The Professional Identities of Women
Carlotta M. Rinke, MD
THE ADMISSION gates are ajar for
women nowapplying medicalto
school. In 1979-1980, 28% of all first\x=req-\
year medical students were women, a
record-breaking number. To the un-
discerning eye it may seem that the
major obstacles to women entering
the medical profession are vanish-
ing. Unknown to many, however, the
graduating classes of Boston medical
schools in 1893-1894 comprised 23.7%
women. This resulted in a peak of
18% women physicians of the total
Boston medical community at the
turn of the century, 1900-1901. Few
may know of women's participation in
the medical profession during that
era, but most are keenly aware of the
small numbers that followed and
endured. During the post-World War
II period, the number of all women
graduates lingered at 5%.1
History has a way of repeating
itself, and the fact that medical
schools have now accepted an unprec-
edented number of women students
does not signify the elimination of
barriers to women in a "male profes-
sion," as the women physicians at the
turn of the century learned. Those
women witnessed a wave of admis¬
sions, then watched their strides be
reversed within half a decade. An
admission ticket to medical education
in a woman's hand should be taken
for nothing more than its face value;
From the Division of Scientific Publications, the
American Medical Association, Chicago. Dr Rinke
is the 1980-1981 Morris Fishbein Fellow of the
American Medical Association.
Reprint requests to Division of Scientific Publi-
cations, American Medical Association, 535 N
Dearborn St, Chicago, IL 60610 (Dr Rinke).
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it promises the freedom to master
technical knowledge and skill, but it
is no guarantee of acceptance and
recognition as peers in the medical
community. If women after complet¬
ing their medical training are not
able to participate actively in profes¬
sional activities and claim the aca¬
demic accolades and financial bene¬
fits entitled to them, nothing at all
has been gained.
Barriers to women physicians still
exist, but they have been transformed
from the visible heraldry of discrimi¬
nation to a more subtle but equally
damaging guise: they prevent women
from fully incorporating a profession¬
al identity. A medical school graduate
does not suddenly awaken on the
morning following graduation feeling
and acting like a physician. The pro¬
cess of internship and residency
training provides a groundwork of
experiences that inculcates the identi¬
ty of a physician. Sociologists call this
development "professional socializa¬
tion." It entails learning roles, values,
responsibilities, and attitudes deemed
important and appropriate for the
profession. As these behaviors are
successfully integrated, the young
physician acquires a self-image of
competence and adequacy and is rec¬
ognized and accepted by the profes¬
sional staff. Ortiz2 emphasizes the
profound import of role socialization:
"Those persons who fail to complete
the process are in one manner or
another unable to claim the final
rights and responsibilities of the pro¬
fession."
There is no classroom or textbook
that fosters identity formation, since
Physicians
the attitudes and behavior that must
be learned are rarely explicit. They
'caught' and not 'taught,'
" "
are
learned during the professional activ¬
ities, such as rounds, discussion, and
conversations over coffee at mid¬
night.34
However, several well-recognized
factors contribute to the formation of
a solid professional identity. The
development of extensive and inten¬
sive personal relationships with the
professional staff is essential to
socialization. The trainee needs sus¬
tained contact with colleagues and
teaching physicians. Ortiz2 believes
that "if the interpersonal relations
are minimal in intensiveness or
extensiveness, it is likely that profes-
sionalization will not be achieved."
White,3 referring to women scientists,
states: "Challenging interaction with
other professionals is frequently
as necessary to creative work as is
the opportunity for solitude and
thought." Close relationships with
superiors allow the trainee's work to
be carefully monitored, encouraging
development of standards of judg¬
ment. Finally, as the physician identi¬
fies with the medical community, he
or she will participate in professional
activities, such as attending meetings,
formulating research, and writing
papers. The physician is then fully
socialized and able to launch a suc¬
cessful career.
Understanding this concept is im¬
portant, because the presence of a
strong occupational identity promot¬
ing an inner sense of competence
sparks a productive and creative
career. For women, however, a series
 of obstacles interferes with the
socialization process during medical
training. They tend to be excluded
from an important but rarely ac¬
knowledged network of contacts and
information that develops during
informal interchanges among the
professional staff, similar to the
"clubbing" of male businessmen in
management who congregate at bars
and male athletic clubs to discuss
professional life.5 The fraternity-like
cliques of men discussing all aspects
of professional life tend to exclude
women and inhibit feelings of peer
acceptance and attitude formation
important to the profession.
The informal exchange of informa¬
tion in the context of extensive and
intensive professional relationships
teaches not only acceptable behavior
and attitudes, but also inside knowl¬
edge about how to operate in the
power structure of academic and pri¬
vate medicine. For example, it would
be important to know who chaired the
stronger medical specialties and who
was accessible and desirable to work
with if one was interested in a fellow¬
ship or project. By extending one's
network of contacts, a resident learns
about the opportunities for private
practice and who would form attrac¬
tive partnerships.
