Doctors' Orders: The Making of Status Hierarchies in an Elite Profession

The United States does not have enough doctors. Every year since the 1950s, internationally trained and osteopathic medical graduates have been needed to fill residency positions because there are too few American-trained MDs. However, these international and osteopathic graduates have to significantly outperform their American MD counterparts to have the same likelihood of getting a residency position. And when they do, they often end up in lower-prestige training programs, while American-trained MDs tend to occupy elite training positions. Some programs are even fully segregated, accepting exclusively U.S. medical graduates or non-U.S. medical graduates, depending on the program's prestige. How do international and osteopathic medical graduates end up so marginalized, and what allows U.S.-trained MDs to remain elite? Doctors' Orders offers a groundbreaking examination of the construction and consequences of status distinctions between physicians before, during, and after residency training. Tania M. Jenkins spent years observing and interviewing American, international, and osteopathic medical residents in two hospitals to reveal the unspoken mechanisms that are taken for granted and that lead to hierarchies among supposed equals. She finds that the United States does not need formal policies to prioritize American-trained MDs. By relying on a system of informal beliefs and practices that equate status with merit and eclipse structural disadvantages, the profession convinces international and osteopathic graduates to participate in a system that subordinates them to American-trained MDs. Offering a rare ethnographic look at the inner workings of an elite profession, Doctors' Orders sheds new light on the formation of informal status hierarchies and their significance for both doctors and patients.

Table of Contents:
Preface Acknowledgments List of Terms and Acronyms Introduction 1. Meet the Residents 2. The Match List 3. A Day on the Wards 4. Grooming 5. Graduation 6. The Navy SEALs and the National Guard Conclusions and Implications Appendix: On Being a “Second-Year Intern” Notes Works Cited Index

About the Author :
Tania M. Jenkins is assistant professor of sociology at the University of North Carolina at Chapel Hill.

Review :
Doctors' Orders adds essential insights to our understanding of both status and elites. This empirically rich comparative study shows how the medical profession conceptualizes itself as rewarding talent, all the while structurally organizing itself to reproduce inequalities. These are important insights for understanding the medical profession, and they extend well beyond, to a general understanding of how stratification works in America. An important reminder that inequality exists everywhere, even within the medical profession. A major contribution to our understanding status hierarchies within medicine and their impact on patient care. Doctors' Orders is an insightful examination of the forces that drive status inequality in medicine. I recommend it for anyone interested in how the U.S. medical residency system really works. Doctors' Orders reveals stark divides in the experiences of medical school students and graduates in the United States based on degree type and nationality. Jenkins' fascinating ethnographic study shows how concerns about status at the individual and institutional levels pervade the selection and training of doctors and reproduce inequalities within the medical profession. The findings, however, transcend medicine, illuminating how taken-for-granted assumptions about the link between educational prestige and individual merit shape career outcomes among US professionals. The book is a must-read for scholars interested in medical sociology and the sociology of professions as well as practitioners. Doctors’ Orders sheds light on an area of medical sociology that is important but not terribly well understood. Jenkins's book is well written, insightful, and compelling. Its contribution will endure. With verve and an ethnographic sensibility, Jenkins explores how the medical profession informally sorts its members into elites and an underclass. Rather than merit, structural and institutional factors determine sharply diverging career paths. In this gripping but disturbing book, medical socialization meets social inequities along class, race, and nativist lines. An absolute must read. A clearly written, accessible, and powerful book based on rigorous research...that should change the way sociologists view the medical profession, professional training, and the reproduction of social inequalities within professions in the United States. Such penetrating analysis makes Doctors’ Orders an instant classic and forcefully announces Jenkins’s place at the vanguard of a new generation of scholars who apply sociological insights to the study of medical education. A must-read for those interested in medical education, the social organization of hospitals, and the reproduction of status hierarchies in the professions.