Finding a niche: Doctors, urban change, and the business of private medical practice in Philadelphia, 1900--1940

Most of what is known about the activities of American doctors in the early twentieth century is limited to the literature on medical "professionalization." Based on this historiography, one might get the misimpression either that doctors spent all of their time crusading for the reform of medical education, licensing laws, food and drug safety, and hospital administration, or that doctors kept busy by hatching plans to wrest power from their "sectarian" competitors and to establish a monopoly in the medical marketplace. But professional activities, such as attending medical society meetings or lobbying state legislatures, comprised but a small part of what doctors actually did. During this period, doctors spent most of their time practicing medicine--an activity that was as much a mundane occupation as it was an idealistic or protectionist profession. Historians know little about private practice, apart from a handful of studies, most of which are biographies of famous doctors. What factors led doctors to select one career path over another in practice? How did doctors make a living from practice? What economic and demographic factors influenced the distribution of practices in cities?; In Finding a Niche, I answer these questions by examining the private practices of doctors in Philadelphia, Pennsylvania from 1900 to 1940. The evidentiary core of this case study is a twenty percent interval sample of the 1909 and 1940 American Medical Directory , which I use to analyze the changing career paths and location decisions of practicing doctors. Supplementing these data are archival records of various Philadelphia practitioners and business advice literature that instructed doctors on how to build a successful career. I argue that in order to make a living in private practice, doctors had to adapt to particular occupational niches that were defined in relation to medical institutions, as well as the medical marketplace and the social geography of Philadelphia. The dissertation is divided into two sections--covering 1900 to 1920, and then 1920 to 1940--with the chapters in each section examining, in turn, the career paths and business practices of doctors and the geography of private practice.