BOOK REVIEW

The Future of the Professions

How Technology Will Transform the Work of Human Experts

Oxford University Press, 2017

Richard Susskind and Daniel Susskind

 

Reviewed by Johny Van Aerde

 

This book provides a descriptive, predictive, and normative account of why our professional institutions, including health care and medicine, will not and should not endure in their current state. Although it addresses all professions (health, education, clergy, law, architecture, and a few others), they share similarities, and one section addresses health and physicians specifically.

 

The Susskinds, father and son lawyer/academics, argue that professions have earned a privileged position in society, a mandate for control in their fields of specialization. In essence, the professions operate under a type of social contract: they are the gatekeepers of specialized knowledge and expertise, they are allowed to self-regulate their activities, and we place our trust in them to advise and help us.

 

This social contract has many drawbacks: the professions are notoriously conservative and reluctant to change, and they have become antiquated, opaque, and unaffordable. Until recently, there was no better system, but soon technology will allow alternatives. It is these alternatives, some of which exist already, that the book explores.

 

The authors challenge the social contract and they propose seven possible new models for producing and distributing expertise in society: Top

 

  • The traditional model is familiar to most doctors, as it is the way we currently deliver our services. That is, human professional providers undertake their work, usually by way of real time, face-to-face interaction, and are rewarded according to the amount of time spent. They use technology for greater efficiencies to streamline and optimize traditional tasks and work.
  • The networked experts model also involves professional human providers, but they cluster, more or less informally, via online virtual teams rather than physical organizations. They offer multidisciplinary services.
  • The para-professional model is similar to the traditional model in that services are provided by way of consultation, one human being with another. However, the provider here is not a specialist, but rather a person with more rudimentary training in a discipline. These para-professionals are supported by procedures and systems that allow them to do some parts of the work historically done by an expert.
  • In the knowledge engineering model, knowledge in a given area of expertise is incorporated into systems made available to less expert or lay people as an online self-help service.
  • In the communities of experience model, evolving bodies of practical expertise are crowd-sourced, that is, built-up through the contributions of past recipients of professional services or of non-experts who have managed to sort out problems for themselves. Wikipedia operates in this manner.
  • The embedded knowledge model involves the distillation of practical expertise into some form that can be built into machines, systems, processes, work practices, or physical objects. For example, digital personal monitoring systems, worn as watches or woven into one’s clothing, feed physiological data into a central processing system that provides feedback about normal limits, abnormalities, and pending risk.
  • In the machine-generated model, practical expertise originates in machines, not humans. Although the machine-generated model will involve big data, artificial intelligence, and technologies yet to be invented, it remains to be seen how this content will be used or distributed

 

No doubt some physicians will find doom and gloom in these predictions. Although the authors see a steady decline in the demand for human professionals in the long term, they think a great deal of work has to be done by humans in the near term. And although machines will take over some tasks, there will be new tasks and physicians will have to think about the future of the professions from the point of view of the recipients of professional work, i.e., the patients. Top

 

Skeptics will say that some tasks can only be done by humans. The authors argue that routine tasks, even extremely complex ones, can be done by rules-based machines, and, although physicians like to think otherwise, much of what they do is fairly routine. Do the benefits of mechanization (e.g., increased access) outweigh the loss of craft, the preference for human interaction, and the need for empathy. The authors argue that the benefits probably do outweigh any single one of these costs.

 

This book is recommended reading because society, professionals, and physicians, in particular, are operating with limited vision and flawed assumptions about the future of professional work. You might disagree, but the Susskinds are correct when they caution us not to let our mental models from the last few centuries limit our thoughts as to what might come to be. We might as well be prepared and participate in the coming revolution.

 

Author

Johny Van Aerde, MD, MA, PhD, FRCPC, is editor-in-chief of the Canadian Journal of Physician Leadership and a former president of the Canadian Society of Physician Leaders. Top

 

Correspondence to:

johny.vanaerde@gmail.com

This book provides a descriptive, predictive, and normative account of why our professional institutions, including health care and medicine, will not and should not endure in their current state. Although it addresses all professions (health, education, clergy, law, architecture, and a few others), they share similarities, and one section addresses health and physicians specifically.