February 23, 1998
Death of the Guilds:

 

Professions, States, and the Advance of Capitalism,
1930 to the Present

 
by
Elliot A. Krause
New Haven, Yale University Press, 1996

 

Reviewed by
Alvin G. Burstein


This is a dense and complex book that, in brief, agues a thesis that many would find troubling but one that gives substance to an unease felt by many doctors, lawyers engineers and academics: that professionals' control over their work, guided by profe ssionally determined standards, is giving way to system of making money for investors. What may be most troubling is Krause's conclusion that this is not a local phenomenon, nor a temporary one. Rather, it is the culmination of a very massive historical t rend, an unexpected (by some) aspect of the victory of capitalism, even though Krause does not take up the question of history's end.

The book is serious and scholarly in tone, but characterized by a vexing tendency toward undefined terms. For example, "liberal professions" in a context where the meaning cannot be a reference to political orientation, "Oxbridge" as a way of referring to the two seminal universities in England and a failure to define "capitalism," requiring me at the outset of this review to provide my own, "a political system characterized by private ownership of the means of work and control of the distribution of i ts product, employment of workers and the consequent accrual of privately owned profit from that ownership. In other words, a system in which the workers do not own the workplace and do not control the conditions of work or of the market in which the work is sold."

Central to this work is Krause’s notion that the professions are the last remnants of medieval guilds, and Krause does include an important history and analysis of the guilds as social institutions. As political institutions developing in the twelfth c entury, guilds represented a challenge to hierarchical authority. They represented an association of equals (a universitas in Medieval Latin) characterized by self-government in contrast to the hierarchical rule of princes and feudal lords legitimi zed by the church. These were groups whose crafts involved "mysteries" or arcane knowledge. Four elements were crucial to guild power: control over who could become and remain a craftsman, control over the workplace (the means and pace of production), con trol over the market (having a monopoly of the product and being able to set its price) and control over the state, at least insofar as being able to wring from the state its gatekeeping and market powers. As guilds developed through the sixteenth century , their increasingly elitist nature opened the door to abuses: exploitation of journeymen whose master’s status was infinitely deferred, restricting production and inflating prices beyond the point of tolerance for the community. These abuses in turn enco uraged increasing restrictions on guild powers be states increasingly committed to free market ideology and capitalism.

Thus the big picture. Krause develops it in considerable detail in modern times by looking at four professions: medicine, law, engineering and the professoriate in five countries: the United States, Britain, France, Italy and Germany during the period from 1930 to 1990. The vicissitudes of each of the professions studied is a function of the structure of the profession and its relation to the state and to capitalism over time. Krause characterizes the United States as a state in which capitalism is dom inant and hence the professions most pressured in a specific way. He describes Britain as a state dominated by social class and a commitment to amateurism (the notion that superior men of general ability are preferable to technicians). France is seen as a highly centrist state with professions that serve it. Italy as a state in which everything, including the professions, is a function of political party. Germany, finally, represents a state in which the aftermath of two world wars includes a highly regio nalized state system in which the loss of guild power by the professions has been slowed.

Krause’s analysis goes country by country, examining each of the relevant professions in turn during the period of study. I will but sample his work (and reverse his procedure), looking at two professions, medicine and the professoriate, in two countri es, the United States and Britain.

