The Paradox of Professional Prestige, Purity, and Publicity
Prestige Assignment in Professional Contexts
Reading Length: 13 Minutes
Keywords: Sociology
When considering the fame and notoriety of professional workers, an interesting disparity comes to the fore. Frequently it is just those professionals admired by the public that are disparaged by those professionals’ peers. Contrariwise, professionals admired by their peers often lack public respect and admiration.
The sociologist Andrew Abbott noticed this contradiction in 1981 and titled a paper ‘Status and Strain in the Professions’ to explore the paradox. In Abbott's terminology, there is an intra- and interprofessional difference in the assignment of prestige to professionals. Intraprofessional prestige would be how much you are admired by your peers, while interprofessional prestige would be how much the public at large considers you to be prestigious.
In Abbott’s words:
A paradox confronts the student of relative status within the professions. Publicly venerated professional roles are often those least respected by professionals themselves.
Abbott goes on to list some examples, although they have become a bit dated 40 years later. The modern reader can consider the disparity between Dr. Oz, a wildly successful media personality, and Dr. Fauci, a physician-science researcher and bureaucrat.
Dr. Oz was the star of a TV show in which he advised viewers on maladies and offered products to them. It is estimated that Dr. Oz made $20 million in a yearly salary for the show, and he publicly reported that his wealth was in excess of $100 million.1 Clearly the public admires Dr. Oz and buys medical products on the strength of his reputation.
On the other hand, Dr. Oz has earned the ire of his peers. Medical researchers have called for Dr. Oz to no longer use the honorific title of doctor, and a group of licensed doctors started a campaign called ‘Real Doctors Against Oz’ to draw attention to his alleged illegitimacy.2
It is interesting to note that Dr. Oz had considerable intraprofessional prestige from his peers before starting his media career:
Marcelle Shapiro, from the University of Pennsylvania's Perelman School of Medicine, noted that Oz was once respected as a renowned cardiothoracic surgeon before he became a celebrity physician on daytime TV.3
In contrast, Dr. Fauci became one of the most politically charged and hated figures in America after being assigned to the COVID task force by President Trump. Prior to his public service, Fauci was one of the most cited medical researchers in the world.4 He had been awarded the highest honor possible by the Association of American Physicians in 2007.5
After recommending the use of masks and other precautionary COVID measures, Fauci was lampooned by skeptics and faced death threats by the American public.6 Although Fauci remains a public enemy to many Americans, he has largely maintained his reputation and prestige among his peers.7 It is true that many medical professionals have cast doubt on the precautions urged by Fauci, but there have been no intraprofessional campaigns urging Dr. Fauci to hang up his medical license, as there have been with Oz.
While the disparity between Oz and Fauci neatly captures the ‘status and strain in the professions’, these two individuals have been highly politicized, and this need not be the case for the paradox at hand. Let’s consider another example in the realm of law.
The public’s stereotypical image of a lawyer is a personal injury lawyer. These law firms pepper highways with their faces and buy expensive TV ad slots to advertise their services. These lawyers sometimes are slandered as ‘ambulance chasers’, but they are assigned high interprofessional prestige by the public in the sense that they symbolically hold the place of the ‘high-paid lawyer’.
Intraprofessionally, personal injury lawyers are considered to be less prestigious than white-shoed Wall Street law firms, federal justices, or even public interest lawyers that represent organizations like ACLU.8
Even in a profession like cooking, the paradox arises.
Ina Garten is an autodidact (self-taught) chef that is revered by the American public. Her TV show Barefoot Contessa regularly captures a million viewers per episode, and her many cookbooks are bestsellers. Ina Garten clearly has interprofessional prestige, but her intraprofessional prestige pales in comparison to say, a Michelin star chef that would be little-known by the broader public. Joël Robuchon, for example, has 32 Michelin stars but his notoriety is nowhere near Ina’s.
This is not to say there are not exceptions to the paradox. The famous chef Gordon Ramsay held 7 Michelin stars and was also a renowned media personality, evincing both intra and interprofessional prestige.
Another exception would be the physicist Richard Feynman, who received the Nobel Prize for work in quantum electrodynamics and wrote many books on science for popular audiences.
Not Just Famous People
When Abbott refers to publicity in his paper, he does not mean just fame but rather engagement with the public. His paradigmatic example is in the medical profession, where general physicians that engage with the public as a course of business are considered less prestigious than specialty surgeons or theoretical researchers. In finance, wealth advisors that serve clients directly are less prestigious than stock analysts and investors that are abstracted from the advisory process. The accountant that works directly with individuals as a tax advisor or bookkeeper is less prestigious than a corporate accountant at a large firm that never engages with the public.
Even within the same professional role, public-facing work is considered less prestigious. This is most obvious in academia, where teaching and doing public-facing work like writing popular papers and going on podcasts is less valuable than direct research that bestows respect and promotions on professors.
