Situating Multidisciplinary Practice within Social History: A Systemic Analysis of Inter-Professional Competition
Nnona, George C., St. John's Law Review
Imagine that medical doctors were involved in a turf war with robotic engineers over a new revolutionary procedure in medicine-a procedure involving the non-invasive use of intense-energy sources such as radiation or extreme cold to perform bloodless surgery. Imagine further that in this struggle, medical doctors find themselves on the losing end, being displaced by robotics engineers who control the robots that administer such intense energy sources to patients. To what might analysts attribute the displacement of medical doctors by robotics engineers in this struggle-a displacement that would have robotics engineers performing operations ordinarily assumed to be within the professional jurisdiction of medical doctors?1 Some analysts would no doubt attribute such a result to scheming by robotics engineers to usurp the more lucrative functions of medical doctors in the area of complex surgery. Others may even attribute it to collusion between the legislature and lobbyists working for medical engineering firms who have an interest in seeing robotics engineers-their cronies-ascend the commanding heights of the medical field. Some may even go as far as attributing the displacement of doctors to sheer professional envy by robotics engineers, pedestrian as this may seem.
None of the foregoing explanations for the professional ascendancy of the robotics engineer would necessarily be false. Indeed, all of them may be true or contain elements of the truth. Yet these reasons, whether standing individually or taken together, would provide too austere and simplified a picture of the struggle between robotics engineers and medical doctors. They would thus be inadequate as an explanation of the causes and outcome of the struggle. A closer look will reveal the shortcomings of these reasons to be, in large part, their non-immersion in the proper social, historical, and even scientific context. They are linear and atomistic in character. Being atomistic and ahistorical, they do not go far enough in capturing the complex contextual issues and other multifarious factors and problems that shaped and determined the struggle between both professions and the final results.2 Yet precisely such explanations were advanced to account for the recent struggles between the legal profession and the accounting profession, as made manifest in the debates over multidisciplinary practice.3 The primary aim of this paper is to challenge this dominant linear and atomistic presentation of the struggles between the accounting and legal professions over multidisciplinary practice ("MDP"), by providing an alternative, holistic account that situates the MDP phenomenon within relevant sociological and historical context. This account focuses on the dynamics of the inter-professional system and the historical development of both professions within that system to explain the relative weakness of the legal profession and its susceptibility to defeat in the inter-professional struggle which MDP represents. Such an account provides a full and fair view of the phenomenon by integrating a multiplicity of factors and actors in a manner that necessarily yields a wide and fresh perspective. Such an alternative account is valuable, not just intrinsically as a historical or theoretical matter, but also to the policy maker of the future who is intent on getting a good grasp on the fundamentals in this area.
This paper is divided into five parts excluding the introduction and conclusion. Part I provides the basic background information concerning MDP and the recent debates surrounding it. In doing so, it also provides greater detail about the shortcomings in the current understanding of the animating factors and causes of MDP, and the objective of this article in addressing those shortcomings. Part II introduces the system of professions, the basic framework for the analysis herein-a system in which the imperatives of natural selection are as real as they are in any ecosystem; where only the most nimble and responsive professions survive. …