Professionalism is both an individual characteristic and an ideological position. The primary definition is that of individual professionalism: the idea that membership of a profession carries with it a set of internalised values that will be reflected in the way in which work is carried out and the ethical standards that are adhered to. As an example, a concept of ‘medical professionalism’ would require that doctors prescribe the most appropriate treatment for their patients, rather than one which would yield them higher fees or would meet an externally imposed objective of cost control. Although the term ‘professionalism’ is associated with a fairly specific range of high-status occupations, much the same claim about other occupations is embodied in terms like ‘craftsmanship’ and ‘public service ethosâ.
As an ideological position, professionalism is the assertion that workers with a professional/craft/public service ethos should be given substantial autonomy to undertake their work in the way they judge to be appropriate. This assertion is most obviously opposed to managerialism (see also), which is based on the claims that all forms of productive activity are amenable to generic management techniques and that work is best organised by ‘letting managers manage’.
However, the most important and damaging critiques of professionalism arise from a neoliberal perspective.
The neoliberal critique has two main components, which partly reinforce and partly undermine each other.
The first is that the idea of professionalism as an individual characteristic is false – given the chance to pursue their own self-interest (narrowly defined to exclude such items as the approval of professional peers) individuals will do so regardless of any attempts to instil professional values. The second is that, in the words of GB Shaw, ‘the professions are a conspiracy against the laity’. That is, adherence to professional values and ethics serves to advance the collective interests of the profession at the expense of society as a whole. Exactly the same critique is made of trade unions.
The neoliberal critique has some validity. However, neither neoliberal market incentives nor managerial control work effectively in situations where the quality of work is hard to observe or to infer from short-run outcome measures such as profit. In these circumstances, attempts to sharpen price signals or managerial controls inevitably create opportunities for arbitrage and cost-shifting.
To some extent, it’s possible to take a middle path, relying on professional values, but employing managerial oversight and the incentive regimes favored by neoliberals as a check against individual and collective rent-seeking. But the room for compromise is limited. Tight managerial control or market orientation is incompatible with adherence to internalised professional values.
When a professional is subjected to managerial directives or market forces that violate professional values, they have a range of choices. Using Hirschman’s there is the option of exit and the possibility of voicing opposition to changes that compromise professionalism.
When these options are exhausted, the most obvious response is to ‘sign on’ and embrace the ‘cultural change’ associated with such objectives as customer focus and shareholder value. The logic of this embrace is that professional values will be replaced by responsiveness to market and managerial incentives. To the extent that these incentives are designed on the presumption that professional values are maintained, opportunities to Îgame the systemâ will be created and exploited. Thus, for example, reforms to universities have been based, in large measure, on the assumption that responsiveness to customer demand involves raising the standard of teaching and that the content will be determined by professional or disciplinary values. But academics learn fairly quickly that customer demand can be satisfied at lower cost by soft grading and, even more, by soft content and low workloads. Similarly the shift in control of infrastructure services from engineers to financially-driven managers is typically associated with a decline in maintenance, which represents an easy way of cutting costs with few direct adverse consequences for those making the decisions.
An alternative is to pay lip-service to managerial objectives while seeking, as far as possible to adhere to professional values. This alternative is typically sustainable only in the short term or where an exit option is available as a fallback.
John Quiggin 
I don’t greatly disagree with the general argument being made here, but want to add something about higher education. The problem here has been a weak professional ethos surrounding teaching competing with a strong research ethos, with students the inevitable losers. The universities with the strongest research record tend to be the worst in teaching surveys, highlighting the tension (the ANU is unusual in being relatively good at both).
Universities over the last decade or so have been trying to improve things for students, but on the whole this has not been through heavy-handed managerial direction of day-to-day activities. Rather, by offering training and rewarding performance through promotion and teaching awards universities have still given academics considerable discretion in how they go about their teaching work. The training especially starts to give academics the tools needed to become teaching professionals. Previously they have usually only been trained as researchers.
On the whole this has not been the deliberate outcome of policy. Various ad hoc programmes have tried to assist universities improve their teaching, but funding policies – no prices, central allocation of places – have still strongly signalled that students’ interests do not matter.
Only universities financial reliance on fee-paying students has changed the incentive structure in any significant way, but that was an unintended outcome of a policy designed to save the Commonwealth money.
The perceived ‘internalisation’ of professional values should be examined carefully in that it ought to be an important part of professional organisations to have the ability to discipline and where necessary eject its members. The fact that most professional organisations are quite poor at doing this and tend to protect their own, reinforces the link with unions, and makes them an easy target for managerial critiques. It’d be interesting to really analyse what people mean when the say that “changes compromise professionalism”. There is an argument to be made that greater autonomy delivers better results over the long term, but I don’t see how “market orientation is incompatible with adherence to internalised professional values” if those values are fundamentally ethical rather than technical.
In my experience, “professionalism” is usually flung about in the context of “stop using your brain to spot problems, and just do what you’re told”.
The Hirshman model of exit, voice, and loyality certainly does become more complex when the actor has dual loyalities to both his profession and some second institutional activity. That is certainly the problem of much maligned agent in the real world.
I am bemused how the second institution so often attempts to frame it’s demands for loyality in the terms of professional ethics. For example customer value is a professional touchstone of the marketing professional. As Hirshman points out cartoon free market commerce worships minimal loyality. Professionals are highly loyal to their craft or calling because retooling would be so expensive.