6.8 The historical development of gender occupational segmentation and stereotyping of medical specializations, 1950-2020

Aim of the Project

This project aims to determine the origins of occupational stereotypes, how and why they change over time, and how they affect the majority gender share of occupations (i.e. the share of male and female workers within occupations) and the (self-)perceived status as well as the relative remuneration of men and women and the working culture within occupations. It intends to identify major reasons for shifts in occupational segmentation, and the mechanisms leading to such shifts. The main focus is gender stereotyping and changes in majority gender shares of medical specializations in the Netherlands since the 1950s.  The project principally engages with challenge 11: identity flexibility and sustainable cooperation, which ascertains that social categorization potentially threatens sustainable cooperation between and within all life domains (SCOOP Condensed Proposal, p. 19). Cooperation between men and women on various societal levels is a key component of strategies designed for mitigating this threat.


This project departs from the hypothesis that by enhancing flexibility in the way people categorize and stereotype others (and themselves), the negative effects of social categorization and identification can be mitigated. Cooperation between men and women; between employers and employees; and between employees and the State is key to tackling this challenge. For instance, a more equal division of household tasks between men and women, i.e. caring for children, taking care of the household (individual and group-level) will help strengthen women’s labour market position. Employers and the State can help facilitate this by encouraging men to take time off after the birth of a child or by facilitating part-time work.

We approach the problem of social categorization and the negative spill-over effects from a long-term (1950-2020) and sectoral (medical sector) perspective. Our main aim is to identify the underlying mechanisms of social categorization and identification, which will inform research on potential solutions to the problem. The medical sector is an excellent case study for such an approach. Since several decades, the medical sector has experienced an influx of women and this development has accelerated during the past two decades. As of the early 2010s, the majority of medical students is female and many specializations will in the near future thus be dominated by women. However, there still are remarkable differences between specializations, women less often obtain permanent positions, and they barely make it to leading positions in the medical field (Arrizabalaga et al. 2014, 364). For instance, gynaecology and clinical genetics have become typical female specializations while most neurologists and cardiologists are men (NOS 2011). Another medical specialization, general practitioner, has not so much experienced a ‘feminization’, but rather a ‘demasculinization’ of the profession, leading to dwindling interest of all graduates to enter that specialization (Mayorova e.a. 2005, 75).

Academic studies suggest that an influx of women in an occupation at some point leads to an acceleration of this ‘feminization’. In other words, there is a ‘tipping point’ at which men en masse move out of a specific occupation because it has become too feminized, which – in their eyes – signals a low level of occupational prestige (Pan 2015). Claudia Goldin has argued in a similar fashion that the social status of an occupation can be “[…] polluted by the entry of an individual who belongs to a group whose members are judged on the basis of the group’s average and not by their individual merits” (Goldin 2014, 314).

The recent influx of women and the widely varying majority gender shares of the different medical specializations thus make the medical sector a highly relevant case to study overarching issue of occupation stereotyping and the negative consequences for female employees. This allows us to explore whether tipping points in majority gender shares also have taken place within different branches of the same sector and whether these shifts have had negative consequences for women in terms of relative remuneration and occupational prestige. Additionally, a wide range of broader societal variables leading to gender-specific cooperation imbalances can be taken into consideration, such as gender values and ambitions, household duties (Arrizabalaga et al. 2014, 367), the lack of female role models and male domination in particular fields (Wolfert et al. 2019, 461), or the lack of adequate policies (e.g. for childcare; Crompton & Le Feuvre 2003). Furthermore, the focus on the long-term development of the medical sector allows us to study society-wide and occupation-specific variables in combination with each other from a longer temporal perspective than hitherto has been done.

