Abstract
Since its inception, positions within occupational therapy have been chiefly filled by women, with men typically constituting a small percentage of the profession’s membership (Rider & Brashear, 1988). The American Occupational Therapy Association (AOTA) reported that 92% of U.S. therapists are women (AOTA, 2012). Inspired by the Arts and Crafts movement, three men and three women founded the profession in 1917 with the establishment of the National Society for the Promotion of Occupational Therapy, which became AOTA in 1923 (Frank, 1992).
Gender disparity is not uncommon in the health care field. Men are substantially underrepresented (i.e., <10%) among registered nurses, licensed practical nurses, dietitians, dental hygienists, health record technicians, nurses’ aides, physician assistants, physical therapists, orderlies and attendants, and dental assistants (Commission on Dietetic Registration, 2013; Coplan, Cawley, & Stoehr, 2013; Frank, 1992; U.S. Census Bureau, 2013).
Workforce diversity is important to the profession of occupational therapy. Reported benefits of diversity in the workforce include increases in creativity and innovation with an increase in balance between the genders (Dreachslin, Hunt, & Sprainer, 2000). For instance, some clients can benefit from having a male role model in their life. Readman (1992) described the importance of having male therapists available for clients.
Previous Research on Men in Occupational Therapy
Job Satisfaction
Historically, occupational therapy has struggled to recruit and retain men within the profession because of a variety of factors. One such factor is job dissatisfaction. A person’s decision to remain in a work situation is heavily influenced by the level of satisfaction with the job (Turgeon & Hay, 1994). Several studies have focused on examining the job satisfaction level of male occupational therapists (Brown, 1995, 1998a, 1998b; Meade, Brown, & Trevan-Hawke, 2005; Turgeon & Hay, 1994).
Brown (1995) surveyed 199 male clinicians who were members of the Canadian Association of Occupational Therapists in 1990. Of the 164 who responded, 74% said they expected to leave the profession within 10 years. Significant predictors of greater global job satisfaction included less colleague and community role strain, fewer hours of overtime, and longer length of time since entering the profession (Brown, 1995).
Turgeon and Hay (1994) surveyed 55 male occupational therapists in Ontario, Canada, on factors pertaining to job satisfaction and other work-related matters. They found significant differences between less experienced and more experienced respondents. Those with less experience reported they were more likely to leave the profession and were more dissatisfied than their more experienced peers. However, both groups reported feeling the same level of isolation. Although statistical significance was not achieved, the study suggested that the more experienced men appeared to be less likely to leave the profession and more likely to be satisfied with their occupation than less experienced men.
In a study by Meade et al. (2005), female and male occupational therapists in Queensland, Australia, were surveyed to examine their level of job satisfaction. Using the Job Descriptive Index (Smith, Kendall, & Hulin, 1969) and the Job in General Scale (Ironson, Smith, Brannick, Gibson, & Paul, 1989), the researchers found that respondents of both genders were satisfied with their supervision, coworkers, work at their job, and job in general. The study also found that therapists of both genders were moderately satisfied with their scale of pay. However, a statistically significant gender difference occurred in views on opportunities for promotion; women were more dissatisfied than men. Additionally, 60% of the sample reported a plan to leave the profession within 10 years.
Other Factors
Birioukova, So, and Barker (2012) argued that previous research on gender-related issues contributing to male occupational therapist attrition from the profession was out of date and incomplete. They focused on three issues previously found to contribute to male attrition: (1) tentativeness in allowing men to carry out personal treatment techniques with female clients, (2) use of male practitioners in manual labor tasks, and (3) absence of proper departmental facilities. In an examination of 37 male occupational therapists from Ontario, Canada, more than half reported being used in manual labor tasks of various types. However, more than 80% reported that they never experienced a lack of appropriate facilities, and more than 90% reported that they had never been deterred from providing female hygiene or sexual education. Only 16.7% of participants reported that they would leave the field in 5 years, and 26.7% anticipated leaving in 10 years, a substantial reduction in 10-year anticipated attrition compared with studies conducted in the 1990s.
Financial remuneration was not the main focus of the above-mentioned studies, but AOTA monitors trends in compensation. The AOTA (2015) Salary and Workforce Survey found that male occupational therapists earned 14.7% greater salaries than their female counterparts. The gender difference for occupational therapy assistants was smaller, at 4%. The salary gender gap within the profession is smaller than the 22% gap reported for all professions in the United States (U.S. Census Bureau, 2014).
