Gender and the Social Construction of Occupations: The Case of Clinical Coders

Abstract

Labour market position is socially constructed through the complex and intertwined relationships embedded in gender, skill, power and occupational status. These interactions are located in the social structures of patriarchy and the capitalist labour process. These concepts explain the persistence of the subordination of female skills and female-dominated occupations. This thesis examines the relationship between these structures, within a women-dominated clerical occupation located in the public health sector - clinical coding. The influence of contextual factors such as employment law changes and public health restructuring are also considered.

As a critical socialist feminist researcher my aim was to critique the dominant structures that entrench the disadvantage that women experience. A mixed method approach was used and included focus groups and two surveys, one for clinical coding managers and the other for clinical coders. This provided a snapshot of the working conditions of clinical coders and enabled their views, concerns and aspirations to be voiced. The data collected was analysed using a thematic approach and where appropriate, compared with earlier research on clinical coders conducted in Australia.

The findings of this thesis demonstrate that clinical coders are similarly impacted by the disadvantage that women experience generally in society and the workplace. Although these workers have good job security and above average wages, the status of their work remains undervalued and the perception of their skill level is poorly understood. Work that is deemed clerical is embedded in certain assumptions; usually woman dominated, and as women's skills are valued less than men's skills, it follows that clerical work is not perceived as skilled. These basic assumptions allow the continuation of discrimination and disadvantage that women experience in the workplace. Occupational status contributes to labour market position and irrespective of the significant level of expertise and knowledge demonstrated by clinical coders they have been unable to improve their labour market position within the District Health Boards.

This thesis highlights the need for labour market models and industrial relations theorists to develop an understanding of the impact that gender and patriarchy have on the working experience of all workers. The pervasive influence of the capital labour process is addressed but often the effect of patriarchy is absent from research and analysis. However, both the structures of patriarchy and the capitalist labour process, equally and synergistically create disadvantage for women. Workplaces are created before workers enter them and an approach to labour market studies is required which confronts these mechanisms which so effectively work to confer privilege and disadvantage along gendered lines.