Collegian (2009) 16, 177—183

avai lab le at www.sc iencedi rec t .com

Why fellowship? Peak professional bodies, peerrecognition and credentialing in Australia

Sandy Middleton, RN, PhDa,b,c,∗, Kim Walker, RN PhDa,d,c, Trina Leighe

a Nursing Research Unit, St. Vincents & Mater Health Sydney, Australiab National Centre for Clinical Outcomes Research (NaCCOR), Nursing & Midwifery, Australiac Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australiad St. Vincent’s Private Hospital, Darlinghurst, Sydney, NSW, Australiae School of Nursing (NSW & ACT), Australian Catholic University, Australia

Received 2 July 2008; received in revised form 3 May 2009; accepted 24 June 2009

KEYWORDSPeer recognition;Collegiality;Networking;Professionaldevelopment;Credentialing;Professional peakbodies

SummaryBackground: Professions frequently distinguish themselves from trades or vocations, by creatingprofessional peak bodies. Usually professional peak bodies offer two levels of subscription:membership and fellowship. Fellowship of a peak body is widely considered as offering statusand prestige by recognising contribution made to one’s profession. Fellowship therefore, oftenbrings with it specific privileges of a symbolic or material nature, or both.Aim: To describe the criteria for eligibility for fellowship; the perceived benefits of fellowshipto individuals from the organisations’ viewpoint; the process of obtaining and maintaining fel-lowship across a range of professional peak bodies; and to apply the outcomes from the surveyto nursing professional peak bodies.Method: A telephone survey of 25 professional organisations representing a range of disciplinesand industries in Australia was conducted. Each organisation was telephoned and the managerresponsible for membership was invited to participate in a 10-min telephone survey.Results: Of the 25 organisations approached, 24 agreed to participate (response rate 96%). For

six (25%) of these participating organisations, membership was exclusively limited to nursesand/or midwives. Fellowship was offered in 22 organisations (92%). Significant professionalexperience (73%) was the most frequently cited criterion for fellowship. Professional leader-ship/contribution to the profession was listed by less than half (45%) organisations surveyed.Over half (55%) of those organisations that offered fellowship programs also were credentialingbodies. The main benefit of fellowship reported was the prospect of peer recognition and higherprofessional standing (77%).

∗ Corresponding author at: Nursing Research Unit, St. Vincents & Mater Health Sydney, Australia; National Centre for Clinical OutcomesResearch (NaCCOR), Nursing & Midwifery, Australia; Australian Catholic University, PO Box 968, Australia. Tel.: +61 02 9739 2340;fax: +61 02 9739 2009.

E-mail address: sandy.middleton@acu.edu.au (S. Middleton).

1322-7696/$ — see front matter © 2009 Royal College of Nursing, Australia. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

doi:10.1016/j.colegn.2009.06.002

178 S. Middleton et al.

Discussion: The majority of organisations reported offering fellowship status and all had cri-teria for fellowship. The most frequently cited criteria were, however, based on longevity inthe profession and continued financial membership rather than demonstrated leadership withinthe profession. There was variability in how fellowship was attained and maintained which maybe linked to whether organisations have a credentialing role or not. A more in depth study offellowship is warranted.

sing, Australia. Published by Elsevier Australia (a division of ReedPty Ltd). All rights reserved.

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© 2009 Royal College of NurInternational Books Australia

eer recognition and the professional bodies

eer recognition is an issue for the professions which arguehat their claim to a perceived (and real) higher status inhe hierarchy of work and occupations is forged from thendividual and collective status and human capital gener-ted in the process of becoming a member of a particularrofessional occupational group. Access to the traditionalrofessions (e.g. medicine and the law), is generally gainedia a rigorous preparatory phase whereby novitiates acquireprimary qualification (at a tertiary level as opposed to