Searching for a Causal Theory
Abbott’s paradox is interesting because it seemingly upends other theories of intraprofessional status. One could presume that income is linked to prestige, so that the higher compensated professional role is also higher paying. But after surveying the empirical evidence, Abbott does not find this to be a satisfactory explanation:
English barristers have often earned no more than solicitors, yet nearly always enjoy higher status (Abel-Smith and Stevens 1967). Employed professionals in general have lower status than free-lance and associated professionals with comparable incomes. Within a given profession, academic professionals receive salaries notoriously incommensurate with their high status. Also, interacting professionals often establish status relations without knowing each others' income.
From our own examples, it is plain that high-powered personal injury lawyers are very well compensated, and likely outearn their more prestigious peers at ‘Big Law’ firms. Ina Garten, through her cookshow and cooking books, does not suffer from lower compensation despite her low intraprofessional prestige.
After discarding income as an explanation, one could think that raw power itself confers prestige. But again this fails to pass muster in Abbott’s eyes:
…while the urban district attorney lacks a judge's status, for example, his effective power is often considerably greater. Administrative physicians similarly increase their power while losing status. Domination of professional associations is only loosely associated with status…Even within professional work groups, positions of power-man- aging partnerships, department chairs-are hardly regarded as status conferring, but as the reverse.
Abbott goes so far as to claim that not only is power not predictive of prestige, but it can be negatively correlated so that those with more power have less prestige. Abbott also rules out other theories, such as the status of the clients of the professions and the non-routine nature of work that professionals must do.
Ruling out all these explanations, Abbott turns to his own novel theory.
Professional Purity
Abbott lands on a strange theory that at first seems to be a paradox underlying the professional publicity paradox itself. If income, power, mundanity of work, and other explanations don’t cause professional prestige, what does? Professional purity.
Intraprofessional status is in reality a function of professional purity. By professional purity I mean the ability to exclude nonprofessional issues or irrelevant professional issues from practice.
Why is it that high-prestige professionals can exclude impure issues?
Within a given profession, the highest status professionals are those who deal with issues predigested and predefined by a number of colleagues. These colleagues have removed human complexity and difficulty to leave a problem at least professionally defined, although possibly still very difficult to solve. Conversely, the lowest status professionals are those who deal with problems from which the human complexities are not or cannot be removed.
To make sense of this, let’s consider some examples from the professions. While surgery is a highly difficult and complex task, the issue at hand is itself relatively simple: an operation must be performed in a certain manner. Certain contingencies will no doubt arise during the surgery, but any impure issues have de facto been ruled out, otherwise the surgery would not have been approved in the first place.
The cardiologist does not worry about liver problems; the internist has defined the patient into specialized terms for him. Such successive purification is, in fact, the norm of professional life. The intern prepares the body, the resident opens it, the cardiac surgeon works with the heart alone
Now compare the surgeon to the lower-prestige psychiatrist or therapist, who must grapple with impure issues such as to what degree mental illness actually exists, has arisen because of personal or societal reasons, and what if any treatments will be efficacious. Impure issues are inexorably caught up in their practice and can only be purified away in the most extreme cases, whereupon the case will be passed up to a higher-prestige specialist.
Similarly, lawyers value professional purity and have created their own legal systems to ensure such purity:
The corporation is the lawyers' creation. The muck of feelings and will is omitted from it ab initio. Where feelings are highest and clients most legally irrational - in divorce - intraprofessional status is lowest.
The corporate lawyer does not have to deal with impure, extraprofessional issues because such issues have been intentionally abstracted away with legal entities.
Publicity and Purity
The purity theory explains why publicity is negatively linked to prestige:
The professional who enters the emergency room, the criminal court, the receiving ward, the client's home, is professionally defiled. Such defilement may follow from issues that professionals of other kinds might handle. But the act of extricating one's own particular set of problems is professionally defiling, precisely because the interwoven complexity of social life always threatens any specific set of professional judgments.
Engaging with the public is difficult because extraprofessional issues have not been ruled out or tidied up. The ‘complexity of social life’ rears its head and threatens the security of the professional to adequately perform their work. The divorce lawyer must contend with the messiness of people’s private lives, while a corporate lawyer can focus on more conceptual, and therefore tidier issues.
If purity explains why professionals assign prestige within their own hierarchies, what explains why the public does not follow suit?
Ordering Disorder
Abbott claims that for exactly the reason professionals desire purity, the broader public assigns prestige to professional roles that handle impurity.
It is this effective contact with the disorderly that is the basis of professional status in society…. The impure or polluting holds the possibility of change, of renewal, of reconciliation.
Abbott draws on a curious theory of charisma to explain why the public admires those who deal with impurity:
To see a crime, to converse with an insane person, to nurse a sick relative -these are defiling acts for an everyday conscience, mind, or body. Only if he can control them can their charisma be transferred to one who under- takes them. In our society, as in any other, those who possess the cultural apparatus sufficient to touch and possibly control these social impurities assume their charismatic status. With his deep knowledge of cultural categories, indeed his partial membership in the group that creates them, the professional possesses that apparatus. He touches the problems and difficulties of our world without personal defilement. His reward is to assume their status.
