Death of the Guilds: Professions, States, and the Advance of Capitalism, 1930 to the Present (review)

In this wide-ranging, provocative study of the professions in Western Europe and America, Elliott Krause paints a dismal picture of the ability of professionals in recent years to maintain any decisive control over the places they work, the markets for their services, the training of their successors, and their freedom from state regulation. Since 1930, and especially since the 1960s, physicians, lawyers, engineers, and university teachers in the five countries studied have all lost much of their independence to capitalism and the state. The work these professionals do lies increasingly within the province of regulation by individual states and influence by capitalistic institutions. Thus, the historic powers of guild institutions—safely preserved by professional groups into modern times—have declined to the point where Krause is ready to pronounce them dead (or at least dying). A profession has become less “something special” and more “just another way to make a living” (p. ix).

In the case of medicine, the determination of how many new students may enter the profession has shifted steadily, in every country, to the state. Similarly, large corporations have worked with government to limit the guild powers of organized physicians over the medical market. Business interests and government have joined to limit costs and to increase the role of other practitioners in health care. As a result, the private, fee-for-service practice of medicine has everywhere become a disappearing feature of the profession. No profession in any country, says Krause, “has flown quite as high in guild power and control as American medicine, and few have fallen as fast” (p. 36).

The traditional guild of early modern times had the right to create all of its own rules (the power of association), to determine who could work in the market (control over the workplace), and to set the goals of production and the price of the product or service delivered (control over the market). As the modern state and modern capitalism gathered strength, they became the enemy of the guilds and only those survived that were not a threat, or that were willing to come to terms. It was these surviving guilds or professions—medicine, law, and university teaching, in particular—that maintained a large measure of independent power into the modern era. What separates a modern profession from other occupations or semiprofessions, in Krause’s argument, lies precisely in the degree of guild power it has retained. The book therefore becomes a study of how these professions (plus engineering) have struggled, with less and less success, to preserve their independence in the face of growing state and capitalist power.

To undertake so sweeping a comparison of the decline in independence of four professions in five countries (Britain, France, Germany, Italy, and the United States) over so long a period is a bold and daunting task. Krause has performed it with surprising ease, moving easily across national and professional boundaries, making constant comparisons, using literature in four languages, and always keeping his eye on the main argument. Inevitably, in so large a framework, minor errors of fact and interpretation creep into the narrative, but all in all it is a remarkable tour de force of imagination and intellectual power. No student of the professions, whether interested in comparative or in single nation-single profession history, will be able to ignore this important work.