he vocational level) and also accrue a degree of practicalxperience, skill and expertise on the journey toward theircademic and professional credentials. The combination ofigher qualifications and specialised skills affords membersf the traditional professions the opportunity to participaten the meritocracy which by definition is how a profession iself- and socially identified. Most professions recognise andmplement this idea of a meritocracy through hierarchies ofmportance in relation to increasingly senior and more com-lex levels of appointments within the profession. As well ashese features, the professions strive to create work envi-onments that ‘ensure the workplace is suitable; the salaryommensurate with the work done; continuing professionalevelopment is in place; safe and flexible workplace prac-ices are working; family friendly policies are on offer; andtaff are consulted, reviewed, oriented, mentored and notiscriminated against’ (Lumby and Osmond in Daly, Jackson,Speedy, 2006, p. 237).One mechanism widely adopted by the traditional profes-

ions as a means to securing their credibility and legitimacys a profession (such as those mentioned above arising fromtertiary education) is the formation of a professional ‘peakody’ (DeLeskey, 2003). Professional peak organisations areomprised of those who have acquired the requisite profes-ional ‘identity papers’ — the entry level qualifications andkills designated necessary to claim a title such a doctor,olicitor or nurse, for example. Just as the trades have theirnion bodies so too do the professions have their colleges,nstitutions and associations. These peak bodies perform aide range of functions in terms of promoting, marketingnd protecting the interests of the profession as well ashose whom they serve (Bauman, 2008; Davies & Clark, 2006;eLeskey, 2003; Van Hoy, 1993). Moreover, they become

ymbolic and actual identifiers of the professions in thathey are able to speak on behalf of the members; representhem in various jurisdictions (such as the courts, tribunalsnd other forums); lobby governments, politicians and mostmportantly, the media; and provide ongoing opportunities

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or the members to advance their practice and theoreticalkills and knowledge through educational and developmen-al events and activities (Carious, 2004; Gruen, Summers, &cito, 2000; Myers, 2007; Thackeray, Neiger, & Roe, 2005;an Hoy, 1993). As well, some peak bodies regulate the pro-ession by credentialing their members at certain levels ofractice without which they cannot specialise and claim therivileges and status ascribed to a higher level of member-hip (as, for example, in the case of medicine and the law).mportantly, all peak professional bodies require individualso pay a subscription in order to become a member and,sually, they must maintain it over time this if they wish toecure the privileges and rights that accompany their mem-ership (DeLeskey, 2003). Indeed, many subscribe (and musto so) for the entire tenure of their professional lives.

Most professional peak bodies have two layers of sub-cription. Firstly, there is a basic or standard level offered toll who hold the minimum levels for entry to the professiontself usually called membership. In nursing, for example,embership of either of the two main professional peakodies (Royal College of Nursing and the College of Nursing)equires a bachelor of nursing or a certificate of enrolledursing. Membership brings with it a range of services andrivileges that the professional body provides (again to vary-ng levels depending on the resources the body has at itsisposal; the more members a peak body has the largerhe financial and social base from which it can develop andeliver such services).

Then there is a higher order level of membership usuallyalled fellowship. Despite a reasonably exhaustive literatureeview we were unable to uncover any material referringpecifically to fellowship as a category of membership orutlining any perceived or actual benefits of fellowship overembership. This, in part, impelled us to initiate this study

o describe the criteria for eligibility for fellowship, theerceived benefits to individuals from the organisations’iewpoint and the process of obtaining and maintaining fel-owship across a range of professional peak bodies.

ethod

convenience sample of 25 professional organisations rep-

honed and the manager of the membership and/or theellowship program was identified (herein called the man-ger). The manager was given verbal information abouthe study and invited to complete a 10-min telephone sur-ey.

179

Box 1 List of professional organisations surveyed (inalphabetical order) (n = 24) [colleges involving mem-bership exclusively of nurses and/or midwives shownin bold (n = 6)].