The professional, in grappling with impurity, is imbued with charisma because the public seems them wrestling with the chaos of the world:
While this power over disorder is most obvious in medicine, psychiatry, law, and the clergy, in fact all the professions attempt to tame disorder or to create new order. This ordering has two major properties. First, its outcome is not guaranteed. Second, it is accomplished by means of esoteric knowledge, usually acquired by extensive training. The professional, then, confronts disorder or nonorder with a system that enables him, most of the time, to control or order it. Even if he does not necessarily succeed, at least he makes effective contact with disorder via his knowledge.
This theory explains why the prestige of scientists vaunted that of medical doctors in the second half of the 20th century:
In contact with the postsputnik unknown, scientists stand above lawyers in status if not in income. The admired special- ties are not referral specialties with their high incomes, but front-line, lower income specialties in immediate contact with disorder.
That is, after humankind was able to launch satellites into outer space, the universe of graspable disorder opened up to rocket scientists, whereas the disorder of the human body looked mundane and orderly in comparison.
The Problem of Status Strain
This paradox between publicity, purity, and prestige presents a problem for societal organization. If it is true that professionals assign prestige based on purity, then the process of slowly abstracting away disorder will remove professionals from the very real vicissitudes of real life that we as humans face:
As professionals seek the admiration of their peers, they gradually withdraw from front-line practice. As a result, the whole profession gradually shifts toward purer practice until, as in the case of psychiatry, the original disorder is the shadow of a shade. This withdrawal from publicly charismatic disorders, both within individual careers and within professions over time, is a kind of drawing back into purity, a regression.
Instead of expanding the scope of professional work, the status strain incentivizes professionals to shy away from disorder and regress to carefully cultivated niches that may not speak to the problems humans face.
The conflict engendered by professional regression has the functional con- sequence of making the professions better at what they do do and worse at what they do not.
If professionals indeed extricate themselves from the complexity of daily life, they risk facing a legitimacy crisis in the eyes of the public. Dr. Fauci and the NIH clearly faced a legimiticay crisis during the politicization of COVID, and the Supreme Court frequently faces charges that constitutional law has become too rarified and esoterically conceptual for the public it purportedly serves.
Ironically, writing from 1981 Abbott sees the media presence of “profession shows” as a possible remedy to status strain and also points towards specialist journalists as another remedy:
Professions may therefore also follow a final strategy, that of slowly dispersing professional charisma to the public. Both by accident and by design, the "profession shows" on television have helped in this. More important are the professionals whose public pronouncements interpret the profession's function and its vision of order to the public. These are the public speakers, the testifiers, the professionals quoted in the media.
40 years later, both the ‘profession shows’ and journalists seem like failed remedies and may have even exacerbated the strain that professionals face.
Conclusion
Abbott’s empirical evidence is admittedly sketchy, and some of the sociological concepts he draws on are admittedly outdated, but the professional paradox he studied remains relevant and evident today.9 The paradox has implications for professional and institutional legitimacy, which has taken on a heightened importance as longstanding American institutions face challenges by the public.
How can professionals incur both intra and interprofessional prestige? What incentives and structures pull professionals towards abstracting away from human impurity and messiness? These are the questions that Abbott explored and unfortunately have fallen out of favor in contemporary sociology.
https://www.foxbusiness.com/lifestyle/dr-oz-how-much-does-he-make
Dr. Oz should not call himself a doctor: https://www.scientificamerican.com/article/dr-oz-shouldnt-be-a-senator-or-a-doctor/
Peer group against Oz: https://www.audacy.com/knxnews/news/national/real-doctors-against-oz-campaign-claims-dr-oz-isnt-a-real-doctor
https://www.audacy.com/knxnews/news/national/real-doctors-against-oz-campaign-claims-dr-oz-isnt-a-real-doctor
https://www.niaid.nih.gov/about/anthony-s-fauci-md-bio#:~:text=Fauci%20ranked%20as%20the%2044th,between%201980%20and%20April%202022.
https://www.nih.gov/news-events/news-releases/anthony-s-fauci-awarded-highest-honor-association-american-physicians
https://www.justice.gov/usao-md/pr/man-pleads-guilty-making-threats-against-dr-anthony-fauci-and-other-federal-and-state
https://www.scientificamerican.com/article/scientists-reflect-on-anthony-faucis-impact/
https://www.georgetown.edu/news/dr-anthony-fauci-to-join-georgetown-faculty-as-distinguished-university-professor/
For example, see Sandefur, 2001, which draws on Abbott’s concept of professional purity: Work and honor in the law: Prestige and the division of lawyers' labor.
For empirical work on occupational prestige tracking, see: Updating Occupational Prestige and Socioeconomic Scores: How the New Measures Measure up
On outdated sociological concepts, Abbott draws on the work of Mary Douglas, who wrote a book titled ‘Purity and Danger’ in 1966 that was considered one of the most important nonfiction books of the 20th century but has since fallen entirely out of favor and influence. The book remains in print as a Routledge Classic.