Status Anxiety in the Professions

The most emailed NYT story at the moment is a litany of complaints from doctors and lawyers:

[S]omething is missing, say many doctors, lawyers and career experts: the old sense of purpose, of respect, of living at the center of American society and embodying its definition of “success.”

[P]rofessional status is now inextricably linked to ideas of flexibility and creativity, concepts alien to seemingly everyone but art students even a generation ago. “Now we have people trying to start a Facebook or a MySpace. You might be working like a maniac, but it’s going to pay off in status. You’re going to be famous, providing something people are going to know and use all over the world” [says one career guidance professional].

In a culture that prizes risk and outsize reward — where professional heroes are college dropouts with billion-dollar Web sites — some doctors and lawyers feel they have slipped a notch in social status[.]

Perhaps a brief swim in the TechCrunch DeadPool could bring these folks out of their quarterlife-style quagmire. For every glittering Mt. Zuckerberg, there’s an iceberg of “wanna-be-preneurs” with little more than a business plan and a prayer. Seriously, there are reasons for doctors and lawyers to be glum, but I think they have little to do with the fantasies of early retirement or nonstop creativity the article adumbrates.

First, on a practical level, lawyers may want to consult Steven Keeva’s Transforming Practices: Finding Joy and Satisfaction in the Legal Life. I imagine there are similar resources for doctors.

Second, the diversity of doctors and lawyers makes this a “best of times/worst of times” market. Though doctors on average make 2-5 times more than OECD averages, specialists do much better than generalists. And as Bill Henderson has shown, there is a bimodal distribution of lawyer salaries that Cook & Frank’s Winner Take All Society likely would have predicted in 1995. Those at the top firms are doing better than ever; those on the bottom have to worry more and more about outsourcing, contract employment, and corporate cost-cutting.

Finally, the political question here is how the professions will respond to this wave of inequality. One individualistic response would be to scramble to attach oneself to the patients/clients that are doing best in the current economy. Boutique medicine, cosmetic surgery, and specialty hospitals all offer opportunities here for doctors. Lawyers will probably have to keep angling for firm jobs, though the entrepreneurial may find inroads as, say, compliance specialists within thriving companies.

Another path points away from individualism and toward a more communitarian approach. Doctors are in the business of saving lives and improving health–how can they get the government to pay them properly so they can expand their services to those who are either un- or inadequately insured? Attorneys might question whether deregulation and limits on lawsuits have gone too far. Both lawyers and doctors may “do well by doing good” if they focus on a frankly redistributive agenda that uses money now reserved for tax cuts for the wealthiest to fund basic medical and legal services.

If they do not, they might see their own political position further erode in the midst of skepticism about restrictions on entry into these professions. Consider Dean Baker’s argument:

[We now] allow[] many less-skilled workers into the country to fill jobs at lower wages than employers would be forced to pay the native born population. While allowing immigrant workers into the country can be seen as part of the free market, like allowing imported goods into the country, this is only half of the picture. The. . . state puts on strict controls to limit the extent to which doctors, lawyers, economists, journalists, and other highly paid professionals must face foreign competition. [Thus] not everyone’s labor is placed in international competition. Those at the top of the wage ladder get to enjoy protected labor markets. This both raises their wages

and means that everyone else must pay more money for their services.

The key justification for a “privileged” position for the medical and legal professions is that they work to provide the entire community with health and justice. If that spirit of noblesse oblige withers, it’s hard to see why its legal underpinnings should persist.

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