Professional Documents
Culture Documents
Bourne 1978
Bourne 1978
* The authors of this study are listed in alphabetical order. Their contributions are equal.
' Our analysis is based on, and uses data from, a recent exploratory national study of sex discrimination
in health professions schools (URSA: 1976). The study was conducted by Urban and Rural Systems
Associates (URSA), a San Francisco firm, under contract to the Women's Action Program, Office of Special
Concerns, HEW contract #HEW-OS-74-291. The URSA study team visited twenty-seven health professions
schools across the country where extensive semi-structured interviews were conducted and taped with admin-
istrators, faculty members and students. The professions included were: medicine, osteopathy, dentistry,
veterinary medicine, optometry, podiatry, pharmacy, and public health. We confine ourselves to materials
from the nine medical schools included in the sample. The authors are grateful to HEW for their support
of the study, and to URSA for their field work, data analysis, and ideas—inevitably interwoven with ours.
We take full responsibility for the conclusions drawn. We are also grateful to the Faculty Research Com-
mittee at the University of California, Santa Cruz, for financial support.
Women in Medicine 431
medicine: acts of commission such as jokes demeaning to women, insults and communications
(verbal and nonverbal) indicating disrespect and disinterest; and acts of omission such as exclu-
sion from conversation and from informal learning experiences.2
The second component of the notion of a discriminatory environment concerns the
"maleness" of the medical profession and its institutions and is even more subtle (cf.
Davidson, 1977a). Though manifest and expressed in behavior, its source lies in the social
structure itself.
There are two aspects to this component: first, medical schools are "male" in the sense that
the personal characteristics expected and valued in physicians are those stereotypically deemed
male. In his discussion of "status contradictions," Everett Hughes' (1945) argues that a status
such as physican comes to be defined by the secondary characteristics of those who occupy
the role (that is, men). In American society, the definition of what good doctors are like, how
they look and behave, is overlaid and integrated with the characteristics and qualities ascribed
2
Covert messages may be transmitted by touch and gesture (Henley, 1977), by language (Thome and
Henley,
3
1975), and by conversational and nonverbal interactional strategies (West, 1977).
The role of expectations in engendering self-fulfilling behavior and the implications in general of R.
Rosenthal's (1968) work here are apparent but so far unexplored in this context. Cynthia Epstein's (1970)
discussion of the creation of confidence under these conditions is also illuminating.
432 BOURNE & WIKLER
be deprived of time with their spouse and children because of the pressures of work, they
will not have the anxieties women experience, related to the urgency of having children before
growing too old. And because two important time and energy consuming endeavors overlap,
male careers and institutions are thus predicated on the fact that every active professional needs a
wife! (Hunt and Hunt, 1977).
In this paper we explore the role conflicts resulting from this structure which affect women's
work choices: 1) the conflict between normative expectations about the qualities and characteris-
tics of women and those about professionals; 2) the conflict between the allocation of time
and energy to two social roles of "doctor" and of wife and mother. Both conflicts crystallize
for women in certain features of their professional training. By examining a particularly
central and salient feature of medical work—professional commitment—we gain insight into the
discriminatory environment and the conflicts it generates for women." Commitment to profes-
sional work is one of the most important values of behavior for an aspiring physician. Indeed,
' Commitment is a central feature of all professions and is one way professions are distinguished from
occupations. Central to the status of a profession is a field's ability to induce members to do their job no
matter how long it takes and no matter what other demands are made in their lives. These requirements
are stringent in medicine, where lives may be at stake in the physician's decision about how high a priority
should
5
be given to finishing a job.
Medical schools place enormous emphasis on the personal qualities of potential recruits. Schools will
often interview seven hundred or eight hundred qualified (as judged by grades, test scores, and letters of
recommendation) applicants in order to choose a class of one hundred students. Much more faculty and
administrative
6
time is lavished on this effort than in other professional and graduate schools.
All quotations are from tape recorded field interviews unless otherwise noted. Names of people and
Women in Medicine 433
Though male physicians virtually never articulated reservations about the capabilities of
women in medicine, they did frequently express reservations about the "pay off" in training
women as physicians. These reservations were generally expressed in a low key, as by a male
faculty member at Middleton; "I just have a feeling that we get considerably less working
years out of women; it's variable and intermittent." At the heart of this reservation is the
assumption that a woman will not practice, or will practice much less, if she is married.
For being married is viewed as a handicap for a woman. As this faculty member put it:
I don't recall any bias [against women] myself. I don't happen to have run across it.
When women are married, a woman must often sacrifice her own career goals. Medicine is
very demanding. If you have any handicaps, it makes it very difficult (Male faculty,
Middleton Med).
Because a medical career and marriage are often viewed as mutually exclusive, it is expected
that a woman will renounce the former in favor of the latter. Women frequently report that
There is a feeling of personal fulfillment for these wives in putting their husbands through
school, attending to their needs, and seeing them progress and learn. It is rewarding for them
to ease their husband's tensions and smooth things over for them when they are discouraged or
upset (Coombs, 1971:142).
Men know that married women are unlikely to have such a support system behind them to
sustain their professional commitment and will, in fact, have to be the support system for
others as well as for themselves. Even if this expectation does not affect the admission
process in medical schools, it necessarily affects the expectations male faculty will have about
the performance in training and the future professional commitment of their female students.
For women, the knowledge that they will have to play the roles of doctor, wife and mother,
and social worker while their male counterparts have only the role of doctor, was very much on
the minds of women medical students in the interviews. Those who are already married find
that the double demands on their time creates friction with their mates. Those who contem-
When I was thinking of going into medicine, I told myself, 'Well, you're not going to have any
children because you're not going to have any time. If you want to be a good mother you're
going to have to have all your time for the formative years. But now I feel differently. How-
ever, that hasn't changed my feelings about children, but I do feel it can be done. I think it
requires more energy and a lot of planning and a lot of help from the outside (Female
student, Middleton Med).
