
Is There a Future for the Professions? - kawera
http://www.thegoodproject.org/is-there-a-future-for-the-professions-an-interim-verdict/
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m52go
I think it's a question of barriers. You can't charge tens of thousands (often
totaling hundreds of thousands) of dollars and many years for a professional
degree and expect folks to buy it over other options that cost far less time
and far less money.

I'm not saying coding bootcamps are panacean, but hiring does occur at such
places and their cost (again, in terms of time & money) is a fraction of the
cost of traditional professional education.

Professional education will need to adapt. I've heard of disaster-prone areas
producing doctors in a matter of weeks. I don't want to be treated by a doctor
who only has 8 weeks of training, but I don't think it's a bad start to a
more, immersive, apprenticeship-based program that allows candidates to earn
decent money while learning the full profession.

~~~
Zach_the_Lizard
>I don't want to be treated by a doctor who only has 8 weeks of training, but
I don't think it's a bad start to a more, immersive, apprenticeship-based
program that allows candidates to earn decent money while learning the full
profession.

I think we need multiple grades of doctor. Even something as simple as being
able to stitch up a wound is useful and could lead to positive health outcomes
for those who couldn't otherwise afford a trip to the doctor. Better to get
some healthcare than have all doctors be the best possible, but inaccessible
to the masses.

I'd liken it to gas stations that also have small garages that can change your
oil and top off your fluids. You'd probably never want to have them replace
your transmission, but oil changes alone are in high enough demand that I'm
sure they make up a good portion of all visits to mechanics.

I'm guessing that a similar situation exists with doctors; physicals,
vaccines, and a handful of common diseases (like colds) probably make up a
sizable percentage of visits. There's a market for someone who can just handle
these cases and pass them off to the higher grade doctor when the need arises.

To an extent we have this in the form of various grades of nurses and the
dazzling array of specialists that now exist, but it's not quite there yet.

~~~
fancyketchup
> I think we need multiple grades of doctor.

Don't we have that already?

Doctor / Physician

Physician Assistant

Nurse Practitioner

Registered Nurse

Nursing Aid / Nurse Assistant

~~~
Zach_the_Lizard
You can't book an appointment with most of these directly, and not all of them
can write prescriptions legally. For instance, I can't just book an
appointment with a nurse to take a look at a cut to see if it needs stitches.
The nurse might be the one to actually do the work, but I can't cut out the
middleman legally.

~~~
gherkin0
> You can't book an appointment with most of these directly, and not all of
> them can write prescriptions legally.

You can with many nurse practitioners (and maybe physician assistants, but
I've had no experience with them) at places like minute clinic
([http://www.cvs.com/minuteclinic/](http://www.cvs.com/minuteclinic/)).

I've gone to a similar place that's in my office for some minor routine
things, and it's been cheaper and easier to schedule than a proper doctor
visit.

~~~
Zach_the_Lizard
Nurse practitioners are special in that they can do roughly 80-90% of what
doctors can do, including writing prescriptions. In some cases they can act as
specialists, such as handling mental health needs that your standard GP
wouldn't handle.

They certainly do have an important role to play, but we need a lower level
medical professional that can accept appointments and perhaps write a limited
set of prescriptions and handle treatment of basic ailments.

One shouldn't need a masters for the 'oil change' of medicine, just as one
needn't be a registered engineer to change an air filter.

~~~
alistairSH
PAs fill much of that role. Yes, they do require physician supervision, but at
many practices you can make appointments directly with them, never seeing an
MD.

The last time I needed a basic physical, I saw the PA. She ordered blood-work
and reviewed the results with me. I'm sure one of the physicians signed off on
everything, but as far as I know, she did the work.

Likewise, the last time I had the flu, I made an appointment with one of the
PAs. She did everything, with the physician just signing off on the
prescription at the end.

Post-surgery, my follow-ups were with PAs or NPs, not the physician. He did
drop in to say "Hi." but that was about it.

