Manpower pools for three health professions in Israel

Sot. Sci. & Med. 1973, Vol. 7, pp. 893-910. Pergamon Press. Printed in Great Britain.

MANPOWER

POOLS FOR THREE HEALTH IN ISRAEL*

PROFESSIONS

JUDITH T. SHUVAL The Hebrew University of Jerusalem Ah&ac@-Characteristks of the pool of candidates set limits on the nature of the manpower entering a given profession. Pools of candidates for three health professions-medicine, dentistry and pharmacy--am self-selected from different strata of the Israeli population and are found to differ in terms of prior academic achievement, sex, so&-economic origins, extent of inter-generational continuity and commitment to the field chosen. There is a la& of differentiation between candidates for medicine and dentistry in the skills, motives and personality traits thought by the candidates to be necessary for a “competent” professional. Both groups give most emphasis to interpersonal skills, second in importance are intellectual and science oriented traits while organizational-administrative traits are least emphasized. Candidates for pharmacy emphasize the cognitivoscientific component and organixational-administrative skills more than the other two groups. Pharmacy candidates show a lower’ level of selfconfidence than the other groups and a poorer approximation to their own de8nition of a “competent” professional.

INTRODUCTION

A SYSTEM of medical care, whatever its structure and organization, is dependent on the quality, quantity and commitment of the manpower that fYls its occupational roles. This manpower is selected and socialized by a variety of training institutions whose purpose is to inculcate knowledge, skills, values and appropriate occupational orientations. While socializing institutions can go a long way in molding recruits to appropriate occupational roles, certain limits are set on this process by the range and character of the pool of applicants who are initially attracted to the various occupations. When the pool is large, it has been tacitly assumed that it is principally the selection criteria that need sharpening. However, when the pool of candidates is small, socializers have been aware that the problem is not limited only to improving selection but to assuring that the pool itself includes a sufficient number of the kinds of recruits desired by the profession [I]. If, for example, no women apply to a given profession, the group selected will of necessity be all male; conversely if a high proportion of well qualified women apply in a society which is characterized by strong ideological objections to the use of sex as a criterion in selection, the selected entrants to the profession may include a disproportion of women. In either case, the sex ratio of admitted candidates is associated with the sex ratio in the pool of applicants which is in turn associated with the perceived appropriateness of the occupation for each sex and with occupational alternatives available to men and women. When recruitment of candidates is controlled or directed by a tightly organized medical * This paper is drawn from the Israel Study of Socialization for the Health Professions which began in 1969. This research is designed as a longitudinal study following students through the training process for four professions: medicine, dentistry, pharmacy and nursing. The project is financed by Contract 06704-2 with the Health Services and Mental Health Administration of the United States Delpartmmt of Health, Education, and Welfare. I.J.M.7/l

1-D

893

894

JUDITHT.

SHUVAL

care system which is strongly integrated with the socializing institutions, the nature of the pool can be fairly closely controlled [2]. However, when a society is more loosely structured and is characterized by a system of free occupational choice in which the system of medical care is only indirectly related to the socializing institutions, it would appear that the pool of candidates is somewhat haphazardly constituted. . Under such conditions, entry into the pool is determined by the array of realistic occupational alternatives available and by potential candidates’ evaluation of their own skills, abilities, and suitability for a given occupational role. This judgment is reached through interaction with significant others who provide feedback in terms of their evaluation of the potential candidate as well as their perception of the available alternatives and the requirements and rewards of various occupational roles [3]. The projected image of the medical care system and the kinds of roles it offers is therefore a central factor in determining entry into the pool. Information-accurate and inaccuratefilters into the society concerning the types of rewards offered by various occupations, the setting of practice, the requirements and obligations of the occupational roles, and the investment of time and resources needed for training. Judgments and evaluations of potential candidates and their significant others focus on these traits. The image which is projected from the system to potential members of the pool may be characterized by many inaccuracies or lack of up-to-datedness. It is filtered through a variety of media: mass communication, personal acquaintances, contact-direct and indirect -with these occupations. One thinks for example of shifting sex ratios, changing task requirements, or even changing wage levels in various occupations, all of which may be unknown to potential recruits. Information reaching the age cohort which is confronted with the need for occupational decision-making is often stereotyped and out of date. Such disparities can result in a lack of congruence between the expectations of potential recruits and the realities of the system into which they aspire to move. In fact it is at least partly these incongruities which are responsible for potential change in the system. As long as the professions continue to recruit new candidates in their own image, they are assured of some measure of consistent continuity. But when recruits enter the system with expectations, values and goals which differ radically from those of the members of the established professions, there would appear to be leverage for discontinuity and change. While the socializing institutions can accomplish a good deal in terms of changing some orientations, certain attitudes and values concerning the occupational role may be fairly strongly anchored and less vulnerable to effects of the professional socialization process [4] Ascriptive characteristics, such as sex or socio-economic origins, are certainly not subject to change. Since these characteristics of the pool set important limits on the population admitted to the professions, it is clear that there is a potential for system change in the pool of applicants. There is, therefore, an imperfect circularity in the system. The medical care institutions absorb graduates of the occupational socializing institutions as practitioners. However, in a flexible, open society, the pool of candidates from which the choice of future professionals is made may be such as to feed in populations which differ from the current practitioners in many respects. This opens the system to possible avenues of change. THE RESEARCH

PROBLEM

The present paper starts at the point of recruitment: when candidates present themselves to the respective professional schools. Our major focus is on comparing the pools of

