Abstract
Over the past few years several new occupations have been introduced in health care next to those of vested professionals. In this chapter we analyze the introduction and development of the physician assistant (PA) as one of them. A PA is an allied professional or nurse who has obtained additional university training and who is allowed to work independently in health care practice, conducting certain medical procedures. The central question this chapter addresses is: ‘How do new professionals craft their job by carving out a place in health care practice?’ To explore this topic we build on the theoretical notions of place (Creswell, Place: a short introduction. Blackwell, 2004) and job crafting (Wrzesniewski and Dutton, Acad Manag Rev 26(2):179–201, 2001). Data comes from two case studies; one in emergency care and one in neonatology. Through ethnographic research we analyze how new professionals continuously develop their job and how this changes their place in everyday health care practice. Our results show that increasing experience, developed routines, specialization and trust among the medical and nursing staff enables PAs to gradually expand their occupational place, highlighting the fluidity of its boundaries. PAs do not only create and occupy their place; they add specific meanings to it and in the process create both individually and collectively a new work identity for the PA as an occupation.
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Notes
- 1.
In the UK, the term physician assistant was replaced by physicians’ associate. Yet, the tasks and responsibilities of a Dutch PA are quite similar to that of the physician associate in the UK. A PA in the Netherlands does however bear more clinical responsibility and autonomy than a PA in Germany, which also illustrates the situated nature of the development of a new occupation (Wallenburg et al. 2014b).
- 2.
A job is by Ilgen and Hollenbeck (1992) defined as: “a set of task elements grouped together under one job-title and designed to be performed by a single individual” and described by Dubois and Singh (2009) as loosely coupled elements of education, training, skills, knowledge, experience, competences, tasks and responsibilities.
- 3.
These interactions are visible in the building block of relations that individuals craft as the work itself is dependent on interactional alignments. In the respective actions of arrangements of people, this form of interaction is important (Blumer 1969).
- 4.
In 2012 around 600 PAs were either trained as or were already working as a PA in health care practice in the Netherlands (personal communication, manager the Netherlands Association of Physician Assistants, Oct. 2014).
- 5.
In this broader research project on new professional roles good examples of task reallocation in the Netherlands were analyzed in nine different case studies. The research focused on the Physician Assistant and the Nurse Specialist as new occupations (Wallenburg et al. 2014b).
- 6.
Observations and interviews were conducted by the first author between October 2013 and February 2014.
- 7.
Observations and interviews were conducted by research assistants under supervision of the authors between April and June 2014.
- 8.
This was also found in other research (Wallenburg et al. 2014b). This finding implies that PAs are not automatically introduced and embedded in health care practices. Work of individuals and trust between professionals is required for this to happen. It shows that it is important who the first new professionals at a specific department are and supports our argument about the need to carve out a place.
- 9.
In this chapter job crafting is analysed from the perspective of the PA. As a consequence we analyse how PAs themselves attach meaning to and make sense of their work and occupational identity, we did not directly analyzed how others see the identity of the PA.
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Janssen, M., Wallenburg, I., de Bont, A. (2016). Carving Out a Place for New Health Care Occupations: An Ethnographic Study into Job Crafting. In: Albach, H., Meffert, H., Pinkwart, A., Reichwald, R., von Eiff, W. (eds) Boundaryless Hospital. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49012-9_7
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