The number of working wives, for example, had tripled in the two decades between 1940 and 1960. Before the war, most of them had come from the working class, but by the late 1950s an equal proportion was being drawn from middle- and upper middle-class homes. Indeed, white-collar wives were even more frequent job-seekers than the wives of factory workers.¹ While women worked in unprecedented numbers, after 1960 an increasing proportion of them entered male-dominated fields that had previously remained stubbornly inhospitable in spite of the best efforts of early women’s -rights advocates. In some professions, women have already recouped the losses of the 1930s, 1940s, and 1950s. Medicine, for instance, has reflected such changes both in the rising numbers of women doctors and in their increasing willingness to articulate a female point of view. In 1979-1980 25.3 percent of medical students were women, and a survey of medical school deans predicted that females would eventually account for one physician out of every three.²

What have been the implications of these changes for women? Has capitalism really achieved what feminism could not? Certainly an important contribution to the recent influx of women into the labor corps has been the maturation of what Harry Braverman has called “the universal market”—the transformation of society into a giant exchange for labor and goods.³ My primary concern has not been with the fascinating process by which home labor was rendered uneconomic as cheap manufactured goods produced in harsh conditions and thrust upon not-always-willing consumers drove women out of the home and into industry. Rather, I have sought to study the effect of such developments on a group of middle-class and professional women. And here perhaps one important clue has been the growing economic centrality of consumption. Capitalism, after all, teaches poeple to want more than they have. Historians of women’s work have carefully noted the relationship between the growth of the female work force and the rising material expectations of the average middle-class family. As social custom, style, fashion, advertising, and the educational system created since the 1920s an increasing demand for goods and services just beyond what the ordinary middle-class man could comfortably earn, family life for many became characterized by a gnawing sense that there was never quite enough. The more a man earned, the more was needed: a second car, a new television, a vacation in Florida, a food processor, a better vacuum cleaner. Paid labor for the majority of middle-class women expanded in order to help provide families with these things.⁴

Not always aware of the economic forces propelling middle-class women into public activity, nineteenth-century and early twentieth-century feminists nevertheless laid the groundwork for women’s unprecendented participation in politics, social reform, economic life, and the professions. Yet few of them successfully challenged the cultural mandate that consistently defined women’s priorities as belonging primarily with the family. As we have seen, the overwhelming majority of ordinary women, who continued to marry and have children, accepted this cultural mandate as a given. While women were drawn into the marketplace as paid laborers, there was no concomitant rethinking of gender roles either at home or at work. As a result, the first half of the twentieth century has witnessed most women being “liberated” by the industrial order into more sophisticated forms of degradation: through job segregation, unequal wage differentials, and the perpetual exploitation of their unpaid household labor. Though they suffered in different and unequal ways, both working-class women and professional women were hampered by a domestic ideology that allowed them to work only as long as their labor did not overtly jeopardize family stability.

This particular solution to the problem of women’s dual role took precedence over a more radical alternative offered by some feminists, particularly outspoken by the 1920s, who wished to find a better resolution to the organization of family life, one that could free women to pursue careers with the same seriousness as men. But by the opening decades of the twentieth century, the economy was already focused around the infinitely reduplicated single-family dwelling, designed for consuming goods and providing unwaged, privatized services. Traditional gender definitions were thus powerfully connected to the perpetuation of the economic status quo, and when women entered the public sphere, there were always tacit but mutually accepted limits to their participation. Our study of women physicians has suggested that for them the human cost of such a solution was visible primarily on an individual and a personal level. Women doctors struggled with their complicated lives, often only dimly aware that their difficulties arose because they were attempting to straddle two identities, the professional and the personal. When individual women failed at this complicated task, they unwittingly reinforced the common assumption that there were still important areas of public and professional activity in which they simply did not belong.

Yet the social and economic conditions that I have been describing created fertile ground for the revival of feminist ideas in the 1960s, especially those ideas demanding equality of opportunity and equal pay for equal work. As the job market became even more rigidly sex-segregated in the decades after World War II, while traditionally female professional occupations like teaching and social work were invaded by men with the resulting decline of female professional and technical positions, a mass market of over-educated, underemployed, and underpaid women stood poised and ready to join those bold enough to proclaim aloud their dissatisfaction. The feminism of the 1960s gave them a voice.

