The fragmentation of the health profession into various specialized splinter groups is cause for celebration among some practitioners and patients, and cause for growing concern among others. Regardless of one’s opinion about the fragmentation of the health profession, however, it is unlikely that the U.S. health care system will remain unchanged as the result of this phenomenon. In recent years, the public has become generally more accepting of treatment modalities that were viewed as suspicious just a decade earlier (Tovey, Easthope, & Adams, 2003). In addition, the substantial obstacles that the health profession at large faces at present, including high vacancy rates in some specialties, the escalating cost of provider insurance, and increasing patient dissatisfaction with traditional providers and the empowerment to seek care elsewhere, may serve as motivating factors to drive patients to non-traditional providers. One need not necessarily view the health profession’s fragmentation as a crisis. In fact, the increased variety and number of providers may help confront the very obstacles noted above. What will limit the power of the profession to leverage the increased diversity of the field, however, will be what Tovey et al. (2003) refer to as a “lack of internal cohesion,” not only among practitioner groups, but “within the practitioner groups themselves” (p. 145).
Advances in medical technology and knowledge have made it possible for the emergence of new treatment competencies that were not available until this generation. In addition, some practitioner groups are looking to the healing traditions of ancient societies, dusting off the lessons and techniques that they offered and updating them for the twenty-first century treatment context. Acupuncture and homeopathy, to name just two modalities, are not new; they are just long disused or had never been adopted previously as a legitimate form of medical practice in this country (Johnston, 2004). As patients have expressed an increasing interest in the so-called “alternative” or “complementary” modalities, which can be used to treat a variety of illnesses and symptoms ranging from the common cold to cancer, medical schools and traditional health care providers have rushed to understand how this phenomenon affects the conventional Western healthcare establishment (Johnston, 2004). While some conventional providers may be as enthusiastic about the ancillary benefits of such treatment approaches, others scorn them, raising questions about the training of the providers with respect to anatomical and physiological systems, the legitimacy of their profession’s licensing process, and the economic motives that these providers have (Tovey et al., 2003).
Yet alternative care providers could potentially be an effective weapon in the conventional establishment’s fight to confront substantial obstacles that are crippling the profession and damaging its own reputation, a fight that they do not seem able to win on their own (Bogner, 2004). The shortage of nurses and the demands upon both private and public doctors to fit as many patients as possible into a billable hour means that traditional health care profession has, to a certain extent, lost its human touch. The burgeoning of other specialties, then, may help restore the human connection between provider and patient and, in doing so, may restore the public’s eroding faith in American health care, which would only benefit the traditional provider (Bogner, 2004). It is important to understand that the writer is not advocating that traditional Western approaches to medicine be replaced, but rather, that the emerging specialty providers may provide ancillary care that can promote health and wellness, not only for the patient, but for the profession.
Conventional healthcare providers, however, are often unable or unwilling to see these potential benefits of fragmentation. Instead, the proliferation of specialties feels threatening. As a result, one of the unfortunate consequences of the fragmentation of the profession is that competition and turf wars escalate, further distracting all providers from their primary purpose and professional responsibility: the care of patients. Nevertheless, conventional providers do have some legitimate concerns about the competency of specialty providers (Tovey et al., 2003); the fact of the matter is that many of the new or emerging health care specialties do not yet have clearly defined regulatory structures. Thus, conventional health care providers are often advocates of more stringent licensing and provider and care regulation of the specialty professions, and they use their considerable resources, including powerful lobbying groups, to advance their interests. While the eventual outcome may be positive in that it will provide patients with a clear understanding of the required competencies for a practitioner, the standards for treatment that they can expect, and their rights as patients, the call for greater oversight of the specialties by conventional healthcare providers tends to foster resentment rather than cooperation and collegiality.
In addition, the specialty groups, as Tovey et al. (2003) have noted, often lack cooperation and collegiality within their own ranks. Divided by what they believe should be the standards for their emerging professions, many specialty groups do not present a “united front” (Tovey et al., 2003, p. 145) in order to reach out to other members of the profession and inform and educate about their work. Instead, the division within specialty groups themselves further undermines their credibility and makes the advancement of the specialty challenging, as the development of standards, licensure requirements, and practice boundaries is slowed by conflicts and in-fighting. For this reason, any actions that are taken in an effort to unite the disparate entities that comprise the American healthcare system should begin within groups and then extend between them. Specialty providers should maximize the forums available to them at professional conferences to engage in constructive dialogue that can result in the definition of the profession’s purpose and scope. These conversations should continue beyond the conference, however, and the establishment of professional online forums and public relations committees may be one strategy for reducing some of the negative perceptions that currently plague the profession.
The fragmentation of the healthcare system does appear to be worsening rather than improving, despite-or perhaps because of-the public’s interest in alternatives to conventional care. While there are legitimate concerns about the academic preparation of certain specialty providers, as well as the licensing regulations and standards that govern the specialty professions, all healthcare providers should try to recognize that fragmentation can potentially be beneficial for the profession. Fragmentation does not threaten healthcare as we know it. Rather, it has a transformative power that may help the profession overcome its most serious and pressing challenges, though this power will only be harnessed if all providers can overcome the chasm of opinion that divides them.
References
Bogner, M.S. (2004). Misadventures in health care: Inside stories. Mahwah, NJ: Lawrence Erlbaum AssociateS
Johnston, R.D. (2004). The politics of healing: Histories of alternative medicine in twentieth-century North America. New York: Routledge.
Tovey, P., Easthope, G., & Adams, J. (2003). The mainstreaming of complementary and alternative medicine: Studies in social context. New York: Routledge.