Manpower

Pools for Three Health Professions

in Israel

895

candidates to three health professions in Israel: medicine, dentistry and pharmacy. All lead to university degrees, although the training for medicine and dentistry is longer than for pharmacy. The first two involve direct clinical practice while the third relates to patients and practitioners either in a direct service capacity or through research. Of the three, medicine ranks highest in terms of its status and prestige. Pharmacy is lowest while dentistry falls between. From the point of view of income, however, many dentists probably rank higher than some physicians. The same could be true of some pharmacists who are owners of private pharmacies. The three health professions differ in terms of their setting of practice. Virtually all physicians occupy salaried positions in the various hospitals and clinics. While there is some private medical practice in Israel, it is almost always supplementary to a position in one of the medical care organizations. In contrast, virtually all practicing dentists work as private practitioners: those who hold salaried positions most often do so as a supplement to their dominant private practice [5]. The pharmacists are divided: over half work in hospitals or clinic pharmacies on a salaried basis, about 15 per cent are employed by industry, and about 20 per cent own their own pharmacies. What types of young people are attracted to these professions? In what way are these potential recruits similar to or different from each other? How did they lreach their decision to apply for admission to this profession? How do they view their future profession in terms of the skills it requires and the rewards it offers? It must be borne in mind that we are dealing with a comparative analysis of pools of candidates-not with the subgroups selected for admission. The latter analysis represents a different problem which will be considered in subsequent analyses. Candidates for university entry are permitted to register for a number of different faculties or subjects. They must, however, indicate the preferential order of these registrations. The order indicated by the applicant can be viewed as a measure of his interest in the specific fields, but also as a tactical move reflecting his strategy for maximiz$g his chances of gaining admission. In some cases, the preferred order indicates the candidate’s calculated efforts to assure his admission to some academic framework. It would therefore seem that the field chosen as the candidate’s first preference represents a joint reflection of his special interest and commitment to the field as well as his practical considerations concerning his chances of admission. This process becomes clear if we consider a young girl who, despite a strong interest in helping the sick and her hopes and dreams of studying medicine, has weighed her resources in terms of her academic achievements and the other investments required and made a practical decision to apply fbr nursing school. The point of view taken in the present analysis is that unrealistic or fantasy aspirations are less relevant for analysis than the actual decision to apply for admission to a given field. These cotisiderations have led to the decision to compare candidates who indicated that these fields represented their fist choice. Such an approach has the fu$her advantage of preventing overlap in the pools. In fact, this is also the effective population of applicants since in all three groups over 90 per cent of the candidates admitted are selected from those who indicated that the specific profession was their first choice. Table 1 shows that almost all candidates chose the respective profession as their first choice.* * This analysis does not include candidates who are very professions, but decided to register in another discipline for year to the desired field. We assume that such candidates, who framework, are included as first preference candidates in the

much attracted or interested in one of the 1 year with the intention of transftig next spent their first year in an alternate educational current year.

JUDITH T. &JVAL

896

Profession

Medicine Dentistry Pharmacy

Fiit (%I

Second (3

Third (%I

Fourth (%)

Fifth (%)

2 31

3 18

1

x

94 z

3

2

N 1084 212 237

In sum, the analysis compares all candidates for medicine, dentistry and pharmacy in 1969 who indicated that these fields represented their first area of preference. At the time the study took place there were two medical schools, one school of dentistry and one school of pharmacy in Israel. The data were collected at the time of application.

BACKGROUND

OF APPLICANTS

The strategy of maximizing one’s chances of gaining admission requires that candidates consider their realistic opportunities in terms of their perception of the ratios of acceptance to applicants. These ratios are roughly known to the population of potential applicants, or at least they are thought to be known. However inaccurate this knowledge, it plays a major role in controlling the size and academic level of the pool of applicants. When it is believed by potential candidates or their reference groups that selection is extremely severe and only a small proportion of applicants are accepted, only those who view themselves as highly qualified are likely to apply. The size of the candidate pool and the academic achievement level of its members is therefore at least partially a function of these patterns of perception. In fact the ratios of admissions differ in the three professional schools (Table 2). In 1969, when there were two fully functioning medical schools in Israel, the admissions ratio was roughly one out of nine among all applicants and one out of eight among those whose first choice was medicine.* In dentistry it was one out of five among all applicants; however, it was one out of two or three among those indicating that dentistry was the field of their first choice. In pharmacy it was also one out of five of all candidates but close to one out of two of the applicants indicating that this field was their first choice. In 1969 any person holding a matriculation certificate could apply to these professional schools-regardless of the level of his high school record; only a “pass” grade was a prerequisite.t In fact, however, the selection ratios described above are reflected in the matriculation grades of applicants. The chances of gaining admission to dentistry and pharmacy were similar and fairly high: one out of two or three among first choice applicants. The chances of gaining admission to medicine were on the average only one out of eight. Paralleling this pattern, we find the average matriculation grade for applicants to medicine to be 73 while applicants * In practice admission is determined separately for the Academic Reserve and for candidates who have completed their compulsory military service. The ratios for these sub-groups vary somewhat but we have not considered these differences here. t ln 1970 a minimum matriculation score of 75 was required by the Hebrew University-Hadassah Medical School and 70 by the Tel Aviv University Medical School.

