Career satisfaction and role harmony in a sample of young women physicians

JOURNAL.

OF

Career

VOCATIONAL

BEHAVIOR

12, 1X4-196

(1978)

Satisfaction and Role Harmony in a Sample of Young Women Physicians LILLIAN

KAUFMAN

CARTWRIGHT

Institute of Personality Assessment and Research, University of Culifornia.

Berkeley

In a sample of young women physicians, self-ratings of Career Satisfaction and Role Harmony were correlated with a group of situational, achievement, and personality variables. Career Satisfaction was extremely high with about 88% reporting they are satisfied or very satisfied. However, over half experienced at least a moderate amount of strain in integrating professional and sex roles. In addition women who were high on both Career Satisfaction and Role Harmony were compared with the others in the sample and individual differences were apparent: These women were exceptionally confident, intellectually resourceful, and tolerant: they tended to have clear priorities with either family or work coming first. Overall their current level of personality adjustment was superior to the others who, as a group, were very well-functioning women.

More women are entering American medical schools than ever before. The percentage of women in first-year classes rose from 13.7% in 197 I1972 to 23.8% in 1975-1976 (Gordon and Dub& 1976). Conservative forecasts predict women will comprise 30% of the entering classes by 1985 (Keyes, Wilson, & Becker, 1975). The factors responsible for women’s burgeoning interest in medicine includes the women’s movement, a perceived shortage of physicians, more flexible curricula, and shifts within the profession itself. During the sixties, four out of five women college graduates viewed medicine as incompatible with marriage and family (Special Report on Women and Graduate Study, 1968). Today, women oriented toward the sciences minimize the conflict between careers and sex roles (Kirk, 1975; Perucci, 1974; Robin, 1974). A brief review of the literature on women physicians places this study in perspective: Alumni follow-ups, case studies, and personal accounts of women physicians, although rarely quantitative, portray the woman physician as dedicated and highly involved in her work (e.g., Lopate, This research was financed by a grant from the Robert Wood Johnson requests for reprints to Dr. L. K. Cartwright. Institute of Personality Research, University of California, 2240 Piedmont Avenue, Berkeley, OOOl-879V78/0122-0184$02.00/0 Copyright @ I?78 by Academic Press. Inc. All rights of reproduction in any form reserved.

I84

Foundation. Assessment CA 94720.

Send and

CAREER

SATISFACTION

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HARMONY

185

1%8). At the same time there is substantial documentation that women in medicine have special problems. Conflicts are particularly apparent in the early stages of career development (Bowers, 1968; Notman and Nadelson, 1973; Roeske and Lake, 1977). Williams (197 I) quantifies the stress experienced by Radcliffe alumnae and reports that over 66% have at least one “critical” time in their careers. The most cited problem was a marriage-career conflict (e.g., problems associated with children, child care, stressful relationship with husband) which was resolved commonly through a reduction in career demands. Shapiro, Stibler, Zelkovic, and Mausner (1968) found medical activity negatively correlated with marital status and number of children: Married women with children work less, a result confirmed in WestlingWikstrand, Monk, and Thomas’ (1970) study of Johns Hopkins graduates. The presence of an understanding husband and adequate household help were important adjuncts to an active career. A second set of relevant studies compare the professional characteristics and career patterns of men and women physicians (e.g., Kehrer, 1974). In accounting for distinctively female career lines-more part-time workers, more salaried workers, greater discontinuity in career, preferences for specific specialties, and less professional achievements in general-the concepts of role strain, role stress, and role reconciliation have been advanced (Cohen and Korper, 1976). The recent work of Heins, Smock, Jacobs, and Stein (1976) reveals that Detroit physicians are now working more than before yet there has been no parallel reduction in household participation and responsibilities, leading Roeske (1977) to conclude that some women have unrelenting, unrealistic selfexpectations. One might also conclude that even more stress can be expected in the future if these results are replicated on other samples. Third, the epidemiological studies of suicide and divorce rates are alarming in this context. Women physicians, especially those under 40, are a vulnerable group exceeding base rate expectations (Steppacher & Mausner, 1974; Rose and Rosow, 1972). Drastic resolutions to stress and severe conflicts are thus evident although small numbers of women elect such alternatives. What accounts for the stress? At least three different factors have been cited: (I) Fragmentation: Participation in two sectors of life, an extremely taxing profession and family, leads to dual and competitive claims on time and energy. (2) Internal conjlict: Many suffer from conflict in normative value priorities which expect a professional woman to be committed to work “just like a man” at the same time she is normatively advised to place her family first and act ‘just like a woman” (Coser and Rokoff, 1971). Conflicts between assertiveness, competency, and leadership on

