Elsevier

Social Science & Medicine

Volume 52, Issue 2, January 2001, Pages 179-187
Social Science & Medicine

Towards gender balance: but will women physicians have an impact on medicine?

https://doi.org/10.1016/S0277-9536(00)00218-5Get rights and content

Abstract

The increasing numbers of women in medicine in western societies has raised the issue about their impact on medical practice. As a way of addressing the issue, this paper explores women's position in medicine in the Nordic countries, where the medical profession will soon be gender-balanced. Support for both a ghettoization and a vanguard argument for women physicians can be documented. The final section offers three sociological perspectives — the socialization theory, the neo-Weberian, and the social constructionist — as theoretical explanations for the gender segregation of medicine and as diagnostic paradigms and potential heuristic devices to aid women's empowerment as medical providers.

Introduction

Recent changes in the character of medical work has made the medical profession in many societies concerned about the lack of control over its work. Some of the reactions have been collective and have resulted in strikes or threats of such measures. Other reactions have taken more individualized expression and are appearing as a growing prevalence of health problems and suicides among physicians. During the same period, women have entered into the profession in increasing numbers. As new members and with new capacities, will women physicians, as a new group within the profession, be able to “humanize” the profession?

The increasing proportion of women in the medical profession has been followed keenly both by conservative and feminist observers during the past three decades. The conservative observers have been mollified by the statistics that show that women physicians remain as active members of the profession even after forming a family. But the feminist voices continue to be heard, and for various reasons. One of the early arguments for an increase of women in the medical profession was the quest for equality between men and women. Liberal feminists demanded that women should have the same educational opportunities as men. Many formal barriers for women's entry into medical schools have been eliminated over recent decades. For example, American medical schools followed affirmative action policies in the 1970s and 1980s in order to increase the educational opportunities for women.

Subsequently, the focus of criticism has shifted to the skewed career advancement of women within the profession. Statistics both in Europe and in the United States tend to confirm that women physicians work mainly in niches of the health-care system or branches of medicine characterized by relatively low earnings or prestige. Since the mid-1980s, gender segregation of medical work has become increasingly recognized as a sign of inequality between female and male members of the profession. Furthermore, that women in the profession advance more slowly than men has been alleged to equate with the continuation of discriminatory practices within the profession. Certain structural barriers — such as lack of mentors, collegial support, information and professional networks that aid career opportunities — have been identified as mechanisms that hamper women's careers in the profession (Lorber, 1984, 1993).

In addition to the above structural interpretation of women physicians’ position in the medical profession, there is another explanation, an essentialist and voluntaristic explanation, of the gendered structure of medicine. According to the latter view, women are seen as harboring essentially different qualities from men, resulting in a valorization of women's gender specific tasks in medicine (e.g., Altekruse & McDermott, 1987, p. 85; Ulstad, 1993, p. 75). The argument is that the gender division of labor in medical work reflects women's unique female qualities and their own preferences and choices in career decisions, rather than discriminatory structures that cluster them in certain niches of medicine. Accordingly, the assumption is that an increase — both numerically and proportionally — of women in the medical profession will in the future radically alter the content of care and the direction of medicine. In a health-care system with a sizeable proportion of women physicians, patients will encounter more empathic and care-giving physicians. Furthermore, some feminist scholars argue that the sexism inherent in medicine, and in the diagnosis and treatment of women patients, will disappear as the profession changes from a male-dominated to a more female-dominated one (e.g., Fisher 1995).

The issue addressed by the two perspectives above on the potential of women physicians is: to what extent do women physicians represent a vanguard within the profession, which will head the rest of the profession towards a substantial change in the way medicine is practised; or has such a potential been coopted by a still predominantly male profession that continues to relegate women to marginal positions? In her work on women physicians, Lorber (1984), Lorber (1985) was the first to raise this issue. She predicted that women physicians were likely to be split into two groups: “those who align with other physicians in the fight to maintain professional dominance, and those who align with other female health-care workers and consumers in the fight for a health care system with a flatter hierarchy and a holistic and self-care perspective” (Lorber, 1985, p. 53).

But to what extent have women physicians advanced to positions where they would be able to implement changes in medical practice? This question has to be analyzed from a comparative perspective. Women physicians do not work in an organizational context that is universal: health-care systems vary in the extent to which physicians work in the private or public sector and in the extent that they have as a corporate body been able to influence their numbers and the character of their work (e.g., Wilsford, 1991; Moran & Wood, 1993; Hafferty & McKinlay, 1993; Johnson, Larkin & Sucks, 1995). In the Nordic countries, changes and the developments of the health-care system and health policies have been part of welfare state endeavors. A majority of the physicians work now, as they have worked in the past, in the public sector; but how primary care is organized varies between the Nordic countries (see Riska, 1993). Hence, grand theories of the developments of the professions, mostly based on market-oriented societies, are not immediately applicable to welfare-state societies, nor do they consider the built-in gender contract in such societies. As the medical profession is coming closer and closer to being gender-balanced in the Nordic countries, what have Nordic women physicians been able to achieve, and can their advancements give us any insight into the trend to be followed by women physicians in other countries? This question will be addressed in two ways in this article. First, I will describe the position of women physicians in the organization of medical work in the Nordic countries. Second, I will provide an overview of the major explanations of the gender segregation of medical work and use these theoretical perspectives as diagnostic paradigms and potential heuristic devices for an empowerment of women as medical providers.

Section snippets

Women physicians in the Nordic countries

In 1950, the proportion of women in the medical profession in Nordic countries ranged from 10% in Denmark, Norway, and Sweden to a high of 21% in Finland. There was almost no increase in the 1950s and 1960s, but since 1970 the proportion of Nordic women physicians has increased rapidly (Table 1). By 1998, in fact, women physicians constituted about a third of the medical profession in Denmark and Norway, 38% in Sweden, and almost half of the physicians in Finland (NMA, 1998). These figures are

Sociological explanations of the gendered character of medical work

Mainstream theory building in the sociology of professions has been gender neutral or been tacitly based on the assumption that medical work is done by men (e.g., Parsons, 1951; Freidson, 1970). Even sociologists pondering the changing nature of medical work have neglected to address its gendered dimension (e.g., Hafferty & Light, 1995). But most sociological explanations of medical work contain assumptions about women's capacity to perform certain medical work. Three mainstream approaches will

Conclusion

The increase in the numbers of women in medicine in western societies has raised the issue about their likely impact on the practice of medicine in the long term. Early predictions ranged from women physicians as a vanguard for a more caring profession to the pessimistic view that they will be reduced to a “token” status or else trapped by a glass ceiling (Lorber, 1985, 1993). Recent developments in the Nordic countries, however, indicate a more complex picture. Especially in Finland but also

Acknowledgements

The author would like to thank Cecilia Benoit, Sirpa Wrede, and Katherine McCracken for their comments on an earlier version of the manuscript.

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