Men can HEAL

We need the same effort to get men into HEAL fields as women into STEM ones

Florence Nightingale, founder of modern nursing, fatefully said that the “hard and horny hands” of men meant they were not suited to “touch, bathe and dress wounded limbs, however gentle their hearts may be.”

Top line: We need a massive national effort to get men to move into jobs in the growing fields of health, education, administration, and literacy (HEAL), equivalent to the successful campaign to get women into STEM.

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Stat of the week: Just 5% of psychologists under the age of 30 are men.

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Chart of the week

From Of Boys and Men, Fig. 11.2

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Why it matters: Getting men into HEAL would be good for them (because there are many jobs there), good for the professions (because they face labor shortages), and good for the boys and men using those services (because they often prefer a male provider). It would be a win-win-win.

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Of Boys and Men is published this week! My book comes out on Tuesday September 27th. If you haven’t already, you can order now for release-day delivery in the US and the UK. If you already have, my sincere thanks.

The reviews and endorsements are coming in. I won’t bombard you with those here. That’s what Twitter is for! But I can’t resist mentioning some of the praise the book has received in the last few days from folks like Rep. Ro Khanna (“An important and insightful book”), Larry Summers (“I will think differently because of what his book taught me”) and Nicholas Christakis (“A necessary book, [rigorously and compellingly presented”). In the Sunday Times, Tomiwa Owelade says that “in terms of what is at stake, this is one of the most important non-fiction books of the year”.

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Also, my thanks to those of you who have subscribed to Of Boys and Men, and are helping to spread the word. If you like what I’m doing, here’s an easy way to share:

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“I didn’t know that men could be doctors,” my son said to me when he was about six. We were driving home from a visit to the pediatrician. I was perplexed. But then I realized that the doctor we’d just seen was the first male physician he’d encountered.

I reassured him that men could indeed be doctors. But I was careful to add, “and nurses, of course.” His observation was a powerful reminder of the feminist mantra: “you have to see it to be it.” If any particular activity, including a job, is seen as being for people of the opposite sex, it is unlikely to feature in your own aspirations.

My son’s elementary school had an all-female staff, so it took a while to convince him that men could be teachers, too. Role models matter. In an attempt at balance, we deliberately tried to hire men to provide childcare for our sons. This wasn’t always easy, of course, since men account for such a tiny proportion of childcare workers. one in particular, “Michael the Australian,” was a particular hit. He would pitch tents as “homework camps” and make the boys run after a rugby ball between assignments. Michael instinctively knew how to make doing homework less like a prison sentence and more like playing a game. (I sometimes wonder if this is one reason that Bryce ended up working in the childcare and education field.)

As Gloria Steinem said in 1995:

The way we get divided into our false notions of masculine and feminine is what we see as children.

More women in STEM, fewer men in HEAL

In recent decades, huge progress has been made in smashing the gender stereotypes associated with many traditionally male jobs, including science, medicine, engineering, law, and even the military. When the original Perry Mason series aired in 1966, just 4 percent of law students were female. By the time of HBO’s new version in summer 2020, there were as many women in law school as men. Terms like “female lawyer” and “female doctor” already sound antiquated.

Similar trends can be seen in other formerly male-dominated fields. In 1980, women accounted for just 13% of jobs in the STEM field (science, technology, engineering and math); the share has now more than doubled, to 27%. There’s more work to do here for sure. Progress has been especially slow in the tech world. But in general, what Harvard's Claudia Goldin calls the “auras of gender” around most male-dominated professions have declined.

But the same is not true in the other direction. Traditionally female occupations, especially in what I call the HEAL fields - in health, education, administration and literacy - have, if anything, become even more “pink collar.” Just 26% of HEAL jobs are held by men, down from 35% in 1980. The gender desegregation of the labor market has so far been almost entirely one-way. Women are doing “men’s jobs.” Men are not doing “women’s jobs.”

