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

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Historical Perspectives on Gendered Inequality in Roles, Rights, and Range of Practice Thetis M. Group & Joan I. Roberts MEDICAL MONOPOLY NURSING, PHYSICIAN CONTROL, AND THE NURSING, PHYSICIAN CONTROL, AND THE MEDICAL MONOPOLY Group & Roberts Indiana In Nursing, Physician Control, and the Medical Monopoly Thetis M. Group and Joan I. Roberts trace what they see as the efforts by physicians over time to achieve a monopoly in health care, often by subordinating nurses—their only genuine competitor. According to the authors, attempts by nurses to reform many aspects of health care have been repeatedly opposed by physicians, whose primary interest has been to achieve total control of the health care “system,” often to the detriment of patients’ health and safety. Group and 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 as the growth and complexity of the health-care industry, expanding scientific knowledge, and increasing physician specialization 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 the gender stereotypes remained central to nurse-physician relations in the 1980s and into the 1990s. Finally, Thetis Group and Joan 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 health care system. THETIS M. GROUP is Professor Emerita at Syracuse University, where she was Dean of the College of Nursing for ten years. She is also 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. “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 centered on the development of ‘expanded’ roles for nurses: the ‘independent’ practitioner, nurse clinician, and nurse practitioner. As these professional and societal trends gained momentum in the 1970s, the conflicts inherent in integrating professional and gender roles became overt and critically important. In nursing it became obvious that it would be improbable, if not impossible, to prepare assertive, independent nurse practitioners if they were socialized to be dependent females. Similarly, it is improbable, if not impossible, for female nurses to implement expanded roles if they are unaware of or unwilling to recognize the social constraints imposed on them because they are women. Indeed, the successes or failures of the nursing profession in its struggle to grow in stature and gain autonomy during its long history cannot be fully understood unless they are integrally linked to the relationship between gender and professional roles as these have changed over time.” —from the General Introduction Indiana University Press INDIANA UNIVERSITY PRESS Bloomington & Indianapolis http://iupress.indiana.edu 1-800-842-6796 NURSING, PHYSICIAN CONTROL, AND THE MEDICAL MONOPOLY NURSING, PHYSICIAN CONTROL, AND THE MEDICAL MONOPOLY Historical Perspectives on Gendered Inequality in Roles, Rights, and Range of Practice THETIS M. GROUP JOAN I. ROBERTS Indiana University Press Bloomington and Indianapolis This book is a publication of Indiana University Press 601 North Morton Street Bloomington, IN 47404-3797 USA http://www.indiana.edu/~iupress Telephone orders 800-842-6796 Fax orders 812-855-7931 Orders by e-mail iuporder@indiana.edu 䉷 2001 by Thetis M...