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acconrad
The problem I see is that these jobs already exist (e.g. paralegals, nurse
practitioners, dental hygienists), but are baked into the total practice. My
primary care physician costs the same whether I see him or the nurse
practitioner, and they are performing the same tasks, so why am I wasting my
doctor's time for rudimentary work and simultaneously paying much more for an
NP when I don't need to?

~~~
will_brown
My brother and I started a "member/concierge" primary care network for
uninsured/under-insured patients. Members pay $20/month (individuals) or
$15/month (business plans) and the patients can set appointments to see an
ARNP/PA for $10 copay or the MD for $25 copay. Most primary practices can't
take this issue into consideration because your copay is set by your insurance
policy.

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DrNuke
Consumers in the West are choosing between pyramidal corporations vs
independent professionals in many industries. While the former are often less
expensive to the end user, they drain money out of the local economy towards
fiscal havens. On the other hand, the latter often exploit their local
connections to supercharge clients. For the health of my local environment, I
tend to pay some more to keep the money within my community.

------
lazaroclapp
> But bits can never yield singular values; like any tool, they can be used to
> promote harmony or discord, greed or selflessness. [...] Valid values
> require constant human construction, surveillance, critique, reflection,
> rebuilding, and a commons in which we all have a stake, over which we all
> care, or, to put it more sharply, we all should care.

One thing I don't get from this argument is: does he consider programming a
profession? It seems like his argument is that, replacing professionals with a
strong code of ethics by automated systems might lead to some sort of societal
decay. But that's only true if the people building those systems are
inherently less ethical or perhaps less aware of the issues than the original
professionals. Otherwise, the systems can be build to bias towards a very high
ethical standard, even as they crowdsource some of their functions (there
might be an ethics vs economics trade-off for some systems, but if the trade-
off is approached in an informed manner by ethical people, then a 'reasonable'
compromise should be often found).

Perhaps his argument for the eroding effect of technology is tied to his
argument about the eroding effect of markets: because programmers are employed
by large corporations which have strong incentives to increase profits[1] at
the cost of much everything else they will eventually be led to bend any
professional codes of ethics if market forces act against those. This could
very well be true, but I am not sure that's what the article says.

The article seems to imply than a doctor or a lawyer is likely a more moral
person than a programmer or at least than the system the programmer can build.
I am not sure I understand why it would be so.

[1] Long-term profits, being generous. But still.

~~~
ashmud
> One thing I don't get from this argument is: does he consider programming a
> profession?

If an engineer that programs, probably. But not likely programming by itself.
When I worked at an integration company (industry contractor), we had to be
careful about the language we used on timesheets. We were strictly forbidden
from using "engineer" (verb) since we were not an engineering firm.

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stvswn
"One could say that, in theory, these needs and roles could be satisfied in a
completely marketized society—but we have seen that they are not. Indeed, as
amply documented in 2001 (following the collapse of Enron) and 2008 (following
the collapse of Lehman Brothers), the avowedly marketized society does not
even prevent economic disaster; we need to regulate markets firmly and
fairly."

The author jumps to a conclusion fairly quickly: that free-market capitalism
caused Enron and Lehman Brothers (and not perverse incentives wholly separate
from free-market ideology). This isn't the place to debate that, but rather
it's illustrative of a larger point about academic professionals: they spend
most of their effort engaged in very deep speciality, but occasionally they
come up for air and assert broad knowledge, usually about politically charged
topics.

In those cases, there's a palpable anxiety based on the knowledge that they do
not make as much money as their intellectual inferiors who went off to work in
business, or even worse, to use their professional credentials in the service
of business (as a side note, for proof of this dynamic go read university
professors' blogs about Mark Zuckerberg and his billions -- in the hierarchy
of "deserves their money," tech nerds rank last, because they're
simultaneously capitalists and social inferiors). This must be explained,
internally and then externally -- their life choices are admirable, others'
are not, and something must be done so that elites in the university and in
government institutions can reign in the parasites.

I agree professional certification is important for healthcare and law -- when
my life or liberty is at stake, I want to be sure my chosen expert actually
has expertise. But the author is arguing that some sort of quality of life and
cultural recognition should be automatically granted in exchange for
completing training and passing tests -- something I don't think is worth
caring about too much.

------
roymurdock
This is a fantastically presented and well-written essay. It's too bad the
author stops short of providing any clear, actionable steps towards the
reinvigoration of the professions:

> It’s high time for those of us who continue to value the professions to
> reinvigorate and, as necessary, reinvent the professions. We need to
> acknowledge our complicity in the current undesirable situation, embody the
> principles and values that have enabled professional practice at its best,
> and work to ensure that they will be strengthened, not undermined, by the
> technologies to come, and insofar as possible, in harmony with the ever
> unpredictable winds of history and culture.

This is about as close as he gets to an actual suggestion:

> we need to regulate markets firmly and fairly

Who is "we"? How do "we" do that? Perhaps Prof. Gardner should have had a word
with Larry Summers over a pint at the 2001 Harvard faculty Xmas party when
Prof. Summers returned as the university's president, having helped repeal
Glass-Steagall a few years prior.

More seriously, Prof. Gardner is in a position of power within an institution
that does more to shape the future of the world than any other. He should have
one of the best vantage points in the world to suggest changes, given his
access to the students and faculty that go on to make many of the governing
decisions within the country. It would have been interesting to read more
about how the culture of a pivotal institution such as Harvard has changed
over the past 30 years, and whether that has been in response to, or the cause
of the decline in profession.

------
paulsutter
> a profession consists of individuals who have undergone a standard form of
> training, culminating in some kind of recognized title and degree.

