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Nursing, Physician Control, and the Medical Monopoly

Historical Perspectives on Gendered Inequality in Roles, Rights, and Range of Practice

Thetis M. Group and Joan I. Roberts

Publication Year: 2001

Nursing, Physician Control, and the Medical Monopoly
Historical Perspectives on Gendered Inequality in Roles, Rights, and Range of Practice

Thetis M. Group and Joan I. Roberts

A history of physicians' efforts to dominate the healthcare system.

Nursing, Physician Control, and the Medical Monopoly traces the efforts by physicians over time to achieve a monopoly in healthcare, often by subordinating nurses -- their only genuine competitors. Attempts by nurses to reform many aspects of healthcare have been repeatedly opposed by physicians whose primary interest has been to achieve total control of the healthcare "system," often to the detriment of patients' health and safety.

Thetis M. Group and Joan I. Roberts first review the activities of early women healers and nurses and examine nurse-physician relations from the early 1900s on. The sexist domination of nursing by medicine was neither haphazard nor accidental, but a structured and institutionalized phenomenon. Efforts by nurses to achieve greater autonomy were often blocked by hospital administrators and organized medicine. The consolidation of the medical monopoly during the 1920s and 1930s, along with the waning of feminism, led to the concretization of stereotyped gender roles in nursing and medicine. The growing unease in nurse-physician relations escalated from the 1940s to the 1960s; the growth and complexity of the healthcare industry, expanding scientific knowledge, and increasing specialization by physicians all created heavy demands on nurses.

Conflict between organized medicine and nursing entered a public, open phase in the late 1960s and 1970s, when medicine unilaterally created the physician's assistant, countered by nursing's development of the advanced nurse practitioner. But gender stereotypes remained central to nurse-physician relations in the 1980s and into the 1990s.

Finally, Group and Roberts examine the results of the medical monopoly, from the impact on patients' health and safety, to the development of HMOs and the current overpriced, poorly coordinated, and fragmented healthcare system.

Thetis M. Group is Professor Emerita at Syracuse University, where she was Dean of the College of Nursing for 10 years, and an adjunct faculty member at the University of Utah College of Nursing. She is co-author of Feminism and Nursing and has published numerous articles in professional nursing journals.

Joan I. Roberts, social psychologist, is Professor Emerita at Syracuse University. A pioneer in women's studies in higher education, she is co-author of Feminism and Nursing and author of numerous books and articles on gender issues and racial and sex discrimination.

June 2001
352 pages, 6 1/8 x 9 1/4, index, append.
cloth 0-253-33926-X $29.95 s /

Published by: Indiana University Press


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pp. vii-viii

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pp. ix-xi

Fundingassistanc e for manuscript preparation has been provided by the Omicron Chapter of Sigma Theta Tau (Syracuse University College of Nursing), the Syracuse University Senate Research Committee, the Syracuse University Small Grants Program, and Syracuse University Office of Research. ...

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General Introduction

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pp. xiii-xxxi

Over the past three decades, significant changes have occurred in the nursing profession and in the conventional societal definitions of women and their roles. As the women’s movement reemerged in the late 1960s and many women refused to uphold the traditional roles allocated to them, a parallel trend in nursing ...

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Nursing, Physician Control, and the Medical Monopoly: An Overview

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pp. xxxiii-xlv

Organized nursing and medicine are currently on a collision course, with the American Nurses’ Association (ANA) often taking positions on nurses’ roles, rights, and range of practice in opposition to those espoused by the American Medical Association (AMA). The strained relations in the last few decades have a very long history, ...

PART I. “Exposing the Meretricious Lies”: Early Women Healers and Nurses and the Mythology of Medicine’s “Natural” Supremacy over Healing

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pp. 1

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1. “The Mere Trivia of History”? The Legacy of Early Women Healers and Physicians’ Efforts to Exclude or Control Them

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pp. 3-36

In this chapter, sources on gender and nursing are brought together to make visible a centuries-old lineage of women healers and nurses and to document its relationship to that of physicians. Taking a longer view of women healers over several centuries helps us to understand whether nurses indeed usurped medical rights ...

