The entire division of labor in the Western world, particularly within the health workforce, has been historically structured around the concept of professions. These professions have long been the gatekeepers of specialised knowledge, power, and status—rigid structures that trace their origins to the industrial revolution. But in today’s rapidly changing world, is this traditional professional model still fit for purpose?
The Professions and the Monopoly of Knowledge
Professions, by their nature, have traditionally held monopolies over specialised bodies of knowledge. Doctors, lawyers, engineers, and others have carefully guarded their domains, using education, accreditation, and regulation to maintain their authority. This model worked well in a world where access to knowledge was limited and tightly controlled by those in the know. But that world no longer exists.
With the advent of AI, automation, and digitisation, much of the knowledge that was once exclusive to the professions is now codified and readily accessible. Tasks once reserved for highly trained professionals can be delegated to others or even performed by machines. This democratisation of knowledge raises a critical question: If anyone can access information, how do we ensure that the right skills and expertise are still available in a flexible and responsive manner?
The Need for Flexibility in a Rigid Model
The traditional professional model, while historically effective, is increasingly becoming an obstacle to innovation. In a world where tasks and skills need to be fluid, adaptable, and responsive, the rigidity of the professions can hinder progress. A hierarchical, monopolistic approach to knowledge no longer aligns with the rapidly evolving needs of society.
Health professionals, for instance, often find themselves constrained by outdated regulations, rigid scopes of practice, and siloed bodies of knowledge, as has been well illustrated in the Scope of Practice Review currently taking place in Australia. These structures can prevent individuals from using their full skill set, slowing down decision-making processes and stifling innovation. Additionally, the narrow focus on professional status can overlook the fact that many unregulated workers possess valuable skills and experience that could greatly benefit the workforce if appropriately recognised and mobilised. In fact, the unregulated workforce, such as aged care and disability support workers provide some of the most intimate care to our most vulnerable populations – with little or no formal training or quality oversight (as demonstrated by respective Royal Commissions).
The Case for a Dual Pathway Model
As we look to the future, it’s clear that the professional model must evolve to accommodate a more flexible, inclusive, and responsive workforce. One potential solution is the dual pathway model, which allows individuals to pursue either a traditional professional route or an alternative career path that focuses on practical expertise and specialised skills.
This model recognises that not everyone needs to—or wants to—fit into the traditional professional framework. By providing flexible, stackable certifications and recognising prior learning and experience, the dual pathway model allows individuals to advance their careers without the need for formal professional titles. This approach would enable workers to contribute in new and innovative ways without being confined to rigid professional boundaries.
Unpacking the Professions: The Role of Technology and Codification
The growing influence of artificial intelligence and the codification of tasks offer an opportunity to rethink how we define and distribute work. Tasks that were once complex and required years of training can now be automated or simplified, opening the door for a more agile workforce. This doesn’t diminish the value of specialised knowledge—it redefines how we apply it.
For instance, in healthcare, AI tools can assist with diagnostics, while appropriately trained and credentialed workers can deliver much of the day-to-day care that was once the exclusive domain of health care professionals. The focus shifts from who holds the monopoly over knowledge to how we can best use the available skills and technology to deliver quality care.
Moving Toward a Flexible Workforce Model
To truly meet the challenges of the 21st century, we need to move beyond the idea that professions are the sole gatekeepers of knowledge and expertise. We need to foster a workforce that is flexible, adaptable, and able to respond to changing demands. This means creating pathways for those in unregulated roles to advance their careers through recognition of prior experience, ongoing learning, and specialised certifications. It also means creating opportunities for professionals to step outside their traditional silos and engage with new technologies and interdisciplinary work.
A more flexible workforce model—whether through a dual pathway or another innovative framework—will help break down the rigid structures that limit our capacity to deliver care and services effectively. By rethinking the way we structure, train, and mobilise our workforce, we can create a more responsive and agile system that meets the needs of the future.
Conclusion: A Time for Change
The professions have long been the cornerstone of the Western labour market, particularly in health care. But as we face the challenges of an increasingly complex, automated, and interconnected world, we must question whether this traditional model still serves us. The monopolies of knowledge once held by professions are no longer impenetrable, and new ways of working demand flexibility and adaptability.
It’s time to rethink the rigid structures of the professions and embrace a more flexible workforce model—one that recognises both the value of traditional professional pathways and the untapped potential of alternative careers. By doing so, we can unlock new opportunities, drive innovation, and better meet the needs of our communities.
Susan Nancarrow has had a long-term interest in the evolution and sociology of the professions. She is the author of The Allied Health Professions: A Sociological Perspective, which explores the sociology, history and evolution of the allied health professions under the western medical model of healthcare. Other publications on health workforce flexibility include Dynamic Professional Boundaries in the Healthcare Workforce and Six Principles to Enhance Health Workforce Flexibility.