186

I.II.l>IAN

KAUFMAN

CARTWKIGH’I

the one hand and perceived personal attractiveness. intimacy. and “femininity” on the other present difficulties for single and married women. (3) A non.yrrpporti\~c c>xtsrnul cn\Gronment: For women in male-dominated professions a scarcity of role models. the protege system, prejudice of colleagues, biased patient expectations, and institutional inflexibilities can contribute to stress (Epstein, 1970; Engleman, 1974). Clearly, the present is a period of rapid change and transition in sex roles and occupations (Osipow, 1976). Unfortunately, there is little quantitative information about the degree of satisfaction women obtain from careers or the amount of ease or dis-ease accompanying integration of professional and sex roles. The salient factors associated with high career satisfaction and minimal role strain have received no systematic attention. The aim of this paper is to help fill these gaps by focusing on young women physicians who are in the early stages of their career and family formation. Within a broad vocational context, this study is relevant to research concerned with life-span career development (Super, 1955), particularly the period of early adulthood (cf. Crites, 1976). The question of vocational adaptation and its relationship to personality (Heath, 1976) is also cogent. If some women are better able than others to integrate sex and professional roles, to what extent do personality attributes mediate successful integrations? A third, more circumscribed, issue concerns women electing nontraditional careers (Tangri. 1972) and the nature of individual differences within that group (e.g., Standley and Soule, 1974). METHOD Subjects. This research is part of a longitudinal follow-up of over 1100 applicants and graduates of the University of California, San Francisco, School of Medicine, conducted by Harrison G. Gough at the Institute of Personality Assessment and Research (IPAR) of the University of California in Berkeley. Archival data include personality inventories, biographical information, interest and vocational preferences, and academic information (see Gough and Hall, 1975, for a further description of the sample, aims, and methods of the study). In the late sixties, the author studied 58 women who entered medical school between 1964 and I%7 (98% of the women then enrolled) and found these young women to be advantaged: Their fathers were highly educated; the primary family was stable; in terms of personality inventories, they were very independent and well-functioning women (Cartwright, 1970, 1972a. 1972b, 1972~). Procedure. As part of the follow-up, in 1974-1975,2- to 3-hr structured interviews were held with 49 of the original sample. The women also retook the California Psychological Inventory (CPI) (Gough, 1957) and

CAREER

SATISFACTION

AND

ROLE

187

HARMONY

the Adjective Check List (ACL) (Gough and Heilbrun, 1%5). The changes occurring 8 to I1 years following admission to medical school included increased self-confidence and commitment to work and greater autonomy in setting goals. They were also more aware of their capacity to be nurturant (Cartwright, 1977a). The physicians were asked to estimate the degree of harmony experienced in synthesizing sex and professional roles. “How well are you able to combine the demands of your work life and the demands of your family commitments? To what extent have you been able to harmoniously integrate your role as a physician with your role as a woman?” They rated themselves on a five-point Role Harmony scale with 5 representing a generally harmonious integration, very minimal strain, and 1 connoting a complete absence of harmony, strain that had come to a breaking point, great conflict. In addition, they rated their career satisfaction on a fivepoint Career Satisfaction scale with 5 representing very high satisfaction, and 1. very minimal or limited satisfaction. RESULTS

The results are presented in two parts with Part I providing the correlates of Role Harmony and Career Satisfaction and Part II contrasting the most fulfilled women (high on both Career Satisfaction and Role Harmony) with the rest of the group. Part I: Correlates

of Role Harmony

and Career

Satisfaction

Table I describes the sample’s current status in terms of age, professional characteristics, marital status, etc. Role Harmony and Career Satisfaction as measured in this study are independent dimensions (r = .05). The physicians are extremely satisfied with their careers with 88% reporting very high (53%) or high (35%) career satisfaction. Ten percent rated their careers as “average” and only one subject (2%) felt disappointed with her work. In respect to Role Harmony the picture is less sanguine: Over half of the women (5 1%) have accommodated to intermittent strain (27%), experience much strain (20%), or feel that the strain has come to a breaking point (4%). On the positive side, 33% have achieved harmonious integrations and 16% experience strain very infrequently. Information available for the women included data pertaining to current professional and family life, current and past psychological inventory scores, academic admissions data, and family background ratings and family typologies originating from the author’s doctoral dissertation (Cartwright, 1970). Table 2 provides the significant Pearson product moment correlation coefficients for Role Harmony, Career Satisfaction, and these selected variables.

