The Order of Professionalization

Using data on local, state, and national events in American medicine, this article analyzes the order in which professionalization occurs. A variety of basic “events” in professionalization are investigated: control of work, development of schools and other knowledge institutions, creation of professionally dominated work sites, association, licensing, and scientific transformation. At the local level, the sequence of professionalization seems to be control, practical knowledge, dominated work sites, and scientific transformation, with association coming approximately contemporaneous with practical knowledge. At the state level, control and association begin the process, in that order, with efforts proceeding both at the state level and in a state's major city. Widespread local activity in control and association come only later. Practical knowledge, controlled work sites, and various forms of “tangential” knowledge follow these earlier events. The article argues for a model of professionalization as a multilevel, diffusion process.