The civil rights and student protest movements of the 1960s also unleashed the forces of women’s discontent. The response to “women’s liberation” was electric. By 1970 hundreds of women’s groups had formed in cities across the country. Time Magazine estimated that 10,000 had joined the cause. Tens of thousands participated that summer in the Women’s Strike for Equality. When a group of New York feminists met a year later to publish a national magazine written by and for women, they could not possibly have predicted the extent of its success: the premier issue sold out—all 300,000 copies—within eight days. The ensuing weeks brought over 20,000 letters to the offices of MS. Magazine—letters full of praise for the new publication. Joining with groups of old-style feminists who by the late 1960s had begun to reconstitute themselves in organizations like the National Organization for Women, the Women’s Equity Action League, and the National Women’s Political Caucus, college-age, young-married, and professional women swelled the ranks of the movement and restored feminism to public discourse as a powerful social force.⁵

One result of the feminist revival has been that, since the early 1970s, the attention of middle-class women has been increasingly directed toward the pursuit of professional careers. Feminism and the needs of the marketplace have combined to develop a new norm that directly challenged older assumptions that a woman’s place was only in the home. Perhaps equally compelling among young college women of today is the belief that women belong in the money economy as well—indeed, women who voluntarily choose to stay at home now run the risk of social disapproval in many circles. Furthermore, the accomplishments of the civil rights movement, including the passage of Title VII of the 1964 Civil Rights Act, have ensured that the gatekeepers of the nation’s professional schools would be monitored to guarantee fair admissions and hiring practices. Though enforcement of affirmative action by the Reagan Administration has been lax, for the most part the formal barriers that had lingered on since the 1920s were finally struck down. As a consequence of all these developments, middle-class women have easier access to the professional world than they have ever had before.

Ironically, women’s new and unprecedented freedom to make career decisions has also made the social and structural impediments to their success more visible. For this reason those now entering the professions will have to struggle with powerfully subtle barriers to their achievement of equality with men. Though the remaining obstacles take two forms, they are interrelated. First, women must contend with the persistent social assumption that their, and not men’s, primary obligation is to the family. Second, they must come to terms with the ethos of professionalism that has dominated professional life from the late nineteenth century until the present. Of all the professions, medicine has been perhaps the most eager and unrelenting proponent of this ethos. The tacit assumptions of professional ideology have been powerful indeed, and although all aspiring professionals have to make adjustments in order to conform to the demands of their occupational community, professional women experience special difficulties because those values often stand at odds with their feminine role.

Classical sociology has described the evolution of the professions into their modern guise after the Civil War. During that period of industrial and commercial expansion, medicine, law, academia, engineering, and other special occupations expanded their monopoly over esoteric knowledge, formed associations which established standards for admission, training, and the certification of members ; organized systems of peer review which monitored and regulated practice; and devised codes of ethics which stressed both the importance of professionals’ special knowledge, their consequently justifiable autonomy from lay interference, and their altruistic orientation not characteristic of other workers. Contemporary professionals’ high status is allegedly derived from their expert training in an area of knowledge beyond the reach of ordinary lay people.⁶

In the last decade, revisionist sociologists and historians have emphasized the unique position of power enjoyed by the professions in American society. America has never had a hereditary aristocracy or rigid class system, and, as a consequence, occupational status has been one means of measuring social class. According to historians like David Rosner and Gerald Markowitz, medical professionalization in the early twentieth century involved an effort to raise the status and economic level of doctors by the conscious creation of an elite. The process involved the exclusion of blacks, women, lower-class white males, and other troublesome minority groups.⁷

In addition, the medical sociologist Eliot Friedson has noted the broad social power that accrued to physicians as they earned the right to define the scope and application of their own expertise. Until very recently, doctors’ exclusive right not only to diagnose and treat illness, but to supervise the division of labor in health care and even to regulate the distribution of drugs and therapy has gone unchallenged. For Friedson and other revisionists, the claims of physicians to special altruism have been primarily a justification used to veil their extraordinary exercise of social power.⁸