Manpower Pools for Three Health Professions in Israel

897

to the other two fields averaged 68. The size of the pools and the spread of their matriculation grades as well as the selection procedures are further reflected in the differences in the average matriculation scores of accepted candidates: 82 for medicine, 72 for dentistry and 70 for pharmacy. The absolute number of first choice candidates for medicine was roughly ten times the number of persons who applied to either dentistry or pharmacy-a fact indicating the immense popularity in Israel of medicine as contrasted to these other two health professions. TILE 2. APPUCATIONSAND ADMISIO~ TO THREEHEALTH PROFESSIONS. 1969 Medicine

Dentistry

1084 1574 946 1380 176

212 212 97 1:

t: 50

l/9

l/S

115

Total applicants Total applications+ Fit choice applicants First choice applicationst Candidates acceptedS Approximate ratio: acceptances/total applications Approximate ratio: acceptances/first choice applications# Average matriculation scores among first choice applicants Average matriculation scores of accepted applicants

118

Pharmacy

l/2-1/3

73 82

68 72

237 237

l/2 68 70

* 490 applicants to Medicine applied to both schools. There is only one School of Pharmacy and one School of Dental Study. t 434 applicants indicated that medicine was their first cureer choice but applied to both schools. No preference was indicated by candidates between the two medi+al schools. $ There were 102 acceptances at the Hadassah-Hebrew Univemity Medical School and 66 acceptances at the Medical School of the University of Tel Aviv. Eight weke admitted to both schools. 8 The ratios of admissions were approximately the same at both medical schools.

Fully 60 per cent of the candidates for pharmacy are women, while less than 20 per cent of the candidates for the other two fields are girls (Table 3). We may, therefore, deduce that perceived

sex-typing

of medicine

while the image of the professional

and dentistry

pharmacist

is strongly

structured

appears to be less sex-bound

toward

males

and if anything

is slightly biased in favor of women. It is of some interest

1970 the proportion of women licensed in these 42.6 per cent; dentistry, 41.3 per cent; and medicine, 26 per cent. In Israel, the sex ratio of manpower in these fields is strongly affected by immigrant professionals who join the labor force. In Eastern Europe, in particular, these professions tend to include a comparativeiy high proportion of women practitioners so that the entry of immigrants from these countries into practice in Israel raises the proportion of women [6]. The biggest disparity between the sex ratio of the pool and the profession occurs with respect to dentistry. While over’40 per cent of the practitioners are female, only 18 per cent of the applicants are girls.* Local recruits to this profession will therefore not contribute professions

to note that in

was as follows:

pharmacy,

* In the United States less than 2 per cent of the applicants to dentistry in 1970 were women [7].

898

JUDITH T.

SHUVAL

to its feminiza tion or even to maintaining its present ratio of women practitioners. Perception of the predominantly male dominance in medicine and the strong feminization of pharmacy are fairly accurately perceived and the pool is structured more or less accordingly. Candidates to dental school are characterized by the best educated parents of the three groups : 42 per cent of the candidates for dentistry have fathers with a university education. This contrasts to 32 per cent of the medical school applicants and 28 per cent of the pharmacy applicants whose fathers have an academic education. The pharmacy candidates are characterized by fathers with the lowest level of education: 60 per cent did not matriculate from high school. Candidates for medicine fall between these two groups. When we examine the occupations of candidates’ fathers, a difference emerges with respect to intergenerational continuity.* While there are no striking differences among the three groups in specrf~c occupational continuity, i.e. the proportion of physicians’ children is not significantly different among the applicants for dentistry, we do find a high proportion among the latter of children of fathers working in the medicalfield. A detailed analysis of these cases shows 13 of the 17 to be children of dental practitioners, 3 children of dental technicians and 1 the son of a male nurse. Thus the applicants to dentistry do appear, more than the other two groups of candidates, to be continuing a family tradition in their occupational aspirations. We may also assume that they have therefore been more exposed than the others to a measure of presocialization in their selected field. It is of some interest to recall other research findings which indicate that dental practitioners in Israel are, to a certain extent, “frustrated dentists”, who entered their occupation largely as a result of circumstances in Europe during and prior to World War II which prevented them from studying and practicing full-fledged dentistry [9]. In some sense this frustration may have reflected itself in their children’s occupational aspirations. We also find differences among the three groups with respect to their countries of origin. The candidates for medical school are dominantly native born; the candidates for dentistry include a proportionately high percentage of immigrants from European countries, while the candidates for pharmacy include a relatively high proportion of immigrants from Middle Eastern and North African origins. While the percentage of candidates from the latter countries are generally small, they are comparatively frequent among the candidates for pharmacy. OCCUPATIONAL

DECISION-MAKING

(a) Commitment Candidates for both medicine and dentistry show a stronger and more focused pattern of commitment to their selected fields than candidates for pharmacy. The first two groups are similar in expressing a relatively high commitment by indicating that their chosen field is the only one in which they feel they can gain satisfaction. Candidates for pharmacy, .on the other hand, more frequently stated that this profession is only one of many in which they feel they can gain satisfaction. Furthermore, applicants for pharmacy less frequently state that they never seriously considered occupational alternatives to the selected field [IO]. These patterns suggest a more narrow and specific occupational commitment by applicants to medicine and dentistry and a more diffuse, less exclusive pattern of occupational orientation by applicants to pharmacy. * In the United States, about 7 per cent of the applicants to dentistry in 1968 were children of dentists [S].

