Hospitals used to be run by nurses. Doctors were scared of Matron, the single (often quietly living with their “friend”) woman who did not marry and made nursing their career. Junior nurses were terrified of her. My mother was a teacher then married: my birth mother was a nursing student when she had me, returned to nursing, but chose to leave and marry instead.

Medical students in those times worked 80 — 120 hours a week: I know — I was one of them. The nurse worked shifts, and had a life: we did not. Since the medical school classes are now over 50% female, junior doctors work shifts, are less tired, and see less.

The hospital is much less functional. For equality.

Now we have managers. And our services are failing. This is from this month’s Quadrant.

So, when and why did women become more selfish? And how is this now impacting our society — and its future development — in major ways?

Consider first the very clear example of what happened to the nursing profession. O tempora, o mores! The world has had the benefit of caring nurses for eons, often as part of religious orders, or informally at local level. (Driving through a village in central Java once, I noted a particularly large and well-decorated house, and was told that was where the local midwife lived, as she was the prized professional no village family could do without.)

Modern Western nursing developed as a skilled profession only in the last 150 years, thanks in part to Florence Nightingale’s awful experiences nursing in the Crimea. That skilled profession changed the world. (Up until the 1920s, it is said it was safer when ill NOT to be in a hospital than to be admitted to one.) Within fifty years, nursing was seen as a successful, highly suitable career for young women from a wide range of backgrounds. The profession emphasized — in contrast to the world of business — non-capitalist and decidedly-Christian virtues: Service, unselfish devotion to the needs of others, and disregard for monetary reward.

Older readers will recall just how common it was for so many young women to leave school in their teens to “go nursing”. (Watch Call the Midwife for a rather biased reminiscence of how this had evolved in 1950s London.) Then the young nurses lived in strictly-supervised nurses’ homes, with full board provided, and worked round the clock in the hospital next door, for low wages with little prospect of promotion. If you ask many an older nurse, they had a lot of fun and satisfaction in living and working this way, not to mention their ability to delay choice of a mate, allowing them a little more choice for themselves. The general idea was that most nurses would marry soon, and leave nursing, to make a home and rear children, and be provided for materially by husbands (often delighted they had found a loving, unselfish and skilled partner.

By the 1970s, in many Western countries, there was first outrage at and then legislative action to improve the very low wages that nurses earned (although the housing and catering benefits added something). At the same time, fledgling degree courses in nursing opened up, and graduate nurses were encouraged to stay in nursing after marriage and to follow their interests via sub-specialisation — involving further study, less out-of-hours work, more autonomy, and better wages. (The Greiner government in NSW removed some of these benefits for specialised nurses in the late 80s – much to the chagrin of those who took these roles or worked alongside them.

Since then, to become a registered nurse one must finish high school and undertake several years of tertiary studies in nursing. Arguably, those years at university are just the time when, physically and emotionally, young women are most capable of dealing with the arduous and draining, 24/7 roller coaster ride that busy acute nursing can be. (I say “young women” because – despite various attempts by social engineers to change this – over 90% of nurses are and seem likely to remain women. There are some skilled and devoted male nurses. But perhaps it is most men’s innate selfishness that stops most from ever contemplating a nursing career.

Today, in many Western countries there is a worsening shortage of nurses, which doesn’t bode well for any of us, as we age and become more likely to need nursing care. Almost half of recent nurses employed by the UK’s National Health Service are new immigrants, already trained in nursing overseas, and often in countries where notions of female devotion to unselfish service remain popular, albeit decreasing. Many Western, university-trained nurses drop out or switch to a related (but less 24/7 or emotionally draining) field in health sciences. Some of the best doctors I have met are ex-nurses, who understand all sides of healthcare priorities. But the worrying result is that our ageing society, with many more of us living with some sort of disability that requires skilled nursing help, is running out of its most vital resource – devoted young nurses.

In short, because women have (correctly, according to our society) become more selfish, we may see a decline in our society’s ability to care for basic, unchanging, often unpleasant and sometimes heart-wrenching needs of the sick and aged, even with all the technological advances that restore function and help keep them alive longer. And yet, what we have now is no doubt a more “equal” society between the sexes.

What has happened to nursing is just the tip of the iceberg however. The pendulum of gender-based achievement has swung a long way, and seems unlikely ever to swing back (short of the men with the scimitars taking over). As young Western women’s options and aspirations have changed, so has the brave new (and more selfish) society they are creating. Today’s average woman does better at high school, is more likely to go to and to graduate from uni, is more able to gain stable employment, is more likely to gain early promotion, and in some areas (e.g. medicine) is coming to dominate professions that 150 years ago were off limits to the “fairer” sex.

The flip side of this fast female advancement is that more men drop out of high school, fail to gain tertiary qualifications, have poor or unstable employment records – and are much more likely to be involved in risky behaviours (speeding, alcohol and drug abuse, gangs, criminal activities and suicide). Of course, those failures are not primarily women’s fault (although there is an argument that today’s mothers can/do devote less time to bringing up their boys to succeed, and thus more boys end up in low and risky avenues of life.) Yet, today’s women pay a price if they are unable to find a partner who can equal or complement them, or even stay the course.

Is this all really a problem? And, if so, what can society do about it (short of the scimitar)?

Well, the rise of the selfish-if-successful woman has implications for how we fundamentally treat each other. No longer is the capitalist, win-lose, business model that men created balanced to some degree by a caring, nurturing, pick-up-the-loser model that women mostly created. Oh, sure, politicians of all persuasions will say they are providing better aged pensions, better hospitals, better unemployment benefits, better social housing. But the sad truth may be – as women increasingly adopt a selfish male disregard for the less-well-off – that governments can’t keep up with the goals they have foolishly and deceptively set (Consider the USA’s 20 trillion dollar debt, for example, largely on the back of their social welfare budgets). At the same time, we decrease our charitable giving and works, and we don’t take up careers that look after the needs of the aged, ill or homeless.

In short, the rise of the selfish woman may be sowing the seeds of destruction of our so-called compassionate society. And yet, it is far too late (and probably not a reasonable or equitable proposition) to try to put the I-Dream-Of genie back in the bottle. The inability of Western society to persuade men to take up nursing roles – as these roles became less sought after by women – suggests that there is no ready way to “tweak” gender roles to re-address and hence re-balance the situation.

What is happening is that care is being deprofessionalized. From the Health and disability commissioner saying that those with lived experiences must be involved in running hospitals and psychiatric systems, to the roll out of telehealth and electronic talk without clinical trials, care is moving away from the professions.

For they have converged. They no longer meet their primary goal. They are now disempowered, run by managers and lawyers (such as the HDC commissioner) who have no skin in the game, and their response to failure is to continue down the same path.

As if that has ever worked.