This is why we say that even the interactionist perspective does not allow a proper understanding of how those processes are individually interpreted and, more importantly, individually activated. In other words, the different meanings that justify the reproduction of, or change in, the professional structure. My point here is that while, on one hand, it should be understood that professional structures are as much structuring as they are structured as interactionists have shown, on the other, understanding the interaction processes cannot overlook the role of individual action in the enactment of those processes.
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This argument leads to an important aspect regarding the construction of the theories of professions in which the discussion carried out gradually ignored the key concepts in sociological theory: structure and action. Note that this must be understood only as a discursive omission, since adopting a functionalist or interactionist perspective always involves making a decision on the understanding given to structures and actions.
How can the way Parsons conceptualizes his professional essentialist perspective be detached from the social system theory ? An example of this discursive omission is clearly seen in the analysis made by Strauss et al. They observe that hospital in-patients have distinctive reactions when hospital professionals expect their behavior to consist of submission and passivity in accepting medical treatment thus criticizing Parsons' concept of the 'sick role'. Although the theoretical objective proposed by the authors is not to analyze action and structure, this is actually their theoretical basis: the degree to which professional medical knowledge is unable to standardize what constitutes behavioral diversity.
What this proves is a closing process that sociology of professions has been made in their analytical object, thus ignoring the fundamental sociological basis: social order Pires, However, it must be stated clearly that like any other sociological field, the sociology of professions is not impervious to the interpretations given to such concepts, since they are elements of unequal meaning within different epistemic frameworks, which define the multi-paradigm nature of the discipline Silva, Some recent contributions on professions have already made reference to the need for an analytical investment in individuals, as we theorize here.
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Individual professional activity is mainly conceptualized as a result of what professionals conceive as being their professional roles, possibilities, relations, expectations, interests, and experiences Currie et al. Although the motives for, and the structure of, individual action are not theoretically conceptualized, these studies offer a trace to a sociological approach that does not ignore individual forms of appropriating in the sense of internalizing institutionalization processes as regards professions and their fields of intervention.
Sociological theory's contributions to conceptualizing professionalism from an open-system perspective. As we have seen, the motivation for this discussion is related with problems that the existing conceptual frameworks have to conceptualize freedom of action in professions with a high level of professional discretion. In fact, although at first glance agents seem to be empowered to make changes in the social structures, this ability cannot be seen as common to all: it depends on the places occupied in different social strata and the related power resources possessed Mouzelis, ; Bourdieu, ; Crozier, Friedberg, 7.
However, the possession of the necessary resources to act upon the structures does not mean that this is automatically implemented.
That is why contexts of social reproduction do not mean the absence or eradication of individuality, and it is necessary to conceptualize the meanings given individually to the action: 'I do not want to change because … '. From this point of view, situations of change not only involve the capacity to act but also the intention to do so.
This idea is concerned with any kind of behavioral reification: doctors do not necessarily disagree with managers just because they are doctors. Nor are managers against medical professionals' autonomy simply because hypothetically this might be the main obstacle to managerial control.
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At stake is a more complex and individualized process than institutional professional relations realize. So the objective is to overcome an analytical position that, on one hand, inclines towards a structuralism of individual action and, on the other, does not recognize the existence of objective social frameworks that set limits on the social subjects' horizons. After all, as Lahire mentions, given the complexity of the real, sociology cannot seek pure ways of acting and seeing individuals, supposedly guaranteed by the sharing of similar objective and relational conditions.
On the analytical level, reproduction and change should be left open, and it is necessary to construct a model that takes into account the reasons guiding individual behavior. As Alexander states, social order does not contradict the contingency of individual action, which has both an interpretive and strategic side. One fundamental clarification is that we are not denying any kind of pattern of action or social pressures external and previous to individuals, which could be interpreted as an individualistic approach of human action.
Therefore, the principle of the dualism of structure Archer, is adopted, considering that actions are delimitated by previous constraints 8. Although it has been argued previously that one of the fundamental theoretical arguments of this discussion is the non closure of scientific fields in their empirical objects, a more specific ensemble of pertinent structural dimensions must be considered for the analysis of professional action. Consequently, that principle of non closure process is ensured here on one hand, by the nature of the structural dimensions considered, which involves not only a more specific process to professional sphere but also others from a wider political nature; and on the other hand, by the inclusion of personal besides professional socializations in the influence of reflexivity construction, which brings open processes to professional behaviors.
Therefore, the concrete system of action under discussion is defined by three different structural levels: a macro systemic level of supranational influences generating ideologies of the meaning of public activity and, consequently, the function given to the NPM; an organizational level where that ideology materializes in rules and orientations closely linked with the specific contingencies of each organization and medical services and the national political, economic and financial systems; and a professional jurisdiction level, which is the space of action and responsibility of every profession.
Two kinds of professional jurisdiction are at stake here. An internal jurisdiction that refers to the power resources individually possessed within the medical field. Different places are occupied due to dimensions like the professional trajectory, the monopoly of information, the area of expertise or the personal relations.
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The second kind of professional jurisdiction is external and represents the space of action, competencies and responsibilities that each profession possesses e. Abbott, Authors like Freidson , or Champy argue that these spaces are created through two different but cumulative processes: as a result of social attributions externally given to professions e. Specifically about the medical space of action, Schraiber , considers that its understanding must involve the dimension of knowledge , as well as the dimension of work.