188

LII.I,IAN

Description

KAUFMAN

of Sample

of 49

CARTWRIGHT

TABLE Women

I Physicians

on

Selected

Variables”

Number Current

marital

status

Married Single Divorced Husband Number

(7)

is physician having children

Medical specialty Pediatrics Family medicine practice

and

37 9 3

75.5 18.4 6.1

20 20

40.8 49.8

II

22.4

general

(including

emergency room) Internal medicine Psychiatry

16.3 14.3

Radiology

10.2 6.1 6.1

E.E.N.T. Pathology

14.3

practices

Anesthesiology Dermatology Public Health

4.1 2.0 2.0

Surgery 0 All

were

I

graduates

Role Harmony:

of UCSF

School

of Medicine.

2.0 Age:

mean,

33;

SD.

2.9.

Correlates

(a) Situational and professional characteristics. Two current situational variables are significantly and negatively related to Role Harmony: the number of children (-.30) and the woman’s age (-.29). (6) Currenf personality. On the CPI, Role Harmony is positively correlated with three scales: Tolerance (To) (.46), Achievement via independence (Ai) (.32), and Intellectual efficiency (Ie) (.29). Because the To scale’s correlation is one of the highest in the matrix, Gough’s (1968, p. 13) comments on To are worth quoting: The

Tolerance

authoritarian F Scale sentiments the

Scale

was

constructed

as a subtle

or

indirect

personality syndrome assessed directly by the well . The To scale is intended to reflect benign, progressive, at one end versus feelings of hostility, estrangement,

measure

of

California humanitarian and disbelief

the

known

at

other.

Women high on Role Harmony, besides being “tolerant,” use their intellectual resources more freely than those reporting high strain. On the ACL, 9 of the 24 scales show significant correlations with Role Harmony: Overall, the high-scoring women are better adjusted: They have a more positive self-concept and appear to be moving more toward

CAREER

SATISFACTION

AND

ROLE

189

HARMONY

other people. The Counseling readiness coefficient (- .46, p < .Ol) is noteworthy since it lends construct validity to the Role Harmony rating. Low harmony women are willing to examine their life as would clients contemplating counseling, i.e., change is desired. Summarizing the personality findings, high scores on Role Harmony are associated with a specific personality configuration connoting a higher level of confidence, adjustment, and a relaxed nonjudgmental perspective.

Role

Harmony

TABLE 2 and Career Satisfaction in a Sample Significant Correlations with Variables Role

Current situation Number of children Current age Interruption in training” Specialty choice Genera1 practice Current personality CPI Dominance Capacity for status Social presence Self-acceptance Tolerance Good impression Achievement via independence Intellectual efficiency Psychological mindedness ACL Defensiveness Number favorable Number unfavorable Self-confidence Self-control Personal adjustment Achievement Dominance Endurance Order lntraception Nurturance Affiliation Aggression Succorance Abasement Counseling readiness

Harmony

- .30* - .29* .05

.I5

of Women Indicated

Physicians:

Career

Satisfaction

-.II .I8 - .42*

- .55**

.I7 .21 .I9 .07 .46l** .22 .32* .29* - .03

.34’ .43** .30* .46** .21 .39** .20 .44** .34*

.27 .34* -.33* - .05 .30* .36* .03 .02 .20 .21 .33* .38* .37’ -.36 -.I5 .03 - .46**

.46** .50** .59** .33* .25 .50** .48** .39** .44** .31* .38* .29 .53** .20 .64** .39’ .OS

-

-

190

1.11.1.1AN

K.AUFMAN

TABLE

2 (CON’I‘INUED) Role

~~ Entry Medical College Admission Quantitative ability CPI Dominance Capacity for status Well-being Good impression Psychological mindedness Family background Closeness to father” u Scored on a three-point D See Cartwright (1970) * p < .05. ** p < .Ol.

Career

Career

Satisfaction

- .36*

-.07

scale: (I) no interruption; for derivation of ratings.