So the professions were pillars of society when the world changed little and
education was scarce. Now most people complete college and "the professions"
are a quaint old-timey thing.

It would have been nice if the author weren't such a meandering windbag, but
maybe he has trouble getting to the point because he can't bring himself to
say he just wishes they professions were still considered "elite".

~~~
analog31
>> a profession consists of individuals who have undergone a standard form of
training, culminating in some kind of recognized title and degree.

Yes, and basically ending there, except for being able to teach it to the next
generation. The professions were things like philosophy, geometry, theology,
etc.

As I understand it, the title "doctor" was used by scholars, e.g., PhDs, long
before medicine even existed as a respectable field, and physicians started
calling themselves "doctor" to assume an air of respectability.

The trades may have been respected, but were a couple of notches below the
nobility and the clergy. The idea of achieving a high social status for
actually _doing_ something is a newfangled concept.

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JSeymourATL
> contemporary professions are failing economically, technologically,
> psychologically, morally, and qualitatively, and by virtue of their
> inscrutability (p. 33). Or, as they put it colloquially, “We cannot afford
> them, they are often antiquated, the expertise of the best is enjoyed only
> by a few, and their workings are not transparent. For these and other
> reasons, we believe today’s professions should and will be replaced by
> feasible alternatives”

Anyone retain an attorney for a will lately versus downloading Legal Zoom?

------
theworstshill
For professions to be viable, there has to be a large dip between people
starting out and people who had mastered it already. Otherwise there is no
real incentive for people to start out in the first place; noone will pay a
lot of money and invest years of their time if anyone with a few weeks of
education can do essentially 99% of what they can.

This brings me to the point of software development. Software development is
aweful as a choice of a profession if you work for someone else, and not for
yourself, due to constantly increasing competition (every kid needs to learn
how to code). Most work doesn't need a real understanding of the subject
matter (algorithms, protocols) and can be performed using frameworks and
libraries that "encapsulate" those concepts. I foresee something alike the
split of nurses and nurseaides happening to software developers. There'll be a
few software developers capable of understanding computing from A to Z who
will write the libraries and the tools, and everybody else will be a consumer
of these tools writing apps for the end users.

The only real rewarding part of software development is being able to design
your own product and bring it to life, and reap whatever rewards the market
allows you.

~~~
henrik_w
I beg to differ. I don't see constantly increasing competition, partly because
the demand for (good) programmers is also increasing, and partly because (in
my opinion) most programming work actually does need real understanding.

Besides, programming is a very rewarding activity in itself, due to the
creative nature of it [1].

So I have the complete opposite view - software developer is a great career:
[http://henrikwarne.com/2014/12/08/5-reasons-why-software-
dev...](http://henrikwarne.com/2014/12/08/5-reasons-why-software-developer-is-
a-great-career-choice/)

[1] Why I Love Programming: [http://henrikwarne.com/2012/06/02/why-i-love-
coding/](http://henrikwarne.com/2012/06/02/why-i-love-coding/)

~~~
logfromblammo
The great thing about software is that each new piece of software that is
written opens up more opportunities for writing new software than it closes
off.

And the great thing about software writers is that each new writer creates
more work opportunities for experienced code maintainers and rehabilitators
than they could possibly create for themselves.

Combine those two great things, and you realize that as long as the software
industry can grow wider faster than it can grow deeper, it must. The tide of
crap software with huge technical debt that will eventually have to be fixed
by someone with real experience will only abate when everyone with the
aptitude for writing software has already been doing it for a while.

At that time, people will be able to distinguish between a software writer
that can maintain an existing CRUD app and one that can write new business-
infrastructure software that scales across the entire enterprise.

That last category will be able to demand high compensation well into the
foreseeable future, simply because the type of personality that has
competitive advantage there is relatively rare in the general population.

------
mirimir
Given ready access to information and knowledge, and eventually cognitive
enhancement, maybe the focus of professional education ought to be on core
values and skills. Plus enough general background to know where to start with
any particular project.

------
AnimalMuppet
This is almost like a reverse Betteridge's Law of Headlines. So maybe the real
law is, if the headline asks if there will be a huge change of the status quo,
the answer is no. If the headline asks if the status quo will remain, the
answer is yes.

~~~
vezzy-fnord
Why are people even trying to formulate a consistent model out of Betteridge's
law? It's puerile and missing the point. It's nothing but a sardonic aphorism
that observes how tabloids tend to structure their headlines. It's absolutely
trivial to subvert: "Did six million Jews really die in the Holocaust?".

Is there a law about people egregiously overestimating the applicability of
Internet laws?

~~~
pc86
It's called a "joke."

~~~
vezzy-fnord
AnimalMuppet seems to be trying to make something serious out of it, hence my
response.

