Sociology Compass 4/7 (2010): 454–465, 10.1111/j.1751-9020.2010.00294.

Gender and Feminization in Health Care Professions

Tracey L. Adams*
Department of Sociology, University of Western Ontario

Abstract
Within health care, there has long been a gender division of professional labor: men have predom-
inated in higher-status, higher-paying professions like medicine and dentistry, while women’s
health care work has been clustered in so-called support occupations such as nursing. Historically,
health care professions were gendered, and beliefs about gender came to be embedded in profes-
sional work. Recently, however, traditional gender divisions of labor are being challenged by the
feminization of professions in the United States and Canada. Women’s participation is expanding
in traditionally male-dominated professions. This article explores the nature and causes of this fem-
inization and considers whether feminization is changing the significance of gender to health care
employment.

Although professions have been variably defined, in sociology they are typically treated as
occupations with status, autonomy, and authority that require years of training, education,
and considerable expertise (Adams and Welsh 2008, 253). Most recognized and regulated
professions are in the health field. Precisely who is regulated varies across region, espe-
cially in the United States and Canada where professional regulation is a state ⁄ provincial
responsibility; many regions recognize and regulate over 20 different health practitioners.
These range from long-regulated, high-status professions like medicine and dentistry,
through well-established professions like optometry, pharmacy, and nursing, to newer
groups like massage therapists, audiologists, and speech language pathologists. Regulatory
legislation usually restricts entry to practice to those who can demonstrate their
professional competence through completing a prescribed course of training and passing
examinations.
Among health professions, there has traditionally been a clear gender division of labor.
The most prominent and authoritative professions like medicine and dentistry were
strongly male dominated. In fact, these and many other professions have a history where
women were, at least for a time, formally denied the right to practice (Adams 2000;
Morantz-Sanchez 1985; Witz 1992). Women’s health care labor was often concentrated
in jobs, like nursing and dental assisting, that were seen to support men’s professions. In
the mid-20th century, these jobs were labeled ‘semi-professions’ because, as women’s
professions, they did not possess the autonomy, authority, status, or length of training of
traditional men’s professions (Etzioni 1969).
Over the last several decades, this traditional gender division of labor has altered.
Today, the vast majority of health care workers are women. Women have entered tradi-
tionally male-dominated professions in large numbers, and many newer health professions
are female dominated. At the same time, women have maintained their presence in his-
torically female-dominated professions. In a numerical sense, then, health professions can
be said to be feminizing. The factors driving this trend, the meanings of feminization for
health care work, and the implications it may have for health professions more broadly
have provoked debate and concern (Bottero 1992; Elston 2009; Muzzin et al. 1994;

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 Gender and Feminization in Health Care Professions 455

Riska 2001; Williams 1999). Will the movement of women into traditionally male-domi-
nated professions alter the nature of those professions? Will it affect professional practice
or engender a decline in professional status?
This article explores the feminization of health care professions in Canada and the Uni-
ted States and considers whether feminization is altering the gendered nature of health
care work. Here, feminization is defined simply as the movement of women into occupa-
tions where they were formally under-represented (Le Feuvre 2009, 10). Ultimately, it is
argued, feminization appears to be changing the significance of gender to professional
work, but it has not yet eliminated it.