Manpower

Pools for Three Health Professions

899

in Israel

TABLE3. !h.ECTED

BACKGROUND

VARIABLES

OF CANDIDATES

FOR THREE

HEALTH

PROFESSIONS

(PERCENTAGES)

Applicants for medicine (946)

Applicants for dentistry (97)

Applicants for pharmacy (85)

81 19

82 18

40 60

Sex

Males Females

100% Father’s education Did not complete high school Completed high school University Other

Father’s occupation Physician Dentist Pharmacist Other medical field Other academic profession Senior executive Manufacturer or merchant Middle level white collar Technician Elementary school teacher Skilled workman Artisan Low level white collar Unskilled workman Kibbutz member Moshav member Deceased Other

100%

53 11 33 3

31 11 56 2

60

100%

100%

100%

7 6

4 11 17 9 11 15 3 3 1

2 8 13 13 11 3 11 5

2; 5

: 3 1

: :

1

:

:

100% Country of origin Israel Europe North Africa or Middle Fast

100%

loo% 51 43 6

54 30 16

100%

100%

62 30 8

100%

The timing of the occupational choice sheds further light on these to medicine made their decision to study this field earlier than The pharmacy candidates are quite similar to the applicants to make their decision somewhat later. Adding this pattern to the previous attitudinal findings suggests

patterns (11). Applicants the other two groups.* dentistry; both tend to an ordering of commit-

* To some extent this finding is an artifact of the presence of a large number of 18vyear-old candidates from the Academic Reserves among the candidates for medicine. The candidates for dentistry and pharmacy include a higher proportion of persons who completed their army service and are on the average 3 years older. However, this situational fact does not change the picture with respect to commitment as described

JUDITHT. SHWAL

900

ment between the applicants for medicine and dentistry with the former showing a somewhat earlier and possibly more specific commitment. In sum, the order of commitment as indicated by these two measures is as follows: highest-medicine; middle-dentistry; lowest-pharmacy. This order parallels the order of prestige accorded to the professions in the society as well as the length of formal study required. (b) Factors and considerations in occupational decision-making Candidates were asked to indicate in an open question what three factors should be considered by a young person in occupational decision making. TABLE 4. bfELOPOCCUPATIONAL

COMMITMENTOFCANDIDATJSTOTHREE (PERCENTAOES)

Exclusiveness of commitment* “This is the only profession in which I will get satisfaction” “I prefer this profession but I could get satisfaction from other professions as well” Consideration of occupational alternatives “I never seriously considered another profession” “I considered other professions but this was always my first choice” “I seriously considered other professional opportunities” Reported age of occupational decision-making Before 16-17 15 18 or later

HEALTHPROFESSIONS

Medicine (946)

Dentistry (97)

Pharmacy (85)

61

61

38

39

39

62

15

14

7

69

60

63

16

26

30

398 52

243 73

2: 76

* The two responses indicated in the table each represent a combination of respondents who indicated that they felt certain or fairly certain of the orientation indicated.

In view of the fact that the data were gathered at the time of application, we must assume that attitudinal questions of this variety reflect tactical considerations by some candidates such that they will provide what they consider to be the normative, approved answer reflecting strategic considerations for gaining admission. While there is probably also a projective element reflected in candidate’s statements indicating -something of their own deliberations and the factors they themselves consider important, we are unable to disentangle the two strands. A conservative approach therefore suggests that the findings be viewed primarily on a normative level and be taken to indicate candidates’ perception of expected legitimate reasons for entering these professions. These patterns are in themselves of substantive interest. The three groups show a remarkable similarity in the factors they state are important in occupational choice. Rank ordering these factors in terms of the frequency with which they were spontaneously noted, yields an identical order for all three groups. This pattern indicates that candidates for all three of these health professions consider the same set of

Manpower Pools for Three Health Professions in Israel

901

factors important and legitimate in making an occupational decision and give these factors approximately equal weight. There are no unique patterns associated with any one of the three professions. Considering the structural differences among these professions and the previously noted differences among the population groups applying, this similarity is all the more striking. Almost all candidates mentioned the importance of a personal interest in the field and the satisfaction expected from work in the profession. In a certain sense this factor may almost be viewed as trivial: virtually all candidates state the field is chosen because he “was interested in it”, thought “he would enjoy working in it”, or felt “he could gain satisfaction from it”. What would seem to be important is the universal focusing on the self. Material rewards are the second most frequent factor mentioned by all groups. Here, we refer to statements concerning income, standard of living, and the security offered by the profession. While this factor is emphasized slightly more by candidates for pharmacy, it appears second in frequency for all groups. This indicates its centrality for all three groups of candidates. If we view the reference to “expected personal satisfaction” as, at least partially, trivial, the material factor becomes the most frequently mentioned. References to service motives appear fourth in the ordering of factors. We have included in this category all other-directed references: service to the community, helping others, contribution to medical needs of society, services to others. Between l/4 and l/3 of the three populations refer to this factor. The differences among the three populations seen in Table 5 are not large enough to be of any relevance. If we bear in mind that candidates provided this data at the time of their registration, when there may have been a tendency to exaggerate normatively acceptable answers, this frequency may be viewed as spuriously high. The appearance of the service motive as only fourth in the list of factors mentioned,

TABLE5.

Expected personal satisfaction Material rewards Income, standard of living, security Personal ability Development of skills, ability in field Service to others Medical needs of community, service to others, helping others, needs of society Status of the profession Prestige, respect, social standing of the profession Interest in research and science Family factors Family tradition

Applicants for medicine

Applicants for dentistry

Applicants for Pharmacy

95

95

9s

53

54

63

40

38

38

34

29

25

21 4

21 2

14 3

4

4

-

* Respondents were asked to indicate the three most important factors in occupational decision-making. The frequencies in the table indicate the percentage of candidates indicating the relevant factor spontaneously. We have not considered the order in which the factors were spontaneously noted by respondents.

902

EDITHT.