In broad terms, HEAL occupations can be seen as the opposite of STEM. They are more focused on people, rather than things, and they tend to require more literacy than numeracy skills; hence the L in place of the M. There may only be around 120,000 prime age workers (25 to 54 years) with job titles such as mathematician or statistician, but there are many more jobs where math skills are important.4 Likewise, there are roughly 150,000 authors, writers, and editors, but many more jobs where literacy and communication skills are important. (In my book, from which some of the material here is drawn, and in some forthcoming Brookings work, I define the category more precisely, in order to look at job growth estimates, pay levels, and son on).

Note that these figures are for full-time, prime age (25-54) workers, CPS data

In some occupations, the decline in the male share has been dramatic. The proportion of men in psychology, for example, has dropped from 39% to 29% in the last decade. And the trend is set to continue. Among psychologists aged 30 or less, the male share is just 5%. Fewer than one in five social workers are men (18%), half the proportion in 1980. The only occupation where the share of nurses has risen, albeit painfully slowly, is nursing, which is now 13% male.

Men account for just 24% of K-12 teachers, down from 33% in the early 1980s. Only one in ten elementary school teachers are male. In early education, men are virtually invisible. It ought to be a source of national shame that only 3% of pre-K and kindergarten teachers are men. There are twice as many women flying U.S. military planes as there are men teaching kindergarten (as a share of the occupation).

Why men in HEAL?

There are three pressing reasons to get more men into HEAL. First, given the decline in traditional male occupations, men need to look to these sectors for jobs. Blue collar jobs are disappearing. There will be more STEM jobs, too - but these are much smaller occupations. STEM accounts for only about 7% of all jobs, compared to 23% in HEAL. For every STEM job created between now and 2030, I estimate that there will be three new jobs in HEAL. The labor market is feminizing faster than men.

It is true that some HEAL jobs do not pay that well. Home health aides, for example, only make around $26,000 a year. But there are also plenty of HEAL jobs that offer good pay and benefits, including nurse practitioners ($100,000), medical and health services managers ($71,000), education and childcare administrators ($70,000), and occupational therapists ($72,000). It is no good waiting for the old factory gates to reopen. Whatever promises politicians make, the future of jobs lies in services like HEAL.

The second reason to get more men into HEAL is to help meet labor shortages in critical occupations. Almost half of all registered nurses are now over the age of 50. This means many are likely to retire over the next 15 years, especially if they are under greater stress at work. And the number of nurses and nurse practitioners needed is expected to increase by about 400,000 by 2030. In September 2021, the American Nursing Association urged the federal government to declare a “national nurse staffing crisis.” Kendra McMillan, senior policy adviser to the American Nurses Association. says:

Hospitals were having difficulty finding nurses to fill positions before the pandemic. The pandemic’s demand on the healthcare system has further exacerbated a long-standing projection that has burdened our nursing workforce.

Teaching faces similar challenges, especially in particular cities and states. Enrollment rates in teacher training programs declined by more than a third between 2000 and 2018, and the fall was larger for men than for women. The pandemic made matters worse. Drastic action is being taken in some places. New Mexico has drafted National Guard soldiers as substitute teachers; a Minneapolis school district asked for parent volunteers to get a substitute teacher license; and Polk County, Florida, flew in sixty teachers from eight foreign countries, all with J-1 visas. Gov Ron DeSantis is now allowing veterans without a college degree, to teach.

But these are short-term solutions at best. A massive teacher recruitment drive is needed, including among men. We face labor shortages in two of the largest and most important sectors of our economy—health care and education. But we are trying to solve them with only half the workforce.

The third argument for men in HEAL is to provide a better service to boys and men. Many would prefer to be cared for by a man , especially in certain circumstances. Consider the case of a man in need of help using the bathroom in a hospital or care home, or the middle-aged man needing a therapist to help with his addiction to pornography, or the fatherless teenage boy needing help from a psychologist with their substance abuse. In each case, they may prefer a male provider. At the very least, it should be an option.

It is not ideal if most substance abuse counselors are women (76%) when most substance abusers are men (67%), or that most special education teachers are women (84%) when most students being referred to special education are male (64%). I’m not saying we need to aim for perfect gender parity in these occupations. But it is reasonable to aim for a closer match between users and providers.