The gendering of health care professions

Historically, male-dominated health professions like medicine and dentistry were gen-
dered male: they were defined by men for men and were designed to embody and dem-
onstrate the characteristics and traits idealized for white, middle-class men prevalent at the
time they were formed (Adams 2000; Davies 1996). Professional men, like middle-class
men, were expected to be distinguished, rational, unemotional, authoritative, physically
robust, committed to their jobs, highly educated and broad minded, and especially later
in the 19th and early 20th centuries, scientific. Linking professional work with these traits
bolstered the professional project pursued by professional leaders during this period and
enhanced their drive for authority and respect. At the same time, this definition of pro-
fessional practice excluded and marginalized women. In this era, middle-class white
women were seen to lack these traits; instead they were viewed as frail, emotional,
dependent, less committed to employment, and somewhat narrow minded (Mitchinson
1991). Such social ideologies shaped the organization of practice and training in profes-
sions, further facilitating the practice of middle-class white men of means, while hinder-
ing the involvement of all others (Adams 2000; Davies 1996; Moldow 1987). At times,
women were formally excluded from practice; once they gained access, they often faced
hostility and opposition from male elites (Hacker 2001; Moldow 1985; More et al. 2009;
Witz 1992). Although many female medical doctors and dentists had successful careers, it
was not easy practicing a man’s profession.
When professionalism and competence were defined in accordance with 19th-century
notions of masculinity, it was difficult for women to be both feminine and successful
practitioners. They appeared to some, to be neither fully female nor professional. The
influential Dr. William Osler reportedly joked with his students in the 1890s that
‘humankind might be divided into three categories – men, women, and women physi-
cians!’ (Moldow 1987, 16; Pringle 1998, 28). Although several early women doctors (and
dentists, and others) successfully battled these perceptions (Adams 2000; Hacker 2001;
More et al. 2009), the overall effect was the channeling of women into some (generally
lower-status) practice areas and specialties, and limitations on both their ability to practice
male-dominated professions and their access to leadership and administrative roles (Glazer
and Slater 1986; More et al. 2009).
While much of the literature on women in male-dominated health professions has
focused on their exclusion (and the discrimination they faced), Celia Davies (1996) has
argued that the real focus should be on women’s inclusion. Women have long had a
large role in the health care field, first as care providers within their families and com-
munities, and later – as the health care field became more professionalized, formalized,
and bureaucratic – in important ‘support’ roles, especially as nurses and assistants. Davies
shows that women have been included in gender-specific ways and their work was

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456 Gender and Feminization in Health Care Professions

designed to fit around and support men’s work. In fact, she argues, men’s and women’s
roles have been mutually defining. Men have only been able to assume the role of dis-
tant, authoritative, rational, and broad-minded professional by hiring women in support
roles that require them to be in closer contact with patients and clients, provide hands-
on care, and handle the many details associated with maintaining a practice. Men’s and
women’s health care roles have been defined in contradistinction, in line with nine-
teenth-century separate spheres ideology in which women and men were seen to be
inherently different with distinct traits and abilities. Thus, if medicine and dentistry
were defined as work for men, medical and dental nursing were defined as work for
women. In the words of nursing pioneer, Florence Nightingale, ‘to be a good nurse
one must be a good woman’ and demonstrate ‘quietness – gentleness – patience –
endurance – forbearance.’ (quoted in Gamarinkow 1978, 115). Nurses were taught to
follow the instructions of doctors implicitly, and never to contradict (Coburn 1974). In
Ontario, dental nurses (assistants) were formally taught that a good nurse should antici-
pate their dentist-employers’ needs even before these were articulated, as well as ‘econ-
omize [his] time and smooth out annoyances and make a joy in a work which is nerve
taxing’ (quoted in Adams 2000, 124).
There is also evidence that other health care occupations were shaped by gender rela-
tions. Studies of the emergence of physiotherapy, speech therapy and audiology, and den-
tal hygiene reveal how these professions were established as work for women, under male
doctors ⁄ dentists’ general authority (Adams 2003; Heap 1995; Prud’homme 2003). Some
gender-mixed health care occupations did emerge in the 20th century; notably, medical
laboratory technicians who tended to enter the field either from nursing or from science
laboratory backgrounds, thereby encouraging the participation of both women and men
(Twohig 2005). Nevertheless, such jobs were historically the exception; traditionally,
health care work was defined as suitable for either women or men.

Feminization in health care professions

Table 1 uses census and other data to illustrate the changing composition of the health
care labor force in the United States and Canada in the 75-year period between
1930 ⁄ 1931 and 2006 ⁄ 2008. In the first part of the table, traditional professions are
listed, beginning with historically male-dominated professions. In the second part, occu-
pations that have arisen since the 1930s are listed. The percentage of workers who are
women in each of these occupations is given at two points in time (when data are
available at both points). The table reveals clear evidence of feminization. While
women have maintained their representation in traditionally female-dominated jobs like
nursing, they have also increased their participation in male-dominated professions
including veterinary science, pharmacy, medicine, and dentistry. Furthermore, many
health specialties have arisen since the 1930s, which are typically female dominated as
well. Overall, women’s involvement in health care professions has increased. In the
selection of professions listed in Table 1, women composed roughly half of the health
care labor force in the early 1930s, and their work was heavily concentrated in nursing
– then a relatively new and rapidly growing semi-profession. More recently, women
represent approximately three-quarters of health care professionals in the United States
and Canada, and while the majority are still employed as nurses, they are also found in
a variety of other professional fields. The only fields in which the percentage of men
practicing has increased are nursing and US chiropractic; in both of these fields, the
increase is a minor 7 percent.