%IUVAL

therefore suggests that it might in fact be even lower. Lowest in frequency are references made to research interests and family tradition. In sum, it appears that the factors viewed as important in decision-making for these three health professions are remarkably similar. The three groups of candidates view the same set of factors as legitimate in occupational decision-making-despite apparent objective differences among the occupations. In all groups we find an emphasis on the self in terms of what the candidate hopes to receive from his work in the profession, to a large extent with respect to material rewards; much less emphasis is placed on what he may be able to give to others through work in his chosen field. There is no evidence of a more frequent “other oriented” or service orientation among candidates for medicine. (c) I&ewes

on occupational decision-making

Occupational decisions are made by young people over a longperiod of time and with varying degrees of assistance and support by others. This occurs because candidates are still young when such decisions are made and are subject to the influences of a wide array of concerned and involved persons. Needless to say the candidate is not always aware of certain influences, many of which occurred in the diffuse past or were not specific enough to be consciously noticed. Since the influences on occupational decision-making are dynamic and continuous, we can only focus on those of which the candidate is currently aware [lo, 111. Who and what are recognized by the three groups of candidates as influential in helping them make their occupational decision? Candidates were presented with a list of types of individuals, groups and other potential influences and requested to indicate the extent of influence each had on their decision to study the profession of their choice. All three groups of candidates indicated that the most important influence on them came from practitioners they.knew in the relevant profession. Roughly 2/3 of each group indicated this and this frequency is considerably higher than that appearing with reference to any other specific influence. Such a pattern suggests that candidates, despite their young age, may be quite reality-bound. Primary groups play a major role in influencing all groups of candidates. Friends already studying in the relevant professional schools reportedly influenced about a third of the candidates and about the same proportion refer to parents as important influences. Teachers appear to play a minor role for all three groups. It appears that the applicants to dentistry were more influenced by salient members of family groups; they tend more than other candidates to indicate that they were influenced by their fathers and by other members of their families working in medical professions. They also show comparatively high frequency in referring to the influence of family tradition on their decision making. We may therefore conclude that while all three groups of candidates were influenced by primary group members, the dentistry candidates were more subject to family influences than the others. The latter pattern confirms the finding already noted concerning the high level of inter-generational professional continuity of this group. The candidates for medicine state more frequently than the other groups that they were influenced by the mass media, i.e. books, films, press, etc. This could be explained by the more stereotyped image of the medical profession which appears with some frequency in the mass media while the other two professions are less often referred to and are less clearly

903

Manpower Pools for Three Health Professions in Israel

stereotyped. This finding suggests that candidates for medicine may perceive their selected profession in terms of a set of narrower and more specilic traits than the other two groups whose image of their respective profession would tend to be less structured. TABLE6. INFLUENCE ON OCCUPATIONAL

DECISION-MAKINO (P~~R~~~NTAGE INFLUENCE)

Influences

A STRONG

OR FAIRLY ~TRONO

Applicants for medicine (946)

Applicants for dentistry (97)

Applicants for

21 37 10 65 34 32 24 14 9 26 31

17 37 10 71 46 36 37 z

18 27 17 62 39 41

Teachers Friends studying the profession Other friends Professional acquaintances Father Mother Family members in medical profession Other family members Family tradition Films, plays, novels Daily or weekly press, television

IMAGE

INDICA~G

OF THE “COMPETENT”

13 16

ph$cy

:: 8 17 16

PROFESSIONAL

How do these groups of candidates perceive their chosen profession ? Which qualities do they believe are required by a “competent” professional in these fields? In a sense, this perceived image is that of a layman, but presumably of a selected group of such laymen whose interest and attraction to the profession may have sharpened their image of it. Needless to say the definition of “competent” is the candidate’s own. Candidates were requested to indicate their feeling concerning the importance of sixteen traits of the “competent” professional. This list included a variety of skills, motives and personal qualities and was designed to have respondents project their own image of the “competent” professional. Within each group of candidates we will consider the rank or&r of importance attributed to’ each trait; subsequently we will compare the absolute level of importance attributed by the three groups to specific traits. If we look at the rank order of the skills, motives and personal qualities thought to characterize the “competent” professional, we find a remarkable similarity between the image of the “competent” physician and dentist. “Competent” physicians and dentists are perceived by candidates for these two fields as similar in terms of skills, abihties and motives required (rank order correlation of physician-dentist is O-93-Table 8) whiJe a “competent” pharmacist is perceived along another set of dimensions as characterized by a differently ranked array of qualities (rank order correlation of physician-pharmacist is 0.62 and dentist-pharmacist is O-61-Table 8). This pattern suggests a lack of perceptual differentiation between the qualities required by physicians and dentists while the image of the “competent” pharmacist is structured differently. The nature of the differences can be discerned by a closer look at the rank order. Both the medical and dental applicants give top place to interpersonal skills and motives focusing most strongly on a “confidence-arousing personality”, “desire to help others and

JUDITHT. SHWAL

904

TABLE7(a) Tiurrs OFTHE“COMPETENT” OF TRAITS

AND

PHYSICIAN

SEL.F-RATINCI

Ranked traits

BY

MEAN SCORES ON PERCEIVED

946 APPLICANTS

TO MEDICAL

IMPORTANCE

SCHOOL

(a)

W

Mean of “competent” physician*

Mean of selfevaluationt

Difference (a-b):

Confidence-arousing personality Desire to help others and alleviatesuffering Ability to understand others’ feelingsand

