UNITED STATES ANTITRUST LAW AND THE CONTROL OF NURSE-MIDWIFERY: 1975 TO THE PRESENT.
Contributors: George Washington University.
Published: 1992
Number of pages: 321
Subjects: Sociology, General.; Political Science, Public Administration.; Health Sciences, Nursing.
Description: Using an historical case study approach, this dissertation explores the dialectical process of antitrust law implementation and occupational change for nurse-midwifery, 1975 to the present. Data for this study are from documentation, archival records, and interviews.

To explain why nurse-midwives are involved in antitrust activity involves exploring the interaction between the state, through law implementation, and the occupation of nurse-midwifery. Evidence from this study, at one level, suggests that conflicts between nurse-midwives and physicians are determined by the medical division of labor; nurse-midwives used antitrust law to change their work relations with physicians. However, this occupation-state relationship is more complex.

This study investigates the political process of antitrust implementation including the responses of nurse-midwives, physicians, and policymakers. There is evidence that antitrust law is not, as some argue, the means to open up market competition. Nor, is it merely a tool of the elite as others suggest. This study demonstrates that the political economy of antitrust law implementation for nurse-midwifery is both symbolic and instrumental. Symbolically, the Federal Trade Commission enforcement of antitrust law and private litigation of antitrust cases suggests a pattern of reinforcing the relationship between nurse-midwives and their back up physicians in the hospital setting, maintaining the hegemony of medicine. Instrumentally, there have been changes in the structure of work relations. Physicians are vulnerable as nurse-midwives take their work relations into the courts while seeking work in the private health care market.

It is argued in this study that to explain the dialectical nature of antitrust implementation and its consequences for work relations of nurse-midwifery requires that we place the contradiction of regulation and competition central in our analysis. These are processes in tension, a point that remained invisible to policymakers as they debated whether or not antitrust laws should apply to health care occupations.

One implication of this study is that the conflict between nurse-midwifery and medicine can be expected to continue as it does today because the contradiction of regulation and competition remains. The implementation of antitrust law merely accommodates the conflict.
Notes: Source: Dissertation Abstracts International, Volume: 53-04, Section: A, page: 1279.

Thesis (PH.D.)--THE GEORGE WASHINGTON UNIVERSITY, 1992.

School code: 0075.