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 Gender and Feminization in Health Care Professions 457

Explaining feminization
How do we account for the movement of women into male-dominated fields? One of
the most influential explanations has been provided by Reskin and Roos (1990). They
drew on queuing theory to explain how men and women from different racial-ethnic
backgrounds have traditionally been sorted into different types of jobs, and why some
jobs have recently feminized. Employers, they contend, have ‘queues’ or mental lists
specifying what type of person is best suited for certain jobs; for most professional jobs,
white men have been at the top of the list. Because such jobs are attractive, they are also
at the top of white men’s job queues – their own mental lists of appealing jobs. White

Table 1. The percentage of practitioners who are women in Selected Health Professions in the United
States and Canada

Occupation % Female Total no. of workers % Female Total no. of workers

United States* 1930 2008

Physicians & surgeons 4 153,803 30.5 877,000

Dentists 1.8 71,055 27.2 152,000
Veterinarians 0.1 11,863 56.7 56,000
Pharmacists 4.4 104,727 51.8 243,000
Chiropractors 22.8 11,916 15.3 60,000
Osteopaths1 25.6 6117
Optometrists nd 37,000
Opticians2 4.3 14,385 63.4 50,000
Nurses (RNs)3 98.1 294,189 91.7 2,778,000
Licensed practical nurses 93.3 566,000
Dieticians & nutritionists 90 100,000
Physical therapists 69 197,000
Occupational therapists 96 87,000
Dental hygienists 97.7 143,000
Clinical lab technicians 75.7 351,000
EMTs & paramedics 30.2 138,000
Speech pathologists4 98.1 133,000
Physician assistants 67 99,000
Total 45.9 668,055 76.5 6,030,000

Canada 1931 2006

Physicians & surgeons 2 10,020 36.4 75,920

Dentists 0.8 4039 31.2 18,400
Veterinarians 0 1046 50.3 7895
Pharmacists 3.7 3310 59.4 26,185
Chiropractors5 30.1 6660
Chiroprac + osteopaths 16.6 542
Optometrists 50.4 3890
Opticians2 1.8 869 61 6480
Nurses (RN’s)3 100 20,462 93.8 269,880
Licensed practical nurses 92 47,315
Dieticians & nutritionists 94.8 7750
Physiotherapists 79.6 18,095
Occupational therapists 93.4 10,960
Dental hygienists 97.2 17,460
Medical lab technicians 82.2 21,955

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458 Gender and Feminization in Health Care Professions

Table 1. (Continued)

Occupation % Female Total no. of workers % Female Total no. of workers

Canada 1931 2006

Paramedical 32 21,080
Speech path + audiology 94.1 7375
Total 51.9 40,288 77.4 567,300

*US data: United States Bureau of the Census (1933); Bureau of Labor Statistics (2009).
*Canadian data: Dominion Bureau of Statistics (1936); Statistics Canada (2008).
nd: The Bureau of Labor Statistics does not provide information on percentage female when there are
fewer than 50,000 practitioners.
1
Osteopaths are grouped with Physicians in Surgeons in more recent US data. Many osteopaths would
also be grouped in this category in Canada.
2
The 1930 US and 1931 Canadian census had a category for ‘opticians’ that likely included optome-
trists; the 2008 category in the US is ‘dispensing opticians’.
3
The 1930 US and 1931 Canadian censuses have a category for ‘graduate nurses.’ In most Canadian
provinces these would be also registered nurses. Because they are similar to modern RNs, it was
decided to combine these categories.
4
The American data for 2008 has separate categories for speech pathologists and audiologists, but
the numbers of audiologists are low so there is no information on percentage female. For this reason
it was decided to eliminate this category. The 2006 Canadian census merged the categories.
5
The Canadian Census grouped chiropractors and osteopaths together in 1931.