This means that today it is impossible to ignore the labor structure in relation to any profession - even in the paradigmatic case of medicine - in which the knowledge is considered as its structural and differentiated condition. More specific contexts must therefore be considered for professions as well others from a wider nature, which defines the place that each profession occupies in a given space and function 9.
It is relatively linear to understand that the performance of any profession as dependent work dependent on the professional entity responsible for the contractual relation, including payment, work conditions and all other aspects that are associated with this nature requires submission to different kinds of rules. This submission is the most rigorous mechanism that guarantees the necessary predictable nature of any complex capitalist bureaucratic organization in modernity Weber, From the professional point of view, the acceptance of these constraints is related with the financial, social and emotional necessity represented by the performance of a professional activity in the western modern societies.
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Another straightforward argument is that the submission to rules tends to be intensify progressively as the professions become less liberal private. Although the medical profession involves both dependent and private activity, it must be conceptualized through the submission to a social order composed, as has been seen, of a whole ensemble of rules that are general to society and other professions, as well as more specific rules associated to the particular nature of that profession its social function and the social power acquired.
In fact, the system of rules that organizes and coordinates all interactions within each profession is more or less intense, tacit, informal as well as sanctioning Burns, Flam, ; Giddens, , and it is impossible to search for simple and predictable ways of acting in these constraints. Applying this same open-system basis to both structural rules and intraprofessional relations, the possibility of divergence and contradiction inside relatively stable and similar fields must be considered. For Crozier and Friedberg , the sharing of an individually recognized ethical dimension is the agglutinating element capable of sustainting a system like this - stable even without the necessary formal internal mechanisms of control and domination.
Durkheim has already designated this as the social solidarity present in the division of work, or lately the social function of symbolic power argued by Bourdieu In medicine, the orientation toward the patient, whose social function is granted by medical knowledge expertise , is the ethical dimension responsible for professional stability that is simultaneously individually perceived.
In this case, the ethics responsible for the profession is located in the management of public property in order to guarantee patients' general well-being. As has been argued before, the main theoretical aim of this article is to perceive the dual nature of social phenomena: both from its structural and agential angle Guibentif, According to Schraiber , although daily work is a part of a more general configuration of the labor sphere, it also has an individualized existence.
At stake is a process that results from the link between the individuals and the different places and roles that they assume in society, taking into account the way in which they locate themselves in those spaces as well as the persons in interaction. It is from this perspective that the systemic articulation emerges between system and agent based on individual action Crozier, Friedberg, For these authors the argument is simply that it is not possible to conceptualize the institutional level without knowing how the 'game' is played individually.
A fundamental point must be clearly stated in order to develop this theorization: how can the problem be solved of individual deviations in relation to the external existence of social structures and rules. Durkheim a apud Alexander, and then Bourdieu , considered social order as simultaneously external and prior to action and internal to each member of every social fields.
It is therefore impossible to search for unequivocal ways of respecting social order in any social group, knowing that the first condition for this variability derives from the resources of power socially possessed by the group and by each of its members individually. Accordingly, the structure level is not only located prior to agency, delimitating its behaviors, but is also at a subsequent phase, incorporating the agency's reflexivity. In this way, social reality becomes individually objectified Boudon, , considering behaviors as individual exteriorizations of previous internalization processes.
This internalization relates the reflexive capacities which are constructed in an articulation between social and professional socializations and interests and expectations.
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Note that a full discussion on the theoretical construction of how reflexivity is conceived is beyond the scope of this article. In brief, reflexivity is understood to be the regular cognitive exercise usually made by individuals on how they conceive the surrounding contexts as well their places and roles in those different spaces Archer, ; Hamel, However this does not mean that actions are usually taken consciously in relation to the goals pursued with those actions. The reader must therefore know that it is understood that human action possesses different levels of intentionality: from unconsciousness to consciousness.
In other words, from automatic reproductions, in which individuals do not know 'why' and 'for what' they act - basically the habitus Bourdieu, , , - to reflexive and instrumental intentionality, when the individual is aware of the intent and the purpose of that behaviour. Nevertheless, we are discussing the different ways of 'being' intrinsic to social agents, which allows professionalism to be interpreted by its structures and by the way in which it is structured by the individual action.
Against this double existence of structures - external and simultaneously internal to individuals -, current political contexts, their implementation in each organization and professional jurisdictions can be understood as the product of a symbiosis between constraints and possibilities, exteriority and interiority. First, considering that NPM is chiefly an ideology about how public activity must be provided according to current fiscal and economic pressure Pollitt, , its materialization cannot be dissociated from its policy makers. Once more what is at stake is the professional discretion derived from these structural positions.
Take, for example, the measures that constitute the welfare state s. Their political convictions, interests and pacts, as well as how they conceive such an intervention model must be known when articulating the dimensions presented in the construction of reflexivity.
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Politicians are involved in political structures that socialize them, but their action is the result of how they individually objectify the party's ideology. One leader is not the same as another leader, and the party's action is intimately related to this individuality. From this point of view, they can be assumed as individual and collective subjects, due to their responsibility for how a given model exists and is configured currently and therefore in the future. Second, if NPM is an ideology which is materialized differently by each political leader, its organizational implementation must also be understood as the product of specific interventions; this considers hospital managers again as individual and collective subjects.
Since every organization is a human system that cannot be generalized in its formal and informal conditions and processes Crozier, Friedberg, , any change introduced at this level has to combine these organizational specificities - the so-called organizational culture - with the managers and environmental contexts.
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