Gender, Age and Inequality in the Professions

Exploring the Disordering, Disruptive and Chaotic Properties of Communication

Marta Choroszewicz, Tracey L. Adams, Marta Choroszewicz, Tracey L. Adams

• Publisher: Routledge
• Year: 2019
• eBook ISBN: 9781351052443
• Edition: 1
• Topic: Economia
• Subtopic: Business generale

The literature on gender and professions shows that professional careers continue to be impacted by gender – albeit with important differences among professions and countries. Much less researched is the issue of the significance of gender and age-cohort or generation to professional work.

Gender, Age and Inequality in the Professions explores men's and women's experiences of professional work and careers through an intersectional lens by focusing on the intersection of gender and age. The chapters explore different professions – including Medicine, Nursing, Law, Academia, Information Technology and Engineering – in different Western countries, in the present and over time. Through original research, and critical re-analysis of existing research, each of the chapters explores the significance of gender and age-cohort or generation to professional work, with particular attention to professionals just entering professional careers, those building professional careers, and comparisons of men and women in professions across generational cohorts.

The book contributes to literature on inequalities in the professions by demonstrating the ways in which gender and age converge to confer privilege and produce disadvantage, and the ways in which gender inequality is reproduced, and disrupted, through the activities of professionals on the job. The book constitutes a departure point for future research in terms of theoretical perspectives and empirical findings on how gendered and age-related processes are produced and reproduced in particular organisational, professional and socio-cultural contexts. To enhance generational understanding, relationships and collaboration in educational institutions, organisations and professions, the book ends with a section on policy recommendations for educators, professionals, professional organisations as well as policy- and decision-makers. This book will also appeal to students and researchers in the fields of Sociology, Gender Studies, Organisational and Management Studies, Law, Medicine, Engineering and Information Technology as well as related disciplines.

Section 1
Health Professions

2 Early Career Doctors and In/justice in Work

The Invisibility of Gender in a ‘Male’ Profession

Antero Olakivi and Sirpa Wrede

Introduction

In 2016, we interviewed 38 doctors at different career stages and in different professional settings in Finland for a study that targeted, among other things, the issue of clinical autonomy (Wrede et al. 2017).¹ When listening to the doctors from a gender perspective, we were somewhat surprised: despite the salient gendered divisions of labour in the Finnish medical field, the interviewed doctors seemed to almost avoid talking about the relevance of gender in their work and careers. To make sense of the invisibility of gender in our interview data, we turned to research on the ‘gendering’ of organisations. Rather than considering the superficial ‘gender neutrality’ of our co-constructed interviews to indicate the irrelevance of gender in the medical field, we assumed that all organisations constantly shape gendered inequalities and divisions of labour through policies, practices, culture and interactions (e.g. Acker 1990).

In line with critical studies of work organisation, we assume that, despite the growing proportion of female physicians in younger cohorts, middle-class masculinity continues to dominate over other career and work orientations in Finnish medical culture (also, Davies 1996). This culture of ‘male’ profession, we argue, values freedom from family responsibilities and thus may have problematic consequences for young doctors, particularly young mothers, whose childcare responsibilities can disproportionally limit their opportunities to perform the expected, normative, middle-class and masculine impressions of themselves as completely devoted to their work. In the context of a numerically ‘feminised’ profession, we argue that, by not problematising the organisation of work from a gender perspective, doctors can (sometimes tacitly and unwittingly) reproduce the masculinised career context of their profession.

In the following section, we discuss gendered and age-related inequalities within the Finnish medical profession that are expressed in related patterns of segregation within the profession and doctors’ reports about work-related concerns and challenges. We then elaborate upon our theoretical position, drawing on the interactionist line of thought in the sociology of professions (see Riska 2010). From this perspective, we claim that while masculine expectations dominate within the culture of the medical profession, the legitimacy of the gendered and age-related structures within the profession is an interactional accomplishment and must be constantly negotiated and updated in discursive practice.