Australasian Association for Quality in Health CareAustralian College of Critical Care NursesAustralian College of EducatorsAustralian College of Health Service ExecutivesAustralian College of MidwivesAustralian and New Zealand College of Mental Health

NursesAustralian College of Operating Room NursesAustralian College of Rural and Remote MedicineAustralian College of Veterinary ScientistsAustralian Institute of Agricultural Science and

TechnologyAustralian Institute of ManagementAustralian Institute of Medical ScientistsCollege of NursingInstitute of Engineers, AustraliaRecruitment and Consulting Services AssociationRoyal Australasian College of Dental SurgeonsRoyal Australasian College of PhysiciansRoyal Australasian College of SurgeonsRoyal Australian College of General PractitionersRoyal Australian Institute of ArchitectsRoyal College of Nursing, AustraliaSafety Institute of AustraliaSports Medicine AustraliaVictorian College of Optometry

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Peak professional bodies, peer recognition and credentialing

Instrument

The first question in the two-paged survey instrument askedmanagers if the organisation offered fellowship (one ques-tion). Where fellowship was offered, the managers wereasked to specify the criteria for fellowship eligibility in theirorganisation (one question).

The managers then were asked if their organisation was acredentialing body and, if so, whether fellowship was part ofthe credentialing process (two questions). Next, managerswere asked if fellowship was initiated by an invitation issuedby the organisation, or by application from an individual (onequestion). The managers were then asked about the cost offellowship to their organisation and to compare this cost tothe annual subscription fee for standard membership (twoquestions).

Managers were asked to identify the main benefits toindividuals associated with fellowship of their organisation(one question). Managers next were asked how their organ-isation acknowledged their new fellows, for example byholding an investiture ceremony or by issuing of a certifi-cate or otherwise (one question). The managers then wereasked if ongoing proof of professional activities was requiredto maintain fellowship status (one question). Managers alsowere asked if their organisation employed formal processesto select fellows for professional award nomination such asAustralian Honours awards (one question). Our next ques-tions asked whether the organisation held an annual oration(or equivalent), and if that oration formed a part of theinvestiture process (two questions).

The final part of the questionnaire concerned internallyrun education programs. The managers were asked if theorganisation ran its own educational programs (one ques-tion), and asked to identify the kind of recognition given tostudent graduates for completion of these programs and anylink with fellowship where relevant (one question).

Data analysis

Data were analysed using SPSS Version 14.0. Frequencies forquestionnaire responses were calculated for all variables.Key words and themes in the open-ended response itemswere identified and coded.

Results

There were 25 representatives of professional organisationsinvited to participate in our survey (Box 1 ). Of these,24 agreed to participate (response rate 96%). Twenty-oneof the 24 (86%) had the word ‘college’ or institute’ intheir title. The majority of managers stated that theirorganisation offered fellowship (n = 22, 92%). Managers fromthese 22 organisations outlined 12 criteria for eligibility ofapplicants for fellowship of their organisation. The mostfrequently cited criteria were: significant professional expe-

rience (n = 16, 73%); continuous financial membership of theorganisation for at least the specified minimum period (rang-ing from 2 to 7 years) (n = 13, 59%); and peer references froma current member or fellow (n = 12, 55%). Professional lead-ership/contribution to the profession was cited as a criterion

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or eligibility for fellowship in less than half the organisa-ions surveyed (n = 10, 45%) (Table 1).

Of those organisations who offered fellowship programsn = 22), half were ‘credentialing bodies’ (n = 11, 50%), thats those organisations to which membership confers a ‘cre-ential’ or license to a certain level of practice within therofession. Managers of over half of these reported that fel-owship was part of their credentialing process (n = 6, 55%).anagers from just less than half (n = 10, 45%) of organisa-

ions with fellowship programs stated that fellowship coulde initiated either by a direct invitation from the organi-ation to an individual or by application from an individualTable 1).

