Organizational Powers: Capture of Professional Jurisdiction in the Case of U.S. Retail Clinics
Roman V. Galperin
Johns Hopkins University
June 27, 2011
MIT Sloan Research Paper No. 4904-11
This paper offers a revision of the ecological model of interprofessional competition to explicitly account for the role of organizations in the division of expert labor among professions. Drawing on Abbott’s (1988) theoretical model, the paper analyzes a case of jurisdictional disruption between nurse practitioners and physicians that occurred when nurse practitioners began to practice within a new organizational form of retail health clinics. Using archival and interview data, the paper shows that retail clinic firms, as employers of the nurse practitioners, have inserted themselves into the competition of professions as meta-professional entities and changed a longstanding jurisdictional settlement in primary health care, gaining control over performance of professional work and distributing related economic rents. Since the existing ecological model cannot explain this outcome, the paper elaborates the model, drawing on an insight that possession of equal rights by social actors does not imply possession of equal means to use the rights. By re-conceptualizing professional jurisdiction as a set of rights and their use, and recognizing the problem of professional collective action, the paper arrives at an improved ecological model that can account for the role of organizations in professional competition and better explain the division of expert labor.
Number of Pages in PDF File: 50
Keywords: Occupations and Professions, Professional Jurisdiction, Occupational License, Ecological Models, Organization Theory, Collective Action
JEL Classification: J44, D45, I11working papers series
Date posted: June 27, 2011 ; Last revised: April 1, 2014
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