Beyond pay, emotional attributes may influence attraction to the profession. For example, to account for the gender gap in the nursing profession, Penprase, Oakley, Ternes, and Driscoll (2015) studied college students to determine whether a higher disposition for empathy predisposed young men toward a career in nursing. The researchers found a higher incidence of empathizing traits in female students than male students. However, male nursing students disclosed higher empathy traits (p < .01) than male students in the general population.
Rider and Brashear (1988) can be credited with one of the most comprehensive studies focusing on demographics and factors influencing men in the profession of occupational therapy. Their findings on characteristics of male occupational therapists may suggest strategies for recruiting men into the profession and retaining them. The researchers surveyed 797 male occupational therapists at 3-year intervals from 1978 to 1985 and compared their results with the 1969 and 1982 AOTA Member Data Survey and an unpublished study by Watson (1983). From 1970 to 1985, the number of occupational therapists nearly tripled. However, the proportion of men in the profession increased only from 3.9% to 5%. As a group, male occupational therapists in 1985 were younger, more likely to have a degree beyond the baccalaureate level, and more likely to be unmarried than their 1969 counterparts.
Objective
Previous research implies that the profession of occupational therapy is a less attractive option for men than for women because of a wide variety of practice factors, including job dissatisfaction. The purpose of this study was to explore current issues, factors, and perceptions associated with men in the profession of occupational therapy.
Method
Design
This study used a mixed-methods design with an Internet-based survey to gather quantitative and qualitative data from participants. The quantitative portion is reported using a frequency distribution analysis of Likert scale responses, and the qualitative portion is described using a thematic analysis of the open-ended survey questions.
Participants
Licensed occupational therapists and occupational therapy assistants in the state of Ohio who provided email addresses to the Ohio occupational therapy licensure board were emailed an invitation to participate in this study. The potential sample was 9,467 occupational therapy practitioners, including 5,220 occupational therapists and 4,247 occupational therapy assistants. A total of 699 respondents participated in the study (7.66% response rate).
Instrument
A survey instrument was developed for this study through an iterative process and incorporated feedback from a panel of experts in survey research. The survey comprised 48 questions; 28 presented a statement and required a response indicating level of agreement with the statement on a scale of 0 to 5, 11 were open-ended content-specific questions, and 9 requested participant background and demographic data.
Procedures
This study was approved by the sponsoring institution’s institutional review board. The emailed invitation to participate in the research study contained a link to a survey and was sent to all occupational therapists and occupational therapy assistants registered with the occupational therapy licensure board in the State of Ohio. Practitioners were asked to complete the survey at their convenience. The initial email, sent August 17, 2015, contained an active link to the sponsoring institution’s Blackboard Enterprise Survey system tool, which recorded and housed participant responses. An error occurred with the initial email’s link, so a follow-up email with a corrected link was sent August 18, 2015, to all potential participants. The survey closed on September 14, 2015. Data were downloaded into IBM SPSS Statistics (Version 23; IBM Corp., Armonk, NY) for analysis.
Data Analysis
χ2 analyses were used to examine whether responses on the Likert scale questions differed by gender. Additionally, the effect size for χ2, Cramer’s V, was calculated. An effect size indicates the magnitude of influence the independent variable has on the dependent variable (Stein, Rice, & Cutler, 2013). For Cramer’s V, a small effect size is .10, a medium effect size is .30, and a large effect size is .50 (Cohen, 1988).
For the open-ended questions, thematic content analysis was performed. The two investigators independently read through the raw data to identify themes. Once themes were identified, like themes were clustered through an iterative process. Finally, interrater reliability (κ) was calculated between the two raters for the agreed-on themes (Chmura Kraemer, Periyakoil, & Noda, 2002).
Results and Discussion
Of the 9,467 surveys sent, 347 were returned as having undeliverable email addresses. This left 9,120 as possible viable email addresses; however, an unknown number of emails were rendered as spam. Nevertheless, from the 9,120 possibly viable email addresses, 699 participants responded, yielding a response rate of 7.66%.
