Politically incorrect paper: Given that sex egalitarian countries tend to have the greatest sex differences in personality & occupational choices, sex specific policies (increasing vacancies for the sex with lower hire proportion) may not be effective

Sex and Care: The Evolutionary Psychological Explanations for Sex Differences in Formal Care Occupations. Peter Kay Chai Tay, Yi Yuan Ting and Kok Yang Tan. Front. Psychol., April 17 2019. https://doi.org/10.3389/fpsyg.2019.00867

Abstract: Men and women exhibit clear differences in occupational choices. The present article elucidates sex differences in terms of formal care occupational choices and care styles based on evolutionary psychological perspectives. Broadly (1) the motivation to attain social status drives male preference for occupations that signals prestige and the desire to form interpersonal affiliation underlies female preference for occupations that involve psychosocial care for people in need; (2) ancestral sex roles leading to sexually differentiated cognitive and behavioral phenotypic profiles underlie present day sex differences in care styles where men are things-oriented, focusing on disease management while women are people-oriented, focusing on psychosocial management. The implications for healthcare and social care are discussed and recommendations for future studies are presented.

Definitions of Care
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There are clear sex preferences in the Science, Technology, Engineering, and Mathematics (STEM) domains (Lippa, 2010), and we expect the same sex preferences to underlie the formal care domains. Although sex ratio in STEM occupations has become less unbalanced in recent years, the sex differences remain in social disciplines such as Health and Welfare which has a greater proportion of female Ph.D. graduates (59%), contrasting with engineering, manufacturing, and construction (28%) (European Commission, 2016). Sex differences are also notable within formal care occupations. Globally, females outnumber males overwhelmingly and this sex difference is consistent across all ages, where the bulk of the female workers occupy people oriented professions such as nurses and social workers (Gupta et al., 2003; Rocheleau, 2017; Ministry of Manpower, 2018). The Luxemburg Income Study conducted with eighteen participating countries in Europe, America, Asia, and Oceania showed that across countries, at least 62–85% of health workers are females (Gupta et al., 2003). Specifically, a greater proportion of females worked in the nursing and midwifery specializations compared to physicians. In the following sections, we use EP theoretical frameworks to explicate the evolutionary roots that underlie these patterns.


Human Resource
Given that sex egalitarian countries tend to have the greatest sex differences in personality and occupational choices (Charles and Bradley, 2009; Lippa, 2010), sex specific policies such as increasing vacancies for the sex with lower hire proportion may not be effective. For instance, although demand for male-dominated blue-collar professions (e.g., manufacturing, mechanics) is shrinking while demand for female-dominated healthcare industry is growing, the resultant excess in male population in the work force did not lead to a corresponding increase in male employment in “pink-collar” formal care professions such as nursing or healthcare aides (Dill, 2017). Similarly, an overemphasis on sex-ratio reversal policies undermines the stronger effect of innate preferences. In particular, policies skewed toward promoting atypical sex employment may not ultimately lead to balanced sex employment and may be counterproductive. For instance, medical enrolment in favor of female applicants may place some eligible male applicants at a disadvantage (McKinstry, 2008). Furthermore, even though female students have a slight advantage in many STEM subjects compared to male students, female students nevertheless tend to pursue non-STEM education (Stoet and Geary, 2018).

Sex-role theorists argue that female physicians encounter greater occupational barriers because of the expectation that females are homemakers (Buddeberg-Fischer et al., 2010). Our present analysis suggests that instead, females have a natural inclination to provide care to their families. This understanding will change how we encourage females to remain as physicians. Particularly, females tend to trade-off their career development particularly when they have children so that they can devote more time for the family and more broadly, females also divert more resources toward the community, friends, and less on their careers (Ferriman et al., 2009). Thus, understanding innate preferences for sex differences underlying the effect of family demands and parenthood on career choices for medicine can provide potential solutions to facilitate the enrolment and maintenance of female physicians (Buddeberg-Fischer et al., 2010; Riska, 2011). On the other hand, males tend to undertake jobs that emphasize strong leadership and offer high extrinsic rewards such as higher income and prestige as indicative of one’s social status (Ku, 2011). Policies aimed to increase hiring of males in occupations such as nursing and social work will be more effective if is it coupled with changing societal perceptions of such professions. Awareness about the barriers toward females is nonetheless important, yet ignoring potential EP driven factors that would attract females and males into professions conventionally occupied by the opposite sex would be ineffective.

Conclusion
Today, psychologists understand that pure social constructivist views are insufficient in explaining sex differences and in some instances lead to incorrect conclusions. Furthermore, evidence is clear that innate tendencies exert considerable cognitive and behavioral outcomes. Thus, giving equal weighs to EP and sociocultural theories clarifies the issues related to sex differences in formal care by enabling the understanding of sex differences as emergent phenomena of the interaction between evolved tendencies and sociocultural pressures. Ultimately, this method of examination will generate more holistic views of sex differences in formal care occupations (see Table 1 for other examples and predictions using the EP analytic approach). We propose that key decision makers within the healthcare and social care sectors work with instead of against sex differences elucidated herein and researchers to be sensitive to innate sex preferences in developing research programs. Ultimately, understanding and accepting sex differences elucidated by EP theories not only enhances our knowledge, it sheds light on how problems and research can be fine-tuned based on more precise and nuanced insights additionally informed by sociocultural theories.