.02 .04 .I5 .04 -.24

.31’ .35* .36* .34* .22x*

- .29*

.I8

(2) less than

I year;

(3) 1 year or more.

findings. variables.

showed a negative correlation Satisfaction:

Harmony

Test

(c) Entry. No significant (d) Family background

father,”

CAKTWKl(iHT

The self-rating, “Closeness with Harmony (-.29).

to

Correlates

(a) Situational and professional characteristics. Two current situational variables are negatively correlated with Career Satisfaction: interruption of training (- .42) and being in general practice (- .55). (Note that the correlation between interrupting one’s education and being a GP is .77; six of the eight GPs plan to resume training later.) These women are reluctant GPs; various circumstances (illness, marriage) have led to discontinuity in training and this “slowing down” dampens career satisfaction. In addition, for some, working in settings where the patient-doctor ratio is not optimal lessens satisfaction. (b) Current personality. Career Satisfaction is strongly associated with current personality test scores with 6 CPI scales and 13 ACL scales reaching significance. High scorers possess relatively conflict-free attitudes toward their ambition and independence; they like to achieve on their own and are not apt to solicit help. This description does not imply unfriendliness but rather reflects a high evaluation of individual achievement, confidence, and work habits necessary for accomplishing goals. (c) Entry. The women currently reporting lower Career Satisfaction had higher scores on the Quantitative scale of the Medical College Admission Test (MCAT) on entry. The CPI on entry yielded five significant correlations and all but one of these scales, Well-being, are among the current

CAREER

SATISFACTION

AND

ROLE

HARMONY

191

correlates of Career Satisfaction. On an explanatory level, the data suggest that personality dispositions visible upon entry to medical school (i.e., dominance, level of aspiration, introspection, “tough-mindedness”) relate to later Career Satisfaction perhaps because they mediate the choice of interrupting or not interrupting medical training (cf. Cartwright, 1977b). (d) Family background variables. No significant findings. In summary, current personality is salient to both Career Satisfaction and Role Harmony. Among the shared factors are a high level of personal adjustment, a positive self-concept, free use of intellectual potential, and a liking for people. The differences are these: Role Harmony is directly associated with a relaxed, nonevaluative perspective (To j“rolling with the punches not punching with the roles.” Career Satisfaction has more stable linkages to enduring personality traits in contrast to Role Harmony which is more influenced by situation and is associated with specific life circumstances: If the woman is older and has children, she is under more stress. Clearly some women are better able to reduce life-stage stress through personal resources and Part II addresses these individual differences. Part II: Women High on Both Role Harmony and Career Satisfaction To gain more understanding of the dynamics of optimal adjustments, the 19 women who rated themselves 4 or 5 on both Role Harmony and Career Satisfaction (the Hi-His) were compared with the remaining 30 in the sample. The results of t tests on salient variables are presented in Table 3. For heuristic reasons, interpretation of the findings will be supplemented by case history material and trends in the data (.0.5 < p < .lO). The Characteristics of the Hi-His (a) Situational and professional characteristics. No variable reached exact significance, but there was a very strong trend for the members to be in pediatrics @ < .06). (b) Current personality. Both the numbers and the magnitude of scale differences between the Hi-His and the other women are most impressive: An interpretative resume of the 12 significant scale differences on the CPI and the 9 scale differences on the ACL characterizes the Hi-Hi group as dominant, exceptionally poised, self-accepting, aspiring, and talented in respect to leadership potential. Relative to the other, very wellfunctioning women, the Hi-His are exceedingly resourceful and independent as well as tolerant and nonjudgmental in their assessment of others. The Hi-His appear to have made unusually syntonic integrations between needs for achievement and independence (cf. Dominance, Achievement via independence) and needs for intimacy (cf. Nurturance and Affiliation).

192

LILLIAN

KAUFMAN

CARTWRIGHT

TABLE 3 Role Harmony and Career Satisfaction in a Sample of Women Physicians: t Tests Comparing Women High on Both with the Others Hi-Hi (N = 19) Mean Current situation Specialty choice Pediatrician Current personality CPI (raw scores) Dominance Capacity for status Sociability Social presence Self-acceptance Responsibility Tolerance Good impression Communality Achievement via conformance Achievement via independence Intellectual efficiency ACL (standard scores) Defensiveness Number favorable Number unfavorable Personal adjustment Dominance Endurance Intraception Nurturance Affiliation Succorance Counseling readiness Entry Medical College Admission Test General information CPI Well-being Tolerance Intellectual efficiency Family background Moral-devout*