Our empirical analysis is presented with two slightly different foci associated with gendered and age-related inequalities in the organisation of work. First, we examine the issue of on-call shifts, which are common at hospitals. Through commitment on-call work, we argue, doctors can perform the ‘right’ kind of career orientation, the absence of which appears to be a legitimate excuse for non-advancement. Second, we analyse public health centres as a constraining work context, considering the problematic position of young doctors facing stressful and lonesome work and the cultural ideals that highlight individual and masculine endurance in health centres. These two foci are united by their relevance to young female doctors. In Finland, young (i.e. under 35 years of age) and female doctors are overrepresented in public health centres (Parmanne et al. 2016: 25–26). Young and early career doctors also work on call more often than their senior colleagues (Parmanne et al. 2016: 30). Moreover, doctors on call must often work at times that are inconvenient for young women dealing with family responsibilities (Kiianmaa 2012). The two foci allow us to tackle some of the most salient structural inequalities in the medical profession related to gender and age. Our focus on discursive practice allows us to argue that doctors’ difficulty (and reluctance) to criticise these inequalities is an aspect of the hegemony of a specific, masculine understanding of medicine that tends to treat the difficulties faced by young and female doctors as inevitable and normal features of a demanding profession. We conclude by considering whether career systems that are built on such cultural ‘contracts’ are socially sustainable in the long haul.

A ‘Feminised’ and Numerically Expanding Profession

The male domination in the Finnish medical field may appear paradoxical since the feminisation of medicine (in numerical terms) has such a long history in Finland. The proportion of female doctors increased in Finland earlier than in any other Nordic or Anglo-American country (Riska and Wegar 1993; Riska 2001), and it keeps increasing. Although at the beginning of the 20th century practically all physicians in Finland were men, in 2016 60 per cent of Finnish physicians were women (Parmanne et al. 2016: 8).

Gender segregation, nevertheless, is a persistent feature of the Finnish medical profession. In 1964, Haavio-Mannila noted that, while there was an equal proportion of men and women in most types of medical work, men much more often combined their work with private practice. She explained the figures by noting that most women doctors held double roles as doctors and as mothers and wives (Haavio-Mannila 1964: 12–14). In the early 1990s, Riska and Wegar (1993: 84) observed that female doctors were most often found in organisational settings characterised by a bureaucratic medical practice, relatively low degree of occupational autonomy, high degree of routinisation, low salary and low professional status compared to their male colleagues. To the authors, these divisions of labour were expressions of institutionalised ‘glass ceilings’ that hinder women’s career advancement in the Finnish medical field (Riska and Wegar 1993). In the 2000s, the career advancement opportunities available to female doctors increased in Finland, causing a growing number of female physicians to hold administration, research and teaching positions. In particular, over the past two decades, the proportion of women serving as chief physicians has grown substantially (Parmanne et al. 2016: 27–29). Yet, the proportion of women among these decision-makers still does not equal the proportion of female practitioners.

In Finland, where medical education has constantly expanded since the Finnish government has sought to encourage more people to become doctors, female doctors are overrepresented in younger cohorts (Parmanne et al. 2016: 6–9). Some of the difficulties faced by female doctors regarding job content and hierarchical positioning may be related more to their early career stage and the patterns of practice associated with this stage than to their gender. In Finland, young doctors (i.e. those under 35 years of age) are overrepresented in public health centres (Parmanne et al. 2016: 26), making them more likely to experience precarious working conditions. On average, doctors working at public health centres report more problems—such as poorly functioning IT machinery, constant time pressure and lack of collegial support—than doctors at other workplaces, such as public hospitals and private clinics (Finnish Medical Association 2016).

Young doctors must work at public health centres; training for all medical specialties requires service at a health centre for nine months. Due to such compulsory elements it is not surprising that young doctors tend to report less autonomy at work than their older colleagues (Finnish Medical Association 2016). Young and female doctors also work while ill more frequently but take more sick leave as well: in 2015, 71 per cent of under 35-year-old female doctors took sick leave during the past 12 months, while only 39 per cent of 55–64-year-old male doctors took sick leave (Finnish Medical Association 2016). Some inequalities are more strongly related to gender than to age; for instance, female doctors tend to have more work overload and a higher risk of burnout than men, regardless of their age and workplace (Finnish Medical Association 2016).

