Organizational Powers: Capture of Professional Jurisdiction in the Case of U.S. Retail Clinics

Abstract

Understanding inertia and change in professionalized organizational fields like health care is key to addressing inefficiencies like poor access to services, high costs, and inconsistent quality. New entrants are one source of change that may reduce the inefficiencies, but we lack a good understanding of how new entrant organizations overcome jurisdictional barriers of license and legitimacy that shelter professionalized fields. I analyze a case of emergence of retail health clinics in the U.S. primary care to theorize a strategy that allows external change agents to enter a professionalized field. Circumventing jurisdictional barriers and overcoming resistance of the incumbent profession requires jurisdictional work — cultural and market actions that effectively put forth a jurisdictional claim. Two aspects of jurisdictional work by retail clinics appear important: employing individual professionals as “front-men” who legitimize the new organizational form and finding allies among incumbent organizations that value efficiency. The problem of professional collective action allowed for the front-men strategy, in which organizations decoupled rights encoded in professional license and their use and thus turned license from a barrier into a vehicle for entry. The heterogeneity of logics and the competitive tensions among field incumbents allowed for the subsequent integration. The elaborated process model of entry generalizes the theory of professional jurisdictional competition by including organizations as actors in the division of expert labor.