Religion, law, medicine, and education were the tasks that enjoyed high social status as a “professional” occupation in 1850. These professions had control of a particular area of knowledge and expertise combined with a license to use this knowledge and expertise. The activities of a ‘profession’ were controlled and regulated by the profession itself that sought a degree of monopoly power via restrictive practices.
The rise of the middle class and the needs of a capitalist economy fueled the expansion of professions to support the needs of the industrial revolution. Accounting, surveying, civil and mechanical engineering and the emergence of what has been termed the ‘service class’. Between 1860 and 1900 these professions were organized into formal organizations, such as the Institution of Civil Engineers in 1818 and the British Medical Association in 1856.
This organizing was done to raise their status, increase financial rewards and provide occupational security by means of differentiation, regulation and an emphasis on the gentleman virtues of education and middle-class morality. (Brown 2011)
The Institution of Fire Engineers – the Engineering Model
As World War I was winding down, 8 Chief Officers met at Fire Brigade Headquarters in Leicester, United Kingdom, to set up a professional organization of fire officers. Their mission statement in 1918 was:
To promote, encourage, and improve the science and practice of Fire Engineering, Fire Prevention, and Fire Extinction, and all operations and expedients connected therewith, and to give impetus to ideas likely to be useful in connection with or in relation to such science and practice to the members of the Institution and to the community at-large.
IFE followed the engineering model in terms of credentials and training. Many United Kingdom Chief Fire Officers have graduate degrees in engineering.
Clinical Credentialing of Physicians
Before the Middle Ages physicians were credentialed after a period of study and a demonstration of skill. When the first colonial hospital was established by Ben Franklin:
Physicians to be at least 27 years old, have apprenticed within the city of Philadelphia, have studied physick and surgery for at least seven years, and pass an examination by six physicians of the hospital before being admitted to the house staff. If a candidate was not a resident of Philadelphia, he was required to reside in the city for at least three years before being examined.
Professional Development of United States Fire Officers
The United States fire officer evolved from the big city volunteer foremen and chief engineers of the 1850s. It is a career-long progression of vocational training, experiences, professional education, testing and credentialing.
The current conflict over the academic credential to be required of a paramedic candidate in 2031 is the collision of the fire service professional development model and the medical clinical credentialing model.
Professions build from within the practitioners
Sociologists Alexander Carr-Saunders and Paul Wilson described the development of professions with this observation:
No profession existed until practitioners of some occupation—the potential profession—formed bonds, “and these bonds can take but one shape—that of a formal association”. That happened in medieval times, they noted, as a result of a “powerful impulse towards association”. In the case of physicians, the Royal College of Physicians was formed to discourage unqualified competitors.
American Paramedic Association – Paramedics Advancing Paramedicine
Recently a practitioner-focused association issued its “Paramedic Manifesto” to professionalize paramedic practice through autonomy and self-regulation.
The items covered include:
- Paramedic Scope of Practice
- Paramedic Nomenclature
- Paramedic Education
- National Paramedic Certification
- National Paramedic Regulation
- State Licensure
- National EMS Associations
- Other Healthcare Professions
- The Future of Paramedics
American Paramedic Association is using the clinical caregiver professional development approach. The team leading this effort include paramedics with PhDs and high-profile opinion leaders. You can get more information on their FaceBook page.
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Brown, Richard (2011 July 23) “Why did the professions expand after 1800?” Looking at History. Accessed April 7, 2019: http://richardjohnbr.blogspot.com/2011/07/why-did-professions-expand-after-1800.html
Scoville, Elizabeth and Newman, James (2009 May) “A very brief history of credentialing.” ACP Hospitalist. Accessed April 7, 2019: https://acphospitalist.org/archives/2009/05/newman.htm
Carr-Saunders, Alexander M. & Wilson, Paul A. (1933) The Professions. Oxford: Clarendon Press.
Featured Image: “200 years of Surgery“, (2012) New England Journal of Medicine