Participants reported a mean age of 41.9 yr (standard deviation [SD] = 12.1); 113 (19.5%) were men (Figure 1). They had been in practice a mean of 14.8 yr (SD = 11.0). Three-quarters (76.4%, n = 528) were occupational therapists, and one-quarter (23.6%, n = 163) were occupational therapy assistants. Regarding marital status, 20.3% (n = 138) of respondents reported being single and 79.7% (n = 542) reported being not single; interestingly, 4.1% of those who were not single reported that their spouse was an occupational therapy practitioner. The mean κ for all the open-ended questions was .76, the median was .87, and the range was 1.00 to .23.
Flow diagram of survey delivery and response.
Responses With Differences by Gender
The responses to 12 questions showed a significant difference of opinion by gender (Table 1). Female respondents felt more strongly that their gender was a benefit to them within the profession from an emotional standpoint, whereas male respondents felt more strongly that their gender was a benefit to them from a practical and a financial standpoint. This finding suggests that participants of both genders felt differently about the benefit of their gender within the profession from an emotional, practical, and financial standpoint. Likewise, the male respondents felt, more than the female respondents, that their gender did not present a barrier to them within the profession from a financial standpoint. It is possible that the salary difference between genders (i.e., 14.7% for occupational therapists, 4% for occupational therapy assistants; AOTA, 2015) was enough to influence the differing perceptions of finances between the male and female respondents.
Survey Questions With Significant Differences in Response by Gender
Note. M = mean; SD = standard deviation.
Scores range from 1 = strongly disagree to 5 = strongly agree.
p < .05.
p < .01.
p < .001.
Male respondents felt that their gender did present a barrier from a social, emotional, and practical standpoint more than their female counterparts. For example, men agreed more than women that there are some things a practitioner of one gender can teach certain clients that a practitioner of the other gender cannot teach. Likewise, men agreed more than women that there are some things a male practitioner is more suited to teach male clients than a female practitioner and that there are some things a female practitioner is more suited to teach female clients than a male practitioner. These findings suggest that men felt more strongly than women that some skills are better suited to be taught to clients by a therapist of a particular gender. Although no specific examples were offered, it could be assumed that some of these differentiations might be related to genitourinary and/or reproductive self-care matters.
Responses With No Differences by Gender
Several questions did not yield significant differences in responses, revealing the overall perceptions of respondents as a whole on various issues (Table 2). Both male and female respondents disagreed that they viewed occupational therapy as a woman’s profession or a man’s profession; however, respondents of both genders were neutral in feeling that society views the profession of occupational therapy to be a woman’s profession and disagreed that society views the profession to be a man’s profession. Additionally, respondents of both genders showed neutrality in opinion on the statement “It bothers me that occupational therapy is viewed as a female profession.”
Survey Questions With No Significant Differences in Response by Gender
Note. M = mean; SD = standard deviation.
Scores range from 1 = strongly disagree to 5 = strongly agree.
In addressing the gender gap present in the profession, both male and female participants agreed that the current gender ratio of the profession (i.e., 9:1 female:male) should be changed. In terms of the issue of gender serving as a benefit to practitioners, both men and women were neutral in the belief that their gender had been a benefit to them in the profession from a social standpoint. This result suggests that respondents perceived either that gender could benefit them in some ways and not others or that they did not feel gender helped or hurt them at all from a social standpoint.
Both male and female participants disagreed that people know what occupational therapy is. Additionally, participants of both genders were neutral in their opinion that physicians know what occupational therapy is. These results reveal a concern for the profession and public alike. In a similar vein, when responding to the statement “Often I am assumed to be a physical therapist rather than an occupational therapist because people do not know what occupational therapy is,” respondents of both genders agreed, suggesting that people do not know what occupational therapy is and that physical therapy is better known than occupational therapy.
In general, both male and female practitioners indicated there are things a client is more comfortable learning from a male or female practitioner. In addressing the issue of career choice, both men and women agreed that if they “could do it all over again,” they would still choose to be an occupational therapy practitioner. Both men and women agreed that the profession offers them job security and a satisfying salary. Furthermore, both men and women strongly agreed that the profession is a benefit to society and that they felt that they contributed to society as occupational therapy practitioners. Finally, both men and women strongly agreed that they felt good helping clients as an occupational therapy practitioner.
The results suggest that these occupational therapists and occupational therapy assistants were happy with their career choice. They appeared to enjoy their job and to feel that they reaped both extrinsic and intrinsic benefits from the profession. Additionally, because no significant difference in responses was found between genders on all five questions related to the occupational therapy profession, these findings suggest that both men and women enjoyed being in the profession. The profession may outwardly appear to be a woman’s profession on the basis of its gender ratio, but these practitioners enjoyed their job, contribution to society, and job security, regardless of their gender.
