Early and recent occupational therapy evidence has linked the small proportion of men in the workforce to the seemingly inflexible attitude toward male participation in occupational therapy that has been shaped by the history of the profession, female practitioners, society, and economic events (Figueiredo et al., 2018; Haas, 1925). Outright denial of educational opportunity (Haas, 1925), gender segregation, stereotyping of roles, and characterization of occupational therapy as a women's profession (Figueiredo et al., 2018) have dissuaded men from entering the profession.
Professional Role Factors
It has been reported that roles are “normative models for behavior shaped by culture and society” and that “individuals experience a sense of purpose, identity, and structure in carrying out their roles” (Matuska & Barrett, 2014, p. 164). Gender perspectives, stereotyping, conflicting perceptions, and role strain have the potential to influence practitioners' professional roles and performance.
Men in allied health professions and nursing reported both positive and negative experiences at work (Posthuma, 1983). Turgeon and Hay (1994) reported that male occupational therapists in Ontario delivered a different perspective on workplace issues and were treated with respect by most clients and health care personnel. Penprase et al. (2015) found that male nursing students had greater systemizing characteristics compared with their female counterparts, and male Canadian nurses reported benefits from being a “visible minority” (Rajacich, Kane, Williston, & Cameron, 2013, p. 76), which may have contributed to positive work opportunities (Rajacich et al., 2013). Conversely, research also has shown negative gender-associated experiences.
In occupational therapy and other female-dominated professions, men have reported stereotyping (Posthuma, 1983), confusing or conflicting perceptions (Kantrowitz-Gordon, Ellis, & McFarlane, 2014), role strain (Brown, 1998; Turgeon & Hay, 1994), and other gender-related experiences (Brown, 1998; Penprase et al., 2015; Rajacich et al., 2013). Maxim and Rice (2018) found that male occupational therapists “felt their gender did present a barrier from a social, emotional, and practical standpoint” (p. 4) compared with female practitioners. Male nurses have experienced stereotyping (Penprase et al., 2015) that may have deterred men from entering the field (Abushaikha, Mahadeen, AbdelKader, & Nabolsi, 2014). Penprase et al. (2015) reported that male nurses felt pressured to select practice areas that seemed more masculine (e.g., choosing orthopedics rather than obstetrics), and Cudé (2004) reported on the influence of sociocultural expectations on the practice choice of male nursing students. Male midwives reported that their gender was often attached to their title (Kantrowitz-Gordon et al., 2014), and until 2007, Turkish law categorized those performing nursing functions based on the school attended: women were nurses and men were health officers (Saritaş, Karadağ, & Yildirim, 2009). Abushaikha et al. (2014) reported that male nursing students in Jordan believed that policies favored women. Finally, male Canadian nurses reported a sense of having something to prove to their female counterparts because of gender differences (Rajacich et al., 2013).
Results and Discussion
The experience of male practitioners was influenced by personal, environmental, and sociocultural factors. Five phenomenological themes emerged: (a) personal fit, (b) the male advantage, (c) rolling with the punches, (d) the constraint of masculinity in society, and (e) the effect of unique experience.
Theme 1: Personal Fit
When asked why they entered the profession, all participants made their decision based on the match between the overall job duties and their personal values and interests, even if they were aware of the existing gender discrepancy.
Participant 4: “So it was more the profession that fit me rather than having anything to do with being male or female.”
Participant 2: “It was a matter of finding a fit and knowing that there was a profession that fit my interests, potential, ability, and skill set.”
Overall, gender did not appear to be a factor in participants' reason for entering the profession.
Theme 2: The Male Advantage
The next theme was that men have perceived gender-related advantages. Several factors contribute to this phenomenon. The first one noted was the ability to connect with male clients and colleagues. Male practitioners reported that it was easy for clients to relate to them and for them to build rapport during therapy.
Participant 4: “We need more male occupational therapists, and I think there are a lot of advantages to being male. We're strong, we can do things, and we can build a level of rapport with patients just the same as females, but in a different way.”
Participant 5: “They can feel comfortable talking to me as a male, and I can bring up pertinent male issues very bluntly, and they'll open up to me. I've had comments like this many times: ‘You're the only one who understands me.’”
In addition to having the ability to relate to male clients, all participants noted that they naturally built connections with male colleagues, regardless of career stage or setting.
Participant 6: “You do definitely reach out to other male practitioners a little bit more when you see them. We can kind of joke about some of the experiences and things that we go through. The males are kind of drawn together. We have faced the same challenges all the way back from schooling.”
Another positive aspect of being a male practitioner that was identified was physical strength. Many participants agreed that their strength allowed them to work with “difficult” patients more effectively. The term “difficult” was used to describe larger clients as well as those who were aggressive or were perceived as dangerous.
Participant 3: “I felt like being a male was a strength, just in the sense that I was stronger than my female co-workers. I wasn't worried about hurting myself while transferring patients.”
Participant 5: “I remember one gentleman who was irate, and the nursing staff could not handle him. He was out of control. They got me, and we de-escalated the situation.”