Feminist thinkers have benefited from both types of analysis, but their most important contribution has been to offer their own critique of the ethos of professionalism described by sociologists. As increasing numbers of women enter the professions, feminist observers have had the opportunity to identify more carefully the subtle gender biases embedded in the ideology of professionalism itself. Indeed, they have pointed out, these biases are revealed even in the language commonly used to describe women professionals. We talk of “lady doctors,” “women lawyers,” and “female engineers.” But more important than the language of exclusion, has been an ideology of work culture derived solely from male experience and male values. Professionals value “character”: aggressiveness, scientific objectivity, careerism, individualism, commitment to work. Indeed, expertise is invested with a particular kind of moral intensity. For this reason professional work, unlike office or industrial employment, derives part of its high status from the assumption that such expertise is irreplaceable. Professionals are expected to identify with their work in ways not common to other workers. Because their activities are viewed as an important domain of self-expression and fulfillment, no one objects when professionals shut out personal considerations in the pursuit of rational and efficient devotion to a calling. But such allegiances are implicitly if not explicitly sex-typed. As an observer has noted, “A man owes to his profession what a woman owes to her family.”⁹

In the past as well as in the present, such an ethos has spelled certain conflict for women physicians who wished to marry and have a family. In 1965 Alice Rossi laid the blame for the shortage of women in science squarely on the inability of most women who chose to be wives and mothers to overcome familial obstacles to a fulfilling career.¹⁰ Medical sociologists as well connected the static numbers of women physicians and their relatively high dropout rate to the difficulties potential medical women experienced in handling two careers. Researchers have found that, though women doctors marry in the same proportion as women in the general population, they marry later and have fewer children. Twice as many choose salaried positions as compared to men. On the whole, they work fewer hours than men do. Moreover, marital status and family size was found to be inversely related to career success among women doctors. Those who had published extensively and achieved the highest academic rank of a group studied in 1970 were more likely to be single.¹¹

Another comparative study of women physicians who did and who did not interrupt their careers found that those who dropped out of medicine even temporarily were likely to lead more complicated lives than the women who stayed in medicine without interruption. Struggling to juggle equally the tasks of professional, wife, and mother, temporary dropouts tended to exhibit what the researcher termed more traditionally “feminine” psychological development. They valued family life, children, and interpersonal relationships equally with or above their careers. Those women whose careers exhibited the least amount of disruption deliberately avoided the stresses of multiple roles by emphasizing their careers above all other aspects of their lives. In doing so they successfully reduced potential opportunities for conflict and were generally more satisfied as professionals. Much of their contentment stemmed from their ability to concentrate most of their energy on their careers. Nevertheless, specialty choices among both groups of women were still most often determined by a concern with whether or not work demands could be made compatible with family life.¹²

Though women physicians are presently seeking more effective ways to resolve the conflicts of the dual role, that is only part of their problem. Because most women are socialized to function primarily in the privacy of the family, where sentiment, intuition, feeling, and interrelatedness predominate, even single women who choose medicine experience unease with values purported to be rational, scientific, and gender neutral, but which are in reality masculine. Whether they realize it or not, in this discomfort they are reconnecting with the legacy of their nineteenth-century predecessors. Early women physicians, like other social feminists, were instinctive critics of the dehumanization inherent in industrialization. They feared the tendency of the capitalist order to turn people into commodities, even as they hailed the positive role of individualism in bringing about female emancipation. Though they misunderstood the place of class and misperceived the roots of economic exploitation, from their vantage point as women they quickly comprehended that the rationalization of human knowledge could be carried too far. They brought to medicine a critique of the growing primacy of cure over care, and though their values were ultimately lost or swallowed up in the triumph of twentieth-century medical rofessionalism, this perception, however vague and confused its articulation, formed the basis of their criticism of the profession to which they so fervently wished to belong. In the present decade, some feminist scholars are again boldly challenging the ideological assumptions of the professional elite by suggesting that male and female values differ and that the professional world would benefit from an infusion of female concerns.

The psychologist Carol Gilligan, for example, complains that her own discipline has consistently misunderstood female ethical development and has measured everyone against a male model. Her work argues that women, speaking “in a different voice” from men, prefer an ethic of care that takes into account their primary experience of attachment and affiliation to others. Less concerned with abstact principles of justice when they decide between right and wrong, women are more likely to consider factors like who is being hurt and why. Until recently psychology has labeled this method of making ethical decisions immature. But this orientation toward the preservation of relationships which often colors women’s moral judgments can provide, according to Gilligan, an alternative conception of maturity which, if recognized as equally valid, “could lead to a changed understanding of human development and a more generative view of human life.”¹³

