Gongol.com Archives: September 2023

Brian Gongol

September 23, 2023

The Federal Trade Commission is going after a Texas chain of anesthesia providers and a private-equity investment firm that has a big ownership stake in it. The government alleges that the company "engaged in a three-part strategy to consolidate and monopolize the anesthesiology market in Texas". The case ought to be prosecuted in court, but the allegations sound like far less than what society ought to expect from its physicians. ■ We really have to reconcile ourselves with the definition of "professional". To really be a profession, a line of work needs to recognize that it holds a special kind of power (usually vital knowledge or expertise) over its clients, and that the asymmetry of the relationship requires a binding code of conduct to keep bad actors out. ■ In some (though not all) professions, there's an additional legal step -- certification or licensure that specifically excludes others from representing themselves as being comparable professionals. Of course, those licenses themselves require a lot of self-policing, which is why a state board of medicine is usually filled by doctors. (Likewise for engineers, attorneys, and accountants.) ■ Regulatory licensure inevitably excludes people who wish to perform the work, which constrains supply. This, in turn, raises the amount that the professionals can charge. This market force has to be counteracted by a certain moral expectation: If you're in a line of work that we reserve by law only for some people, then you must not use that power to exploit others for your own enrichment. ■ If your work contains some kind of code of conduct, that's a pretty good step towards being a profession. The code implies that you're going to make choices that may not benefit you personally, because they're right thing to do for the client. The idea of making "professional" choices on behalf of a client is an acknowledgment that there's a principal-agent problem in place: Only one of you has sufficient knowledge about what's best, and it's not the person paying for the services. ■ The designation of "professional" comes with a certain amount of social standing: We, the public, owe you, the professional, some gratitude. You're sacrificing some potential income that you could squeeze out of us, in exchange for the authority to make important decisions for others. Respect goes with that. ■ That definition of professionalism seems patently incompatible with arm's-length ownership. If you're not the professional delivering the service (or immediately adjacent to them), then you probably shouldn't be pulling home the profits from the work. A professional needs to be able to resist some temptation to make a marginal dollar of income from an unwitting client. ■ Professionalism is an extremely important concept to preserve within a market economy. A small but meaningful step towards that preservation might be to stop slapping the word "professional" on work that isn't a code-bound profession. If you play sports for money, you're not really a "professional" -- you're an elite athlete. If you make beautiful art, you may be an eminent artist -- but it's not a profession. And there are many ways to be a good and honorable person in sales, but "sales professional" is a paradoxical title. ■ If your job doesn't require you to profess a code of honorable and self-sacrificial behavior, then you're not really a "professional". You can still be good and decent, and you should be! But for the sake of society, if you're out to optimize your own profits, then you shouldn't demand to be respected as a professional. And if you insist on being respected as a professional, then you shouldn't demand to optimize your own profits. ■ Good people can do either thing, but the act of maximizing returns (which is the kind of thing private equity investors do, almost by definition) isn't consistent with what medical professionals are expected (and generally bound by law) to do. The FTC may or may not be right about the facts and the law in this case; that's why it should go through a judicial process. But the spirit of the case highlights why words matter, and why "professional" shouldn't be the kind of title we just give away.

Feedback link