The cost of an annual subscription for regular member-hip in the participating organisations ranged from $100 to2000, with the median membership subscription fee $308.he cost of an annual subscription for fellowship of the par-icipating organisations ranged from $100 to $3600, with theedian fee $411 per year. For those participating organisa-

ions with fellowship programs, almost half of the managersn = 10, 46%) stated that annual subscription fees for fel-ows and regular or standard members were either the samer only nominally different. A further two-fifths of man-

gers (n = 9, 41%) stated that annual fellowship subscriptionees exceeded regular membership fees; this fee differenceanged from an additional $50 to $2800 per year.

180 S. Middleton et al.

Table 1 Fellowship management practices.

n (%)

Do you have fellowship? (n = 24)Yes 22 (92)No 2 (8)

Criteria for fellowshipa (n = 22)Significant professional experience 16 (73)Continuous financial member of organisation 13 (59)Peer references from current member or fellow 12 (55)Professional leadership/contribution to the profession 10 (45)Peer reference from current fellow only 5 (23)Continuing professional development 5 (23)Postgraduate qualifications 4 (18)Pass fellowship entrance examination 4 (18)Evidence of published scholarly work 2 (9)Evidence of research grants 2 (9)Current employment in an accredited organisation 2 (9)Minimum age requirement (>35 years) 1 (5)

Credentialing organisations (n = 22)Yes 11 (50)No 11 (50)

Fellowship is part of the credentialing process (n = 11)Yes 6 (55)No 5 (45)

Fellowship is initiated by (n = 22)Either invitation or application 10 (45)Application only 9 (41)Invitation only 3 (14)

Main benefits of fellowship statusa (n = 22)Peer recognition/professional standing 17 (77)Acknowledgment of industry service 7 (32)Opportunities for professional advancement 4 (18)Superior benefits to those of regular members 3 (14)

Fellows are recognised through (n = 22)Certificate but no investiture 15 (68)Both certificate and investiture 5 (23)Investiture but no certificate 2 (9)

Additional othera

Post-nominal 9 (41)Badge, plaque 4 (18)

Ongoing proof of professional activities required to maintain fellowship status (n = 22)Yes 6 (27)No 16 (73)

Award selection (e.g. Australian Honours) (n = 21)Formal processes for candidate nomination 15 (71)No formal processes 6 (29)

Annual oration held (n = 24)Yes 21 (87)Forms part of the investiture of fellow (n = 22) 15 (68)No 3 (13)

Organisation runs education programs (n = 24)Yes 17 (71)No 7 (29)

Peak professional bodies, peer recognition and credentialing 181

Table 1 (Continued )

n (%)

Student graduates are recognised bya (n = 17)Certificate 7 (41)Professional development points towards gaining fellowship 5 (29)Internationally recognised graduate credentials 1 (6)Student of the year award 1 (6)Listed in recruitment journal 1 (6)National accreditation of course 1 (6)

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Listing in the members recordLetter of attendance of educational program

a More than one answer possible.

The majority of managers reported that the main bene-fit of fellowship was the prospect of peer recognition andhigher professional standing (n = 17, 77%). Less than one-third of participants reported formal acknowledgement ofservice to the industry as a benefit (n = 7, 32%). A minor-ity of managers reported that fellowship conferred superiorbenefits to those of regular members (n = 3, 14%) (Table 1).

The majority of managers stated that their organisationacknowledged new fellows by awarding them a certificate(n = 20, 91%). Five of these 20 organisations (23%) also con-ducted an investiture ceremony in addition to awarding acertificate to new fellows. Availability of post-nominals spe-cific to fellowship was reported by nine managers (41%)(Table 1).

Over one quarter (n = 6, 27%) of organisations with fellow-ship programs required fellows to submit ongoing proof ofprofessional activities in order to maintain their fellowshipstatus.

Almost three quarters (n = 15, 71%) of the organisationssurveyed had established formal processes for nominat-ing members/fellows as candidates for professional awardselection, such as Australian Honours awards.

