Evolving Professions: Navigating Change in the Contemporary World

The dissertation is situated in a context in which professional work is being reshaped by technological innovation, changing care models, organizational fragmentation, shifting public expectations, and a broader crisis of traditional expertise. In healthcare in particular, these pressures make professional boundaries more permeable, destabilize established jurisdictions, and increase the need for forms of work that are more adaptive, relational, and collaborative. Recent scholarship has responded by moving away from a view of expertise as a stable body of abstract knowledge possessed by a profession, and toward a relational understanding in which expertise is accomplished through interactions among professionals, clients, organizations, devices, and institutional arrangements. Yet, despite the growing recognition that expertise is relational and increasingly contested, we still know relatively little about how professional actors construct identity, enact expertise, and sustain collaboration under these changing conditions. It is precisely this gap that the dissertation addresses by examining these three dimensions as interconnected aspects of contemporary professional work. The overall aim of the thesis is therefore to contribute to the sociology of professions and expertise through three research questions: how professional identity work in emerging healthcare professions is currently understood and what conceptual gaps remain; what happens to the relational construction of expertise when professionals and patients cannot directly communicate with one another; and what individual motivational factors incentivize public service professionals to collaborate in teams. The first chapter addresses the question of identity through a conceptual review of emerging healthcare professions. It argues that collective professional identity in these settings is shaped by four strategic dilemmas concerning stability, coordination, positioning, and control. The chapter shows that identity work in emerging professions is not merely a matter of self-definition, but a cognitive and political process through which actors must negotiate internal diversity while also seeking legitimacy from external audiences. In doing so, it highlights a set of unresolved problems in the literature, especially regarding the recursive relation between identity and practice, the role of occupational communities, temporality and failure, and the place of materiality in identity formation. The second chapter turns to expertise and examines how it is enacted when professional–patient communication is impaired. It develops an ethnographic analysis of mediated healthcare encounters and shows that incommunicability does not simply block expertise, but can reconfigure it. The chapter introduces the concept of relational opening to explain how expertise is reassembled through learning, relating, and contextualizing. Its central contribution is to extend relational accounts of expertise beyond cases involving influential or highly knowledgeable clients, showing instead how expertise is relationally accomplished when communication itself is obstructed and professionals must rely on distributed cognitive, emotional, and contextual resources. The third chapter examines the individual factors of multi-professional collaboration. More specifically, it investigates the motivational drivers that shape public service professionals’ willingness to collaborate in teams, while also considering how team composition and contextual conditions affect those preferences. The chapter shows that collaboration is more attractive when team activities are engaging, publicly recognized, and perceived as beneficial to a broad set of beneficiaries. At the same time, it finds that collaborative motivation is not sufficient on its own because it can be weakened by organizational fragmentation, rigid procedures, resistance to change, and broader systemic constraints. In this way, the chapter brings a micro-level perspective to the study of multi-professional collaboration by showing that collaborative action depends not only on structures and formal arrangements, but also on the motivational orientations of professionals themselves. Overall, the dissertation contributes to the sociology of professions and expertise by showing that contemporary professional change must be understood at the intersection of identity work, relationally enacted expertise, and the individual motivational foundations of collaboration.