Gilligan’s argument has drawn criticism from other feminists for sounding dangerously close to nineteenth-century concepts of “natural” female moral superiority which resulted in women’s relegation to a separate sphere. Yet modern feminist thinkers who admit to the existence of differences between men and women would respond that they are well aware of the possible conservative implications of such an approach, and, having the benefit of an historical perspective, need not fall into such a trap. Nevertheless, an important and crucial debate now raging among feminists concerns the question of whether those virtues that have been labeled traditionally “feminine” —“maternal thinking,” nurturing relationships, protective social concern, intuitive respect for nature, the high valuation of mercy over justice—are qualities inherent in female development or have emerged in Western society solely as a consequence of women’s experience of subordination. For if female moral and social sensibilities are a mere result of their social status, will they not disappear if a truly gender-neutral society is achieved? No one yet has satisfactorily answered this question. ¹⁴

Occasionally women physicians have joined in this debate, bringing to it their own perspective. In 1975, for example, Mary Howell, the first woman associate dean at Harvard Medical School, restated the belief of nineteenth-century women physicians that founding a woman’s health school informed by “collaborative sharing of effort and responsibility, nurturance, care giving and personal service to others” was necessary to counter the massive resistance of the medical profession to “the beliefs and values held by women for women.” At that time, Howell felt strongly that traditional medicine continued to glorify “science and technology to the detriment of face-to-face care giving.” She cited

Like Howell, other women physicians have criticized the masculine professional style. Seeking a more nurturing patient-physician interaction, Dr. Carola Eisenberg, dean of student affairs at Harvard Medical School, voiced the opinions of many when she praised women’s tendency to show emotion and argued that it could be done without compromising professional identity. “Strength,” she urged, “is not incompatible with compassion.”¹⁶ “If what is epitomized as a good physician’ embodies a masculine set of traits and ideals,” agreed Dr. Carlotta Rinke, in an article written for JAMA, “women will invariably suffer an identity crisis in attempting to adapt their womanhood into a male professional model.”¹⁷

Equally forthright from spokeswomen in medicine has been the demand that the profession recognize women’s family obligations and seek to alter a situation in which “women trade career advancement for time” to raise their children. Many have turned to co-parenting as a solution, demanding that husbands share family responsibilities equally and “be open [about them] with ... colleagues at work.”¹⁸ “What can male physicians do to help their female colleagues?” asked Dr. Marilyn Heins in 1983. “They can,”

There is some evidence that the profession is beginning to respond to these criticisms in various ways. Efforts to improve doctor-patient interaction in the form of courses and seminars are now standard fare in most medical schools. Equally promising has been the recent recognition that professional ideology has often stood at odds with a healthy family life, not just for women doctors, but for men as well. In 1982 the Journal of the American Medical Women’s Association reported the results of a pioneer program at the University of Medicine of New Jersey. Directly addressing the anxiety of medical students “who sense that their career choice threatens to bankrupt their private lives,” a course entitled “Parenting and Professionalism” was instituted to help them develop creative methods of solving work/career conflicts. ²⁰

In a particularly interesting recent incident in 1984, the chairman of the obstetrics department at Stanford University was forced to resign under intense criticism when he reprimanded a woman resident for getting pregnant. Declaring that chief resident Zena Levine’s pregnancy was “presumptuous and a disservice to oneself and to one’s colleagues” and warning that he would hesitate to appoint more women to the department, Dr. Lee Roy Hendricks found that he could muster little open support for his views among other faculty members. Less than fifteen years ago it would have been Dr. Levine who would have resigned.²¹

In addition to challenging traditional images of the doctor, women physicians have criticized other vestiges of medical professionalism—“ old—boy” networks, rigid tracking systems, and the organization of medical training in a manner unresponsive to the female life cycle. They have demanded power in setting healthcare policy, in making decisions pertaining to medical practice, and in determining how medicine is taught.²² But difficulties persist, and it is still impossible to assess the long-range effect of the changes wrought in the last decade. What seems to be apparent is that a critical number of women have achieved professional status in medicine in the 1970s, and that the issues that were raised but not solved in the last century are being raised once again with greater vehemence and wider applicability. Clearly the rising numbers of women doctors are having an impact on the medical profession. One can hope only that at least some of the concerns that they brought to medical practice in the past—an emphasis on humane care and a concern for the profession’s responsibility to the community—will occupy center stage in the practice of medicine once again. In the meantime women are taking their places beside male colleagues as full-fledged professionals determined to demonstrate that leading a fulfilling private life is not incompatible with the competent practice of medicine.