1.3 I.4

2.2 1.5

-0.9 -0.1

problems Ability to learn and rcme&cr Ability to work with and get along with others sCienti6ccuriosity Desire to solve community health problems Knowledgeand skill in the natural sciences Awarenessof limitations Warm personality

1.4 1.7 1.8 1.8 1.8 1.9 2.1 2.2 2.2 2.4 2,4 2.8 3.5 4.1

1.7 1.9 1.7 1.8 21 2.2 2.1 2.4 2.5 2.1 2.6 2.7 2.8

-0.3 -0.2 +0*1

Research ability Tolerance and flexibility in relations with others Originality Desire to carry responsibility Administrative ability Desire for prestige and status

-0; -0.3 -0; -0.3 +0.3 -0.2 +0*1 +0.7 +0*1

* Scores range from 1 = trait is extremely important to a “competent” physician to 5 = trait is not at all important to a “competent” physician. Scores are means of the population for each trait. Lower means indite higher importance. t Scores range from 1 = very high selfevaluation on the trait to 5 = very low self-evaluation on the trait. Scores are means of the population for each trait. Lower means indicate more positive self-evaluation. $ Negative d indicates that self rating is lower than rating perceived as appropriate for “competent” professional.

alleviate suffering*’ and the “ability to work with and get along with others”. A number of cognitive intellectual and science-oriented traits appear with somewhat lower emphasis : “ability to study and remember”, “scientific curiosity”, “ knowledge and skill in the natural sciences”, “research ability”. Lowest in terms of the importance attributed to them by these two groups are traits associated with organizational and administrative qualities: “desire to carry responsibility”, “administrative ability”, and “desire for prestige and status”. The order of traits perceived by candidates for medicine and dentistry as characterizing the respective “competent” professionals may therefore be summarized as follows (from most important to least important): interpersonal skills, intellectual and science skills, administrative ability. The pharmacy candidates indicate a somewhat different rank order of the skills required by a “competent” professional in their field. They rank three cognitive intellectual and science oriented skills as first in importance: “ability to learn and remember”, “knowledge and skill in the natural sciences” and “scientific curiosity”. Interpersonal traits are spread in the middle of the range. The “desire for prestige and status” is ranked by all three groups at the lowest point in the range, but the pharmacy candidates tend less than the others to

Manpower Pools for ThreeHealth

Professions in Israel

905

TABLE7(b) TRAIXS OFTHE“COMPETENT"DENTISTMEANSCORESON PERCEIVED IMPORTANCE OFTRMTS BY 97APPLICANTSFDR DENTLWRY

Ranked traits Cotidcncaarousing personality Desire to help others and alleviate suffering Ability to work with and get along with oihers Ability to learn and remember Ability to understand others’ feelings and problems Desire to solve community health problems Scientific curiosity Knowledge and skill in the natural sciences Tolerance and flexibility in relations with others Warm personality Awaremss of limitations Originality Research ability Desire to carry responsibility Administrative ability Desire for prestige and status

AND SELF-RATING

(4

0)

Mean of “‘competent” dentist*

Mean of selfevaluation?

1.4 1.4 1.5 1.6

2.1 1.5 1.5 1.8

-0.7 -@I -0.2

1.7 1.8 1.9 20 2.0 21 2.1 2.2 23 2.3 3.4 3.7

l-7

-0-2 -0.2 *-a5 +0.2 +@l -0.1 -0.2 +@l +0*9 -

;:y 2.5 ::; 2.0 f:: ;:: g,

Difference (a-b):

:::

* Scores range from 1 = trait is very important to a “competent” dentist to 5 = trait is not at all important to a “competent” dentist. Scores are means of the population for each trait. Lower means indicate higher impktance. t See Table 7(a). $ See Table 7(a).

place other organizational and administrative skills at the bottom. The general order among the pharmacy candidates is therefore (from most important tq least important): intellectual and science skills, interpersonal skills, administrative ability. The different ranking of these traits by the medical and dental candidates on the one hand and the pharmacy candidates on the other is confirmed in the absolute emphasis placed by these three populations on the various traits (i.e. how important they are thought to be for the “competent” professional as reflected in the size of the mean scores). In almost all cases we find the candidates for medicine and dentistry placing a stronger absolute emphasis than the pharmacy candidates on the importance of interpemonal skills and motives. On the other hand cognitive and science-oriented skills tend to be more strongly emphasized by the pharmacy candidates. Finally, although the evidence is not entirely consistent, it appears that the pharmacy group gives somewhat greater emphasis to organizational and administrative skills. Bearing these constellations of traits of the “competent” professional in mind, it is of some interest to examine candidates’ self-evaluation with respect to each (Tables 7(a), (b), (c) ). These data permit us to consider the following questions: are there differences among the groups in their general level of self-confidence? On which traits do the different groups of candidates differ from their own definition of the “competent” professional and

JUDITHT. SHUVAL

906

TABLE7(c). TRAITSOF

THE

“COMPETENT”

P HARMACIST RATING

MEAN BY 8s

SCORES APPLICANTS

ON

PERCEIVED

FOR

(4 Ranked traits Ability to learn and remember Knowledge and skill in the natural sciences Scientific curiosity De&e to solve community health problems Desire to help others and alleviate suffering Confidence-arousing personality Research ability Ability to work with and get along with others Desire to carry responsibility Tolerance and flexibility in relations with others Ability to understand others’ feelings and problems Administrative ability Awareness of limitations Warm personality Originality Desire for prestige and status

IMPORTANCE

TRAITS

AND

SELF-

W

Meanof “competent” pharmacist*

Mean of selfevaluationt

1.4 1.7 l-7 1.7 1.8 l-8 20 2.1 2.4 2.5

l-7 2.4 1.9 2.0

;:; 2.7 2.8 2.8 3.8

OF

PHARMACY

;:; 2.8 1.7 2.4 2.1 2.0 2.8 2.2 2.5 3.0 R= ::s

Difference (a-N -0.3 -0.7 -0.2 -0.3 -O*l -0.7 -0.8 f0.4 +0*4 10.7 -0.1 +o*s +0.3 -0.2 +o-2

l Scores range from 1 = trait is extremely important to a “competent” pharmacist to S = trait is not at all important to a “competent” pharmacist. Scores are the means of the population for each trait. Lower means indicate higher importance. t See Table 7(a). : See Table 7(a).

in which direction?