Four participants mentioned that their gender allowed them to stand out during job searches because they increased diversity in the workforce, although they were never explicitly informed that this was the reason for hire.
Participant 3: “With getting hired at the hospital, they didn't come out and say it outright, but toward the end, once I put my two weeks in, my supervisor said that he was really excited to have hired me, and he kind of hinted that it was because I was a male.”
Participants indicated that they received respect from clients and colleagues. This was a common perception among participants, but the men interviewed had different opinions as to whether this respect was deserved.
Participant 4: “I'm seen as a person of respect and as someone who knows what I'm doing . . . and the profession of occupational therapy is valued.”
Participant 1: “I think I come across as more of an authority figure than maybe I deserve . . . but I feel that I garner more respect from being a male in the workplace than I always deserved.”
The next two themes are formatted differently, beginning with a quote rather than a narrative. This was done to orient the reader toward the reason for the provocative theme titles. The last theme follows the previous formatting.
Theme 3: Rolling With the Punches
Participant 6: “You've got to have some thick skin, and you're going to have to roll with the punches [relating to the negative aspects of being a male practitioner].”
The consensus among participants was that it was more common for male occupational therapists to work with “difficult” clients compared with their female counterparts.
Participant 6: “You run into sometimes getting the more difficult patients. I know that people deny that, but you know that you're going to get the heavier patient, the more aggressive patient, the one who maybe had some psychosocial issues that, you know, if a female therapist doesn't feel comfortable with, you're going to get them.”
All participants specified that intimacy issues arose while completing activities of daily living with female clients. This sometimes led to client refusals for therapy and client reassignment.
Participant 3: “I definitely got denied by a lot more patients because I tried to go in there and help them with activities of daily living and dressing, going to the bathroom, all that stuff. It was because I was walking into a female patient's room, and they just didn't want me, being a male, to do that with them.”
Participant 6: “You know you are going to have patients who do not want you to work with them because you're male. You can't take it personally, but you're going to get dismissed sometimes.”
Theme 4: The Constraint of Masculinity in Society
Participant 5: “Society has changed . . . society wants to strip males' masculinity, and everyone's supposed to be the same. Women are supposed to be empowered, and yes, I get that. But at the same time . . . our culture, our society is just totally castrating men. And I see that in the profession.”
Participant 5 spoke most passionately about the effects of sociocultural influences, although multiple participants expressed this sentiment. Most participants reported that they felt less able to perform best practice because of the risk of being viewed as sexually inappropriate by female clients.
Participant 5: “There are parts of treatment that male therapists just could be very good at. And they just go, ‘No, I'm not gonna go there.’ And that's things like women's health with incontinence issues, pelvic floor stuff . . . all of these different very intimate things . . . so male therapists, some of them, just go, ‘I'm not doing it.’ That's just out of fear of being seen as sexually inappropriate.”
This quote illustrates the idea that men may feel less able to perform certain tasks or may avoid completing some aspects of the job. Notably, the sociopolitical and cultural climate in the United States at the time of this study may have influenced participants' perceptions. Although it was not explored in this study, women also may experience specific issues when treating clients of the opposite gender.
Theme 5: The Effect of Unique Experience
The experiences that participants encountered played a significant role in the advice that they deemed important for novice therapists. Participants noted that skill set was more important than gender within the practitioner role.
Participant 2: “I would say to hang your morals, your plan for the future, your potential career, on the possibility that you got there on your skill set. It's your potential as an occupational therapist first and being a male second.”
Participants emphasized assertiveness, open-mindedness, and flexibility in the role of occupational therapist. They agreed that men and women often say and do things differently and that all practitioners should continue to use their gender-related strengths.
Participant 5: “My advice is that there's really not an issue, but men and women are different. We are composed differently. We think differently. We shouldn't feel as though men and women are equal because we're not. We're very different creatures and for a reason. We need to embrace that and use it in our profession.”
Gender did not appear to be a factor for participants in choosing a profession, which is congruent with existing literature. Participants noted that they found the ability to work with clients, use skills, and pursue opportunities for leadership more important than consideration of gender (Rider & Brashear, 1988). Similarly, in both the nursing and occupational therapy literature, possessing a unique perspective (Kantrowitz-Gordon et al., 2014), job security, salary, and contributing to society through serving clients (Maxim & Rice, 2018) were perceived as more important than gender in choosing a career.
Our findings showed that it is important for men to use their ability to connect with male practitioners and clients to build support systems and provide effective care. Department leaders can build mentoring programs for male students and practitioners to promote social connectedness. Fieldwork supervisors, in particular, may have a significant influence on students' experiences (Rezaee, Rassafiani, Khankeh, & Hosseini, 2014; Thomson, Docherty, & Duffy, 2017), and it may be beneficial to pair male students with male practitioners. Occupational therapy educators, students, and practitioners also may benefit from education on diversity that includes the influence of gender on the profession. Additionally, certain factors, such as physical strength, diversity in the workforce, and respect from certain client populations and health care professionals provide male practitioners with potential advantages.