Men who are uncomfortable accept¬
ing women as colleagues will not feel
comfortable sharing these kinds of
activities and "how-to" information
with them. Since the stereotype of
physician is masculine (and white
upper-middle-class), faculty may
identify the promising young physi¬
cians by their male behavior, judging
them worthy of special attention,
encouragement, and professional op¬
portunity. White refers to the protégé
system: "Sponsorship is common
the upper echelons of almost all pro¬
fessions, including the scientific
fields. One must be 'in' both to learn
crucial trade secrets and to advance
within the field."3 Part of the ground¬
work for a brilliant career is laid by
stimulating and challenging interac¬
tion with other professional staff;
therefore, women deprived of this
opportunity are less equipped to
develop their own talents and maneu¬ .
ver into opportunities.
The definite role conflict women
encounter when competing in the
male domain of medicine poses anoth-
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er obstacle to full professional sociali¬
zation during medical training.*8
Medicine and its practitioners have
traditionally exemplified the mascu¬
line stereotype: assertive, ambitious,
independent, and dominant. Most
physician role models are men, except
for the infrequent woman faculty
member, and most women in medical
training today are products of an
upbringing that associates femininity
with dependence, compassion, passiv¬
ity, and emotionalism. If what is
epitomized as "a good physician"
embodies a masculine set of traits
and ideals, women will invariably
suffer an identity crisis in attempting
to adapt their womanhood into a male
professional model.
Hilberman et al9 state: "Entry into
medical school usually occurs before
issues of identity and sex role are
fully resolved. The young woman stu¬
dent who has identified with a male
professional may encounter difficul¬
ties in resolving her own female iden¬
tity." The anxiety of young women
entering medical school has been well
documented by both Roeske and
Lake10 and Hilberman. At their
respective medical schools, they de¬
veloped female support groups that
provided regular contact with women
faculty members to help ease the role
conflict."0
The situation fully emerges during
postgraduate training when wide-
eyed interns must fully embrace the
physician role and embody the ideals
of medicine. This is the time when the
conflicts a woman experiences in try¬
ing to combine her female personality
traits into a masculine field teeming
with competence and ambition sharp¬
ly surface. Baruch and Barnett" have
established that technical compe¬
to tence, the cornerstone of professional
success, is not part of a traditional
woman's stereotype. For example,
when a man behaves competently and
authoritatively with the medical
staff, he enhances his self-esteem and
masculinity. When a woman acts in
such a manner, she does not necessar¬
ily increase her self-esteem—cer¬
tainly not her femininity—and she
may even risk the degradation of
name-calling. It truly becomes a dou¬
ble-blinded dilemma: if a woman
behaves femininely, she is considered
not "as good as a man," and if she
does not act "womanly," she risks
being called a "bitch" or "castrating
female."
A number of writers have charac¬
terized the methods women use to
resolve these sexual identity con¬
flicts.269 Some women will react by
denying any differences exist between
them and their male colleagues; by
identifying with men physicians, they
become "one of the boys" and thus
supposedly better than other women.
Others isolate themselves from peers
and professional staff, withdrawing
in anger and frustration. They at¬
tempt to establish supportive friend¬
ships with other women and sympa¬
thetic male colleagues. Adopting a
flirtatious or seductive pose that
adheres to the female stereotype of
dependence and passivity provides
another way of coping; however, this
reaction prevents a woman from
acquiring the necessary professional
traits that are part of the masculine
model. If men experience tension
working with women professionals,
they tend to sexualize their anxiety
and reinforce this potentially damag¬
ing behavior. Finally, a woman may
play the role of superwoman and
outperform everyone. There is no
appeasing the relentless drive to excel
in both career and personal concerns.
The lack of peer acceptance from
many male physicians can also stunt
the growth of a woman's professional
identity. Men have integrated many
aspects of the female stereotype and,
hence, will associate those character¬
istics with all women. This can be
professionally fatal, since a woman
identified as a stereotype will never
appear rational, competent, or asser¬
tive—all hallmarks of the "good phy¬
sician." Several recent studies sam¬
pled attitudes with questionnaires.
Standley and Soule" found that
almost two thirds of the practicing
male physicians questioned did not
accept women as peers. Heins et al12
discovered from their questionnaires
that one fourth of the male physi¬
cians sampled accepted the female
stereotype as negatively emotional.