Are there differences in the closeness with which the different groups see themselves as approximating a “competent” professional in their selected field? Using the mean of mean scores on self-evaluation as an approximation of candidates’ level of self-confidence, we find the candidates for medicine to show the highest level of self-confidence (2-O), the dental candidates follow with a somewhat lower level of selfconfidence (2.2) while the candidates for pharmacy are lowest (2.4). The order follows the general prestige ranking of the three professions; it does not entirely follow the order of scholastic ability as estimated by average matriculation grades. It will be recalled from Table 2 that the dental and pharmacy candidates are characterized by a similar average matriculation score which was lower than that of the medical school applicants. Since only a few of the traits under consideration here are scholastic, there seems to be only a partial spill-over from the matriculation scores to candidates’ self-evaluation on a wider array of qualities. The medical and pharmacy candidates are at the top and at the bottom respectively and this accords with their earlier academic achievements; however, the dental school candidates show a somewhat higher level of self-confidence and fall between the other two groups. Despite these differences in self-confidence, the dominant pattern is one of modesty which is not surprising in a group that is just about to start on its professional training. This is shown in Tables 7(a), (b) and (c) by negative d’s on nine or ten of the sixteen traits.

Manpower Pools for Three Health Professions in Israel

907

Among the traits viewed as most important to the “competent” professional (traits at the top of the list in the tables), all groups show negative d’s, i.e. rate themselves lower than their own standard for the “competent” professional. Among the medical and dental candidates the only traits on which they tend to rate themselves higher than their own standard for a “competent” professional are the organizational-administrative traits at the bottom of the list: here we find positive d’s- at least partially because of a “floor” effect brought about by the low means attributed to the “competent” professional. It is also worth noting that the medical and dental candidates show the greatest gap between self-evaluation and their image of a “competent” professional on the topranked trait: confidence-arousing personality. How closely do the candidates approximate their own image of a “competent” professional ? Despite the overall pattern of modesty, do they perceive themselves as possessing these traits in the order of prominance required by a “competent” professional? It is of course possible for the d’s in the tables to be consistently negative while the order of self-evaluation on the traits remains the same. We will examine this question by comparing the rank order correlations between the two sets of scores in each population. (Table 8). TABLE8. RANK

~RRELA~ONS: SIXTEENTrurrs [from Tables (7(a), (b) and (c)] ’

ORDER

“Competent” professional Physician-Dentist Physician-pharmacist Dentist-pharmacist “Competent” professional-self-rating Physician Dentist Pharmacist

0.93 0.62 0.61 @81 04O 0.61

The medical and dental candidates show a similar pattern with a fairly close approximation of their self-evaluation to their definition of the traits required by a “competent” professional: rank order correlations between self-evaluation and traits of the “competent” professional are 0.81 and 0.80 respectively. We may therefore conclude that despite a general picture of modesty (somewhat more among the dental candidates), the two groups see themselves as possessing these traits in roughly the order and quantity required-in their eyes-by a “competent” professional. The pharmacy candidates are considerably farther from the mark. The rank order correlation between their self-evaluation and their rating of the traits of the “competent” pharmacist is only 0.61which suggests that their self image is somehow farther from their own goal than is the case for the medical and dental groups. SUMMARY

AND

DISCUSSION

The pools of candidates for these three Israeli health professions are drawn from different strata of the Israeli population which apparently view these occupations as differentially selective, appropriate, and rewarding. Medicine is most popular and most demanding in terms of earlier scholastic achievement : the high school records of the candidates for medi-