This PhD-project approaches the research topic, tracing developments in medical specializations during the past seventy years and will study institutional, ideological and personal factors influencing gender inequality from an integrated and historical perspective. Central questions are:

  1. How did the influx of women in (particular) medical specializations develop in the period 1950-2020?
  2. Which tipping points – after which the masculinization/feminization of medical specializations rapidly increased – can we detect, and how can we explain them?
  3. Did stereotypes of specializations change in tandem with changes in the majority gender share?
  4. How did remuneration in relation to the majority gender share in particular medical specializations develop?
  5. Which moderating variables predict an influx of women in certain specializations, but not in others (e.g., specialization fits with gender stereotypes [think of paediatricians], institutional moderators like specializations that commonly operate in partnerships, or differences in shift lengths)?
  6. What kind of past and present cooperation has explicitly tackled the problem central to this project? Why have these attempts been successful/unsuccessful?

Research Design

Data collection for this project will take place in three (concurrent or subsequent) steps. First, the selected PhD-student will map the development of the absolute and relative number of male and female students and workers in the medical sector as a whole and within specializations in particular for the period 1950-2020 (research questions 1 and 2). To this end, he/she will make use of occupational censuses (available online) and the extensive archives of the Dutch Centraal Bureau voor de Statistiek and Dutch universities. Moreover, Nivel statistics will be used for an analysis of gender occupational segmentation for the post-1980 period. This will help identify if and when tipping points have taken place and which specializations have undergone the most drastic change over time.

Second, through interviews with members of professional medical associations, such as the general medical association KNMG (established in 1849) and the association for women doctors VNVA (established in 1993), the selected PhD-student will investigate the work cultures of specific specializations and how they changed over time (research question 3). Based on semi-structured interviews, he/she will investigate the perception of male and female doctors about their own specialization and will explore whether there are structural aspects to be discerned from these individual accounts. Variables such as work pressure, perceived collegiality, facilities for work-life balance will be scrutinized.

Third, to answer research question 4, the PhD-student will collect information on remuneration of male and female doctors for a selection of medical specializations. This selection will be based on the results of steps 1 and 2 (for instance, a couple of specializations in which no change and a couple in which a clear shift in the majority gender share has taken place). The PhD-student will explore whether shifting majority gender shares and work cultures within these specializations have affected the absolute and relative remuneration of male and female doctors. Finally, based on a synthesizing analysis of the results yielded during steps 1, 2, and 3, the PhD-student will attempt to draw more generic conclusions about if and how occupation stereotyping negatively influences women’s labour market position (research questions 5 and 6). He/she will consider i) which moderating variables have stimulated women to enter or leave a specialization and ii) which kinds of past and present cooperation attempting to mitigate the negative results of occupation stereotyping are (un)successful.



Arrizabalaga, P. et al. (2014). Gender inequalities in the medical profession: are there still barriers to women physicians in the 21st century? Gaceta Sanitaria 28(5): 363-8.

Crompton, R. and Le Feuvre, N. (2003). Continuity and change in the gender segregation of the medical profession in Britain and France. International Journal of Sociology and Social Policy 23(4/5): 36-58.

Goldin, C. (2014). A pollution theory of discrimination: Male and female differences in occupations and earnings. In Platt Boustan, L., Frydman, C. and Margo, R. A. (Eds.), Human capital in history: The American record. Chicago: University of Chicago Press, pp. 313-348.

Mayorova, T. et al. (2005). Gender-related differences in general practice preferences: longitudinal evidence from the Netherlands 1982–2001. Health Policy 72: 73–80.

NOS (2011). Medisch specialisten vaker vrouw. 18 April 2011.

Pan, J. (2015). Gender segregation in occupations: The role of tipping points and social interactions. Journal of Labor Economics 33(2): 365-408.

Wolfert, C. et al. (2019). Female neurosurgeons in Europe—On a prevailing glass ceiling. World Neurosurgery. 129: 460-6.


Project stakeholders

Corinne Boter (daily supervision), Elise van Nederveen Meerkerk, Belle Derks



Economic and Social History Group, Utrecht University

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