Almost all of the managers from the 24 participatingorganisations (n = 21, 87%) reported that their organisationheld an annual oration or equivalent event. Of those organ-isations that offered fellowship (n = 22), the annual orationformed a part of the fellowship investiture in just over two-thirds of cases (n = 15, 68%).

More than two-thirds of managers stated that their organ-isation ran education programs (n = 17, 71%). The mostfrequently reported methods of recognising the studentgraduates of these programs were by issuing a certifi-cate of program completion (n = 7, 41%). Five managersreported that their organisation awarded graduates pro-fessional development points to support an application forfellowship of the organisation (n = 5, 29%).

Discussion

Fellowship was an integral part of the majority (92%) ofthe organisations surveyed as a method to acknowledge ser-

vice and a significant contribution to the profession. The useof criteria for eligibility for fellowship, that is, ‘fellowshipqualifiers’ confirm the notion of a profession as a culturalphenomenon that values the criteria of constancy and con-sistency in an individual’s performance and recognises and

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ewards merit and ambition. Most (88%) of the professionalodies surveyed adopted the rubric of ‘college’ or ‘insti-ute’ thus defining themselves as a body of learned men andomen who have higher knowledge and skills than one wouldxpect or require of the general lay public (Box 1).

On closer examination of the criteria for fellowship,he following were the most frequently cited as neces-ary for this level of recognition: significant professionalxperience (73%); continuous financial membership of therganisation (59%); peer references from a current mem-er or fellow (55%). Of note, and worryingly professionaleadership/contribution to the profession was an essentialriterion for fellowship cited by less than half (45%) of par-icipating organisations. This seems especially puzzling inhe face of the 73% that required significant professionalxperience before fellowship could be considered. We posehe question: how would one ‘measure’ the value of signifi-ant professional experience in the absence of a significantontribution to a profession? Is not one’s contribution toprofession a measure of one’s significant experience? Itould also seem that fellowship can be obtained on the basisf professional longevity and continued financial member-hip rather than demonstrated leadership. Further, evidencef published scholarly work, one method of establishing con-ribution to a profession, was a criterion for fellowship innly two (9%) organisations.

One differentiating factor amongst those surveyed werehose peak bodies for whom fellowship signified a profes-ional credential which then enabled the holder to practicet a higher level within the profession (e.g. a consultanturgeon or physician as opposed to a resident or regis-rar). Unlike nursing professional bodies (which comprised5% (n = 6) of those surveyed), more than half of all therganisations (55%) were credentialing bodies. This raisesome interesting issues about the ways in which the vari-us professional groupings regulate and promote themselvess professions. By credentialing one’s own members a pro-ession demonstrates a very high level of self-regulationnd self-promotion in comparison with those that do notr cannot. In a sense it almost creates a hierarchy within aierarchy amongst the professions themselves. This point isarticularly salient for a still struggling (quasi) profession

uch as nursing which has not used its peak professionalodies to credential, and therefore self-regulate and pro-ote nursing in the same way or to the same level as hasedicine. Our study was limited by its small convenience

ample; a larger sample size may reveal more meaningful

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ifferences for fellowship practices between credentialingnd non-credentialing organisations.

Initiation of fellowship by either invitation or applicationrom an individual was possible in less than half of organ-sations surveyed (n = 10, 45%), with a further 41% (n = 9)elying on applications alone without invitations. Organi-ations wishing to promote fellowship to their professionhould consider more actively targeting key, high performingndividuals within their profession.