The inequalities affecting young and female doctors described earlier are relatively well-known and have been reported in previous research—and recently, Finnish media (Järvi 2011; Paatero 2018; Piirainen 2018). Critical media coverage might signify a minor disjunction within the hegemonic culture of the medical profession. In particular, the Finnish association representing young doctors is increasingly critical of phenomena linked to gender- and age-related inequalities in medical professions (e.g. Paatero 2018; Piirainen 2018). Despite this criticism, the legitimacy and acceptability of divisions of labour seem to be maintained in the Finnish medical field. Young doctors in health centres and hospitals still report surprisingly low—and similar—levels of dissatisfaction with their work. In a 2013 survey (Sumanen et al. 2015: 45–48), only seven per cent of recently graduated doctors working at health centres and hospitals reported being somewhat or extremely dissatisfied in their current jobs. The majority of respondents (average age, 34) considered their current jobs to be their first choice and expected to hold similar jobs in 2025. Interestingly, the respondents’ preferences were significantly gendered: women much more often preferred working at health centres (20 per cent of women versus 11 per cent of men). To an extent, doctors’ personal preferences thus aligned with the existing career systems in Finnish medicine.

Based on the observations made earlier, one can speculate that many young doctors learn to adjust their individual expectations to match the options that are socially and practically available to them. For instance, health centres have much less need for on-call work than hospitals (Parmanne et al. 2016: 30). One could speculate that, since women perform a larger share of domestic responsibilities (e.g. childcare and housework) compared to men (Kiianmaa 2012), many young women ‘choose’ to pursue a career in health centres rather than in hospitals. This apparent alignment between individual expectations and existing career systems is an important source of social legitimacy for any liberal profession; the profession maintains an impression of a division of labour based on the free will and personal choice of individual actors rather than open, explicit and unjust exclusion of certain people (e.g. Olakivi 2018).

Previous commentators (Sumanen et al. 2015: 20) have also identified a culture of individual endurance in the Finnish medical field. In line with Davies’ (1996) discussion of medicine as a ‘male’ profession, ideals of individual endurance can be interpreted as expressions of hegemonic masculinity. The ethos of individual endurance highlights and values doctors’ ability to individually manage the difficulties they face. Consequently, this masculine ethos can individualise and privatise gendered and age-related problems in professions that might otherwise receive political and transformative attention. A doctor who talks about problems in her work, including precarious work environments or lack of collegial support, is liable to be stigmatised as an uncommitted or incompetent doctor who lacks the (masculine) abilities of self-management and endurance. Against this cultural background, it is not surprising that the challenges and obstacles faced by young and female doctors are not always explicitly articulated as public concerns that require intervention from professional agencies, not even by young and female doctors themselves.

Theoretical Perspective on Inequality Regimes in Medicine

In line with Acker (2006), gendered and age-related inequalities in the medical profession can be examined as elements of ‘inequality regimes’, that is, of the social processes and practices that create, make sense of and legitimate inequalities in work. Two dimensions of inequality regimes are particularly relevant to our study: the visibility and legitimacy of inequalities (Acker 2006). Inequalities are not always publicly visible and recognised as matters that require collective intervention. As Berbrier and Pruett (2006: 261) note, ‘[a]ny “inequality” may be recognized as real and existing, but still taken for granted as the inevitable, normal, and/or functional means of distributing wealth, power, prestige, safety, and security, or anything else considered valuable’. Additionally, according to Acker (2006), societal change is more likely for social inequalities with high visibility and low legitimacy and less likely for inequalities with low visibility and high legitimacy.

From the cultural and discursive perspective we adopt in this chapter, the visibility and legitimacy of inequalities depend on the meanings that doctors collectively assign to the problems they—or some of them—face in their work (e.g. Harris 2006). By drawing on collectively recognisable values, narratives and identities as building blocks and resources of discursive practice, doctors can mobilise different interpretations of such problems (see Berbrier and Pruett 2006; Harris 2006). Some interpretations help doctors visualise illegitimate inequalities in their—or their c...

Table of contents

• Cover
• Half Title
• Series
• Title
• Copyright
• Contents
• List of Figures
• List of Tables
• List of Contributors
• Acknowledgments
• Introduction
• Section 1 Health Professions
• Section 2 Legal Professions
• Section 3 Further Professions
• Conclusion