Getting more men into HEAL occupations would be good for men, good for the professions, and good for clients—a win-win-win.

But how?

By learning the lessons from the successful movement to get more women into STEM professions. As a society, we recognized the need to get more women into STEM jobs, and invested accordingly. Now the same is true of men and HEAL. I propose at least a $1 billion national investment, over the next decade, in service of this goal.

We need new scholarships for young men choosing to study HEAL subjects at college, like the existing ones for women pursuing STEM. This should include getting more men into vocational training courses, too, such as in health administration. We need an aggressive recruitment program to get more male educators in HEAL subjects: right now, only 6% of nursing professors are male. We need subsidies for HEAL employers to diversify their workforce by hiring more men. Higher pay would help, too. K-12 teachers have not seen a pay rise this century.

Funds should also be made available to HEAL employers to encourage them to hire more men. Again, we can learn here from the women-into-STEM movement. There is already a good policy framework in place, the Workforce Innovation and Opportunity Act (WIOA). This allocates funds toward workforce development pro- grams, particularly in order to help displaced or less skilled workers find employment in the fast-growing sectors of the economy. In 2021, $5.5 billion was spent. A number of programs to support women, including in STEM fields, are funded through this legislation. But there are no WIOA programs to help men into HEAL occupations, as far as I have been able to discover. This is a serious policy blind spot.

Identity Matters

Above all, we need a culture shift so that certain jobs stop being seen as no-go zones for men. This means tackling the stigma faced by many men who do choose these roles as effeminate, or as professional failures. Women have had to break down gender stereotypes to enter male professions; men will have to do the same for female-dominated HEAL jobs.

Back in 2000, Rachel Kranton and George Akerlof created a new scholarly field of “identity economics.” They showed that individual decisions are shaped not just by the hard numbers of a cost–benefit analysis but by the more personal aspects of human identity. As they wrote:

In a world of social difference, one of the most important economic decisions that an individual makes may be the type of person to be. Limits on this choice would also be critical determinants of economic behavior, opportunity, and well-being.

Breaking prescribed gender identity norms, for example, comes at a cost to an individual. This acts as a deterrent. An equilibrium is created that maintains the norm, and thus the cost of breaking it. or as they put it: Ij = Ij(aj,a_ j;cj,ej,P)

Kranton and Akerlof applied their model to segregation in the labor market, as well as unpaid work at home. They argued that feminism reduced the “identity loss” for women choosing to work in traditionally male jobs, and to men working in pink-collar jobs or in the home. But so far only the first of these has been true. The same year that Kranton and Akerlof published their paper, the comedy film Meet the Parents hit the screen. one of the main themes of the movie is that the main character, played by Ben Stiller, is a nurse. As another character to him:

That’s great to give something back like that. I’d love to find time to do volunteer work.

Role models are crucial here. You can’t be what you can’t see. Popular culture has an important part to play here. Decisions made in Hollywood and New York about the TV shows, adverts, and movies consumed by millions can influence behavior more than any laws passed in Washing- ton, DC. Will and Grace helped pave the way for marriage equality. MTV’s 16 and Pregnant significantly reduced teenage pregnancy rates. A stronger representation of men in HEAL roles in shows and ads could help to reduce the identity loss for boys and men who might pursue these professions.

All these proposals will require intentional effort and institutional support. Some can be public. Just as the National Science Foundation supports a range of initiatives for women into STEM, the Department of Health and Human Services could do the same for men into nursing, and the Department of education for men into teaching. But we also need philanthropic foundations committed to gender equality to de- vote some of their resources to the cause of men in HEAL. We need companies to sponsor conferences, mentoring programs, and marketing campaigns. We need new, well-resourced nonprofit and advocacy organizations, like those that have been so successful at getting more women into STEM.

We need, in short, a national effort. As I have argued here, getting more men into HEAL jobs is important for their own economic prospects, given the decline of many traditional male jobs. But I also hope to have persuaded you that it would be good for society too. Men can HEAL.

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