Krause characterizes the course of the medical profession in the United States from 1930-90 as "the fall of a giant." When Roosevelt took office, American medicine was consolidating control of medical training by the American Medical Association under university auspices. The system of freestanding medical schools and/or apprenticeship training of physicians were replaced by a system of university related medical schools and internship and residency programs. Roosevelt’s plans for national health insur ance, attacked by the AMA as socialized medicine, were soundly defeated and replaced by voluntary insurance plans favorable to fee for service practice. Even though the health status of World War II draftees spoke to the inadequacies of the health care sy stem and even though military service provided evidence of the advantages of "socialized" care, the AMA continued to dominate politically, establishing, in fact, hegemony over other health professions by supporting their quasi-professional status in state licensing laws on the condition of medical supervision. In this period, then, medicine controlled the educational programs that were the gateway to the profession; they controlled the workplace and the market, setting their fees, deciding their activitie s and maintaining control of hospital operations, and enjoying unchallenged power politically. These halcyon days came to an end when an increasingly liberal state in the Kennedy-Johnson years passed Medicare/Medicaid legislation that effectively and abru ptly ended charity medicine and led to explosive increases in the cost of medical care for the old and the poor. The eruptive increase in health care costs mobilized American capitalism, footing the bill for much health insurance, to look to a variety of solutions, all of which involved sharp restrictions on fee for service medicine and physician control of the workplace and the market. At the same time, medical school dependence upon government grants for training and research and the pressure to deal wi th physician undersupply lead to failure of the AMA’s policy of keeping the supply of physicians fairly constant (130:100,000); between 1960 and 1990 that ration more than doubled. The AMA’s membership has dwindled as have fee for service practice and med icine’s control over the workplace and the market. By 1990 over half of the physicians were salaried, and most current medical students anticipate such positions, where bottom lines are at least as likely to determine practice and procedures as profession al standards.

In Britain, social class is a critical factor in all professions, including medicine, and a primary determinant of social class is a generalist education at Oxford or Cambridge following preparatory schooling at one of the elite schools: Eton, Harrow, etc. Early in the nineteenth century, these universities were primarily finishing schools for the gentry or training grounds for the ministry. By the middle of that century the pressures of capitalism and the need to manage an empire led to a reform of th ese universities and of the preparatory schools intended to produce a well educated leadership elite that would acquire further experience in the professions or in government…well educated amateurs. Physicians were not and are not trained in the universit ies but in hospital programs. The social class oriented model permeated the British medical hierarchy of physician, surgeon and apothecary. In the early nineteenth century, most physicians were the sons (often second sons) of landed gentry who, after an O xford or Cambridge undergraduate degree, took medical training in a hospital and then were accepted into the Royal College of Physicians on the basis of their social connections. Most surgeons were not university graduates, but took their training as appr entices of other surgeons, taking some concurrent hospital classes. Apothecaries trained almost entirely by apprenticeship. Only physicians were gentlemen and did well financially; many surgeons took joint training as apothecaries. The General Medical Act of the mid century was intended to unify the medical profession, but not to shake the grip of social class. In the context of the development of the modern hospital, Oxford and Cambridge graduates would become, after their training hospital specialists ( mostly in London), anticipate a good income and be accepted into their Royal Societies. General practitioners from the working class would practice in the provinces, and have relatively low status and incomes. The development of health insurance in the ea rly twentieth century and Lloyd George and the Liberal party began to provide for health care for the less wealthy and slowly increasing income for the general practitioners that treated them. World War II and the concomitant National Health Service were a massive turning point. In the United States, the war brought socialized health care only to the military; in Britain it was extended to the entire country. For the first time specialists who previously would practice in elite London hospitals were detai led to the provinces where they experienced first hand the inequities in equipment and services. A broad consensus emerged that nationalized health care would continue after the war, but given the context of social class, the conditions of that continuati on were negotiated with the specialist elite in the Royal Colleges, not with the general practitioners represented by the British Medical Association. After the war, the specialists continued on salaried hospital positions, at much higher salaries and sup plemented by the option of an auxiliary fee for service practice. General practitioners treated outpatient panels at far lower rates, but with assured income. Initially, the government covered all costs, but increasing costs resulted in a combination of a co-payment for some services and a rationing of others. Although the very poor, therefore, did not use the service at the same rate as the working class and the wealthy, the system was and remains very popular with the public. In the last two to three de cades the central government has established increasing control over the profession and over the hospitals in which medical training occurs. Under Thatcher, as part of the Conservative attempt to disestablish the welfare state, private insurance and for p rofit medicine has been encouraged and now covers perhaps 10% of the wealthiest. In sum, the British medical profession remains class divided and is increasingly subject to state control of practice and of entry into the profession.

