Organizational Powers: Contested Innovation and Loss of Professional Jurisdiction in the Case of Retail Medicine

Abstract

Innovative technology may reduce organizations’ reliance on professionals in the performance of expert tasks, weakening professions’ control over work. However, professions resist and challenge such innovation, framing it as unsafe and immoral. This paper theorizes a process by which innovative nonprofessional firms overcome the resistance, enter professionalized markets, and weaken professional control over work. It analyzes the rise of a new organizational form—retail health clinics—that deprofessionalized some medical tasks in U.S. primary healthcare. An analysis of newspaper articles, archival documents, and interviews with key industry participants suggests that retail clinic chains capitalized on long-standing jurisdictional tensions between the physician and nursing professions. The clinics operated by relying on nurses’ legal rights to perform physicians’ tasks and defended retail medicine as a safe and morally justified innovation by using the nursing profession’s established repertoire or frames and arguments. Sentiment analysis of over 1,600 newspaper articles suggests that the legitimacy of retail clinic chains in public discourse improved with the proliferation of the clinics, but the legitimacy of nurse practitioners did not. Nonprofessional firms thus introduced an innovation that weakened professional control over medical work by capitalizing on interprofessional tensions and repurposing professions’ own jurisdictional claims.