Responses to Open-Ended Questions
The iterative process used to identify and categorize themes among the responses to the open-ended questions revealed several major themes. In responses to the question “Why do you think the profession is predominantly female?” we identified the themes of Activities of Daily Living (ADLs) and Nursing. Responses in the Nursing theme included the following quotes: “I was a nurse prior to becoming an OT and when working, I was able to observe an OT and decided to go back to school to become an OT.” “[I wanted to be in a] medical profession but not a doctor or nurse.” “[OT is] more creative and holistic than PT.” “I wanted to do something in the health care profession, but not nursing.” Quotes from responses in the ADLs theme included the following: “Medical helping profession (especially one based in ADLs) is viewed as female,” “[I wanted to] focus on ADLs,” and “Maybe females feel more comfortable with ADLs.”
For the question “In what direction do you see the profession’s gender gap heading in the future?” we identified the following themes: Same, Decrease, More Female, and Close. Most practitioners’ responses reflected the Same theme, suggesting that most felt that the profession’s gender gap will remain unchanged for the foreseeable future.
In responses to the question of what could be done to attract more men to the profession, we identified the themes of Social Media, Education, Pay, Market, Awareness, and Men in the Field Promotion and Media. The Education theme garnered the greatest number of observations, and the Social Media and Education themes had an almost perfect level of agreement between raters. The general consensus among participants was the belief that education of the public would enhance recruitment of men into the profession.
Finally, for responses to the question “How does your gender affect/influence your ability to build rapport, trust, and empathy with a patient?” we identified the themes of Women, Personality, ADLs, Female, Issue, and Same. We recorded the most observations for the Women and Personality themes. Quotes from the Women theme included “I don’t think my gender makes a difference except that people assume OTs are women,” “[My gender] helps with women clients especially,” and “I believe as women we are faster and more open to relationship building.” Quotes from the Personality theme included “My gender doesn’t impact this; my personality does,” “I believe my personality and approach are what makes the difference,” and “I don’t feel it is gender specific. It’s personality specific.”
Comparison With Previous Studies
Although the current study has little similarity to previous studies focusing on men in the profession of occupational therapy, some results align with previous findings. Rider and Brashear (1988) concluded that their male participants chose to enter the profession not because of pressure or a recommendation from family members, but because of an internal desire to become an occupational therapist. Likewise, we found that the most popular response to the question “Initially, what attracted you to the profession?” by both male and female respondents expressed the desire to be in a profession that is directly involved with helping others.
Although Turgeon and Hay’s (1994) study revealed dissatisfaction with all variables examined (e.g., satisfaction with standing of occupational therapy, feelings of isolation within profession, and thoughts of leaving the field), the current study revealed dissatisfaction primarily with misunderstanding of the occupational therapy profession among the public and other health care professionals rather than with variables such as perceived discrimination and isolation. Additionally, responses in the current study reflected a general disdain for perceived increased regulation, required paperwork, and reaching treatment unit quotas.
Limitations
Although the results of this study may be representative of practitioners located in Ohio, they may not be representative of all U.S. practitioners, particularly in light of the low response rate. The study was conducted using an online survey; many survey invitations may have been lost in spam filters. Additionally, results may be biased toward people who frequently take or are open to taking online surveys. Last, respondents may have differed in their interpretations of the survey’s terminology.
Implications for Occupational Therapy Practice and Conclusion
The results of this study have the following implications for occupational therapy practice:
Although male practitioners perceived their gender to be more beneficial within the profession than their female counterparts regarding financial and practical matters, female practitioners perceived their gender to provide more benefit from an emotional standpoint.
Practitioners of both genders appeared to be happy with their career choice, to enjoy their job, and to feel that they reaped both extrinsic and intrinsic benefits from the profession.
The profession may outwardly appear to be a woman’s profession because of its gender ratio, but these practitioners enjoyed their job, contribution to society, and job security equally, regardless of their gender.
More research is needed to determine with greater clarity gender-specific perceptions and how differences affect practice and to develop strategies to improve recruitment and retention efforts for occupational therapy practitioners, regardless of gender.
Footnotes
Acknowledgments
This study was completed at the University of Toledo as part of the first author’s occupational therapy doctoral degree. The authors thank Barbara Kopp Miller for sharing her expertise and input with survey development.