Medical Careers and Feminist Agendas SOCIAL INSTITUTIONS AND SOCIAL CHANGE An Aldine de Gruyter Series of Texts and Monographs EDITED BY James D. Wright, University of Ceiztral Florida V. L. Bengtson and W. A. Aclienbaum, The Changing Contract Across Generations Thomas G. Blomberg and Stanley Cohen (eds.), Punishment and Social Control: Essays in Honor of Sheldon L. Messinger Rand D. Conger and Glen H. Elder, Jr., Families in Troubled Times: Adapting to Change in Rural America Joel A. Devine and Jaines D. Wright, The Greatest of Evils: Urban Poverty and the Ameri- can Underclass Ann E.P. Dill, Managing to Care: Case Management and Service System Reform G. William Domlioff, State Autonomy or Class Dominance: Case Studies on Policy Making in America Paula S.E ngland, Comparable Worth: Theories and Evidence Paula S.E ngland, Theory on Gender/Feminism on Theory R. G. Evans, M. L. Barer, and T. R. Marmor, Why Are Some People Healthy and Others Not? The Determinants of Health of Populations George Farkas, Human Capital or Cultural Capital? Ethnicity and Poverty Groups in an Urban School District Joseph Galaskiewicz and Wolfgang Bielefeld, Nonprofit Organizations in an Age of Uncer- tainty: A Study in Organizational Change Davita Silfen Glasberg and Dan Skidmore, Corporate Welfare Policy and the Welfare State: Bank Deregulation and the Savings and Loan Bailout Ronald F. Inglehart, Neil Nevitte, Miguel Basafiez, The North American Trajectory: Cul- tural, Economic, and Political Ties among the United States, Canada, and Mexico Gary Kleck, Targeting Guns: Firearms and Their Control James R. Kluegel, David S. Mason, and Bernd Wegener (eds.), Social Justice and Political Change: Public Opinion in Capitalist and Post-Communist States Theodore R. Marmor, The Politics of Medicare (Second Edition) Thomas S. Moore, The Disposable Work Force: Worker Displacement and Employment Instability in America Clark McPhail, The Myth of the Madding Crowd Jaines T. Richardson, Joel Best, and David G. Bromley (eds.), The Satanism Scare Elianne Riska, Medical Careers and Feminist Agendas: American, Scandinavian, and Russian Women Physicians Alice S.R ossi and Peter H. Rossi, Of Human Bonding: Parent-Child Relations Across the Life Course Peter H. Rossi and Richard A. Berk, Just Punishments: Federal Guidelines and Public Views Compared Joseph F. Sheley and James D. Wright, In the Line of Fire: Youths, Guns, and Violence in Urban America David G. Smith, Paying for Medicare: The Politics of Reform Linda J. Waite et al.(eds.)T he Ties That Bind: Perspectives on Marriage and Cohabitation Les G. Whitbeck and Dan R. Hoyt, Nowhere to Grow: Homeless and Runaway Adolescents and Their Families James D. Wright, Address Unknown: The Homeless in America James D. Wriglit and Peter H. Rossi, Armed and Considered Dangerous: A Survey of Felons and Their Firearms (Expanded Edition) Mary Zey, Banking on Fraud: Drexel, Junk Bonds, and Buyouts Medical Careers and Feminist Agendas AMERICAN, SCANDINAVIAN, AND RUSSIANW OMENP HYSICIANS Elianne Riska ALDINE DE GRUYTER New York About the Author Elianne Riska is Academy Professor of tht Academy of Finland, and von Wille- brand-Fahlbeck Professor of Sociology at Abo Academi University, Finland. She received her Ph.D. in Sociology at the State University of New York at Stony Brook in 1974, and has served as an assistant professor and an associate professor of soci- ology in the Department of Sociology and College of Human Medicine at Michi- gan State University. She was a senior researcher at the$ocial Insurance Institution of Finland from 1981 to 1984 and began teaching at Abo Akademi University in 1985. Her published works include Gcizdel; Woyk, mid Medicine and Geudcred Moods. Copyright 0 2001 Walter de Gruyter, Inc., New York All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage or retrieval system, without permission in writing from the publisher. ALDINE DE GRUYTER A division of Walter de Gruyter, Inc. 200 Saw Mill River Road Hawthorne, New York 10532 This publication is printed on acid free paper @ Library of Congress Cataloging-in-Publication Data Riska, Elianne Medical careers and feminist agendas : American, Scandinavian, and Russian women physicians / Elianne Riska p. cm. - (Social institutions and social change) Includes bibliography, references and index. ISBN 0-202-30667-4 (cloth : alk. paper) - ISBN 0-202-30668-2 (pbk. : alk. paper) 1. Women physicians-Cross cultural studies. 2. Women physicians-United States. 3. Women physicians-Russia (Federation) 4. Women physicians-Scandinavia. 5. Women in medicine-Cross cultural studies. 6. Sexism in medicine-Cross cultural studies. 7. Social mediciiie-Cross-cultural studies. I. Title. 11. Series. R692 .R57 2001 61 0 ’.8 2-dc2 1 2001022600 Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 1 Contents Preface vii Introduction 1 Social Theories about Medical Work and Gender 9 Women’s Entry into Medicine and Medical Practice in the United States 33 Conditions Influencing Women Physicians’ Careers in Scandinavia 57 Women Physicians in Russia and the Soviet Union 73 Does Gender Matter? Women as Medical Practitioners 87 New Pioneers: Women in Pathology 103 Women’s Challenge of Medicine: A Revolution From Within or Outside Medicine? 