Most usually these concerns form a steady undercurrent of feeling. On occasion they come to a
head in quite genuine desperation:
I am at a point where I dread the next step. I know I will be tired, unhappy, out of control of
the situation, feeling inadquate, that I don't know anything, that I don't know how to handle
anything, and there will always be that lack of time in managing my home.
I'm much more supportive of his career than he is of mine. I don't know what's going
to happen when I start clinical. This morning I was thinking of quitting. I just want to be
happy. Why do I have to achieve something? Why do I have to be a thing! A name,
The interview data substantiate Coser and Rokoff's argument. While men are angry if women
are prevented from doing their work by other obligations, they simultaneously disapprove if a
woman seems to be allowing work commitments to interfere with family obligations.
At Mayberry Med [during an admissions interview] I was asked by a professor of gynecology,
'Won't this interfere with your husband's career? You should be home with your child.' He
went on to suggest that I was simply the type of person who likes to set difficult goals for her-
self and that I would eventually be dissatisfied with medicine (Female student, Middleton
Med).
A woman at Marion Med described others' responses to her intention to specialize in ob/gyn.
Again, the message is that it is inappropriate to neglect one's responsibilities as wife and mother
in favor of professional commitment:
I would like to go into ob/gyn as a specialty. People's first reaction is oftentimes, 'Well, what
is your husband going to do?' And it's not that they're concerned that being an ob/gyn will
The problem with this resolution is, of course, that one does not attain authority, leadership,
or high income by limiting one's commitment to work. This holds for men as for women: top
jobs do not come to those who have not persuaded others of their full and intense commitment.
But what is important here is that this phenomenon operates differentially on men and women
and thus has a discriminatory effect on women.
The interaction of the structures of family and professional careers means that women are
much less free to choose an intense commitment to work (it is our guess that many more would,
if the price were not so high) because of the threat to chances of a satisfactory personal life. For
women, the choice of a high level of commitment risks not only a sacrifice in quality of family
experience, but of not having the experience at all. Whenever professional work is predicated
on a base of a home support system and lack of responsibility for one's personal life, that will
discriminate against women. They just cannot find "wives" to do it for them.
Perhaps the clearest indication of the damage done to women physicians by this feature of their
I've learned that you're supposed to say that you want to have children because that's normal.
And you're supposed to have plans set up and assume that you'll work in group practice. And
you're supposed to say that you'll wait until you're out [to have children] and you'll go into
a field like pathology where you'll have good hours (Female student, Mansfield Med).
Such a scenario is "what you are supposed to say" because it does not threaten expectations of
women as good wives and mothers, but allows them a role in limited areas of work in the pro-
fession where their divided loyalties will not disrupt professional work.
Constructing positions in which women may limit their hours without disruption is only one
of the components of the emerging definition of what is appropriate work for women in medicine.
They are also thought to be better suited to working with certain kinds of patient groups. Women's
gynecological medical problems are often cited as appropriate work for women:
I think women students contribute something to the atmosphere—an appreciation of certain
patient problems. I can't document that very well, but Ifeel it. For instance, the hysterectomy.
CONCLUSION
These definitions of women's work and woman commitment are part of the environment in
which women are "professionally socialized." Whether these expectations and male assumptions
about women's place in medicine are ever communicated directly, their existence constricts the
range of women's options. Single women who are convincingly uninterested in family life or
unmarriageable may be presumed by male faculty to have sufficient professional commitment.
Yet, they will still have difficulty overcoming the sex stereotypes of "appropriate" medical special-
izations and "suitable" contexts for medical work. Since married women are neither expected
to, nor rewarded for, giving full commitment to professional life, their struggle to achieve full
professional status is laden with additional difficulties.
Few of the women interviewed would use the term "channeled" to describe the process by
which they chose medical specialties or selected contexts for professional work. The term implies
that forces other than "free choice" determined their decisions, and they believe that they have
freely "chosen." But it can be argued that channeling is precisely what occurs. In some measure
women collude with the stereotypes held by men, and their careers are invisibly shaped by their
own expectations of women's roles. Women's choice of specialty and work setting cannot be
called "free", when those choices are made in a discriminatory environment such as we have
described. Not surprisingly, women will "choose" to go where they feel comfortable, welcomed,
and competent. These "comfort zones" will be chosen to reduce the stress accompanying the
violation of deeply held norms of women's role and place. To accommodate by "choosing" to
abandon marriage or children to carry out the role is no less costly.
This analysis suggests that affirmative action policies to increase the number of women in
medical training institutions are indispensable for ultimate change, but are impotent at present
to correct the effects of a discriminatory environment. Numbers alone will not undo the norms
and values we have observed; these will remain until we change the relation of male roles to the
family, and crucial features of the structure and organization of professional work.
Women in Medicine 439
REFERENCES
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Campbell, Margaret A.
1973 "Why would a girl go into medicine"? Medical Education in the United States: A Guide for
Women. The Feminist Press.
Coombs, Robert H. and Clark E. Vincent
1971 Psychological Aspects of Medical Training. Springfield: Charles C. Thomas.
Coser, Rose Laub and Gerald Rokoff
1971 "Women in the occupational world: Social disruption and conflict." Social Problems, 18 (Spring):
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Davidson, Lynne R.
1975 Sex Roles, Affect and the Woman Physician: A Study of the Impact of Latent Social Identity
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Davidson, Lynne R.