Profession on the move Changing conditions and gendered development in physiotherapy

Abstract: Physiotherapy in Sweden has developed from a practical, hands-on, assistant job predominantly taught at college level to a university-based academic discipline emphasising evidence-based practice and research. Women are in majority although an increasing number of men have entered the profession. Women and men physiotherapists tend to undertake different career paths. The overall aim of the present thesis was to use a gender perspective to describe and analyse attitudes to the professional role, health care work and the development of the profession among actors engaged in physiotherapy education.A questionnaire was distributed in 1997 to all Swedish physiotherapy students in the second semester of the education (n=273). The same cohort was investigated in 1999 at the completion of the education. The response rate was 93 percent at both occasions. For an international comparison, the same questionnaire was distributed in 1997 and in 1999 to a group of Canadian physiotherapy students in their first and last semesters (n=60). Qualitative research interviews were conducted with 8 novices in physiotherapy and with 14 women educators in academia. Five focus group discussions with clinical supervisors were conducted (10 women and 5 men). Methods used were Grounded theory, factor analysis, logistic regression and path analysis. Feminist theories and Bourdieu's theory of culture constituted a theoretical frameworkFour ideal types were identified among the novices representing attitudes to the professional role. The Treater and The Supervisor were attitudes found among the women, whereas The Coach and The Entrepreneur were attitudes among the men. Type of health care facility was important for their positioning in the organisational hierarchy. Swedish students favour future employment in private practice. Sports medicine clinics and fitness centres are health care facilities highly endorsed, as is health promotion. Neither care of elderly nor hospital work are preferable fields of practice. Research is not favoured. Men students are more likely to have chosen the profession because of their interest in physical activity and sports. They are also more likely to prefer owning a private clinic and working with alternative approaches such as fitness training in sports medicine clinics. Women students are more likely to prefer an employment in private practice. The Canadian men students favour private practice whereas the women prefer the public sector of health care. The academic educators experience a gap between theory and practice which causes conflicting messages to students. Competing professions, emergent societal change and a conservative clinical practice constitute threats to the profession. The uniqueness of professional competency, theoretical development and new arenas such as home rehabilitation, consulting and research constitute a vision for future development of the profession. Masculinity is highly valued for status and power whereas femininity symbolises empathy and caring. The clinical supervisors update their theoretical knowledge base through supervision of students, but claim that students lack hands-on skills. Stress at work, unequal power relations in the hierarchy and restructuring of health care are factors that influence work satisfaction negatively. To conclude, gendered habitus, different symbolic capital and different attitudes towards health care work and development of the profession were found in the sub-fields of physiotherapy.