SD

Mean

t

SD

No significant findings .37

.50

.13

.35

1.96***

32.21 24.68 27.74 41.47 24.16 33.89 28.37 20.00 26.53 31.89 27.26 46.00

3.76 2.93 3.52 3.44 1.71 3.98 1.83 5.31 1.07 3.35 1.94 2.40

27.93 21.97 24.40 37.33 22.43 31.60 25.20 16.43 25.57 29.77 25.37 42.83

6.14 3.38 5.33 6.20 3.43 2.85 3.56 5.35 1.57 3.49 2.81 4.53

3.02** 2.89** 2.41* 3.00** 2.33* 2.35* 4.10** 2.28* 2.34* 2.11* 2.57** 3.19**

56.76 63.76 40.59 58.47 59.94 61.41 60.12 54.82 53.47 40.29 53.47

5.21 8.29 3.87 5.87 7.43 8.15 9.99 7.05 4.60 5.40 6.11

50.38 53.38 47.88 49.88 53.77 54.35 52.92 47.65 43.92 47.00 58.58

10.41 2.66** 11.70 3.17** 9.84 -3.40** 11.10 3.30** 11.40 2.04* 11.52 2.19* 10.62 2.22* 9.79 2.61** 11.48 3.80** 11.19 -2.62** 10.51 -2.01*

549.74

78.27

599.67

89.82

39.05 28.68 44.89

2.97 1.86 2.47

37.00 25.90 42.97

4.62 4.36 4.66

.05

.23

.23

n See Cartwright (1970) for derivation of rating. *p < .05. **p < .Ol. ***p < .06.

Others (N = 30)

- I .99* 1.89*** 3.08** I .89***

.43 - 1.91***

CAREER

SATISFACTION

AND

ROLE

193

HARMONY

(c) Entry. MCAT: Although the Hi-His’ MCAT scores were acceptable (means fell between 529 and 588), the scores were not as impressive as those of their peers. Specifically, their General Information score was significantly lower, suggesting that their entrance into medical school was based on criteria other than the MCAT (i.e., personal qualities, extracurricular activities). CPI: The Hi-His’ Tolerance scores were higher than those of their peers tp < .Ol), implying a long-term personality disposition favoring a relaxed, open, nondogmatic perspective. In addition there was a strong trend (p < .06) for the Hi-His’ scores on Well-being and Intellectual efficiency to be initially higher. (d) Family background variables. The Hi-His tended not to come from “moral and devout” families (Cartwright, 1970) where religion played a major and formative role in their childhood training @J< .06). (e) Case history. From a case study perspective, the Hi-Hi group is singular in respect to priorities and allegiances. The majority are married and without children (1 I subjects), having deliberately postponed child rearing until their careers were launched. None of the four single women is anxious about her single status; three are dedicated career women and as one put it: “Medicine is my lust.” Of the five married women with children, four have placed their families first and reduced their professional activities considerably. These Hi-His have a patient perspective and endorse “A career of limited ambition.” One woman with two children states. Now, medicine is secondary; I define my life in terms of my family, my just one of my interests. Someday I’ll have more freedom and this will career. I really don’t think of life in terms of goals, I think in terms of hope for a comfortable life, I hope to see my kids grow into reasonable hope to be able to have continuing and growing satisfaction from my

career is affect my hopes-I adults, I work.

In contrast to the Hi-His, others in the sample were more likely to hold dual allegiances and suffer from more fragmentation and internal value conflicts or to perceive their environment as nonsupportive. For example, a married pathologist with one child who currently works 53 hr a week comments on strain stemming from having too much to do. time to read, The thing is I have no time for myself . . That’s what gets lost-no to play tennis. In fact, no time to play at all. It’s hard to give these things up. In essence, I’ve narrowed my world. If I expected things to go on this way indefinitely I’d be really worried. but I expect things to change.

A single woman psychiatrist talks of strain coming flicts and a nonsupportive environment.

from value con-

1 believe I have more strain than a nonprofessional woman. I’m stereotyped in a social situation: “Oh you’re so young to be a doctor.” There is also strain on the part of some men I meet; there aren’t as many men who are “acceptable” for me to date.

194

I.IILIAN

KAUFMAN

CARI‘WRIGHT

The case material suggests that some women under high stress also have. in comparison with the Hi-His, more difficulty coordinating activities. They may increase strain through broad interests. a mercurial bent, and planning difficulties. To illustrate, one married physician without children states: I had right-l

a hard try

know

time learning making lists

if I had

A married I had

kids.

my

job.

