The Death of the Professional: Are Doctors, Lawyers and Accountants Becoming Obsolete?
The following is an excerpt adapted from the new book The Future of the Professions by Richard Susskind & Daniel Susskind (Oxford University Press, 2015):
The end of the professional era is characterized by four trends: the move from bespoke service; the bypassing of traditional gatekeepers; a shift from a reactive to a proactive approach to professional work; and the more-for-less challenge.
The Move From Bespoke (Custom) Service
For centuries, much professional work has been handled in the manner of a craft. Individual experts and specialists—people who know more than others—have offered an essentially bespoke service ("bespoke" is British for "custom"). In the language of the tailor, their product has been “made-to-measure” rather than “off-the-peg.” For each recipient the service has been disposable (used once only), handcrafted ordinarily by a solitary scribe or sole trusted adviser, often in the spirit of an artist who starts each project afresh with a blank canvas.
Our research strongly suggests that bespoke professional work in this vein looks set to fade from prominence, as other crafts (like tailoring and tallow chandlering) have done over the centuries. Significant elements of professional work are being routinized: in checklists, standard form materials, and in various sorts of systems, many of which are available online. Meanwhile, the work that remains for human beings to handle conventionally is often not conducted by individual craftspeople, but collaboratively in teams, sometimes collocated, but more often virtually. And, with the advance of increasingly capable machines, some work may not be conducted by human beings at all.
Just as we witnessed the “death of gentlemanly capitalism” in the banks in the 1980s, we seem to be observing a similar decline in bespoke professionalism.
The Bypassed Gatekeepers
In the past, when in need of expert guidance we turned to the professions. Their members knew things that others did not, and we drew on their knowledge and experience to solve our problems. Each profession acted as a “gatekeeper” of its own, distinct body of practical expertise. Today this set-up is under threat.
We are already seeing some work being wrested from the hands of traditional professions. Some of the competition is coming from within. We observe professionals from different professions doing each other’s work. They even speak of “eating one another’s lunch.” Accountants and consultants, for example, are particularly effective at encroaching on the business of lawyers and actuaries. We also see intra-professional friction, when, for example, nurses take on work that used to be exclusive to doctors, or paralegals are engaged to perform tasks that formerly were the province of lawyers.
But the competition is also advancing from outside the traditional boundaries of the professions—from new people and different institutions. We see a recurring need to draw on people with very different skills, talents, and ways of working. Practicing doctors, priests, teachers, and auditors did not, for example, develop the software that supports the systems that we describe. Stepping forward instead are data scientists, process analysts, knowledge engineers, systems engineers, and many more. Today, professionals still provide much of the content, but in time they may find themselves down-staged by these new specialists. We also see a diverse set of institutions entering the fray—business process outsourcers, retail brands, Internet companies, major software and service vendors, to name a few. What these providers have in common is that they look nothing like twentieth-century doctors, accountants, architects, and the rest.
More than this, human experts in the professions are no longer the only source of practical expertise. There are illustrations of practical expertise being made available by recipients of professional work—in effect, sidestepping the gatekeepers. On various platforms, typically online, people share their past experience and help others to resolve similar problems. These “communities of experience,” as we call them, are springing up across many professions (for example, PatientsLikeMe and the WebMD communities in medicine). We say more about them in a moment. More radical still are systems and machines that themselves generate practical expertise. These are underpinned by a variety of advanced techniques, such as Big Data and artificial intelligence. These platforms and systems tend not to be owned and run by the traditional professions. Whether those who do so will in turn become “new gatekeepers” is a subject of some concern.
The keys to the kingdom are changing. Or, if not changing, they are at least being shared with others.
Shift From Reactive to Proactive
Traditional professional work is reactive in nature. The recipient of the service tends to initiate the engagement and then the professional responds.
There is a paradox here, in that the burden of recognizing that professional help is needed lies in the hands of the inexpert. Sometimes the trigger can be obvious—for instance, an unbearable pain, an eviction notice, receipt of a threatening letter from a tax authority, or a meltdown over homework— but often recipients do not know if, or at least when, they should best seek advice. When they are eventually (and unhelpfully) told that it would have been better if they had sought help many weeks earlier, we see the paradox in action. It seems you need to be an expert to know if and when to consult an expert. The concern here is that problems have often escalated unnecessarily by the time a professional is called upon.
To tackle this problem, professional work is becoming increasingly proactive. We have witnessed this phenomenon for some years in health, for example, in the shift towards preventative medicine and health promotion. People are encouraged to opt for exercise and sensible eating rather than heart surgery, or to limit their exposure to the sun rather than have chemotherapy for melanoma. People generally prefer problem-avoidance and problem-containment to problem-solving. In short, they prefer a fence at the top of the cliff to an ambulance at the bottom. And yet, traditional, reactive providers, in their quest for greater efficiency, are often preoccupied with equipping the ambulance better than rivals or ensuring its arrival at the scene of the problem sooner than competitors.
There is evidence that this is changing in sophisticated ways. In medicine, for example, remote monitoring systems track patients’ vital signs, and can prompt an intervention before the patient realizes something might be wrong. In education, personalized learning systems track students’ progress, and can provide advance warning of particular difficulties in understanding. In some professions, this shift to proactivity is expressed as a growing focus on risk management. Another dimension to this issue is that proactivity can be achieved by “embedding” practical expertise in our machines, working practices, and regular daily activities.
The More-for-less Challenge
A more prosaic driver of change is the intense cost pressure that we find across the professions. All recipients of professional service, from major corporations to individual consumers, seem to be short of money. More than this, though, managers in businesses complain not only of shrinking budgets but also that they have more need of professional help. Industry and commerce are becoming increasingly complex, which means that there are more calls for professional help from lawyers, consultants, accountants, tax advisers, amongst others. Similarly, hospitals and schools, especially those that are publicly funded, are also strained, always balancing smaller purses with growing demand. We call this problem the “more-for-less” challenge. How can we find ways of delivering more professional service at less cost? Most individuals and organizations are struggling to respond.
It might be thought that the more-for-less challenge is a child of the global economic downturn. However, in our research and consulting work in 2004 and 2005, prior to the crisis, we were already hearing from the clients of professional firms that cost pressures were building. The recession, we suggest, was an accelerator of a trend that began to take shape a few years before. The challenge will continue after the recovery.
In broad terms, we observe two responses to the challenge—what we have called the “efficiency strategy” and the “collaboration strategy.” The former involves finding ways of cutting the costs of professional work, while the latter requires that users of the professions should come together and share the costs of the service. Both strategies tend to rely on technology.