Soc. Sci. Med. Vol. 47, No. 2, pp.

181±193, 1998
# 1998 Elsevier Science Ltd. All rights reserved
PII: S0277-9536(98)00058-6 Printed in Great Britain
0277-9536/98 $19.00 + 0.00

WOMEN IN GENERAL PRACTICE: RESPONDING TO THE

SEXUAL DIVISION OF LABOUR?
FIONA BROOKS
Institute for Health Services Research, The Spires, 2 Adelaide Street, Luton, Bedfordshire LU1 5DU,
U.K.

AbstractÐThis paper provides an exploration of the gendered nature of the working experience of
women within a high status and predominantly male dominated medical specialty, that of general prac-
tice or primary care physician. Women currently represent just over a third of all general practitioners
in the U.K. and their numbers have been increasing. Women now account for 60% of new recruits into
general practice. Despite this increase, consideration of the experience and role of women within medi-
cine has largely focused on hospital medicine. The ®ndings presented are derived from a three year pro-
ject, that aimed to develop an understanding of the role women health workers play in the U.K. in the
construction and provision of primary health care services for women. The methods employed consisted
of a series of postal surveys and qualitative interviews conducted with GPs, female nurses and women
service users. The ®rst section of the discussion provides an exploration of the nature and impact of the
sexual division of labour within general practice and the resulting occupational marginalisation of
women GPs. Attention is given to identifying the key processes whereby the sexual division of labour is
maintained and reproduced, particularly through the normative expectations of colleagues, patients and
women GPs themselves. The ®nal section presents a typology of the di€ering strategies the sampled
women GPs adopted for managing their working roles in response to the existence of a sexual division
of labour. The conclusion highlights the possible impact of the di€ering strategies upon the functioning
of women within general practice and their relationship with women users of the service. # 1998 Else-
vier Science Ltd. All rights reserved

Key wordsÐgeneral practice, primary health care, sexual division of labour, woman health workers

INTRODUCTION focused on the negative impact of the behaviour

Women currently represent just over one third of
all general practitioners in the U.K. (Department of
Health Joint Working Party on Women Doctors
and their Careers, 1991), a position which is set to
alter radically over the next decade with twice as
many women as men wishing to enter general prac-
tice (Allen, 1996). The numbers of women as a pro-
portion of all new recruits have been increasing and
women now account for approximately 60% of
recruits into general practice. This change has
occurred despite an overall picture of low recruit-
ment, retention and morale within general practice
(Handysides, 1994; Allen, 1996).
At the same time, a popular view appears to have
emerged which suggests that improvements in the
delivery of women's health care could be achieved
by women workers. Riska and Wegar (1993, p. 77)
indicate that this perspective is grounded in two
assumptions. Firstly, that increases in the numbers
of female physicians will result in an increased
prioritisation and promotion of women's health
issues (Ehrenreich and English, 1979; Relman, 1980,
1989). Secondly, the potential to alter the character
of doctor±patient interaction positively has been a
key feature of women workers' perceived contri-
bution to women's health care. During the 1980's a
substantial body of critical literature emerged which
and functioning of male medical practitioners in re-
lation to female service users (Oakley, 1980;
Macintyre, 1981; Roberts, 1985). Women workers,
it has been suggested, are more likely to provide an
equal and empathic dialogue with women service
users (Leeson and Gray, 1978; Altekruse and
McDermott, 1987; Foster, 1989; Kutner and
Brogan, 1990). However, as some commentators
have pointed out (Lorber, 1985; Weisman and
Teitelbaum, 1985), such assumptions beg further
evaluation.
This paper o€ers a critical exploration of women
GPs' approach to the provision of health care for
women. The discussion seeks to present an explora-
tory analysis of the working experience of women
in general practice and to examine critically the
notion that women GPs will o€er a `woman-
centred' approach to the delivery of health care for
women.
The paper will ®rstly identify the body of litera-
ture concerned with the character of the sexual div-
ision of labour within medicine, and speci®cally
general practice. The concept that women GPs are
both marginalised and ghettoised within general
practice will be explored (Lawrence, 1987). Then
secondly, through consideration of existing litera-
ture and analysis of women GPs' own accounts, an

181
182
examination will be provided of the in¯uence of the
sexual division of labour on role de®nition, appor-
tionment of responsibilities within general practice
and on the character of women GPs' relationships
with both colleagues and patients. Consideration
will also be given to how the sexual division of
labour may be ultimately in¯uential in determining
the status of women's health care as a speciality
within general practice. This is not to suggest a
prior assumption concerning the existence of a sex-
ual division of labour but to highlight the need to
explore its potential existence and level of impact.
The ®nal aim of this paper is to build on these
analyses further by presenting a model of the way
women GPs may be attempting to manage their
role, through an exploration of the di€erent strat-
egies adopted by a sample of women GPs. This will
attempt to provide a framework to interpret any
diversity of approaches among women GPs. In par-
ticular women GPs' reactions to the marginalised
position of women's health work is investigated.
METHOD
Findings are reported from a three year project
which aimed to develop an understanding of the
role women health workers play in the construction
and provision of primary health care services and
to explore women users' priorities and preferences
in terms of primary health care (Brooks and
Phillips, 1996; Phillips and Brooks, 1997). One of
the main objectives of the project was to identify
the nature of the relationship between women
workers and women service users.
The project employed a two-stage method,
designed to gather both quantitative and qualitative
data. Information was sought from providers and
from women service users and non-users. The role
of GPs was initially explored through a postal sur-
vey of all GPs (both male and female) within the
chosen research site, a former industrial city in the
north of England. The postal survey achieved a
75% (85% for women GPs) response rate (338
sample base) and provided information on practice
structure, the extent of current service provision for
Table 1. Characteristics of female GP interview sample: (N = 45)
Ages
Aged 25±35
Aged 36±45
Aged 46±55
Aged 55+
Gender of practice partnerships
Predominantly female practices
All female
1 or more male and 2 or more females
Balanced in terms of gender
1 male and 1 female practice
2 or more males and 2 or more females
Predominantly male practices
F. Brooks
women (such as the provision of well woman
clinics) and some data on approaches to women's
health care. Themes identi®ed from the analysis of
the ®rst stage material, such as perspectives on the
role of the practice nurse were then adopted as a
framework for the development of questions for the
second stage. This consisted of 45 interviews with
female GPs and observation at 2 practices. The
analysis undertaken for the typology was based on
44 interviews as one interview was limited in scope
by the GP. The interviews were semi-structured
which enabled the interviewees to raise issues and
discuss aspects of their work they perceived as im-
portant.
The central concern of this paper is to provide an
exploratory analysis of the experiences and percep-
tions of the women GPs studied in terms of their
role within general practice and especially in the
delivery of women's health care. Consequently,
although ®ndings presented in this paper are drawn
from both aspects of the ®eldwork, the main focus
is the qualitative interview material.