men have predominated in professional jobs, then, because they had a preference for this
work, and employers and professional gatekeepers had a preference for them. Recently,
however, Reskin and Roos (1990) argue that social change has disrupted the labor and
job queues held by employers and workers alike. Occupational change has rendered some
good jobs less rewarding and hence less attractive to white men, who have begun to pur-
sue other options. At the same time, the influx of more women into the labor force,
combined with their rising education levels, has ensured that women are more attractive
employees, and the growing prevalence of antidiscrimination legislation means that the
cost of not hiring women (and minorities) has increased. The end result is the influx of
women into some formerly male-dominated jobs.
Reskin and Roo’s (1990) framework was first applied to the feminization of health
professions by Phipps (1990) who explored changes in pharmacy in the 1970s and
1980s. Phipps argued that changes to the field – particularly the rise of large pharma-
ceutical manufacturers and chain drug stores – decreased the autonomy and indepen-
dence long-associated with pharmacy work. As a result, men’s interest in pharmacy
work declined, and employers and gatekeepers had to move further down the queue to
recruit women. The implication here, and to some extent queuing theory more
broadly, is that feminization may be spurred by occupational decline. Is it true that
women’s entry into professions is related to the deterioration of working conditions
and status decline?
Further research on pharmacy casts this explanation into doubt. While it is clear that
substantial change in the pharmaceutical industry and in pharmacy practice shaped femini-
zation, Collin (1992) argues that this was at least in part because these trends expanded
opportunities in hospital pharmacy – an area of pharmacy practice where women
had long been over-represented – and reduced opportunities in the male-dominated area
of private pharmacy ownership. Furthermore, Bottero (1992) finds no evidence that

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 Gender and Feminization in Health Care Professions 459

pharmacy’s status as a profession declined with occupational change and feminization;

indeed she contends that the profession’s status is increasing.
Research on feminization in other health professions finds some support for Reskin
and Roos’s (1990) queuing theory but encourages a nuanced interpretation. Most impor-
tantly, studies suggest that feminization has been spurred more by the elimination of bar-
riers to women’s participation, than men’s lack of interest (Boulis and Jacobs 2008; Elston
2009). With the rise of anti-discrimination laws and policies, it is no longer acceptable, as
it once was, to use gender, race or religion as criteria for screening applicants to profes-
sional schools. Explicit and implicit quotas on the number of women accepted into train-
ing programs have been generally removed. And with the influence of the women’s
movement, women increasingly have the educational background and the motivation to
pursue professional practice (Adams and Bourgeault 2003; Boulis and Jacobs 2008; Pringle
1998). In both the United Kingdom and the United States, there is evidence that
women’s interest in medical careers has increased considerably, while men’s interest has
remained stable or declined slightly, as men pursue business, math, and ⁄ or information
technology-related fields (Boulis and Jacobs 2008; Elston 2009). Nonetheless, feminiza-
tion cannot simply be explained as the result of declining male interest but rather has
been shaped by a confluence of trends including expansion of and changes to medical
education and practice, the women’s movement, and the expansion of women’s higher
education (Boulis and Jacobs 2008; Elston 2009).
Labor market trends are also important. Women appear to move into male-dominated
occupations more rapidly during times of labor shortages and ⁄ or job growth (Chiu and
Leicht 1999). Studies of feminization in medicine, physician assistant work, and pharmacy
all suggest that labor shortages, and expanding opportunities in certain practice areas,
played an important role (Boulis and Jacobs 2008; Collin 1992; Elston 2009; Lindsay
2005). Thus, it may not be a decline in men’s interest that spurs feminization, but a situa-
tion where men’s interest is no longer sufficient to meet the demand for skilled labor in a
given field. This latter situation may occur even in occupations not undergoing substan-
tial growth and change. Occupations such as veterinary science and dentistry have under-
gone feminization without clear evidence of labor shortages. Changing social attitudes
and women’s increasing levels of education have combined to increase the availability of
qualified women interested in pursuing health professions, and this appears to have con-
tributed to feminization, even without substantial male flight (Elston 2009).
One additional, and often ignored, contributor to feminization in traditionally male-
dominated health professions is immigration. Many women entering professions like
medicine and dentistry in the United States and Canada are foreign born and foreign
trained. Global inequalities, immigration policies, and the ongoing high demand for
health care workers in developed countries encourage the immigration of health care per-
sonnel. Many of those who immigrate are women, and many come to the United States
and Canada from nations – such as those in Eastern Europe – where health care profes-
sions are strongly female dominated. The case of dentistry provides an extreme example.
By the early 1960s, the majority of women in the profession in the US and Canada were
foreign born and predominantly from Eastern Europe (McFarlane 1964; Snow Talbot
1961). While the involvement of native-born women in dentistry has increased signifi-
cantly in the Unites States and Canada in recent decades, still over one-third of female
practitioners in Ontario in 2001 was foreign trained (compared to only 15 percent of
male dentists: Adams 2005). Boulis and Jacobs (2008) report a similar figure for physicians
in the United States: 30 percent of female physicians are foreign born. In some locales,
then, immigration appears to shape feminization in some professional fields. Its impact,

