On the margins of the system of professions: Entrepreneurialism and professionalism as forces upon and within chiropractic.

摘要

The profession of chiropractic is beset with conflicting images: a physician (as defined in many state statutes) but one who unglamorously "cracks backs." Chiropractic's history is characterized by tension between two opposite orientations: professionalism (prototype: medical physician) versus entrepreneurialism (prototype: businessman). This research traces the evolution of chiropractic and how its jurisdictional claim of expertise was shaped by myriad forces: macro social trends, interrelationships with other practitioners, strategies formulated from within chiropractic, as well as previous decisions that came to limit the availability of options.;Relying on historical methodology, I describe three "episodes" of chiropractic. Like a pendulum, chiropractic initially pursued an entrepreneurial orientation in period one (1895--1961) and repudiated anything professional or medical. With the culmination of social and interprofessional pressures, chiropractic reversed its trajectory, and pursued a professionalization process in the second period of history (1961--1992). But, as quickly as professionalism was attained, the health care environment and chiropractic's role within it was altered leading eventually to the re-emergence of entrepreneurialism (1992--present). Each period of history involved ongoing attention to the specific claims being made about work and expertise in order to fit into the perceived exigencies and requirements of the health care system. While the existing literature tends to focus on more mainstream actors (physicians, hospitals) this research demonstrates that studying a profession on the margins of health care sheds new light upon the social forces (entrepreneurialism and professionalism) affecting occupations and the strategies devised to adapt to such challenges.