(Re)creating spaces within rural general practice : Women as agents of change at the organisational and practitioner levels

This thesis examines how women, as agents of change, contest the male-dominated structures at the organisational and practitioner levels of rural medicine in Australia. The premises for this study are that females now outnumber males as medical graduates and general practice trainees, yet women are significantly less likely than men to occupy rural and remote practice positions in Australia. Furthermore, the organisation of medicine remains strongly patriarchal. A feminist qualitative design underpins this empirical study involving: in-depth interviews with seventeen women activists and thirteen rural women general practitioners; grounded theory analysis of transcribed interviews; and interpretation of findings through a feminist poststructural lens. Findings uncover the gendered organisational and practitioner environment through which change is negotiated. At the organisational level, male exclusionary practices – played out through the ‘male as norm’ and the ‘problem is women’ discourses – position women in highly contradictory ways and marginalise their voices. Yet simultaneously, activists are challenging entrenched interests through individual and collective strategies of change which include: initiating gender-awareness projects; claiming legitimacy by using male-centred tactics and women-defined discourses; developing female-friendly initiatives; and mentoring of and building alliances between women. At the practitioner level, results reveal how women’s everyday lives as rural general practitioners are shaped by oppositional tensions. However, beyond the struggle of ‘fitting in’, women are altering rural medicine by (re)shaping meanings and (re)constructing work practices. Furthermore, their narratives suggest that rural spaces are integral to ways women carve out women-defined practice. A key innovation of this thesis is analysis of change at dual levels, both organisational and practitioner. This thesis marks a significant advancement upon the usual themes that attend only to the marginalisation of women and rural areas. It highlights the transformative process through which women (re)create the discursive spaces of rural general practice.Doctor of Philosoph