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460 Gender and Feminization in Health Care Professions

however, appears to vary substantially by profession and region. For instance, immigration
has contributed to the feminization of the medical profession in Portugal (Ribeiro 2008),
but most medical doctors immigrating to the United Kingdom are men (Elston 2009).
Studies of feminization in male-dominated professions have tended to ignore the role of
immigration, but this is a topic worthy of further consideration.
Overall, explanations of feminization highlight the significance of the changing labor
supply – with the increase in educated native-born and immigrant women in the labor
force, we can expect more women to enter these professions. At the same time, it is clear
that demand-side factors are also important – occupational change, and employers’ and
gatekeepers’ increasing willingness to accept women have clearly contributed to feminiza-
tion. There is little evidence to support a link between professional decline and feminiza-
tion. Health profession jobs are still among the most attractive, autonomous, secure, and
well paying in the labor market (Adams and Welsh 2008).

Will women change practice?

Over the last several decades, some have suggested that the influx of women into health
professions will bring about fundamental change (Le Feuvre 2009; Riska 2001). For
instance, some believe women have a different commitment to care and better communi-
cation skills (Cassell 1997; Pringle 1998). Thus, women’s entrance could bring about a
more caring medical profession that is more patient centered and collaborative. In con-
trast, others have speculated that women’s entrance could have negative implications for
service provision. Because women in the labor force tend to work fewer hours than
men, some fear that feminization could exacerbate health care labor shortages (as dis-
cussed in Elston 2009; Muzzin et al. 1994; Williams 1999).
Thus far, there is little evidence that feminization is completely altering traditionally
male-dominated professions. Adams (2005) found that male and female dentists tend to
work roughly the same number of hours a week and weeks per year, and their attitudes
on professional issues and practice are quite similar. Although women are more likely to
be in group practice and younger women dentists in their prime child-bearing years do
tend to work slightly fewer hours than their male colleagues, older women and men
work the same number of hours and in similar types of practice. Studies of women in
medicine (Boulis and Jacobs 2008; Williams 1999) and pharmacy (Muzzin et al. 1994)
have produced similar findings. Women physicians and pharmacists do not work substan-
tially fewer hours per week than their male counterparts. In medicine, observed differ-
ences in the number of patients seen, or time per patient visit (and other related factors),
are small, inconsistent, and appear to be more a function of the types of practice in which
women work (Boulis and Jacobs 2008; Williams 1999). American women physicians are
more likely to work as employees and in managed care. Women physicians are also more
likely to treat women and to have interrupted careers (Williams 1999). Yet, overall,
women do not appear to have professional attitudes that differ from their male counter-
parts, and there is little evidence that they practice differently. It is possible that men and
women professionals might interact with patients somewhat differently (Williams 1999);
however, studies find few differences in the treatment decisions of male and female physi-
cians, and none that can be attributed simply to gender (Boulis and Jacobs 2008; Riska
2001). Such findings are not surprising: the goal of professional education is to produce
relatively homogenous practitioners (Larson 1977). In their training, students are taught
that their gender, ethnicity, and sexual orientation are irrelevant to patient care and
professional practice (Beagan 2000).