The aim of the depth interviews was to examine
closely the role of women professionals within gen-
eral practice with a particular focus on their percep-
tions of their impact on women's health care and
women users' health decision-making. All intervie-
wees were asked a range of questions concerning
their view of general practice; their motivation to
enter general practice, their perception and de®-
nition of their role within the practice, their re-
lationships with colleagues, including nursing and
administrative sta€, their approach to women
patients and their views on health promotion work
and women's health work. Initially the main objec-
tive was to elicit material concerning women
doctors perceptions on information giving to
women and preventive health care, however after
the ®rst interviews it became clear that in order to
gain an understanding of the nature of care pro-
vided by women GPs it was important to explore
their experience of working within general practice.
The GPs were randomly selected for interview
from the 104 women GPs who responded to the
postal questionnaire. All the women interviewed
Working hours
18 Full time 30
19 Part-time 15
8 Part-time <30 hours 9
0 Part-time >30 hours 6
8
4
4
23
11
12
14
 Women in general practice
were partners in group practices. No statistical
di€erence was found between the characteristics of
the interview sample and the larger postal sample.
Table 1 provides details of the relevant sample
characteristics. The interviews were all tape-
recorded and later transcribed. Analysis was under-
taken by using a grounded theory approach,
(Glaser and Strauss, 1967; Strauss, 1987). In con-
structing the typology discussed in the latter section
of this paper a strict process of theoretical re®ne-
ment and validation against the data was underta-
ken (Strauss and Corbin, 1990).
THE POSITION OF WOMEN IN MEDICINE
The sociological ®eld of ``women and work'' has
provided important theoretical insights into the
nature of women's position within male dominated
professions. Speci®cally, it can be largely character-
ised as ``continuity in change'' (Hakim, 1979); i.e.
despite an increase in the numbers of women in
these professions, women's position has remained
one of relative disadvantage.
Studies undertaken in the U.K., by McPherson
and Small (1980), Lawrence (1987) and Elston
(1993) and also in Europe (Riska and Wegar, 1993)
have all identi®ed the way the organisation of work
within medicine, or speci®cally primary care, is
de®ned by a sexual division of labour. It is known
that for women in medicine, the division of labour
results in occupational segregation: women are
under-represented in the top posts and proportion-
ately over-represented within the lower ranks
(Allen, 1988; Riska, 1988).
Women also tend to be located in certain special-
ties such as anaesthetics, radiology and general
practice (Mackie and Pattullo, 1977), specialties
which have in the past tended to o€er either more
¯exible working patterns or fewer unsociable hours,
but which are also perceived as being lower status
specialties. In addition, a widely held set of beliefs
holds that certain specialities such as paediatrics
represent a suitable match for a woman's ``apparent
innate skills'' (Lawrence, 1987; Miles, 1991). It has
been argued that a focus on the ``softer'' caring
aspects of the work, in a particular area, is central
to the categorisation of that area as a ``women's spe-
cialty'', with the result that these specialities become
almost exclusively perceived as ``a woman's pro-
vince'' (Miles, 1991).
Homans (1987, p. 103), in a study of the experi-
ences of NHS women scientists, identi®ed the way
that certain ``components within a job'' are per-
ceived as being more suitable for either a man or a
woman to undertake according to the exact nature
of the task. Even where women and men are con-
tractually undertaking the same job, components of
it are unlikely to be free from gender-derived de®-
nition and a ``gendered-label'' which will determine
who undertakes them. Lawrence (1987) has argued
183
that such compartmental specialism is imposed on
women in general practice through normative ex-
pectations which de®ne their role and professional
approach. Lawrence found that, although women
were frequently motivated to enter general practice
because they wished to practice medicine as a gener-
alist, the reality was that they were faced with ex-
pectations to focus within a narrow range of work
that was labelled as women's work, such as gynae-
cological and reproductive health work, paediatrics
and psycho-social work. Shapiro et al. (1983) found
that patients also held gendered normative expec-
tations in terms of technical and emotional skills:
women physicians were expected to have good com-
munication skills and an empathetic approach, in
addition to technical medical expertise, while male
physicians were expected to interact only on a tech-
nical level. West (1993) has argued that this process
constitutes a gendered di€erential accountability for
men and women within their professional lives.
Overall, women's careers in medicine appear to
be limited by vertical segregation, being concen-
trated in lower status jobs within occupations
(Hakim, 1979) and also by gheottoisation in that
such jobs are di€erentiated by gender (Reskin and
Roos, 1990). The consequence appears to be that
women physicians are subject to similar processes
of marginalisation and segregation found to be typi-
cal of women's working experience in a range of
other occupational and health settings (Spencer and
Podmore, 1987; Walby, 1988; Crompton and
Sanderson, 1990).
WOMEN'S WORK IN GENERAL PRACTICE
Lawrence (1987) noted that the perception of
general practice as o€ering an opportunity to
undertake a generalist role constituted a major
motivational factor for women wanting to enter
general practice. General practice in the U.K. is
currently characterised by a climate of rapid change
and as a result the ``traditional generalist'' role of a
GP may be disappearing, a factor which could in
part account for the reported low morale among
general practitioners (Handysides, 1994). However,
the idealised notion of a traditional generalist GP
caring for families and a community throughout
their career may still have an attraction, and per-
haps help to explain the continued numbers of
women entering general practice (Allen, 1996). The
reality for women may be very di€erent from such
idealised notions, with general practice being far
from ``a happy hunting ground for women doctors''.
(Allen, 1988, p. 241), as many of the problems
women encounter in the hospital sector appear to
be replicated within the primary health care ®eld.
A number of studies of general practice have
found that certain areas of work such as ``women
and child health work'', are almost exclusively allo-
cated to women health workers (Eisner and Wright,
184 F. Brooks
1986; Williams and Calnan, 1994). Bensing et al.
(1993) in a study in the Netherlands suggested that
the combination of gender and the hours of work
may be a contributory factor, with part-time female
physicians being more likely than their full-time
counterparts to see women patients and undertake
gynaecological work. It has been suggested (Eisner
and Wright, 1986) that women are disadvantaged
through the pressures they encounter to focus their
clinical work predominately within ``women and
child'' health work (Lawrence, 1987), because these
clinical areas, alongside preventive health work gen-
erally (Williams and Calnan, 1994), are seen within
general practice to comprise lower status sub-special-
ties and procedures. The main clinical role for
women within general practice has been seen as one
which is largely located within feminised ``segregated
niches'' (Crompton and Sanderson, 1990, p. 183;
Elston, 1993). As a result of the way the gender div-
ision of labour functions to produce ``feminised
niches'', women GPs are subject to professional ghet-
toisation through being ``channelled into a limited
form of general practice'' (Lawrence, 1987, p. 155).
The image of ``women and child health work'' as
routine and low status is, as Elston (1993) notes,
located within a speci®c historical context and is a
fairly recent phenomenon. In addition, recent policy
developments within the U.K., such as the pro-
vision of mass cervical screening and the extension
of well woman clinics, combined with increased
consumer demand have served to increase dramati-
cally the amount of women's health work within
general practice. However, what is perhaps particu-
larly signi®cant is the allocation of this work almost
exclusively to women workers, either female GPs or
practice nurses. The ascription of low status to
work undertaken predominantly by women has
been found to be a feature of women's experiences
within other professions in the NHS (Homans,
1987) and of caring work which is undertaken more
generally by women (Finch and Groves, 1983).
