Läkarprofessionens feminisering : ett köns- och maktperspektiv

Sammanfattning: There is a pervasive assumption about the effects of gender composition that presumes that a devaluation and deterioration in professional prestige and power goes hand in hand with feminization of a profession. In this study about the Swedish medical profession, these assumptions are challenged through an analysis of structural processes and administrative reforms in the Swedish welfare state.The study traces the changes beginning in the 1950s to the end of the 1990s. At the outset of the study, women comprised about 10 percent of the medical profession; in 1999 about 40 percent of medical doctors are women; and among the youngest cohorts, they are about 60 percent. During the same period, the medical profession has undergone profound changes in its authority, autonomy, prestige and power. The most visible sign of the deteriorating position of doctors can be seen in the overall wage loss, which has decreased between 40-60 percent in the period covered by this study.The thesis analyzes these processes using three concepts: deprofessionalization, proletarianization and disempowerment. In the context of the medical profession deprofessionalization refers to a process that reveals a reduction in the professional authority, which is reflected in the weaker position of doctors as experts and supervisors in the health service system. Proletarianization is defined as the loss of professional autonomy or freedom to choose an employer as well as economic devaluation, the relative loss in wages. The concept of disempowerment is used to describe the process of their reduced influence inside the political policy process where decisions about the health system and professional privileges are made.Because the medical profession is a prototype of a high prestige profession, which exemplifies how the power of the expert is socially organized in modern society, it is a paradigm to test the feminization thesis and the processes of deprofessionalization, proletarianization and disempowerment in professions. This study suggests that the transformation in the medical profession reveals broader structural changes in the authority, autonomy, prestige and power of professionals in welfare states. Although doctors in many western industrialized countries have experienced loss in authority and autonomy, in the Swedish case several reforms in the administration of health services produced a dramatic shift in the privileges that previously belonged to doctors. The profession is no longer a part of the state bureaucracy or the power elite; doctors exert little influence over the planning and organization of the health service system in Sweden. Instead other professional groups, such as politicians, bureaucrats and other professional organisations within the health service have taken over the areas of decision making that earlier were controlled by the medical profession.This study concludes that the shift in the gender composition of the medical profession does not explain the transformation of the medical profession in Sweden. The swedish case challenges the thesis that women´s entry into the profession leads to deprofessionalization, proletarianization and disempowerment and shows that these processes were consequences of broader institutional changes. Furthermore, the research challenges the assertion that feminization follows upon the heels of the devaluations in the profession, that women have greater access to a profession when it is losing power and prestige. Rather in the Swedish case, the increasing number of women in medicine can be seen as an effect of a set of conjectureres: the overall changes in the labour market, most importantly, the expansion of the health service and the public sector and the shortage of doctors; the increased numbers of women in higher education in general, in particular because of higher numbers of students admitted to medical education, and the tendency of women to seek employment in the public sector. The aim of this study has been to contribute to the development of knowledge and the theory building concerning the feminization thesis and the transformation of professions. This research also underscores the importance of analyzing the different aspects of power and professionalization.