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Ultimately, it is not clear that feminization, in and of itself, will fundamentally alter
health care professions. Women are likely drawn to professional work because these jobs
are high-status, remunerative professions that provide a needed service to others. It seems
unlikely that women would do anything drastic to change professions and alter their very
nature.

Gendered jobs no more?

Does the increasing participation of women in health professions, and the fact that they
tend to practice in ways similar to men, mean that professions are no longer gendered?
According to a large body of literature, the answer is no. Gender is still relevant in many
ways. Studies document numerous challenges to women pursuing careers in male-domi-
nated fields, as well as income inequality and sex segregation.
Given evidence that men and women in medicine, dentistry, and other male-
dominated health professions work a similar number of hours, it is perhaps surprising that
there is a significant sex gap in earnings. In the United States, women physicians earn
about 70 percent of their male colleagues’ income (Boulis and Jacobs 2008; Wallace and
Weeks 2002). Canadian census figures reveal a similar sex gap: women on average earn
68–69 percent of what men do in general medical practice, veterinary medicine, chiro-
practic, and pharmacy. Women dentists in Canada earn 60 percent of male dentists’
income (Statistics Canada 2008). Gender income gaps persist (although they are typically
slightly reduced) when hours worked and age are controlled for (Wallace and Weeks
2002); because feminization is a relatively recent trend, women in male-dominated
professions are, on average, younger than men. The sex gap in earnings also reflects
differences in employee status and ownership. Men are more likely to own a practice, or
a portion of one, while women are more likely to work for others (Adams 2005; Boulis
and Jacobs 2008; Muzzin et al. 1994). Income inequality is also related to specialization:
women and men tend to work in different subspecialties (Bolton and Muzio 2008; Elston
2009; Lindsay 2005; Pringle 1998). Nevertheless, even within these specialties, women
earn less than men (Boulis and Jacobs 2008).
The fact that professional employment is internally sex segregated provides further evi-
dence that health profession work is still gendered. In medicine, women tend to cluster
in those specialties (like pediatrics) that have lower incomes, and they are under-repre-
sented in high-status, high-paying specialties like surgery (Boulis and Jacobs 2008: 80–81;
Elston 2009; Hinze 1999; Pringle 1998). In dentistry, women are under-represented in
virtually all specialties, except pediatrics, tending to concentrate in general practice
(Adams 2005). A number of studies have explored the factors shaping specialty choice in
medicine. These studies reveal both the subtle and unsubtle steering of women away
from high-status specialties like surgery, toward lower-status fields that may be viewed as
more appropriate for women, and ⁄ or more compatible with family responsibilities, like
pediatrics and psychiatry (Bourne and Wikler 1982; Elston 2009; Gjerberg 2002; Hinze
1999, 2004; Pringle 1998). While the most overt of these processes appears to have
declined, studies continue to suggest that in both medical school and practical training
social interactions marginalize and exclude women, making it more difficult for them to
participate on the same terms as men (Beagan 2001; Gjerberg 2002; Hinze 2004). Gender
differences in specialization seem to reflect the different choices men and women make
about their careers and work–family balance, but these choices are structured and con-
strained by working conditions, and the input of their mentors, teachers, and colleagues
(Beagan 2001; Bourne and Wikler 1982; Pringle 1998). Revealing is a study of specialty

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choice among Norwegian doctors by Gjerberg (2002). She shows that in this locale,
women are under-represented in specialties like surgery, but not because they choose not
to enter these specialties; women entered surgery in similar proportions to men, but they
had higher rates of exit. Gjerberg’s (2002) research illustrates that subtle processes of
exclusion have the effect of channeling women into less-prestigious subfields, leaving the
highest-status subspecialties strongly male dominated. Despite feminization, women con-
tinue to be under-represented in important posts and have less access to key resources,
thereby limiting their influence and ability to make change (Elston 2009; Lorber 1993).
Even when women do work in the same areas as men, there is evidence that there are
particular challenges associated with being a woman in a man’s field. Women’s bodies
may appear not to belong (Bolton and Muzio 2008; Cassell 1997). For instance, many
women in medical school experience sexual harassment (Hinze 2004). Further, women
in male-dominated professions articulate feeling a disjuncture between their professional
identity and their gender identity (Cassell 1997; Hinze 1999; Pringle 1998). Remember
that, historically, professionalism and masculinity were intertwined (Adams 2000; Davies
1996). This can create a challenge for women professionals as they strive to demonstrate
competence and professionalism but at the same time remain feminine. Research suggests
that women have had to walk a very fine line. For instance, the female surgeons studied
by Hinze (1999) had to, metaphorically, ‘grow balls’ and demonstrate their physical and
mental toughness to succeed in their job but at the same time were conscious of appear-
ing feminine in their interactions and their appearance. According to Cassell (1997),
women surgeons are expected to behave in gender-appropriate ways, and this shapes how
they do their work. Achieving a demeanor that is both professional and feminine can be
a challenge.
Although the literature points to the continuing significance of gender, Le Feuvre
(2009) argues that the impact of feminization can be variable. The social context in
which feminization occurs, and the culture surrounding professional work can vary across
location and occupation. In some contexts, feminization may be more transformative than
in others.

