’s also because lay people are more willing and able to acquire specialist knowledge for themselves that the grand bargain is falling apart. Of course, all these changes are not, in general, happy news for the professions and the authors acknowledge as much:

We can sympathize with professionals whose work may be destined to be less stimulating than in the past, but it is hard to sustain the position that we should not modernize for this reason alone. It is not the purpose of ill-health, lack of education, religious belief, bad teeth, legal disputes, human beings’ appetite for news, and the tax system to keep professionals in stimulating employment. Our professions are solutions to these problems or challenges. What, then, should we do if we can find better, quicker, cheaper, and less forbidding ways of meeting these problems and challenges that, at the same time, diminish the excitement or motivation for the human professional who will be involved?…The value of maintaining the traditional way of working has to be weighed against the promise of far greater access to affordable practical expertise for others.

Having made their main arguments, the authors close with predictions about the future of the professions, and the world they describe is quite unlike what we have today. Just around the corner, they argue, is a grand bargain 2.0, if I may call it that, in which professionals will be able to justify special status only if (a) all other technical options are impractical/dangerous/socially undesirable and (b) their existence continues to provide a social good that machines cannot. In one of the book’s most important passages, the authors warn today’s professionals not to underestimate their risk of obsolescence on the basis of how their work is performed today. Indeed, the authors believe that it is by completely reimagining the way in which today’s professions work that one can see around the corner at the future of law, journalism, consulting, teaching, management, etc. Much as an off-road motorcycle is in many ways a much better horse, despite having nothing in common in the way they both work, a computer may soon make a much better litigator, healer or teacher. Indeed, the barriers to such a world are much lower than people imagine, as any lawyer who has worked with the latest generation of legal AI technologies can attest.

What is left for humans, then, in this new grand bargain? What will it mean to be a professional in thirty or fifty years? Here is the authors’ answer:

…what are left for human experts are tasks that demand the exercise of some kind of cognitive capability that are not routinizable, that is, capable of being reduced to some routine form, whether by some protocol, algorithm, decision tree, checklist, or the like…As machines become increasingly capable, in response to the question ‘What is left for human professionals to do?’, it is also hard to resist the conclusion that the answer may be less and less.

While the words above may seem a dark vision, The Future of the Professions is in many ways an optimistic book, for it is not just about the end of the old professional model but also about what the authors call the “liberation of expertise.” In their view, today’s professions are human firewalls, keeping specialist knowledge a captive of guilds, titles, degrees, and certifications. As the first professional age comes to an end, specialist knowledge will become something that we all can strive to acquire. Of course, this does not mean that lay people are going to go around designing airplanes or operating on people; however, it does mean that to be a “professional” may just distinguish those who do something for money from those who do it for other reasons. Already, people are more informed and engaged in their selecting their healthcare, protecting their legal rights, making their own news and entertainment, and (with the advent of additive manufacturing) the creation of their own products. Knowledge that was once passed on only in well-guarded spaces and rituals is now available to anyone who seeks it. Understanding this momentous shift and engaging with its repercussions are required of all professionals today. The Susskinds’ outstanding book is a great place to start that evolution.

 

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