Understandably, the situation of the professoriate is intertwined with the history of the university and of the guilds. The medieval universitas was a body of peers, craftsmen, controlling entry into their group, the conditions of work and with a monopoly over their products permitting control of the market. Of the medieval guilds, the professoriate has, at least until recently, retained more vestiges of these essentials of guild power, at least until recently. The early university was not, as w e think of it today, a collection of buildings, it was a collection of people, masters and their students, in rented space and with a universal language, Latin. Their mobility gave them power in their dealings with the towns; for example, when, in the thi rteenth century, the government and the church in Paris failed to make sufficient concessions to the university, many left for Cambridge and Oxford where they helped to turn little collections of church schools in to Parisian scholar’s guilds, some to ret urn to France a few years later with their guild’s power clearly spelled out. Though student guilds early had some power, notably in Italy, in most areas masters were in control from the start with the student in an apprentice status. Achieving master sta tus was a matter of satisfying a committee in an oral defense of a thesis at an open meeting at which grocers and shoemakers, along with the masters, asked questions. This pattern remains in place today, albeit in vestigial form and minus the grocers and shoemakers. In Britain, Oxford and Cambridge, in part as a result of the migration of the academics from Paris described above, became preeminent early, in that class divided society, primarily as a finishing school for the gentry and a training ground fo r ministers. Pressured by the demands of capitalism and the need for an efficient beaurocracy to run an empire, the young ministers awaiting assignment to a church that served as tutors in the early nineteenth century were replaced by dons, professional s cholars, and serious academic standards instituted, a development which, in turn, occasioned a reform of the preparatory schools. The higher education system in Britain by the first part of the twentieth century came to consist of Oxford and Cambridge, wh ere the elite went for a liberal arts education, the polytechnics, "Redbricks," where the children of working class got an education for engineering careers, and apprenticeship training for barristers, counselors and hospital based or apprenticeship train ing for physicians, surgeons and apothecaries. Thus, the university system is bifurcated; Oxford and Cambridge on the one hand, London University and the other municipals (founded at the end of the nineteenth century) and the polytechnics on the other. Ox ford and Cambridge are seen as clearly of higher status; nearly half of all academics in Britain have taught or studied there, and almost all regard them as the institutions of choice. At Oxford and Cambridge, professors are attached as fellows to largely independent colleges; at London and the Redbricks, the model is more hierarchical, with each department having a professor controlling research and running the department, supported by a group of readers and lecturers. In recent years, Oxford and Cambrid ge have been moving more toward a departmental model, but not nearly so much as the others; even today, as in a guild, each fellow has a vote. Until the war, the central government played a minimal role. Oxford and Cambridge had their endowments and the m unicipals were supported by their communities. There was a University Grants Committee that received a sum from the treasury yearly and distributed it among the university, but awards were small.

After World War II, the professoriate began to grow rapidly, from 3000 in 1920 to 15000 in 1960, doubling again to 30000 in the next decade. The explosive growth was due to the post war liberal philosophy, embodied, for education, in the Robbins plan o f the mid-sixties. What was envisioned was not a mass-education oriented, United States style G. I. Bill, but a vast expansion of the elite Oxford Cambridge style system: a tutorial system with a student-faculty ratio of 8:1, a short school year, opportun ities for all professors to do research, tenure after a three year probationary period and generally excellent working conditions. Eight new universities on the model of Oxford and Cambridge were built and a major expansion of the municipals undertaken. T here were full tuition scholarships for any student achieving well on the national entrance examination. Funding from the University Grants Committee became the major source of income, and faculty salaries were arbitrated across the system. Increasing cos ts and increasing oversight by the government, coupled by political reaction to student protests in the late sixties led to a gradual scaling back of projected plans. In the seventies, as the top tier of universities began to be unable to handle demand fo r admissions, students and public support began to flow toward the second tier. The Redbricks, originally established for vocational and technical training, began to take students interested in the arts and social sciences.