Portents and prospects

Despite feminization and considerable social change, gender continues to be relevant for
employment in health professions. Will its significance decline over time? Will women
become the majority in most formerly male-dominated professions? It is difficult to know
what the future will hold. Given current trends, however, there are several aspects of
health profession work that deserve a closer look.
First, it is important to consider further, not only the extent of feminization, but also
its impact on the gendering of health care work. Are there conditions under which femi-
nization is more likely to challenge the gendering of jobs? If, as Le Feuvre (2009) con-
tends, the elimination of gender barriers is more likely in some contexts than in others, it
is important to explore further how feminization varies across time and place. We need
to explore whether there are conditions under which feminization is more likely to chal-
lenge or alter the gendering of professions.
Second, it is important to explore how and in which contexts feminization is inter-
twined with immigration trends and greater ethnic diversity in the labor force. Although
there is a growing body of research documenting the difficulty the foreign-trained
have in entering many health professions (Austin 2007; Ribeiro 2008), less is known
about their experiences of practice, once they do gain entry. There is evidence that

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foreign-trained women earn less and have higher rates of unemployment and underem-
ployment than do their male counterparts and the locally trained (Boyd and Kaida 2005;
Ribeiro 2008). More research on the experiences of foreign-trained men and women and
the extent to which immigration trends contribute to or counter feminization and its
impact within professional fields is needed.
Third, it is important to explore further the significance of feminization for profession-
alization. Historically, successful professions were men’s professions, and there was a clear
association between masculinity and professionalism. This link has been disrupted in
recent decades as female-dominated professions such as nursing, midwifery, and dental
hygiene have pursued professional projects by overtly making a link between femininity
and professionalism (Adams and Bourgeault 2003). Furthermore, Bolton and Muzio
(2008) have suggested that some professions like law and management have encouraged
feminization as part of a professional project to enhance their legitimacy; however,
women’s marginalization in the field leaves the masculine structure and culture of the
professions intact. Taken together, this research suggests that gender may still be relevant
to professional projects, but in ways very different than in the past. More research needs
to be carried out on the significance of feminization for professional projects, and
whether such professional activity is less gendered than it once was.
In the end, the growing participation of women in traditionally male-dominated fields
has the potential to shape health profession work considerably and to alter the significance
of gender to work in these fields.

Short Biography
Tracey Adams’ research focuses on professions, gender, work, and social change. She is
the author of the book, A Dentist and a Gentleman: Gender and the rise of Dentistry in
Ontario (University of Toronto Press, 2000), and, with Sandy Welsh, co-author of the
text book, The Organization and Experience of Work (Thomson Nelson 2008). She has pub-
lished numerous articles on professions, gender, and work in journals such as Social Science
and Medicine, The Sociological Quarterly, Work, Employment & Society, and Gender & Society,
among other venues. Her current research focuses on the regulation of professions and
how it has changed over time, and inter-professional relations. Adams is a professor in
the Department of Sociology, at the University of Western Ontario, in London, Ontario
Canada. She holds a PhD in Sociology from the University of Toronto.

Note
* Correspondence address: Tracey L. Adams, Associate Professor, Department of Sociology, University of Western
Ontario, London, ON N6A 5C2, Canada. E-mail: tladams@uwo.ca

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Journal Compilation ª 2010 Blackwell Publishing Ltd