James (1992, p. 494) quotes that:
It is the gender division of labour which predicts that
women provide the greater part of direct care and it is the
gender division of labour which structures the value attrib-
uted to physical and emotional labour.
Women health care professionals are likely to be
directed through the mechanisms outlined above,
into the less prestigious work which comes to be
de®ned as suitable and ``natural'' work for women.
Consequently, the low status of such work is re-
inforced precisely because it is being predominately
undertaken by women. Furthermore, the ascription
of low status to working in women's health care
has additional implications for the delivery of
health care by women to women, and for the way
women users experience services. It is plausible to
suggest, for example, that women health care provi-
ders may have internalised values concerning the
relative status of women's health work.
ORIENTATIONS TO PRACTICE AND THE DOCTOR
PATIENT RELATIONSHIP
Women physicians have generally been perceived
as being inclined to possess a social as opposed to a
medical orientation to their work (Calnan, 1988, p.
582). A number of studies have identi®ed di€erences
between male and female physicians in their
approach to clinical practice and patterns of inter-
acting with patients. These studies suggested that
women physicians were more likely to provide user-
centred health care, such as: negotiating with
patients, responding to them as equals, spending
longer overall time in direct communication with
more conversational symmetry and facilitating
greater levels of continuity of care (Langwell, 1982;
Margolis et al., 1983; Preston-Whyte et al., 1983;
West, 1984; Weisman and Teitelbaum, 1985). A sig-
ni®cant feature of such ®ndings is that they have
indicated only that women physicians are more
likely than their male counterparts to provide an
empathic approach, thereby leaving aside a sys-
tematic analysis of the potential existence of a
broad range of approaches among women GPs.
Explanatory models accounting both for di€er-
ences between male and female physicians and
between di€erent female physicians in their
approaches to care have remained underdeveloped.
Suggested explanations have tended to be located in
essentallist notions concerning learnt nurturing abil-
ities (Foster, 1989, p. 355; Miles, 1991, p. 158). This
perspective has been criticised by West (1993) for fail-
ing to account for the impact of professional sociali-
sation in altering both men and women physician's
attitudes towards the ``humane side of medicine''.
Women cannot be assumed to be immune to pro-
cesses of professional socialisation and the domi-
nance of bio-medical approaches, so they may also
``serve as functionaries of the medical gaze'' (Wegar,
1993, p. 185). It appears that assumptions concerning
women health care provider's natural alliance with
user-centred health care suggest a degree of hom-
ogeneity among women which may not be supported
by an exploration of the reality of medical practice by
women (Carpenter, 1977; Wegar, 1993, p. 185).
Additionally, Lorber (1985, p. 52) proposes that
the orientation to practice which is adopted by
women physicians may be determined by their sta-
tus and position of authority. This raises a further
area for consideration: the view that women health
workers have a potential ability to respond more
appropriately to meet women's health needs
(Foster, 1989, p. 355) is not easily reconciled with
the signi®cant area of literature concerned with
women's employment. This literature, as previously
noted, has documented the character and e€ects of
the ``discriminatory environments'' (Bourne and
 Women in general practice
Wikler, 1978), within which women health workers
generally (Spencer and Podmore, 1987; Crompton
and Sanderson, 1990) and women doctors speci®-
cally (Lorber, 1985; Riska, 1988; Lorber, 1993;
Riska and Wegar, 1993) provide care.
Accounts which have acknowledged the potential
of diverse responses from women GPs and which have
sought to provide an explanation for some women
users' reported experience of an unsympathetic
woman GP or apparent preference for a male GP,
have focused on the values and norms that women
users bring to their interactions with women GPs,
i.e. socially constructed gender-based expectations
(Roberts, 1985, pp. 17±19; Miles, 1991, p. 169).
It is possible that stereotypical notions of female doctors
as likely to be sympathetic raise expectations too high, so
that a professional approach disappoints.
Such explanations seem to be unable to address
the complex range of in¯uences and processes
which construct the nature of the relationship
between women providers and users. Lorber (1985,
p. 52) argues for a need to understand how overt
behaviour by women physicians may be constructed
by situational and interactional context: for
example, a response to normative expectations from
colleagues and patients, or dominant medical or
gender discourses. Lack of control and autonomy
over the organisation of their work may also result
in women adopting a more traditional role with
patients (Shuval et al., 1989; Lorber, 1993). This
position is further developed by West (1993) who
suggests that, in order to understand the character
of female physicians' approaches to care, what is
required is a reconceptualisation of how ``gender''
has been understood and how it ``structures distinct
domains of experience'' through normative expec-
tations concerning appropriate attitudes and activi-
ties in an on-going process.
THE POTENTIAL FOR RESISTANCE?
The literature concerned with the position of
women in the health professions has given relatively
less attention to exploring the range of women's re-
sponses and strategies for managing their working
roles in the light of their disadvantaged position.
Although it is important to recognise that, as
Lorber (1993, p. 81) indicates, occupational choices
of women doctors are likely to be reactive responses
to restricted options generated by institutional bar-
riers, Walby (1986) has argued that women do not
invariably acquiesce to their fate, but can be ``sig-
ni®cant actors in resisting their exploitation''
(Walby, 1986, p. 1). Similarly, Gould (1980) has
argued that the potential for women to change and
*All the quotations from respondents are from female
GPs, the details provided with the quotation refer to
the structure of the partnerships within each practice.
Numbers are inclusive of the GP speaking.
185
direct service policy, is an important issue for con-
sideration if the nature of women's working experi-
ence is to be uncovered.
Lawrence (1987) found that a woman GP's de-
cision about the type of practice she worked in was
frequently determined by her experiences of the sex-
ual division of labour within general practice. In re-
sponse to a marginalised position within group
practice, some women GPs actively choose single-
handed practice as a strategy to enable them to
exercise control over their work (Lawrence, 1987).
However, seeking single-handed practice can only
represent one option for women GPs and, is
increasingly a less than viable option, given recent
policy shifts towards group practices.
Findings from an analysis of women physicians
in Finland by Riska and Wegar (1993, p. 86)
suggests that age could be a valuable factor in pre-
dicting the strategies used by women doctors to
manage their position and role in medicine. Riska
and Wegar (1993) suggest that physicians in the
older age groups were more likely to subscribe to
biological explanations for the existence of a sexual
division of labour, while the younger age group
provided accounts which perceived such di€erences
as generated by ``external forces''. However,
younger women were also more likely to hold the
view that, by virtue of gender speci®c skills and ex-
perience, women will humanise general practice
(Riska and Wegar, 1993, p. 88) and ``capture'' the
social and emotional side of medicine as a province
for women. In contrast, women in the middle years
(aged 36±55) tended to stress their role as tra-
ditional doctors irrespective of any gendered in¯u-
ences. It therefore seems plausible to suggest that
an exploration of the di€erences among women
health care providers could further the understand-
ing of women's role in structuring health care deliv-
ery and their potential for re-structuring it.
DISCUSSION AND FINDINGS
From the women GPs' accounts of their motiv-
ation in entering general practice, three features
emerged which were seen as the most attractive
aspects. The ®rst was the desire to combine a family
with a career, also found by Parkhouse (1986).
