Towards the end of the last century, health professional educators began to take a greater interest in the topic of professionalism, and related concepts such as professional development and professional behaviour.  Courses such as ‘personal and professional development’ (PPD), for example, were introduced into medical curricula and the number of published articles on the subject increased exponentially.  More recently we have seen growing consideration of the importance of professional identity in all health professions.  In addition, interprofessional identity has emerged as a concept.

Professionalism and ‘profession’ have long histories but continue to be hard to define concisely.  Google what it means to be a professional or professional and you will find multiple positive attributes such as ethical, industrious, dependable, and productive.  Health professionals and educators debate just what it means to be a professional in the context of contemporary practice and, more widely, what society understands by and assumes what a professional should be.  

A criticism now levelled at the professionalism discourse is that it is ‘stuck in a background of western, white, heteronormative views of society’.^[1]  When I first became interested in the topic in the late 1990s while refreshing a PPD course at a UK university, I discovered authors from other disciplines writing about professions not solely medicine. These, however, were typically writing in English and with a western gaze.  What I refer to as the darker side of professionalism stems from the history of the professions and has been studied and described by sociologists in the 20^th century.    A defining feature of a profession has been professional autonomy which is underpinned by self-governance and self-regulation.  In other words, a profession would decide through its governing body who should be admitted to its club, the code by which it operates, and whose membership should be revoked.  While these decisions should be based on the interests of the community the profession serves, there is always a danger that they lead to elitism and to serve the economic interests of the members.    The patient voice is becoming more prevalent in many areas but there is still room for improvement.  While the National Health Service in the UK was set up in 1948 to provide care that is free at the point of delivery funded by taxation, it and many other health services globally do now operate to greater or lesser extents within market frameworks in which doctors and other health professions charge patients fees and compete with one another for business. 

The professions do offer a service and therefore health professionals serve a community. They are still perceived by many to be motivated by a sense of vocation to help others, though this altruism is usually remunerated.  The medical profession particularly has a social contract with the population it serves, with the government as a third party.  In return for its service, doctors have social professional status and financial rewards while being expected to maintain certain standards including fitness to practise.  This model is being rethought as health professions in some countries withdraw their services and ‘strike’ for better conditions – for patients and themselves – and fairer pay.  Workforce issues, poor resources and the covid pandemic have severely affected the mental and physical health of health professionals.  Their professionalism as encapsulated by professional standards such as efficiency, effectiveness, taking pride in a task, excellent communication and putting patients first is being tested by increasing workloads, a reduction in patient safety, ignominies such as patients being treated on trolleys because of lack of hospital beds, and rationing of care. 

Sadly, the public’s trust in doctors seems to have lessened in many jurisdictions, the outcome of poorer and less equitable access to health care due to complex factors.  There are calls for the development of a new social contract to include adequate funding and infrastructure from government, long term workforce planning, appropriate public health measures, health professional education to place added emphasis on the social determinants of health and improvement in a population’s health literacy.

Just as there is no one correct answer to what is professionalism, there is no simple solution to the pressures on health care systems in the 21^st century. It is important when students are learning their professions to ensure they have a good understanding of their role and the difficulties they will face in practice.  It is not only medical knowledge they require but the ability to navigate through a challenging landscape and to collaborate with more experienced colleagues to advocate for change. 

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^[1] Goddard, VCT, Brockbank, S.  Re-opening Pandora’s box: Who owns professionalism and is it time for a 21st century definition? Med Educ.  2023; 57(1): 66- 75. doi:10.1111/medu.14862