The literature identified differences in the way that men and women communicate. These differences have the potential to influence the career trajectory for male therapists. Research suggests that male head nurses tend to communicate with greater assertiveness, practicality, and technicality, and these characteristics may lead men to achieve leadership positions ahead of their female counterparts (Evans, 1997; Nilsson & Larsson, 2005). Our findings showed that men perceived that they easily established relationships with clients and male colleagues, garnered respect from their peers, and stood out during interviews. All of these characteristics may be related to communication style and leadership qualities.
An assertive communication style also may lead to negative experiences for practitioners. Milligan (2001) found that male nurses were often paired with clients who required more physical strength, needed redirection, or presented risk for harming others. Participants mentioned that they were assigned difficult patients more often than their female counterparts. We anticipate that the previously mentioned male qualities (direct communication, physical strength, and perceived respect from clients) may have contributed to this phenomenon. To enhance team building and determine departmental processes (e.g., working with clients of a different gender), supervisors should facilitate discussions of the influence of gender and understand the perceptions of practitioners.
Another factor that contributes to the negative experiences of male occupational therapists is dealing with intimate issues with female clients. Inoue, Chapman, and Wynaden (2006) found that the provision of intimate services for women has been identified as a factor that has contributed to negative perceptions by male nurses and the need to develop strategies to allow for completion of job duties. Participants in our study reported the need to alter treatment approaches to address intimacy issues. Examples include adapting activities of daily living (i.e., putting a bra on over a shirt), developing trust and rapport before intimate encounters, and adjusting caseloads. Social forces yielded another factor that male occupational therapists should recognize.
The sociocultural climate in the United States at the time of data collection may be construed as critical toward men, particularly those in positions of power or authority. Women nationally have shared their experiences of sexual harassment, and high-profile men have been accused and prosecuted for sexual misconduct (Pazzanese & Walsh, 2017). The movements that relate to the treatment of women have increased awareness of these issues in the United States. Although awareness is important, it may create psychological stress for male practitioners who must address intimate topics with women. Fisher (2009) reported that male nurses felt the need to have a witness present when administering sensitive care. Participants also expressed fear of perceived sexual inappropriateness when working with female clients. Despite acknowledging that they could have provided beneficial services to women, many practitioners chose not to do so because of the possible perception of sexual inappropriateness. Because of the potential effect on a male practitioner's job duties, some participants believed that this concern may steer male practitioners into settings where sensitive care is uncommon. Men may need to develop additional skills to modify their approach, and appropriate occupational therapy training is needed. All practitioners should carefully monitor the content and delivery of information. Similarly, male practitioners must be aware of events that influence the sociocultural climate and practice settings. With such awareness, practitioners can use best practice; this includes maximizing safety for both the client and the practitioner.
In the workplace, men may be seen as having more physical strength and assertiveness in difficult situations compared with women. There are times when these attributes must be used; however, when dealing with certain personal issues, this role must shift to assume appropriate sensitivity. If this shift does not occur, men may appear inappropriate in their encounters with women. This shift is described by Fisher (2009) as “chameleon-like” in that male nurses changed their attitude and behavior to match clients, meaning that they must be cognizant of their approach. Participants saw this as a surmountable challenge, describing it as “part of the job.” It is apparent that some men may feel less able to use their natural strengths and perspectives to benefit the profession as a result of current sociocultural views.
Participants' experiences formulated the final theme, which involved the information that they considered most important to share with novice therapists. In explaining the Model of Human Occupation, O'Brien (2017) described the “lived body experience” as the subjective collection of personal encounters that shape perception and behavior. This phenomenon was evident in the way that participants spoke about information that is pertinent for future practitioners, with a clear focus on embracing the positive aspects of gender in the workplace.
Limitations and Future Studies
Limitations included a small sample size, no northeastern U.S. representation, no participation of occupational therapy assistants, and omission of interview responses on role strain. Notably, participants' interpretations of fieldwork experiences had a strong influence on their careers, although it was not determined to be a focal point of this study. Several participants recalled experiences that happened 20 years previously and molded future practice endeavors. Future studies using similar methods would be beneficial, with a primary focus on education or practice settings. What are the experiences of male and female students in occupational therapy programs, and how do they differ? How do occupational therapy educational programs specifically address the needs of men versus women? Examining educational programming with regard to gender may yield useful information that can enhance learning and awareness of gender as a diversity variable. What are the experiences of female practitioners when working with male clients, and how are they similar to or different from the current findings? Are there gender-related differences in the strengths and weaknesses of practitioners? What are the experiences of students or practitioners who do not identify with traditional gender categories? Capturing the global experiences of men would also help us to understand the differences in the composition of the workforce in various countries. Better understanding of occupational therapy students and practitioners is needed to recruit and maintain a more diverse workforce, build more effective educational programming, and enhance service delivery in a profession that should be as diverse as the clients it serves.