Secondly, many felt that general practice o€ered
opportunities to employ caring skills and develop a
degree of personal involvement with patients which
was absent from a hospital based medical career.
General practice just covers all sorts of areas of life and
it's just got greater contact with people and greater conti-
nuity over the years. Positive reasons (group practice; 2
female and 2 male GPs*).
Thirdly, and in common with ®ndings from the
study undertaken by Lawrence (1987), general prac-
tice was also attractive to the women interviewed
precisely because it appeared to o€er a generalist
186 F. Brooks
role. A generalist role was felt to provide an oppor-
tunity to practice a broad range of medical skills
and additionally, to combine nurturing and caring
skills with the more medical aspects of ``doctoring''.
Part of the appeal of general practice is therefore
likely to be due to the traditional image of the
``family doctor'', a GP who is able to employ their
skills to the full by responding to a wide range of
health care needs.
In support of ®ndings from previous studies
which identi®ed a marginalised role, the majority of
women GPs interviewed acknowledged an overt
pressure to focus their work within what can be
broadly de®ned as the provision of women's health
care.
If I didn't like women's medicine then I probably wouldn't
have done general practice because if you are a woman
and you go in to general practice you're going to do
women's medicine. (Group practice; 1 female and 3 male
GPs.)
The GPs interviewed for the ``Women and
Primary Health Care'' project reported actions from
the range of colleagues and co-workers within the
primary health care team which reinforced their
position. An illustration of this process can be seen
through some of the interviewees' reporting of the
approach of their practices' receptionists.
Receptionists (in all cases female) were frequently
cited as being likely to perceive the role of a
woman GP as being primarily concerned with
women's health care.
The receptionists, perhaps decide for the patient, they tend
to book them with us rather than the patient speci®cally
requesting a woman. (Group practice; 2 female and 2 male
GPs.)
The expectations of women patients were also felt
to constitute a signi®cant factor in the shaping of
their working experience.
Women do come with an expectation of an automatic
understanding (group practice; 2 female and 2 male GPs).
Almost all the GPs (42 out of the 45) stated that
they felt that proportionately more women booked
with them than with male colleagues. The percep-
tions of the GPs who were interviewed were also
supported by the ®ndings from the questionnaire
survey in which 85% of women GPs and 61% of
male GPs agreed with the statement ``that pro-
portionately more women choose to consult a
female GP than a male GP'',
The female partner has gone on maternity leave and in
that short time I have seen a higher proportion of women
with gynae, ``lady doctor problems'' (male GP postal ques-
tionnaire).
A recent study in the Netherlands also identi®ed
signi®cant di€erences in the consultation patterns of
female patients with high numbers of women
patients being seen by women doctors, (Bensing et
al., 1993). Colleagues, patients and to a large extent
women GPs themselves, were found to have
adopted the highly gendered view that women GPs
would focus their work within speci®c areas of
practice, indicating a ``gendered label'' attached to
these areas of work (Homans, 1987):
Lady doctors do what lady doctors are perceived as being
good at doing which is basically family planning, ante-
natal and babies. (Group practice; 1 female and 3 male
GPs.)
The experience of many of the women GPs was
therefore of a workload weighted towards a narrow
area of specialism, that of women's health care, and
this contributed to their occupational marginalisa-
tion through the construction of a feminised niche.
The ®ndings further indicate that normative
assumptions have an impact beyond de®ning clini-
cal areas of speciality. Women GPs reported an ex-
pectation that their ``style'' of practice would di€er
from their male counterparts: speci®cally that they
would possess a more sympathetic and approach-
able manner in terms of their interactions with
patients than male colleagues. Such expectations
were identi®ed by the women GPs as being held by
colleagues and in addition were felt to be grounded
in the views of women patients and that in part
accounted for women users' high numbers of con-
sultations with them. Women patients were felt by
the interviewees to anticipate that, as women prac-
titioners, they would approach topics concerned
with women's health needs with heightened sensi-
tivity arising from their own experiential under-
standing. The GPs also stated that they were
expected to provide a more empathetic response to
women presenting with gynaecological health issues,
from a basis of an improved understanding of
women's feelings arising from the belief that they
shared such experiences:
I think also women like to bring their children to some-
body that they know has had children and therefore have
you know experience of childbirth, the problems of having
babies and so on. (Group practice; 2 females and 3 male
GPs.)
The same normative expectations, which de®ned
an appropriate style of service delivery for a female
GP, were also found to extend into expectations
concerning their role in the management of the
practice. On a broad level, colleagues and women
GPs themselves frequently assumed that they would
undertake the major share of the ``emotion work''
of the practice and especially responsibility for the
``emotion-management'' work of the practice
(Hochschild, 1979). This frequently resulted in
women undertaking formal responsibility for per-
sonnel management and, on an informal level, in
their having responsibility for ensuring that the
emotions of others were managed within the prac-
tice team. As James (1989) has argued, ``smoothing''
is a key aspect of emotional work that women
health workers typically undertake.
 Women in general practice
One of my roles is responsibility for sta€, which I think is
not a coincidence being a woman and getting that respon-
sibility... Because you are a woman you do take on much
more of the sta€'s feelings and problems and diculties,
just in that you sit and you chat to people more than men
tend to do. (Group practice; 1 female and 2 male GPs.)
The analogy of the nurse, doctor and patient re-
lationship as constituting a family, with the doctor
as the dominant ``father ®gure'', is a frequently
cited one (Gamarnikow, 1978; Game and Pringle,
1984; Carpenter, 1993). This raises the question:
what is the role and status of the doctor likely to be
when the doctor is a woman? One answer which
could be drawn from the women GPs' accounts, is
to suggest that women GPs recognise the traditional
role of the GP as constituting the dominant pro-
fessional role over other groups in the practice, but
that they perceive their role as being predominantly
gender de®ned. An illustration of this process can
be seen in the way some of the women GPs
described their role as that of ``the mother of the
practice'' and their relationship with male col-
leagues as being akin to a marriage. Overall,
women GPs either were, expected to take or
assumed responsibility for the ``emotion work'' of
managing a practice and caring for sta€ and
patients.
I think in a way the partnership works, a bit like a mar-
riage... (The male GP) His is I suppose more a traditional
role and I think I'm the one who does the sort of caring
and the smoothing very much as you would have in a tra-
ditional marriage. (Group practice; 1 female, 1 male GP.)
My role? Well I would say it's the mummy to the practice
really... (Group practice; 1 female, 2 male GPs.)
The expectation that women will adopt a caring,
empathic approach was found to form an ad-
ditional part of their professional role: an add-on to
their medical expertise. This additional aspect of
their role and responsibilities can become a norma-
tive requirement for a woman working in general
practice; but signi®cantly, it is not part of the nor-
mative requirements expected of a male undertaking
the same job.
...like if you have got a child that's howling at night or
won't sleep at night I would expect a male doctor to sort
out whether it's a medical problem or a behavioural pro-
blem that the Health Visitor can deal with...then he can
wash his hands of it and I think that the patients accept
this. He has a right to wash his hands of it. But I often
feel I'm there to deal with the problem and come to a sat-
isfactory solution rather than just doing the medical bit.
But if a male doctor is quick and in a hurry he is still
doing his job if he doesn't sort of solve the whole thing.
