Book Review: Riska, Medical Careers and Feminist Agendas

Elianne Riska.
Medical Careers and Feminist Agendas: American, Scandinavian, and Russian Women Physicians.
Aldine de Gruyter, 2001, 172 pp.
$US 19.95 paper (0-202-30668-2), $US 39.95 cloth (0-202-30667-4)

Elianne Riska had two intentions for writing this book: first, a desire to examine the careers of female physicians in three different political and cultural settings – the United States (US), the Scandinavian or, more precisely, Nordic countries (Finland, Norway, Sweden, Denmark), and Russia / Soviet Union; second, to address some of the main feminist and sociological debates about women’s capacity to change the structure of medicine and create a health care system that is more responsive to women’s health care needs and concerns. The result is a concise monograph that is historically interesting while at the same time offering much food for thought regarding women physicians’ careers and feminist agendas in the twentieth-first century.

Medical Careers and Feminist Agendas begins with an initial look at the research literature on women’s position in the professions and in large-scale organizations. The author highlights the different theoretical viewpoints on gender and the medical profession implicit in existing studies on the topic — medicine as fundamentally gender neutral, medicine as characterized by gender processes and social practices, medicine as a universal patriarchal culture. Riska notes that these three theories have mainly been used to explain women physicians’ position in US society, and that a question remains as to their utility for understanding women physicians in other political and cultural contexts. The author takes as her central task to test the analytical value of these theoretical perspectives in three distinct geographical regions that vary significantly in regard to their political economies (market-based, strong welfare state, communist society in transition) and gender systems.

Chapters 3, 4 and 5 present a detailed picture of women’s initial entry into medicine in the different geographical regions covered in the book. In both the US and Russia, women had gained access to medicine as early as the 1860s and 1870s. However, as Riska notes, their gateway into medicine was largely through gender-segregated medical educational programs. By contrast, Nordic women did not enter medicine until the end of the 19th century but did so through a more open-door policy – i.e., via coeducational medical schools.

Women’s role in medicine throughout the 20th century was likewise intrinsically shaped by the existing political economy and gender system. Paralleling organizational changes in the larger society, medicine moved in the early decades of the 20th century from a small-scale cottage industry to a factory mode of production within the structure of hospital medicine. The economies and medical systems of the three case examples have undergone change once again in the recent decades. A corporate-oriented medical system has emerged in the US, while the Nordic countries have reformed their health care systems to include a mix between welfare state and market-oriented strategies. Russia remains an anomaly, comprised of a mix of public and private-sector funding at the regional level yet chronic funding shortages overall.

The gender systems of these societies have likewise changed, with important consequences for women physicians. While in all jurisdictions women have made admirable numerical gains in medical school and medical practice (for example, in 1999-2000, 46 percent of entrants in US medical schools were women, and in 2000, 67 percent of physicians under age 30 years in Finland were women), Riska nevertheless provides convincing evidence that a gender-based “glass ceiling” continues to exist, keeping the number of women in some of the most prestigious sub-fields, including surgery and academic medicine, comparatively low. The latter is especially apparent in the Nordic countries where less than 20 percent of women physicians serve on medical faculties. Riska wonders whether the higher percentage of US women doctors in academia is to a large extent due to feminist advocates for women’s health leading the cause. Such a movement has been all but absent in the Nordic countries. In contrast, the tendency in the Nordic countries has been to integrate women’s health needs into general health care policies organized around the principles of universality and public access. The result has been the creation of a welfare state occupation for Nordic women physicians in the “liberated zone” of primary care, a special niche where female physicians can work largely free from male control. As for Russian medicine, the post-communist period has resulted in the resegregation of medicine along gender lines, with male doctors elevated to more prestigious positions, despite their comparatively small numbers.

Medical Careers and Feminist Agendas concludes with the question of the likely impact women physicians will have on the institution of medicine in the future. Will they humanize medicine and improve health care for women? According to Riska, much depends upon how medicine will be organized in the different countries in the decades to come. Hence her conclusion that, “[a]s health care systems and gender systems vary, so do the working conditions and status of both women physicians and of the field falling under the general rubric of “women’s health”.”

Riska’s short book — concise, nicely organized and convincingly argued — deserves a wide audience on both sides of the Atlantic. It is likely to attract the attention of senior undergraduate and graduate students as well as colleagues interested in the gender underpinnings of the medical profession in different welfare states and economic systems.