The absence of female role models
in medicine may not only contribute
to the identity crisis women experi¬
ence but also interfere with its resolu¬
tion. Women need figures of identifi¬
cation, and the lack of untraditional
female role models in medicine not
only hinders resolution of the identity
 conflict, but may also perpetuate mal¬
adjusted coping.9
The stress of professional training
would seem to generate a comarader-
ie of support and sharing amongst
women, but strangely, the reverse is
true. A number of observers have
described the prejudice women physi¬
cians develop toward other women's
professional performance.46 In trying
to forge a professional identity in
a masculine field, women may find
themselves absorbing the prejudices
that exist against their own gender
and thus devalue the competence of
other women. Many women enter
medical school with negative self-
images, feeling less adequate than
men, and these feelings are projected
onto female peers: no woman can be
as competent as a man. This unfortu¬
nate phenomenon occurs at a time
when women could benefit from sup¬
porting each other and sharing their
common experiences.
The structure of the medical pro¬
fession was organized by men who
devoted their prime years to academic
achievement or to building successful
practices. Meanwhile, their wives
stayed home managing children and
household responsibilities. Tradition¬
al role models pressure women to
bear the burden of child care. This
social pressure in addition to the
professional career structure of medi¬
cine make it extremely difficult for a
1. Walsh MR: 'Doctor Wanted: No Women
Need Apply': Sexual Barriers in the Medical
Yale
Profession 1835-1975. New Haven, Conn,
University Press, 1977.
2. Ortiz FI: Women and medicine: The process
of professional incorporation. J Am Med Wom
Assoc 1975;30:18-30.
3. White MS: Psychological and social bar-
riers to women in science. Science 1970;170:413\x=req-\
416.
4. Batt R: Creating a professional identity.
Am J Psychoanal 1972;32:156-162.
5. Hennig M, Jardin A: The Managerial Wom-
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woman to maintain multiple roles of
wife, mother, and brilliant physician.
The period of intense career building
coincides with a woman's peak biolog¬
ic childbearing years. To expect wom¬
en's careers to follow the same course
as those of men is unreasonable. The
structure needs to accommodate the
occasional interruptions of childbear¬
ing and motherhood without squeez¬
ing women out of competition for the
top careers in medicine.3"
Thus, this scenario of underpaid
women physicians filling the lower
echelons of power and prestige in the
medical world is not a course willful¬
ly chosen by women, but, rather, a
career carved by limited alternatives.
The career choices of women physi¬
cians simply reflect tensions gener¬
ated by role conflicts and efforts to
combine a traditional family life¬
style with a demanding, competitive
career. The attitudes and sex role
stereotypes that affect professional
socialization are difficult to define,
and more difficult to quantitate, but
they take their toll from women's
incomes and upward mobility.
The dimensions of this problem
assume enormous proportions when
placed in a historical context. At the
turn of the century, a rise in feminist
political activity for women's equal
rights paralleled the acceptance of
large numbers of women into medical
schools. As the feminist attention
References
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6. Notman M, Nadelson CC: Medicine: A
career conflict for women. Am J Psychiatry
1973;130:1123-1127.
7. Bourne PG, Wikler NJ: Commitment and
the cultural mandate: Women in medicine. Soc
Probl 1978;25:430-440.
8. Baruch GK, Barnett RC: Implications and
applications of recent research on feminine
development. Psychiatry 1975;38:318-326.
9. Hilberman E, Konanc J, Perez-Reyes M, et
al: Support groups for women in medical school:
A first year program. J Med Educ 1975;50:867\x=req-\
moved toward suffrage and away
from professional representation, the
numbers of women physicians and
students declined. At the height of
female representation in medicine,
however, no women physicians as¬
pired to key policymaking, leadership
positions, and so their hard-won
gains were readily lost when the
women medical schools closed. Wom¬
en medical students of the 1970s owe
their education to the politically
astute feminists of the 1960s who
prodded the legislatures to pass the
Equal Opportunity Act in 1971. It was
this key legislation that forced open
the doors of professional education
for women.
History can repeat itself, however,
and women physicians are likely to
watch their number ebb again if they
are unable to embrace fully profes¬
sional identities and compete for
academic and administrative power.
Forthright solutions to these prob¬
lems are as difficult as changing
attitudes and cultural stereotypes.
But clearly, defining and outlining
those problems particular to women,
a formidable task when considering
their vague and subtle nature, is
paramount to physicians and medical
educators. For only in fully recogniz¬
ing and dealing with these difficulties
will the medical profession really tap
the full potential of its women mem¬
bers.
875.
10. Roeske NA, Lake K: Role models for
women medical students. J Med Educ 1977;
52:459-466.
11. Standley S, Soule B: Women in profes-
sions: Historic antecedents and current life\x=req-\
styles, in Hardy RE, Cull JC (eds): Career
Guidance for Young Women. Springfield, Ill,
Charles C Thomas Publisher, 1974, pp 3-16.
12. Heins M, Hendricks J, Martindale L, et al:
Attitudes of men and women physicians. Am J
Public Health 1979;69:1132-1139.