1 couldn’t

psychiatrist no

strain

before

around coordinating be alone with my I am

how to organize so nothing gets manage

I had

how

children,

to arrange

If I can get organized. this is difficult

I’m att for me. 1

at all.

with two children

all the activities-it’s husband, and take

learning

my life. slighted-but

but care

now

comments: much

strain.

hard to have a dinner of the kids, let alone

party, trying

my

life

I have

without

feeling

It’s

mainly

find time to do well

to at

guilty.

SUMMARY AND DISCUSSION The great majority of these women physicians are content with medicine, finding it to be absorbing and satisfying. The results pertaining to Role Harmony are more alarming with half reporting at least moderate strain in coordinating professional and sex roles. One can convincingly assert that the reason the doctors tolerate strain is that their profession is so gratifying to them. Without minimizing the pleasures in work, there is still a pressing need to investigate systematically the sources of role disharmony as more women enter highly demanding male-dominated professions. The women who have made optimal adaptations to career and role demands offer clues to the reduction of stress. These women cannot be accounted for simply: They include single women, married women, women with children; they are just as likely to be married to physicians as are their peers; their work week is no different from the others in the sample. Current personality functioning on a very high level of integration is the strongest forecaster of successful career and role adjustments. There is evidence that a long-standing nondogmatic, humanitarian outlook is an antecedent of later accommodation. Also the support systems embedded in the work setting are salient as judged by the excess of pediatricians in this group (Note: Because pediatrics is the specialty most often chosen by American women, there is no paucity of suitable role models). The fact that the most contented women were not necessarily academically outstanding upon admissions should also be noted. In this context bear in mind that the outcome variables, Career Satisfaction and Role Harmony, are self-ratings. Because the focus was on the early stages of career development, little attempt was made to include independent indexes of career attainment (e.g.. income, academic rank, board certification)

CAREER SATISFACTION

AND ROLE HARMONY

195

with the possible exceptions of number of hours worked and specialty choice. It’s conceivable that women currently stressed may be more “successful” in terms of external criteria in the later stages of their careers. It is also possible that the future health of the women will be differentially related to Role Harmony. Clearly many questions are now raised which can only be answered at another time. As in all assessments, conclusions depend upon who is doing the evaluation (self, family, peers, or patients), using what criteria (satisfaction, productivity, health, etc.), at what point in time. REFERENCES Bowers, J. Z. Special problems of women medical school students. Education.

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of Medical

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Cartwright, L. K. Women in medical school. Unpublished doctoral dissertation, University of California, Berkeley, 1970. Cartwright, L. K. Conscious factors entering into decisions of women to study medicine. Journal of Social Issues, 1972. 28, 201-215. (a) Cartwright, L. K. Personality differences in male and female medical students. Psychiatry in Medicine, 1972, 3, 213-218. (b) Cartwright, L. K. The personality and family background of a sample of women medical students at the University of California. Journal of the American Medical Women’s Association.

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(c)

Cartwright, L. K. Personality changes in a sample of women physicians. Journal of Medical Educarion, 1977, 52, 467-474. (a) Cartwright, L. K. Continuity and noncontinuity in the careers of a sample of women physicians. Journal of the American Medical Women’s Association, 1977, 32, 316321. (b) Cohen, E. G., & Korper, S. P. Women in medicine: A survey of professional activities, career interruptions, and conflict resolutions. Connecticut Medicine, 1976, 40, lO3110. Coser, R. L., & Rokoff, G. Women in the occupational world: Social disruption and conflict. Sociul Problems, 1971, 18, 535-554. Crites. J. 0. A comprehensive model of career development in early adulthood. Journal of Vocational Behavior, 1976, 9, 105-l 18. Engleman, E. G. Attitudes toward women physicians. Western Journai of Medicine, 1974, 120, 95-100.

Epstein, C. F. Encountering the male establishment: Sex-status limits on women’s careers in the professions. American Journal of Sociology, 1970, 75, 965-982. Gordon, T. L.. & Dub& W. F. Medical school enrollment, 1971-72 through 197576. Journal

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Check

List

manual.

Palo Alto,

196

LILLIAN

Heath,

KAUFMAN

CARTWRIGHT

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Received:

April

4, 1977