Cecilia M. Benoit
University of Victoria
cbenoit@uvic.ca



		Canadian Journal of Sociology Online January - February 2002 Elianne Riska. Medical Careers and Feminist Agendas: American, Scandinavian, and Russian Women Physicians. Aldine de Gruyter, 2001, 172 pp. $US 19.95 paper (0-202-30668-2), $US 39.95 cloth (0-202-30667-4) Elianne Riska had two intentions for writing this book: first, a desire to examine the careers of female physicians in three different political and cultural settings – the United States (US), the Scandinavian or, more precisely, Nordic countries (Finland, Norway, Sweden, Denmark), and Russia / Soviet Union; second, to address some of the main feminist and sociological debates about women’s capacity to change the structure of medicine and create a health care system that is more responsive to women’s health care needs and concerns. The result is a concise monograph that is historically interesting while at the same time offering much food for thought regarding women physicians’ careers and feminist agendas in the twentieth-first century. Medical Careers and Feminist Agendas begins with an initial look at the research literature on women’s position in the professions and in large-scale organizations. The author highlights the different theoretical viewpoints on gender and the medical profession implicit in existing studies on the topic — medicine as fundamentally gender neutral, medicine as characterized by gender processes and social practices, medicine as a universal patriarchal culture. Riska notes that these three theories have mainly been used to explain women physicians’ position in US society, and that a question remains as to their utility for understanding women physicians in other political and cultural contexts. The author takes as her central task to test the analytical value of these theoretical perspectives in three distinct geographical regions that vary significantly in regard to their political economies (market-based, strong welfare state, communist society in transition) and gender systems. Chapters 3, 4 and 5 present a detailed picture of women’s initial entry into medicine in the different geographical regions covered in the book. In both the US and Russia, women had gained access to medicine as early as the 1860s and 1870s. However, as Riska notes, their gateway into medicine was largely through gender-segregated medical educational programs. By contrast, Nordic women did not enter medicine until the end of the 19th century but did so through a more open-door policy – i.e., via coeducational medical schools. Women’s role in medicine throughout the 20th century was likewise intrinsically shaped by the existing political economy and gender system. Paralleling organizational changes in the larger society, medicine moved in the early decades of the 20th century from a small-scale cottage industry to a factory mode of production within the structure of hospital medicine. The economies and medical systems of the three case examples have undergone change once again in the recent decades. A corporate-oriented medical system has emerged in the US, while the Nordic countries have reformed their health care systems to include a mix between welfare state and market-oriented strategies. Russia remains an anomaly, comprised of a mix of public and private-sector funding at the regional level yet chronic funding shortages overall. The gender systems of these societies have likewise changed, with important consequences for women physicians. While in all jurisdictions women have made admirable numerical gains in medical school and medical practice (for example, in 1999-2000, 46 percent of entrants in US medical schools were women, and in 2000, 67 percent of physicians under age 30 years in Finland were women), Riska nevertheless provides convincing evidence that a gender-based “glass ceiling” continues to exist, keeping the number of women in some of the most prestigious sub-fields, including surgery and academic medicine, comparatively low. The latter is especially apparent in the Nordic countries where less than 20 percent of women physicians serve on medical faculties. Riska wonders whether the higher percentage of US women doctors in academia is to a large extent due to feminist advocates for women’s health leading the cause. Such a movement has been all but absent in the Nordic countries. In contrast, the tendency in the Nordic countries has been to integrate women’s health needs into general health care policies organized around the principles of universality and public access. The result has been the creation of a welfare state occupation for Nordic women physicians in the “liberated zone” of primary care, a special niche where female physicians can work largely free from male control. As for Russian medicine, the post-communist period has resulted in the resegregation of medicine along gender lines, with male doctors elevated to more prestigious positions, despite their comparatively small numbers. Medical Careers and Feminist Agendas concludes with the question of the likely impact women physicians will have on the institution of medicine in the future. Will they humanize medicine and improve health care for women? According to Riska, much depends upon how medicine will be organized in the different countries in the decades to come. Hence her conclusion that, “[a]s health care systems and gender systems vary, so do the working conditions and status of both women physicians and of the field falling under the general rubric of “women’s health”.” Riska’s short book — concise, nicely organized and convincingly argued — deserves a wide audience on both sides of the Atlantic. It is likely to attract the attention of senior undergraduate and graduate students as well as colleagues interested in the gender underpinnings of the medical profession in different welfare states and economic systems. Cecilia M. Benoit University of Victoria cbenoit@uvic.ca http://www.arts.ualberta.ca/cjscopy/reviews/medcareers.html February 2002 © CJS Online