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

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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.

Indiana University Press

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Editorial Reviews

Doody's Review Service
Reviewer: Bonnie L. Saucier, PhD, RN (Indiana State University)
Description: This book is the second in an interrelated set of books that provide a comprehensive perspective on gender and nursing. The second volume in this series analyzes resources that exemplifies the writing of social scientists, nurses, and physicians on gendered relationships from very early periods to the 1990s. The first volume relates the status of women to the status of nursing and to nurses' awareness of feminist issues. The third volume focuses on recent role changes involving nurses and their interactions with physicians. A fourth volume focuses on the historical interrelation between nursing and the discriminatory patterns inherent in patriarchial educational and economic systems. There are two additional volumes that address major published sources and problems of male nurses.
Purpose: The purpose is to examine sources on gendered nurse-physician relations over time. The authors trace the centuries- old effort of physicians to dominate and to achieve a monopoly over healthcare. The book also adresses the efforts of women healers and nurses to sustain medical-nursing functions. The objectives of the book are met and are indeed worthy for all nurses to develop an awareness of the historical perspective of a medical monopoly.
Audience: Nursing students, particularly those in graduate education, and nurses can excel in their practice by becoming aware of social contraints in the development of the profession. Authors identify nurses in the profession to profit from the book. The authors are experts in the subject.
Features: In this book, the authors trace the development of the continued efforts by physicians to achieve a medical monopoly. Early women healers, prior to the nineteenth century are analyzed. Nurse-physician relations, before and after the turn of the century, are examined. The consolidation of the medical monopoly in the 1920s and 1930s are discussed and the growing unease in nurse-physician relations from the 1940s to the 1960s is addressed. Reference lists are extensive and the index is inclusive.
Assessment: This second book in a related series provides a thorough examination of the effforts by physicians over time to achieve a monopoly in healthcare. Historical events are reviewed while the activities of the early healers/nurses are covered in a thoughtful and inclusive manner.The phases of organized medicine and nursing throughout the 1990s are described in-depth. This book is a valuable asset for all nurses to better understand and explain what the impact of medical monopoly is on the healthcare system today.
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Product Details

  • ISBN-13: 9780253339263
  • Publisher: Indiana University Press
  • Publication date: 10/28/2001
  • Pages: 560
  • Product dimensions: 6.12 (w) x 9.25 (h) x 1.52 (d)

Meet the Author

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.

Indiana University Press

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Table of Contents


General Introduction

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

Part I. "Exposing the Meretricious Lies": Early Women Healers and Nurses and the Mythology of Medicine's "Natural" Supremacy Over Healing
1. "The Mere Trivia of History?" The Legacy of Early Women Healers and Physicians' Efforts to Exclude or Control Them
2. "She Hath Done What She Could": Reforming Nursing as Physicians Tighten the Medical Monopoly in Great Britain, 1800s to the Early 1900s
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

Part II. The Purposeful Move Toward Dominance: Subordinating Nurses and Achieving a Medical Monopoly
4. "For Their Own Good": Physicians Manipulating, Trivializing, and Coercing Nurses, Later 1800s to 1920s
5. "The Exclusive Guardians of All Matters of Health": The Consolidation of Medical Monopoly in the 1920s and 1930s
6. A Growing Unease: Nurse/Physician Interprofessional Relations from the 1940s to the 1960s
7. Reconciling Practice with Protest and Confrontation with Cooperation: Nurse/Physician Relations in the 1970s

Part III. An Outdated, Burdensome Model of Monopolistic Control: Entering the 21st Century with a Fractured Health-Care System and Continuing Medical Opposition to Nurses' Autonomy
8. Who Needs the Autonomous Professional Nurse? Gender Stereotypes Remain Central to Nurse-Physician Relations
9. Challenges to the Medical Monopoly: Nurses' Gains in Direct Payment, Hospital Privileges, Prescriptive Authority, and Expanded Practice Laws
10. The Results of the Medical Monopoly: "A Regulatory and Policy-Making Quagmire"


Indiana University Press

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