Authority and Expertise in Contemporary Professions: How Mid-Status Healthcare Professionals Navigate Inappropriate Physician Referrals

• In Event: 40226 - Reimagining and Reconstructing Occupational Work and Identities in Changing Environments

Abstract

The expansion of the healthcare workforce in recent decades has led to an increasing need fo inter-professional collaboration. Yet challenges arise when mid-status professionals’ (e.g., allied health professionals’) expert opinions are at odds with high status professionals’ (e.g., doctors’) authority. One scenario in which this occurs is during the referral process, when a doctor writes an unnecessary or ‘inappropriate’ referral for another healthcare professional to provide specialized care. When faced with an inappropriate referral, these non-doctor professionals must decide whether they will comply with or resist the referral from someone in a position of authority over them. Leveraging eleven months of ethnographic observations and 37 interviews with speech-language pathologists (SLPs) and related healthcare professionals, I find that SLPs are faced with competing institutional logics stemming from their obligations to serve patients and their obligations to adhere to doctors’ orders. SLPs must weigh each logic when making a decision on whether to refute an inappropriate referral, then leverage these logics as justification to doctors if they attempt to resist a referral. Understanding how ‘mid-status professionals’ like SLPs make decisions on patient care when constrained by doctors’ authority adds to our understanding of professional work and expertise, institutional logics as cultural resources, and the changing power dynamics in the medical institution.

Author

• Emily A. Ekl, The Ohio State University