It's a delicate di€erence (my emphasis) (Group practice; 2
females (job share), 1 male GP male full time.)
This ``delicate di€erence'' illustrates a clear dis-
tinction between the normative expectations sur-
rounding male and female GPs' roles. To adapt
the formulaic approach to de®ning care developed
by James (1992), the de®ning character of a
woman GP's role = technical labour + emotional
187
labour + emotional organisation, while the con-
trasting male role is focused around the application
of clinical and technical medical expertise. This is
not to suggest that some male GPs do not under-
take emotional work; but instead to highlight the
normative expectations which de®ne how a female
and a male GP are di€erently perceived or are ``dif-
ferently accountable'' in any interaction within
social relationships (West, 1993, p. 59). Emotional
work appears to be speci®cally expected of a
woman GP; yet, if undertaken by a male GP, it is
likely to be remarked on quite di€erently, being
perceived as an optional extra for the male. Neither
is this technical and emotional division solely a fea-
ture of the women GPs' and their colleagues' expec-
tations but, as noted earlier, it has been found to
constitute a central element also of women patients'
gendered expectations of doctors (Shapiro et al.,
1983).
Overall, the evidence presented indicates that the
role of a woman GP is in part constructed through
the cultural expectations that women will provide
love and tenderness and ``are skilful providers of
a€ective support'' (Miles, 1991, p. 97). The ®ndings
suggest that such cultural and normative expec-
tations represent a clear indication that the nature
of emotional labour in general practice is a gen-
dered phenomenon, subject to and reinforcing the
sexual division of labour.
Thus women within general practice, conforming
to notions of the appropriate role for ``a woman
GP'', face the potential threat of low professional
status as the de®nition of a ``good GP'' is de®ned
in terms of the masculine.
RESPONSES TO THE SEXUAL DIVISION OF LABOUR: A
TYPOLOGY
In terms of the ®ndings presented so far, an
attempt has been made to clarify the nature of the
sexual division of labour within general practice
and to demonstrate the main implications such a
sexual division of labour has for women GPs.
Section 7 identi®ed the manner in which the ma-
jority of female GPs interviewed overtly acknowl-
edged pressure to focus their clinical time within the
area of women's health care and to accept responsi-
bility for the emotional work of the practice.
However, these pressures were di€erently responded
to by the GPs interviewed. In particular, it is poss-
ible to identify a number of di€erent discourses
expressed within the statements of the women GPs.
These discourses re¯ect sets of meaning being
applied by the women GPs to their experience of
the sexual division of labour within their working
environment. The aim of the remainder of this
paper will be to map out these di€erent interpret-
ations and illustrate the way they can operate to
create di€erent forms of service delivery. In doing
so, a typology is put forward which seeks to di€er-
188 F. Brooks
Fig. 1. Typology: view of role.
entiate between responses to the sexual division of
labour by women GPs, and to suggest a framework
through which these responses can be interpreted.
The typology is structured around two main
groups of GPs (from 44 interviews), ``the women's
GP and the general GP''. The ®rst main group, ``the
women's GP'', consists of those who welcome the
role of a specialist in women's health care and has
two sub-groups that of ``the committed women's
GP'' and ``the natural women's GP''. The second
main group ``the general GP'' represents those GPs
who sought to adopt a generalist role encompassing
the notion of a traditional family GP. Figure 1 pro-
vides an overview of the typology.
THE WOMEN'S GP
The ®rst main narrative apparent in the GPs'
accounts was that of a GP who actively welcomed
her role being primarily concerned with the pro-
vision of women's health care (19 GPs). Those
working in exclusively female practices were more
likely to conform to the portrait of a ``woman's
GP'' as were those working in practices with a
higher ratio of males to females.
The ``women's GP'' group accepted or frequently
sought to direct their role towards seeing pro-
portionately more women patients and especially to
undertaking most of the health promotion and pre-
vention work with women. Women's health care
was perceived by this group as a clearly identi®able
sub-speciality within general practice. These doctors
tended to stress their common ground with women
users of services, and their ability to provide a
uniquely empathetic response resulting from shared
experiences as women. In addition, such GPs
tended to stress that their style of practice could
often be di€erentiated from that of their male col-
leagues. In the main these di€erences in style
focused on the provision of an holistic response and
the resulting longer consultations. Doctors who
were allocated to this group also tended to see their
own personal and domestic experiences including
their experiences of childbirth and motherhood as a
 Women in general practice
valuable means of informing their clinical practice.
Personal life experiences were identi®ed as enabling
e€ective communication with women patients; or,
as the following GP stated, ``learning it from mum''
was seen as a valid source of expertise:
I sometimes sit here and think, ``now what of the advice
I'm giving: how much is what I learned at medical school
and how much did I learn from my mum'', and quite a lot
of what I actually do with people is what I learned from
my mum. (Group practice; 2 female GPs, 2 male GPs.)
In terms of personal motivation to specialise in
the ®eld of women's health care, two very distinct
and seemingly polarised ideological perspectives
were apparent in the accounts as underpinning the
GPs' view of their role. These two perspectives can
be summarised by: on the one hand a political com-
mitment to women's health issues and, on the other
hand, a belief in a ``naturally derived sexual division
of labour''.
The committed women's GP
This group of GPs represented a small minority
of GPs interviewed (7) and were identi®ed by their
possession of a political commitment to women's
health issues that was grounded in an understand-
ing of feminist critiques of service provision. Those
who welcomed a workload focused on women's
health and espoused a feminist perspective tended
to be among the older GPs with the majority (4)
being located in the 46±55 age group and only one
worked part-time. This group of GPs were motiv-
ated to challenge the low status of women's health
care and to ensure that women's health issues were
taken on board as an issue by other GPs. These
doctors were also more likely to articulate an overt
awareness of their own occupational segregation
and to have developed strategies to resist marginali-
sation. Strategies employed by this group included
actively seeking partnerships with other like-minded
GPs and establishing support networks with other
GPs outside of their own practice.
The natural women's GP
In contrast to the ``committed'' group, many of
the GPs interviewed appeared to accept a demar-
cation within their working practice based on gen-
dered roles; and hold a belief in a ``natural'' sexual
division of labour. Those who were ascribed to the
``natural women's GP'' group (13 GPs) were in the
main younger, comprising all of the eight younger
GPs in this group (aged 25±35 age) and ®ve of the
eight ``women's GPs'' aged 36±45. The ``natural''
group also accounted for 7 of the 15 part-time GPs
(see Table 1) the majority of whom worked less
than 30 hours a week.
It was noted earlier that components within an
occupation will be subject to gendered labels which
will in¯uence who undertakes those tasks (Homans,
1987, p. 103). Similarly the GPs who could be allo-
cated to this sub-group tended to present a belief
189
that, by virtue of an innate feminine personality or
biologically derived skills and characteristics, there
were certain tasks for which they, as women, were
more suited to undertake than their male col-
leagues. This group tended to argue that being a
woman GP provided them with a basis to employ a
distinctly feminine sphere of clinical expertise and
to develop that expertise through specialising in
women's health care and the emotion work of the
practice.
