Marketplace, Power, Prestige: The Healthcare Professions’ Struggle for Recognition
Developments, Conflicts, and Areas of Tension among Healthcare Professions in the Twentieth Century
Institut für Geschichte der Medizin der Robert Bosch Stiftung, November 15 to 17, 2017
The differentiation of non-physician healthcare professions that occurred at the same time as the specialisation of medicine and the development of medical technology gained momentum at the end of the nineteenth century. At this point, the academically educated doctors had already ousted their less-qualified competitors, such as traditional surgeons (Wundärzte or Handwerkschirurgen), from the medical marketplace. This development put doctors in a position, from which they had since secured great influence in the state accreditation process of new or newly regulated healthcare professions: a status that they still possess today. According to the German Vocational Training Act (Berufsbildungsgesetz), for example, the state medical associations (Landesärztekammern) are responsible for education and training of medical professionals.
As widely known, the medical care of the population is currently facing issues in a number of areas. Therefore, it is in the interest of the state and society to allow alternatives to the care by physicians. Especially in recent years, the delegation of doctors’ tasks to other healthcare professions has been discussed. Already in 2010, the Cooperative State University (Duale Hochschule) in Karlsruhe established a bachelor degree as physician assistants (Arztassistent). Examples for this endeavour are corresponding job profiles, which partly exist in other countries since decades. In this context, the professionalization or academisation of nursing plays an increasingly important role. One current example for this development represents the model course ‘Evidence Based Nursing’ at the Medical Faculty of the Martin Luther University Halle-Wittenberg, established in 2016.
The shift of competency and agency, however, led and leads into a number of problems as well. Therefore, the main focus of the conference will be the conflicts and areas of tensions, which accompanied the development or differentiation of the healthcare professions.
For example, the reasons and topics will be discussed because of which conflicts among medical professions occurred. Which parties were involved, which coalitions were established, how did the parties present themselves, and for what aims did they campaign for? Of particular concern will be the question, to what extent contributed such disputes to the shift on the suppliers’ side in the medical marketplace and what consequences had this development on the demanders’ side.
The key questions can be discussed on three levels and with retrospective considerations of the pre-modern period (monopolisation, professionalization).
1. Conflicts and Areas of Tensions Within one Healthcare Profession
On the first level of investigation, the negotiation process within one healthcare profession will be analysed. Within nursing, topics such as the conflicts between men and women, migrants and natives, or also between academic and non-academic people would be possible. Within the doctors’ profession, the main questions would be the conflicts between medical specialist and general practitioners, hospital and private doctors, or also between conventional and complementary or alternative medical practitioners.
2. Conflicts and Areas of Tensions Between Different Healthcare Professions
The second level puts the lines of conflict and tension between the different healthcare professions at the core of the investigation. Which occupational groups exercised influence on the development of adjacent occupations? For this level, it would be possible to analyse the disputes between conventional and alternative practitioners, doctors and osteopaths, psychiatrists and psychologists, gynaecologists and midwives, doctors and nurses, or doctors and psychotherapists.
3. Transnational Perspectives
The transnational perspective describes the comparison of the developments in Germany with other European countries. The question is how the different structural organisation of medical care impacted the development of healthcare professions? A comparison between centralist and federalist or capitalist and socialist systems would be of particular interest to the third level.
Presentations, Discussion, and Reimbursements
A slot of 45 minutes will be given to every presenter, in which a maximum of 20 minutes should be used for the paper and 25 minutes will be reserved for discussion. The spoken language at the conference will be English. The participation at the conference will be funded by the Institute for History of Medicine of the Robert Bosch Foundation, which includes the costs of accommodation, conference meals, and 2nd class train tickets for traveling to and from Stuttgart (only in exceptional cases, cheap flights will be reimbursed as well). Unfortunately, the costs incurred when traveling by car cannot be reimbursed.
Registration
To participate at the conference, please apply with an abstract of 400 words maximum, which includes title, research question, methods, and used sources as well as possible hypothesis and results, until 30 June 2017 via post or email to Dr Pierre Pfütsch and Dr Sylvelyn Hähner-Rombach, Institut für Geschichte der Medizin der Robert Bosch Stiftung, Straußweg 17, 70184 Stuttgart, Germany, or pierre.pfuetsch@igm-bosch.de and sylvelyn.haehner@igm-bosch.de.