Professions as Politics: the Deregulation of Medicine in the United States, 1790-1860

• In Event: 213 - Section on Organizations, Occupations and Work Paper Session. Power, Professions, and Movements

Abstract

This paper examines the deregulation of the medical profession in the United States during the first half of the nineteenth century. Between 1830 and 1850, all states but one repealed or nullified their medical licensing laws. To explain this striking case of apparent professional collapse, we draw on insights from political sociology to disentangle the processes linking together professional organization and regulation. Professions, like other kinds of interest groups, face the twin challenges of uniting diverse constituencies of practitioners around shared goals, while at the same time overcoming resistance from competing interests. We argue that professional sovereignty can be challenged if rival practitioners are organized, find support among the laity, and define their grievances in a way that places them in opposition to dominant professional groups. But if orthodox practitioners are also organized, they too may mobilize to defend their authority, recruit supporters, and discredit their opponents, even after the profession loses its legal monopoly. Our analysis adds to sociological knowledge of the professions in two ways. First, we show that medical practitioners’ grievances only turned toward advocacy for deregulation when they came to see their work in explicitly sectarian terms, standing in opposition to the “aristocracy” of regular medicine. Second, we show that while deregulation was a setback for regular physicians, it did not significantly weaken the organizational base of regular medicine. Instead, orthodox and sectarian physicians continued to found new medical schools, national associations, and medical journals as they jockeyed with one another for influence.

Authors

• Jacob Habinek, University of California-Berkeley

• Heather A. Haveman, University of California-Berkeley