117 Conclusions 137 References 149 Index 167 V This page intentionally left blank Preface This monograph is the result of a research effort that was originally gen- erated while I was teaching medical students at the College of Human Medicine at Michigan State University in the 1970s. I was intrigued by the character of the socialization process that the medical students had to undergo during their training, a process quite different from that typical in other disciplines. Ever since, I have studied and followed the changes in the status and power of the U.S. and Scandinavian medical profession. Theory and research in the sociology of professions and health sociology have shown me how knowledge is generated and organized in the mod- ern world. In most of my work I have been interested in the sociology-of- knowledge aspect of the development of modern medicine. My adoption of a gender perspective on the medical profession can be traced to reading Judith Lorber 's pioneering book on women physicians in 1984. While I was doing the research reported in this book, Judith Lor- ber offered invaluable advice, comments, and encouragement. Some of the early ideas for this book derive from a plenary talk I gave at an international conference on the changing status of the physicians, a con- ference organized in Oslo in May 1997 by Olaf Gjerl~wA asland of the Research Institute of the Norwegian Medical Association. That presenta- tion was published later in Socinl Science nndMedicim (Riska 2001) and some sections of this book have been adapted from that article. In the fall of 1998, I ran a research seminar on health professions in the Department of Sociol- ogy at Abo Akademi University in Finland. The core participants in this research seminar-Cecilia Benoit, Elina Oinas, Sirpa Wrede-served as a litmus test for the draft versions of the chapters included in this book. From the beginning of the writing, their constructive comments set me on the right track. A number of other persons have had an important part in enabling me to complete this project. AM Yrjala assisted me in conducting interviews with women pathologists. Solveig Bystedt, with her usual patience and kindness, assisted me in preparing the final version of the manuscript. Julia McMurray, Bente Rosenbeck, and Liisa Husu have provided infor- mation that has documented some of my main arguments. As a profes- vii viii Preface sional editor and longtime friend, Katherine McCracken has provided much-appreciated assistance in detecting the Swedish influence in my English writing. My colleagues and graduate students at my professional base since 1985, the Department of Sociology at Abo Akademi University, Finland, have offered a most inspiring environment for doing research. Finally, I am indebted to Richard Koffler, the executive director at Aldine de Gruyter, for his interest in my early ideas for this book and for promot- ing them into publication. I would like to thank Sissy Girard, Mike Soh, and Jan Goldsworthy, who have helped in the production of this book. A research position as an academy professor granted by the Academy of Finland from 1997 to 2002 offered me an opportunity to embark on the larger comparative research project on women physicians reported in this volume. A subsequent grant (Academy of Finland nos. 53343 and 59221) enabled me to collect data at U.S. university libraries. Elianne Riska Introduction Doctor Discontent Many American doctors are unhappy with the quality of their professional lives. Abundant anecdotal evidence and several surveys identify some of the factors that underlie their discontent. The actions doctors are taking confirm that there is substantial dismay. What are they complaining about, and what are they doing about it? Can a health care system function effectively if a sizeable fraction of its physicians are disgruntled? Are patients well served by unhappy physicians? Kassirer, ”Editorial,” Neiu Efzglu~idJo ziriinl of Medicine Recent changes in the character of medical work have made the medical profession in many societies concerned about the lack of control over its work. Some of the reactions have been collective and have resulted in strikes or threats of such measures (Burke 1996).O ther reactions have taken more individualized expression and are appearing as a growing prevalence of health problems, stress, alcoholism, and suicides among physicians (Stimson 1985; Lindeman, Laara, Hakko, and Lonnqvist 1996; Arnetz 2001; Firth-Cozens 2001). During the same period that the profession is experi- encing a loss of control over the conditions of its work, women have entered the profession in increasing numbers. As new members and with new capacities, will women physicians be able to ”humanize” the profession? The increasing proportion of women in the medical profession has been followed keenly both by conservative and feminist observers during the past three decades. The conservative observers have been mollified by the statistics that show that women physicians remain active members of the profession even after forming a family. But the feminist voices continue to be heard, and for various reasons. One of the early arguments for an increase of women in the medical profession was the quest for equality between the sexes. Liberal feminists demanded that women should have the same educational opportunities as men. Many formal barriers to women’s entry into medical schools have been eliminated over recent 1