Professionalism between the Authority of Expertise and the Authority of Office

According to Charles Perrow (1972) it was a footnote in Talcott Parsons’ introduction to his translation of Weber’s Economy and Society that made the hard-lived dilemma of expertise and discipline famous. Parsons (1947) declared that Weber confused two types of authority; one based on technical competence and one based on legally defined office. Perrow notes that although Weber never himself made such a distinction, Parsons’ footnote is ‘possibly the most important in the history of organizational theory’ as it has led to an understanding of professionals as being in a conflict between their ‘professional values’ and more bureaucratic values and obligations linked to their professional office. Following Parsons’ seminal writings, this imagined discrepancy has led to a myriad of images of professionalism as a kind of resistance or power struggle against bureaucratic or hierarchical control within the sociology of professions. Most prominently perhaps Eliot Freidson Professionalism, The Third Logic (2001) in which he argues for professionalism and bureaucracy as to contrasting institutional logics and thereby for an inherent conflict between the authority of expertise and the authority of office.

In this paper, I take the medical profession as a case to rethink the relation, interdependence and possible overlap between these two types of authority. Based on readings of classic medical sociology and on fieldwork conducted in a Danish university hospital, the paper investigate the question of authority in the clinic and it is shown how it is impossible to understand medical professionals as merely extra-organizational selves in supposedly collegial organizations. Rather, it is shown how medical expertise is often transmitted exactly through hierarchy and a clear distribution of responsibility, duty and role-obligation.