Well I suppose over the years I've developed techniques
for dealing with women patients again on the gynaecologi-
cal ®eld and I have taken over responsibility for all the
paediatrics surveillance. I enjoy it, it seems to fall naturally
to the woman doctor to do it and when I said I would do
it, everybody else heaved a big sigh of relief. (Group prac-
tice; 2 female GPs, 3 male GPs.)
In terms of the impact on their status as
``women's specialists'' the ``natural group'' of GPs
had an awareness of the low status women's health
care work has within general practice and the sub-
sequent marginalisation that could occur. However,
in contrast to the GPs who expressed a political
commitment, they tended not to stress any active
strategy to combat occupational marginalisation.
For this group the sexual division of labour was
unproblematic, representing a valid means of setting
the boundaries of their role.
Irrespective of any di€erences in their personal
justi®catory framework for identifying themselves
as a ``women's health specialist'', the ``women's
GP'' group as a whole did present a very uni®ed
approach to the delivery of women's health care,
which focused on an holistic empathetic response.
In addition they also tended to present a consist-
ently similar approach to the management of prac-
tice nurses, an entirely female dominated group of
sta€. In the questionnaire, GPs were asked if the
practice nurse had any specialised role with women
patients and 60% of all GPs gave an armative re-
sponse. Broken down by gender, 65% of male GPs
and 55% of female GPs said ``yes''. Those women
GPs who gave a negative response to this question
tended to identify a special role with women as
their own sphere of expertise.
Well, I mean if we were an all male practice we'd probably
think along the lines that wouldn't it be nice if the practice
nurse got more involved in family planning and all this
sort of thing. But I suppose because we're all women and
we tend to do it fairly comfortably anyway, it's not some-
thing that I particularly want to o€ load on her because I
like doing it myself. (Group practice; 4 female GPs.)
This group of GPs also tended to express reser-
vations about any expansion of the role of the prac-
tice nurse and the development of nurse
practitioner status. The potential for this form of
competition between female doctors and nurse prac-
titioners has also been previously noted by Lurie
(1981) and Lorber (1985). Thus the nature of the
relationship between practice nurse and female GP,
190 F. Brooks
the gender division of labour and the professional
hierarchical division of labour, seem to interact to
de®ne the role and activities of both practice nurses
and these GPs.
``A GENERALIST GP'': A GP WHO HAPPENS TO BE A
WOMAN
The GP's allocated to the ``generalist group'' (25
GPs) conformed to Lawrence's (Lawrence, 1987)
assessment, that many women GPs feel they are
prevented from being ``true'' GPs in the sense of
being a well rounded family doctor by the pressures
they encounter to specialise in women's health
work. These pressures were seen to limit their
opportunities to practice general medicine, as their
surgery time would be fully booked up by women
presenting with ``women's health issues'' and as a
result they perceived their workload to be dispro-
portionately weighted towards that single area of
specialism. One consequence of this was that they
felt they had little chance to develop their expertise
in other areas relating to general medicine and par-
ticularly to the more high status areas.
And my surgery would be fully booked with predictable
problems, so that the acute headache that was a meningitis
wouldn't get to see me it would always go and see my
partner who has got space available. (Group practice; 2
female, 3 male GPs.)
I do feel that I am not being a true GP just because I am
just seeing women and I do think ``oh wouldn't it be nice
to see a man with a sore throat rather than another de-
pressed woman''. (Group practice; 3 female (all part-time),
2 male GPs.)
This group predominantly perceived their role as
being that of a medical practitioner whose approach
to clinical practice was identical in nature to that of
their male counterparts.
I would rather see myself as a family doctor rather than a
woman's doctor...Which is actually what I've always
wanted to be, just a doctor. I don't think I should be here
exclusively for women if you see what I mean. (Group
practice of 2 female, 2 male GPs.)
Those allocated to this group were likely to be in
their middle years (16 out of 25 were aged 36±55)
and more likely to be working either full-time or
over 30 hours part-time than those in the ``women's
GP'' group. The GPs allocated to the ``generalist
GP'' group comprised those women GPs who per-
sonally opposed any notion of gender as constitut-
ing a signi®cant category in de®ning their working
role. Not only did they emphasise a desire to work
in a broad manner, as a generalist GP, they also
actively rejected the role of a specialist with a
speci®c expertise to o€er in the area of women's
health care. Instead they de®ned their role in terms
of a ``traditional general/family practitioner''.
GPs who could be assigned to this group tended
to be dismissive of the concept that they could have
a potentially empathetic relationship with women
patients, and that they might have an enhanced
ability to communicate with other women arising
from shared experiences.
I am just a person, just a GP, I don't feel very strongly
that I am female. (Group practice 1 male GP, 2 female
GPs.)
Linked to their rejection of the signi®cance of
gender many argued that personal experience did
not inform their own practice. Consequently their
own reproductive and maternal experiences rather
than being seen as a resource to be drawn upon in
their relationship with female patients, were instead
felt to be irrelevant to their practice. Typically the
GPs in this group stressed the dominant place that
their professional medical training had as the source
of their expertise, as doctors. This perspective con-
sequently informed their view of consultations with
female patients. A couple of GPs felt that within
the context of patient choice, women patients did
have a right to choose to see another woman if
physician gender was an important consideration
for the individual concerned. However, the majority
of GPs within this group tended to be hostile to
consultations by women patients who did not con-
form to their perception of the boundaries of their
role. This adverse reaction included patients who
booked an appointment with them because they
were a woman GP, and also those patients who
during the consultation expected or sought to relate
to the GPs experience as ``a woman and a doctor''
rather than as simply ``a doctor''.
Certainly I do the well woman clinics, because I think
people expect women doctors for those sort of things...
Personally, I wouldn't mind, I was quite happy to see a
man doctor for child health or ante-natal I don't mind
seeing a man doctor myself, and I don't really see why
patients should. (Group practice; 2 female and 2 male
GPs.)
The view that the single most signi®cant factor
determining their clinical practice was professional
medical training consequently shaped the nature of
these GPs' de®nition of an e€ective consultation. A
quality consultation was de®ned as having provided
a clear solution to a medically de®ned presenting
problem. Quality could also be improved by achiev-
ing a quick consultation, thereby reducing waiting
times, enabling clinics to be completed on time and
greater numbers of patients to be seen.
Overall, a speci®c role in women's health work
was rejected for a number of key reasons.
Primarily, such work was felt to represent an area
which did not e€ectively employ their medical skills
but involved mundane and routine work combined
with a heavy emphasis on work which was poten-
tially very time consuming. These factors, combined
with the threat of marginalisation ensured that
these GPs were actively resistant to any notion of
having a ``special'' role in women's health work.
Strategies apparent in their accounts to guarantee
that they would not become the single provider re-
 Women in general practice
sponsible for women's health work included dele-
gating a substantial proportion of women's health
work to the practice nurse or ensuring that they
entered into a partnership in a group practice which
had another women GP who was responsible for
the women's health work.
I encourage it (consultations re-depression) because I
don't want to see them and it's much better that they
don't see me because I'd give them a ¯ea in their ear and
it would be better for them to get a sympathetic hearing
from the nurse. (Group practice 1 male GP 1 female GP.)