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2. “She Hath Done What She Could”: Reforming Nursing as Physicians Tighten the Medical Monopoly in Great Britain,1800s to the Early 1900s

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pp. 37-74

Medical control over women’s healing activities in Europe, particularly in Great Britain increased during the eighteenth century, becoming a reality by the mid to late nineteenth century, despite the fact that university-educated physicians were a distinct minority among health-care practitioners. ...

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3. The Search for American Nursing Origins: Differing Approaches to the History of Nursing and the Medical Monopoly in the United States,1800s to the Early 1900s

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pp. 75-102

The extent to which the long history of women healers and the experiences of European, particularly British, nurses, have influenced the development of American nursing and nurse-physician relations has not been studied in depth. Instead, a number of American researchers have focused on nurses in a women’s world, ...

PART II. The Purposeful Move toward Dominance: Subordinating Nurses and Achieving a Medical Monopoly

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pp. 103

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4. “For Their Own Good”: Physicians Manipulating, Trivializing, and Coercing Nurses, Later 1800s to the 1920s

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pp. 105-146

This chapter focuses on the continued efforts by physicians in the United States to achieve a monopoly in health care in the mid to late nineteenth century and into the first two decades of the twentieth century. From previous chapters, it is clear that physicians over several centuries were determined to create a gendered monopoly, ...

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5. “The Exclusive Guardians of All Matters of Health”: The Consolidation of Medical Monopoly in the 1920s and 1930s

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pp. 147-173

By 1920 the Western world had been through a terrible war, in which close to 550,000 Americans were killed, including 300 nurses who had served overseas. World War I not only claimed a horrible toll in human life, it also served as a catalyst to swell the ranks of qualified graduate nurses. ...

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6. A Growing Unease: Nurse-Physician Interprofessional Relations from the 1940s to the 1960s

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pp. 174-201

With the entrance of the United States into the Second World War, the prestige of physicians and the power of organized medicine were substantially reinforced. Following the war, the rapidly expanding knowledge in the basic sciences; the widespread use of sulfa, penicillin, and eventually antibiotic drugs; ...

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7. Reconciling Practice with Protest and Confrontation with Cooperation: Nurse-Physician Relations in the 1970s

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pp. 202-270

By the 1970s the medical monopoly had been strongly buttressed by the rapid expansion of knowledge from the physical and biological sciences and by increased technological capacities.The health-care industry had become the third largest in the nation; indeed, there was an 80 percent increase in the number of health workers ...

PART III. An Outdated, Burdensome Model of Monopolistic Control: Entering the Twenty-First Century with a Fractured Health-Care System and Continuing Medical Opposition to Nurses’ Autonomy

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pp. 271

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8. Who Needs the Autonomous Professional Nurse? Gender Stereotypes Remain Central to Nurse-Physician Relations

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pp. 273-322

By the 1980s the backlash against the reemergent feminist movement was very apparent in the return to a more conservative political agenda. We begin this chapter with the resurrection of the traditional stereotype of the nurse as mother surrogate, brought back to life to reduce the widespread dissatisfaction ...

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9. Challenges to the Medical Monopoly: Nurses’ Gains in Direct Payment, Hospital Privileges, Prescriptive Authority, and Expanded Practice Laws

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pp. 323-395

By the 1980s it was possible for nurses to attack the medical monopoly directly. Following the U.S. Federal Trade Commission’s ruling in 1975 that antitrust laws also applied to professional workers in the health-care system, unfair laws and practices affecting nurses could now be legally challenged. ...

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10. The Results of the Medical Monopoly: “A Regulatory and Policy-Making Quagmire”

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pp. 396-476

By the end of the twentieth century, the results of the centuries-old medical monopoly were singularly unimpressive. In this chapter, focused on the last decade of the twentieth century, we consider nurses’ and consumers’ critiques of the health-care “system,” discuss the efforts at reform by nurses, ...


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pp. 477-506


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pp. 507-514

E-ISBN-13: 9780253108616
E-ISBN-10: 0253108616
Print-ISBN-13: 9780253339263

Page Count: 560
Illustrations: 1 index
Publication Year: 2001