Physician dominance in the 21st century: Examining the rise of non‐physician autonomy through prevailing theoretical lenses

Abstract

Theories of physician dominance are a foundational contribution of medical sociology to the study of health care, but must be revisited in the light of ongoing changes in medicine. As non‐physician specialists like nurse practitioners grow in number and acquire more autonomy, increasing medical profession differentiation presents a challenge for traditional physician dominance theories. After evaluating potential theoretical explanations for subordinate occupations' autonomy gains, we conduct a state‐level quantitative analysis of variation in nursing policies across U.S. states. We construct our dependent variable, nursing autonomy, using seven state‐level advanced practice nursing policies adopted from 2001–2017. Using an ordered scale, we code nurse practitioner, nurse anaesthetist, nurse midwife and clinical‐nurse‐specialist practice and prescription polices according to each policy's autonomy level. We then use time‐series regression to examine theory‐driven propositions regarding nursing autonomy change. Nursing autonomy has increased over time, signalling a general erosion of physician dominance. However, we find differential patterns of policy adoption, indicating that erosion is not uniform. Physicians have maintained dominance in relatively prestigious specialties (e.g. anaesthesiology) while dominance declined in others (e.g. obstetrician). Factors external to the profession, such as consumer power, continue to influence within‐profession dynamics. Examining ongoing professional differentiation in medicine illustrates how physician dominance depends on shifting social and professional contexts.

Investigation into the enablers and barriers of career satisfaction among Australian oral health therapists

“…This has resulted in role ambiguity, reduced career satisfaction and increased practitioner turnover in allied healthcare professions 24 . However, in the past few decades, changes in the socio‐political landscape and shifts in consumer power resulted in allied healthcare professions gaining more autonomy and recognition 23 . Furthermore, with changes in population healthcare needs, an innovative workforce model with greater stratification on care delivery was proposed to improve efficiency, effectiveness and access to care 1,25 .…”

“…19,20 Traditionally, physicians and dentists possessed a monopoly of knowledge and services in their respective fields and served as the 'captain of the ship' while other healthcare professions functioned as supporting team members and undertook tasks that are often below their skill level. 23,24 This has resulted in role ambiguity, reduced career satisfaction and increased practitioner turnover in allied healthcare professions. 24 However, in the past few decades, changes in the socio-political landscape and shifts in consumer power resulted in allied healthcare professions gaining more autonomy and recognition.…”

“…24 However, in the past few decades, changes in the socio-political landscape and shifts in consumer power resulted in allied healthcare professions gaining more autonomy and recognition. 23 Furthermore, with changes in population healthcare needs, an innovative workforce model with greater stratification on care delivery was proposed to improve efficiency, effectiveness and access to care. 1,25 In this model, OHTs serve as the primary care provider for patients with routine treatment needs and collaborate with dentists in treating patients with more complex needs.…”

Advanced practice nurse case managers improve efforts by US hospitals to address patient social needs

“…They are known to contribute to improved patient outcomes and satisfaction (Jennings et al., 2015), and there is growing belief that APNs will also produce similar outcomes in roles such as case management (Yip, 2021); APNs are highly capable professionals that could provide relief where hospitals are seeing patients readmitted for things out of their immediate control. The use of APN case managers is growing, and understanding more about their emerging roles is of interest to many hospital stakeholders and policymakers, both in the United States and internationally (Feyereisen, McConnell, et al., 2021; Feyereisen, Puro, et al., 2021). By examining over 2000 recent hospitals from the 2021 American Hospital Association (AHA) survey, we are able to add to the growing literature concerned with hospital‐based social prescribing and partnership strategies.…”