Those who could be identi®ed as being primarily
a ``generalist GP'' were more likely to be found in
practices which were not only balanced in terms of
gender (see Table 1) but which included 2 or more
other female partners. Before joining a new prac-
tice, careful consideration of the gender compo-
sition of that practice and the clinical interests of
any other female GP, was for a generalist GP an
active strategy of resistance to women's health
work.
One of the positive reasons for joining the practice was
that there was another woman there. I didn't want to par-
ticularly end up with all the female problem workload...I
was speci®cally looking for a practice where there was
another woman. (Group practice; 2 female and 2 male
GPs.)
Extreme dissatisfaction with their role was more
likely to be expressed by a ``generalist GP'' who
worked either part-time or in practices with higher
numbers of males than female partners, especially
where they were the only female partner, suggesting
that occupational marginalisation may be more
complete for such GPs, and as a result there is per-
haps less opportunity for them to adopt strategies
of resistance.
CONCLUSIONS
Previous research concerned with the nature of
the relationship between women users and women
providers has tended to focus on the identi®cation
of any improved quality of communication between
female physicians and female users in medical
encounters; while critical accounts of this relation-
ship are rare (Brozovic, 1989). The ®ndings dis-
cussed here suggest that an explanatory model
incorporating an understanding of the functioning
of the sexual division of labour within medicine can
enable a more comprehensive analysis of women
GPs' role in the provision of primary medical ser-
vices for women service users.
The ®ndings support the utility of West's (West,
1993) analytic model, as it appears that the gender
of the GP serves to generate normative expec-
*The numbers of GPs sampled for this study were some-
what smaller than both the Finnish and Dutch studies
and consequently direct comparisons need to be made
with caution.
191
tations, thereby constructing the complex ``delicate
di€erence'' de®ning the most appropriate role and
style of practice for male and female GPs. Women
GPs consequently have a ``di€erent accountability''
(West, 1993) in terms of their medical practice than
their male counterparts which is replicated and re-
inforced during their day to day working experi-
ences. The character of the organisation of work
within general practice is a gendered phenomenon,
in which feminised niches and occupational segre-
gation are a function of the sexual division of
labour. In this paper the analysis sought to examine
the response from women GPs to this identi®ed
position by attempting to construct a typology
which provides a framework through which an
apparent diversity of approaches among women
GPs can be interpreted.
The responses were characterised by two main
groups the ``women's GP'' and the ``generalist GP''.
The two groups can be distinguished largely by
strategies of either accommodation to normative ex-
pectations or resistance. In the case of the ``women's
GP group'', there was a readiness to undertake the
emotional work of the practice and specialise within
women's health work, while among the ``generalist
group'' there was active resistance to such feminised
occupational niches. Additionally the typology
highlighted the implications that each response had
in constructing the type of doctor±patient relation-
ship women patients could experience and for de®n-
ing the role and responsibilities of another group of
predominately female health workers, that of the
practice nurse.
The number of part-time GPs found in the ``natu-
ral women's GP'' group suggests, in line with
Bensing et al. (1993), that part-time working and
particularly the number of part-time hours worked
may be in¯uential in the construction of an exclu-
sively women's health role for female GPs. The
®ndings indicate a degree of support for the signi®-
cance of age in explaining orientation to practice
found by Riska and Wegar (1993, p. 86)*, particu-
larly in terms of a more traditional commitment to
the medical model found among middle-aged GPs.
The ®ndings also provide some support for the view
that younger GPs may be likely to hold that
women have gender speci®c skills, which enable a
distinct approach to the provision of women's
health care, although possibly not in as high num-
bers as found by Riska and Wegar (1993).
The sexual division of labour and in particular
the impact of gendered normative expectations and
the resulting occupational segregation appears ulti-
mately to place women GPs in general practice in a
contradictory position. Women GPs face competing
demands to be sensitive and caring, while at the
same time working within an environment where
the dominant values are ones based on scienti®c
notions of clinical objectivity and professional dis-
tance. The two most common strategies found
192 F. Brooks
among the GPs to respond to such a contradictory
position are both problematic, for the status of
women in the profession, or for the delivery of
women's health care. The view that by virtue of
gender speci®c skills women can claim a distinct
role to play in women's health care, raises questions
concerning the future professional status of women
in general practice and of the status of women's
health care. As Spencer and Podmore (1987, p. 3)
have argued, stereotypes concerning women's innate
nature are one of the key factors contributing to
women's professional marginalisation. In contrast
the strategies of resistance to marginalisation
characterised by the ``generalist GPs'' suggests an
approach to the delivery of women's health care
that reproduces the very form of care women have
criticised male providers for delivering.
It therefore seems plausible to suggest that the
organisation of work and the character of the sex-
ual division of labour within general practice has
direct implications for the character and quality of
care that is being delivered by women health care
providers. It is important that a further understand-
ing is developed of the way women within the male
dominated medical profession experience and inter-
nalise gendered stereotypes, including an analysis of
both conformity and resistance. This will facilitate
the development of a critical understanding of the
role women health care providers play in the con-
struction and delivery of services for women.
AcknowledgementsÐI owe many thanks to John Paley,
Penny Curtis, David Clark, David Phillips and Peter Scott
for their very helpful advice on drafts of this paper and
general encouragement. Thanks also go to Sue Thompson
and Karen Ricci who were researchers on the project and
who were involved in the GP interviews. I am very grate-
ful to the anonymous reviewers for Social Science and
Medicine, for their constructive advice and encouraging
response to the paper. The greatest debt is to the women,
both members of the general public and service providers,
who agreed to take part in the study. The project was sup-
ported by the ESRC.
REFERENCES
Allen, I. (1996) Career preferences of doctors. BMJ
(Editorial) 313(3).
Allen, I. (1988) Doctors and their Careers. Policy Studies
Institute.
Altekruse, J. and Mcdermott, S. (1987) Contemporary
concerns of women in medicine. In Feminism within
Science and the Health Professions: Overcoming
Resistance, ed. S. Rossner. Pergamon Press, Oxford.
Bourne, B. and Wikler, N. (1978) Commitment and the
cultural mandate: women in medicine. Social Problems
25, 430±440.
Bensing, J., Van Den Brink-Muinen, A. and De Bakker,
D. (1993) Gender di€erence in practice style: a Dutch
study of general practitioners. Medical Care 31(3), 219±
229.
Brooks, F. and Phillips, D. (1996) Do women want
women health workers? Women's views of the primary
health care service Journal of Advanced Nursing 23,
1207±1211.
Brozovic, M. (1989) With women in mind. British Medical
Journal 229, 689.
Calnan, M. (1988) Images of general practice: the percep-
tions of the doctor. Social Science and Medicine 27(6),
579±586.
Carpenter, E. (1977) Women in male dominated pro-
fessions. International Journal Of Health Services 7,
191±207.
Carpenter, M. (1993) The subordination of nurses in
health care: towards a social divisions approach. Gender
Work and Medicine: Women and The Medical Division
of Labour. Sage, London.
Crompton, R. and Sanderson, K. (1990) Gendered Jobs
and Social Change. Unwin Hyman, London.
Department of Health Joint Working Party on Women
Doctors and Their Careers (1991) Department of
Health, HMSO, London.