The conservative Thatcher government of the eighties concluded that slower growth of the academy was not sufficient; what was necessary was reduction in size…on the order of 10-15%. Not only did the government make highly differential cuts to the vario us universities, but cuts were directed to specific subject areas, especially social sciences and the arts, with favoritism extended to hot areas like cell biology, computer science and information technology. And academic tenure was ended for anyone not having it. Only Oxford and Cambridge, with their private endowments, were spared, and Britain has seen an exodus of academics to Australia and the United States. In sum, the guild power of the professoriate in Britain, except for the island of Oxbridge, h as virtually evaporated, to be replaced by governmental management, and the system that remains exemplifies and educational system that continues the socially stratified British system rather than facilitating social mobility.

The situation of the professoriate in the United States is perhaps both better known to us and of more immediate concern. Reading Krause does provide some important insights, even for the insider, as it were. More than most occupational groups, and mor e than the professoriate in most other countries, professors in the United States live in two worlds: that of the campus at which they are employed and that of the discipline in which they were trained, as represented by learned societies or professional groups at which research is presented and reputations established. In addition to national meetings, these groups usually publish refereed journals in which research is published. The publication and the presentation of research are the primary means of b uilding an academic reputation and of securing advancement in the field. There is one organization, the American Association of University Professors, founded in 1915, which purports to represent academics across disciplines and which has been active in e stablishing the principle of academic tenure and advocating for faculty involvement in the governance of universities. The AAUP has been relatively successful, but has tended to collapse in the face of political pressure. It was notably to stand by while individual professors were denied employment during the McCarthy era.

Neither the disciplinary groups nor the AAUP enroll a majority of academics. Professors are not licensed and do not need to belong to such organizations to teach. However, the Ph.D. degree is virtually a requirement for being hired everywhere but at a two-year community college, and in the manner of medieval guilds, the degree is awarded to only about half of the apprentices seeking it. Over the years the professoriate in the United States has been growing and becoming more specialized, especially beca use vocational training that in other countries might take place in vocational schools or by apprenticeship is increasingly a university function, leading to the replacement of the university by what Clark Kerr called the multiversity. As remarked above, entry into the profession is relatively in the hands of committees awarding the doctoral degree. On the other hand, budget decisions and the impact of those decisions on educational policies, are increasingly in the hands of an administrative elite, thems elves constrained by budgetary pressures consequent upon a public resistance to tax increases, and an educational system increasingly dependant upon tax support. The most general consequence has been an increasing reliance on part-time and non-tenure trac k faculty; in percentage terms, the growth has been from 22% in 1960 to 32% in 1980. There has been a growth of an academic proletariat, academic gypsies, doctoral degree in hand, but unable to secure a tenure track position, hanging on in a series of pie ce work positions. After a few years, such a person is cruelly typed and not likely to compete successfully for a position against a newly graduated person. In consequence of the growing interest in part-time faculty and the erosion of full time slots, jo b security has become problematic. Fully 28% of the part-time faculty in 1995 were formerly full time at institutions that did not keep them, leading some to say that the old maxim, "publish or perish" should be revised to "publish and perish." In additio n, there has been a general deterioration of the workplace, with amenities such as research support, summer teaching, travel funds and secretarial support becoming scarcer. In other words, in the United States as in Britain and the other countries studied (least perhaps for Italy) the professoriate, the last vestige of the guild, has experienced increasing lack of control over who teaches and under what circumstances. The degree of control over what gets taught is an issue to which Krause does not address himself. He does point to the unsettling congruence in the United States professoriate of an underclass of perennial journeymen and apprentices supporting the perks of a shrinking overclass of "real" professors that presaged the collapse of many of the c raft guilds.

In sum, Krause sees the professions of medicine, law, the professoriate, and to a much lesser extent, engineering as the last vestiges of the medieval guilds. He sees their guild powers, control over entry into the guild, control over the workplace, an d control over the marketplace, eroding in different ways, because of different histories and social contexts, in the face of more centralized government and the advances of capitalism. He predicts that the globalization of politics and business will acce lerate the trend. While he tries to claim an air of Veblenian detachment, his implicit concerns are clear. Whatever the role that self-interest played in the development of guilds, principles of workmanship, artistry and the public good were also importan t. And these principles are hard pressed by the focus on profit of an unremitting commitment to capitalism.