The majority of managers reported that the main benefitf fellowship status was peer recognition and professionaltanding (n = 17, 77%). This may be a largely symbolic bene-t and a largely personally symbolic benefit at that. Data onhe benefits of fellowship from the individual’s perspectiveather than from an organisational perspective of perceivedenefits for individuals would further inform this issue. Its possible that since nursing transferred all undergraduateducation and most postgraduate education to the tertiaryector that the professional colleges have lost some of theirrestige as a result. Prior to the 1980s, the colleges of nurs-ng were the only bodies with the capacity to confer a levelf professional status on individual nurses and recogniseheir contributions to nursing scholarship and practice as aonsequence. Since then, the universities now confer higheregrees and doctoral qualifications which are increasingly invidence across clinical practice and the academy. Whilene nursing college offers professional education leadingo a graduate certificate (and soon to diploma) qualifica-ion these levels of award are generally not held in theame esteem as degrees. Both colleges do however, issue

certificate of fellowship as was reported in the major-ty of organisations (n = 20, 91%) with and without a formalnvestiture ceremony.

Ongoing proof of professional activities was not necessaryn the majority of organisations in order to maintain fellow-hip (n = 16, 73%). Such a requirement would have significantesource implications and organisations would need to con-ider the trade-off between the benefit to the professionnd the cost of authenticating or recognising specific profes-ional activities for this purpose before implementing suchprocess. Clearly for those peak bodies which only confer

ellowship as a credential (e.g. medicine) proof of ongoingompetence is essential as advanced practice depends onstrong commitment to ongoing professional development

nd the maintenance of a high level of practice skills. Foruch bodies members must provide evidence of such ongo-ng professional education in order to maintain their levelf accreditation (i.e. fellowship).

Managers from 71% (n = 15) of organisations surveyedeported formal processes for nomination of fellows forwards such as an Australian Honour award. This seemsnconsistent with our arguments above about the functionf a peak body which is to enhance the standing of therofession and recognise and reward the contribution of itsembers. We suggest a professional peak body should for-ally undertake this process in order to reward its fellows

urther still by nominating them for the Australian Honours

nd similar prestigious awards.

An annual oration was a frequently reported eventn = 21, 87%) and this formed part of the investiture of newellows in 68% of cases. An oration is a talk usually given byn esteemed member of the profession to the members at

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S. Middleton et al.

he investiture. An investiture is usually modelled on theniversity tradition of the graduation ceremony at whichegrees are conferred on those who have so completed theecessary requirements. A university graduation ceremonys replete with formal pomp and circumstance, dramatisedith processions of richly enrobed officials and academics,nd marked by formal procedures and rituals for the con-erring of the degree or award. A peak body’s investitureodels very closely on this format such that in some case,

nvestitures are sometimes held in university great halls as ifhey were a graduation ceremony (which in some respects,hey are).

Almost three quarters of the organisations surveyed randucation programs (n = 17, 71%). Interestingly, over a quar-er of these organisations (n = 5, 29%) recognised completionf these courses towards fellowship application thus sup-orting maintenance of the knowledge and skills of itsellows through a rigorous and strong commitment to con-inuing professional development. This is clearly not as atrong a commitment however, as those professional peakodies which mandate such activities for ongoing status asellowship (but it is at least consistent in this regard).

onclusion

he data presented here provide a snapshot of the ways pro-essional bodies across Australia recognise and reward theirembers and highlight a range of similarities and differ-

nces in form and function. However, the similarities appearo outweigh the differences which suggest a level of con-istency about what constitutes a peak professional body,nd more significantly, how fellowship is constructed as aategory superior to membership.

It would also appear that the difference in the pro-esses and outcomes of fellowship of a professional bodyre related to the way each of the professions credentialsor otherwise) its members. This survey has highlighted theeed for a more nuanced and deeper interrogation of theole and function of professional bodies and, specifically,he category of fellowship than has been presented here.n terms of further research in this area a profession-wideurvey canvassing the opinions of members and fellows ofhe professional peak bodies might shed more light on thessues raised here. This could also be augmented by a seriesf case studies which highlight the value of fellowship withinhe professions. In any event, the authors hope this reportaises conversation amongst the readership and generatesew debate about how best to recognise and reward our pro-essionals in Australia and what role the peak bodies shouldnd could play in such a strategy.

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