Eisner, M. and Wright, M. (1986) A Feminist Approach to
General Practice. Feminist Practice in Women's Health
Care. Wiley, Chichester.
Ehrenreich, B. and English, B. (1979) For her Own Good:
150 Years of Experts Advice to Women. Pluto Press.
Elston, M. (1993) Women doctors in a changing pro-
fession: The case of Britain. In Gender, Work and
Medicine: Women and The Medical Division of Labour,
eds. E. Riska and K. Wegar. Sage, London.
Finch, J. and Groves, D. (eds.) (1983). A Labour of Love:
Women, Work and Caring. Routledge and Kegan Paul,
London.
Foster, P. (1989) Improving the doctor/patient relation-
ship: a feminist perspective. Journal of Social Policy
18(3), 337±361.
Game, A. and Pringle, R. (1984) Gender at Work. Pluto
Press, London.
Gamarnikow, E. (1978) Sexual division of labour and the
case of nursing. In Feminism and Materialism: Women
and Modes of Production, eds. A. Kuhn and A. Wolpe.
Routledge and Kegan Paul, London.
Glaser, B. and Strauss, A. (1967) The Discovery of
Grounded Theory. Aldine, Chicago.
Gould, M. (1980) When Women create an organisation:
The ideological imperatives of feminism. The
International Yearbook of Organisation Studies.
Routledge, London.
Hakim, C. (1979) Occupational Segregation a Comparative
Study of the Degree and Patterns of Di€erentiation
between Men and Women's Work in Britain, The United
States and Other Countries. Department of
Employment, London.
Handysides, S. (1994) Morale in general practice: is
change the problem or the solution. British Medical
Journal 308, 32±34.
Hochschild (1979) Emotion work, feeling rules and social
structure. American Journal of Sociology, 551±575.
Homans, H. (1987) Man-made myths: the reality of being
a woman scientist in the NHS. In In A Man's World:
Essays on Women in Male-dominated Professions, eds.
A. Spencer and D. Podmore. Tavistock Publications,
London.
James, N. (1989) Emotional labour: skill and work in the
social regulation of feelings. Sociological Review 37, 15±
42.
James, N. (1992) Care = organisation + physical
labour + emotional labour. Sociology of Health and
Illness 14(4), 490±507.
Kutner, N. and Brogan, D. (1990) Gender roles, medical
practice roles, and ob-gyna career choice: a longitudinal
study. Women and Health 16(3±4), 99±117.
Langwell, K. M. (1982) Di€erence by sex in economic
returns with physician specialization. Journal of Health
Politics, Policy and Law 6, 752±761.
 Women in general practice
Lawrence, B. (1987) The ®fth dimension: gender and gen-
eral practice. In In a Man's World: Essays on Women in
Male-dominated Professions, eds. A. Spencer and D.
Podmore. Tavistock, London.
Leeson, J. and Gray, J. (1978) Women and Medicine.
Tavistock, Su€olk.
Lorber, J. (1985) More women physician: will it mean
more humane health care? Social Policy Summer, 50±54.
Lorber, J. (1993) Why women physicians will never be
true equals in the American medical profession. In
Gender, Work and Medicine: Women and The Medical
Division of Labour, eds. E. Riska and K. Wegar. Sage,
London.
Lurie, E. (1981) Nurse practitioners: issues in professional
socialization. Journal of Health and Social Behaviour 22,
31±48.
Mackie, L. and Pattullo, P. (1977) Women at Work.
Tavistock, London.
Macintyre, S. (1981) Communications between pregnant
women and their medical and midwifery attendants.
Midwives Chronicle and Nursing Notes Nov., 387±394.
McPherson, A. and Small, J. (1980) Women GP's in
Oxfordshire. Journal of the Royal College of General
Practitioners 30, 8±11.
Margolis, A., Greenwood, S. and Helibron, D. (1983)
Survey of men and women residents entering United
States Obstetrics and Gynaecology Programs in 1981.
American Journal of Obstetrics and Gynaecology 146,
541.
Miles, A. (1991) Women, Health and Medicine. Open
University Press, Buckingham.
Oakley, A. (1980) Women Con®ned: Towards a Sociology
of Childbirth. Martin Robinson, London.
Parkhouse, J. (1986) Career preferences of doctors qualify-
ing in the United Kingdom in 1983. Health Trends 18,
59±63.
Phillips, P. and Brooks, F. (1997) Women users views on
the role and value of the practice nurse. Health and
Social Care in the Community. In press.
Preston-Whyte, M., Fraser, R. and Beckett, J. (1983)
E€ect of a principals gender on consultation patterns.
Journal of the Royal College of General Practitioners 33,
654±658.
Riska, E. (1988) The professional status of physicians in
the Nordic countries. The Milbank Quarterly 66 (Suppl.
2), 133±147.
Riska, E. and Wegar, K. (1993) Women physicians: a new
force in medicine? In Gender, Work and Medicine:
193
Women and The Medical Division of Labour, eds. E.
Riska and K. Wegar. Sage, London.
Relman, A. (1980) Here come the women. New England
Journal of Medicine 302, 1252±1253.
Relman, A. (1989) The changing demography of the medi-
cal profession. New England Journal of Medicine 321,
1540±1542.
Reskin, B. and Roos, P. (1990) Job Queues, Gender
Queues: Explaining Women's Inroads into Male
Occupations. Temple University Press, Philadelphia.
Roberts, H. (1985) The Patient Patients: Women and their
Doctors. Pandora, London.
Shapiro, M. C., Najman, J. and Chang, A. (1983)
Information control and the exercise of power in the
obstetric encounter. Social Science and Medicine 17(3),
139±146.
Shuval, J., Javetz, R. and Shye, D. (1989) Self-care in
Israel: physicians views and perspectives. Social Science
and Medicine 29(1), 233±244.
Strauss, A. (1987) Qualitative Analysis for Social
Scientists. Cambridge University Press, Cambridge.
Strauss, A. and Corbin, J. (1990) Basics of Qualitative
Research: Grounded Theory Procedures and Techniques.
Sage, London.
Spencer, A. and Podmore, D. (eds.) (1987) In a Man's
World: Essays on Women in Male-Dominated
Professions. Tavistock Publications, London and New
York.
Walby, S. (1986) Patriarchy at Work: Partriarchal and
Capitalist Relations In Employment. Polity Press,
Cambridge.
Walby, S. (1988) Gender Segregation at Work. Open
University Press, Milton Keynes.
Wegar, K. (1993) Conclusions. In Gender, Work and
Medicine: Women and The Medical Division of Labour,
eds. E. Riska and K. Wegar. Sage, London.
West, C. (1984) When the doctor is a lady; power status
and gender in physician patient encounters. Symbolic
Interaction 7(1), 87±106.
West, C. (1993) Reconceptualizing gender in physician
patient relationships. Social Science and Medicine 36(1),
57±66.
Weisman, C. and Teitelbaum, M. (1985) Physician gender
and physician±patient relationship: recent evidence and
relevant questions. Social Science and Medicine 20(11),
1119±1127.
Williams, S. and Calnan, M. (1994) Perspectives on pre-
vention: the views of general practitioners. Sociology of
Health and Illness, 373±393.