Reimagining U.S. medicine's professionalism movement: institutional professionalism and medicine's collective identity crisis

U.S. medicine's modern-day professionalism movement is approaching its third decade. Within this movement and across a broad array of initiatives, medicine has recast issues of professionalism from a more macro-level and sociological focus on the profession to a more micro-level and individual-oriented focus on professionals. In this commentary, the authors adopt a historical lens and briefly outline the movement to date before recommending a shift from professionalism's current focus on the individual to a more macro- and institutional-level framing. In doing so, the authors seek to redirect the focus of prevailing professionalism discussions from professionals to the profession as they argue for a more sociological emphasis on the issue of medical work and its control as opposed to an emphasis on the values, motives, behaviors, and competencies of individual physicians and trainees. To better respond to contemporary professionalism challenges, the authors introduce a new concept-institutional professionalism-and identify 3 foci in arguing for placing a greater emphasis on the profession rather than the individual: (1) semantics, (2) theory (including the deployment of sociological constructs such as organizational fields and institutional logics), and (3) a more layered micro- (individual), meso- (organizational), and macro-level (institutional) understanding of medical work. The authors argue that professionalism, as the countervailing logic to those of managerialism and commercialism, will cease to functionally exist unless medicine responds in a more collective and institutional-level fashion to current encroachments on its work. A failure to do so will leave behind a conceptually isolated and hollowed-out profession that retains the language of professionalism while losing the institutional conditions needed to support it.