This paper discusses social and cultural factors that impede collegial interaction of physicians and nurses. While physicians encourage a form of 'team work' in which nurses are subordinate, nurses seek mutual collegiality with physicians. This phenomenon is apparent in various degrees between all educational categories of nurses and physicians. We suggest that nurse expectations of status enhancement through increased knowledge and skill--the nurse practitioner model--fail to consider the deeply rooted structures of hierarchy, in particular gender hierarchy, that pervades medical care. Physician-nurse collegiality does offer benefits to patients; to achieve it nurses must devise methods to alter these structural barriers.