In Module Eight, we examined the health care staffing crisis, and as
mentioned, it is very difficult to determine just when the actual staffing
levels reached critical levels. Many professionals in the field of health care
erroneously assume that the shortage is a recent development. As such,
they look at current factors contributing to the problem rather than looking
back far enough to see the big picture. The staffing shortage has been
prevalent and well documented for the last 100 years, mostly aligned with
the ramifications of the Flexner Report. In this module, we turn our
attention to a process that has affected nearly every industry, but none
more so than the field of health care: that of deprofessionalization.
Deprofessionalizationoften refers to the loss of power or knowledge to the
point where the original profession is no longer needed; however, this does
not hold true in health care. As such, for purposes of this lecture and
module, the term deprofessionalization will be a synonym to that of de-
skilling, the reason being that many authors in the field still use the term
deprofessionalization to discuss what has been a moving-target solution to
the staffing shortages. Perhaps some further explanation is in order. If we
truly were to deprofessionalize an existing profession, the original starting
point would no longer be necessary. Using the original field medics of World
War I as an example, if we were to deprofessionalize them to paramedics,
we would no longer need medics. However, we know that today we have
and certainly need both. As such, despite the fact that the true meaning of
deprofessionalization is the eradication of the original profession and duties,
we cannot remove them in health care; however, as writers have taken
liberty with the word, so then shall we. Now that it is clear as mud, let’s look
at the deprofessionalization of health care.
Rather than examining all of the professions, this lecture highlights the two
most prevalent: nursing and physicians. Prior to the Civil War, the United
States looked minimally to the European countries for standards in medical
practice. After the Civil War, the German method of training nurses was
adopted (as was the idea of kindergarten). It has been well explained in this
course that after the war, money began to flow into the system, and health
care grew rapidly. With this growth, and with the new method of training
nurses, there simply were not enough licensed nursing professionals to keep
up with the expansion. In the 1890s, schools were developed to train
practical nurses. Practical nursing did not take as long as the traditional
German method adopted; therefore, it was not only easier to become a
nurse, but the shorter time frame appealed to a wider range of individuals.
Temporarily, the nursing shortage was solved. It was not until 1917 that the
practical nursing program became formalized into the licensed practical
nurse; the first round of deprofessionalization within nursing had occurred.
During the Second World War, there was another drastic shortage of
nurses. As such, the second round of deprofessionalization occurred, and
we saw the development of the nursing assistant. Certification within the
nursing assistant profession did not formally appear until 1987. Today, the
nursing profession has been deprofessionalized/de-skilled to include the
advance practice registered nurse, registered nurse, licensed practical nurse,
registered medical assistant, certified medical assistant, medical assistant,
certified nursing assistant, and nursing assistan While we can see where
deprofessionalization has indeed occurred at multiple levels, the original
positions are still in place and very much in demand.
Our last profession to discuss is that of physician. As was mentioned in a
previous lecture, the federal government began to indirectly (and quite
heavily) influence the direction of physician education. As such, when and if
the government believed that certain areas of training (e.g., primary care,
surgeon) were going to run short, licensing requirements and/or the
standards for the acceptance of foreign-trained physicians were lowered. It
was not until the 1960s that the physician staffing level reached a critical
level. In addition, servicemen were coming home from Vietnam heavily
trained in medical practice; however, they were not quite at the level of
physician. These two factors led to the creation of the physician assistant.
Deprofessionalization has been around for over a hundred years. As
mentioned in Module Eight, the staffing shortage that we are facing may
result in even further de-skilling of existing health care professions. Only
time will tell. In this module, you will examine other solutions to the health
care staffing shortage.
Reference
Yale School of Medicine. (2012). Physician associate program: History of
the profession. Retrieved from
http://paprogram.yale.edu/profession/history_profession.aspx