908

JUDITHT. SHUVAL

tine are somewhat better than those of the applicants of the other two fields. Women are highly attracted to pharmacy but much less frequently to medicine and dentistry which are apparently viewed as less appropriate for women. For dentistry this assumption is not borne out by the current sex ratio of the licensed professionals but is fairly accurate with respect to medicine and pharmacy which currently have a low (26 per cent) and a high (43 per cent) proportion of women practitioners respectively. Using fathers’ education as a rough index of candidates’ socio-economic background, it appears that dentistry candidates rank at the top, pharmacy candidates at the bottom and candidates for medicine in the middle. Candidates for dentistry show a higher level of intergenerational continuity in their occupational choice but their fathers tend to be dental practitioners or technicians rather than full-fledged dentists. This group appears to be carrying on something of a family tradition. We have suggested that this pattern indicates more exposure to pre-socialization; it could also be relevant to the level of commitment. Even though our candidates in the populations under consideration indicated the specific profession as their first choice, they do not show the same level of commitment to the occupation chosen. Candidates for medicine show the highest level of positive commitment, with the dentistry and pharmacy candidates following in this order. The level of commitment appears to be roughly correlated to the amount of prestige accorded to the professions and to the high school achievement level of candidates. In reporting the factors considered in making their occupational choice, candidates are probably reflecting their own appraisal of the kinds of consideration they believe the professional schools consider legitimate and appropriate for these professions. It is therefore of interest to find a remarkable similarity in the factors noted by the three populations which differ, as noted, in terms of social background and in terms of their level of commitment to the respective occupations. The data show that the same set of factors were spontaneously noted and in the same order of emphasis. There is almost universal mention of the importance of the expected personal satisfaction to be gained from working in the chosen field but over half of each group mentions the importance of material rewards : we have suggested that there is some basis for considering this factor the most prominent of those mentioned. Nor is there any apparent reluctance to openly acknowledge such a down-to-earth factoreven at the time of application. Other-oriented, service motives are mentioned by l/4 to l/3 of the populations and there is little evidence that this plays a particularly prominent role for any one of the professions. One might have expected the candidates for medicine to give greater emphasis to the service motive either because they believe their chances for admission would thereby be enhanced or because this motive actually plays a more prominent role in their selection of this profession. The evidence supports neither of these possibilities. . In comparing candidates’ perception of the skills, motives and personality traits of a “competent” professional in their chosen field, we have been struck by the lack of differentiation between candidates for medicine and dentistry; the two groups see their chosen profession in very much the same light, as requiring a similar array of traits. Both groups give most emphasis to the interpersonal skills, second in importance are intellectual and scienceoriented traits while organizational-administrative traits are least emphasized for both medicine and dentistry. We have assumed that the image of the “competent” professional held by candidates at the time of application has been filtered to them from the system of medical care of the society through a variety of media. Despite the disparities in the realities of practice settings and the unequal prominence and specific structuring given to the profes-

Manpower Pools for Three Health Professions in Israel

909

sion in the mass media, the “competent” dentist and physician are seen by these groups of candidates as remarkably similar. Our guess is that the less structured or stereotyped image of the dentist has been assimilated to the more stereotyped image of the physician. While this is in the nature of a hypothesis, it would seem to make some sense in view of the more frequent and clearly defined image of the physician as portrayed in the mass media. There could also be a measure of wishful thinking in this pattern, associated with the higher status of the physician. In any case it is reasonable to wonder, in light of the real and not irrelevant structural differences between these two professions, whether such a lack of differentiation in the initial perception pattern of candidates is functional for subsequent socialization and practice. If the “competent” dentist is seen as so similar to the “competent” physician, are not candidates heading for some real and possibly disturbing surprises? A separate, structured image of dentistry could be functional for candidates and the profession as well. Pharmacy emerges as fairly distinct from the other two professions. Candidates for pharmacy emphasize the cognitive-scientific component of their profession more than the other two groups; they also tend to upgrade the importance of organizational-administrative skills. On the whole they place less emphasis on the importance of interpersonal skills than the medical and dental candidates. Pharmacy candidates show a lower level of self-confidence than the other groups and a poorer approximation to their own definition of a “competent” professional in their field. In this sense they have farther to go than the other two groups in the course of their professional socialization in restructuring their own skills and personal traits. The medical and dental group are better off in this respect in that their self-evaluation more closely approximates their own image of a “competent” professional in their fields. Pharmacy as a profession is probably less clearly defined in the lay community in terms of its professional role requirements and the traits needed for proper performance. There is certainly much less stereotyping of this profession than of the other two. It seems reasonable to guess that this combination of factors could lead to greater discontinuity in the socialization of pharmacists.

REFERENCES 1. WORLD HMLTH ORGANIZATION,Regional Ofiice for Europe, Copenhagen. Report of the Working Group on the Selection of Students for Medical Education, 1971. 2. WEINERMAN, E. R. So&l Medicine in Eastern Europe, Harvard University Press, Cambridge, Mass., 1969. 3. GINZBERG,E. Occupat~naI Choice, Columbia University Press, New York, 1951; BARRON, F. Creative Person and Creatbe Process, Halt, New York, 1969; SUPER,D. and BACHRACH, P. D. Scientific Careers and Vocational Development Theory, Columbia University Teachers College,.Bureau of Publications, New York, 1957; SEWALL, W. H., HALLER,0. and P~RTPS,A. The educational and early occupational attainment process. Am. Social. Rev. 1%9,34,1969. 4. BRIM,0. G. and WHEELER,S.Sockzlization after Chilabod, Wiley, New York, 1966. 5. SHUVAL,J. T. Patterned ambivalence in orientation to medical professionals: general practitioners and dentists. Sot. Sci. & Med. 5, 127, 1971. 6. ISRAELMINISTRY OF HEALTH,Report of the Division of Medical Professions, Jerusalem. August, 1971 (Hebrew). 7. AMERICAN DENTALAssocurt~~, Division of Educational Measurements, “Analysis of Applicants to Dental School and First Year Enrolment, 1970”, Table 4. July, 1971. 8. AMERICAN DENTALAssocun~~, Division of Educational Measurements, “Inventory of Accepted and Rejected 1968 Dental School Applicants”, Table 3. September, 1970. s&M.7/11-E

910

JUDITHT.

%iUVAL

9. SHWAL,JUDITHT. Levels of professionalism in a duel system of dental care. J. publ. Hlth Dentistry 31, 38, 1971. 10. Rosarw~ci, M. Occupations and Values, Free Press, Glenux, Illinois, 1957. 11. See for an interesting comparison HENRY, W. A., SIMS,J. H. and SPRAY,S. L. The Ftyth Profession, Chap. VI, Jossey-Bass, San Francisco, 1971.