Doctoral Dissertation Research: Understanding Hierarchies within Internal Medicine Graduate Education

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SES-1303276 PI: Margot JacksonCo-PI: Tania JenkinsBrown UniversityIn 2012, 55 percent of all residency positions in internal medicine were filled by graduates from American medical schools (USMGs). The remaining 45 percent went to foreign medical graduates, US-born foreign medical graduates and osteopaths (DOs). This dissertation examines the experiences of this 45 percent by questioning the widely-held assumption that physicians are a monolithic "community of equals." As growing numbers non-US medical graduates fill less desirable positions within the medical profession, there is the potential for an unequal opportunity structure to form, putting these residents at a disadvantage relative to US-trained MDs. By pursuing the medical sociological tradition of hospital ethnography, this project will compare the experiences of residents in two types of residency programs - one that caters to USMGs and another to non-USMGs - in order to answer the following research questions: 1) How is medical education organized hierarchically and how does this organization lend itself to stratification among internal medicine residents of different training backgrounds? and 2) How does the occupational structure of graduate medical education affect the professional mobility of internal medicine residents? This dissertation will contribute to sociological understandings of occupational stratification by focusing not on gender or race, as other scholars have done, but on educational pedigree (degree type and location of medical school) as the driving force behind inequalities in professional status.Broader impacts:The results may help us make sense of the implications associated with a wide range of health care policies and the experiences of both patients and physicians. For example, internal medicine is a pivotal residency, as it offers graduates the option of either practicing primary care or going on to subspecialize. With health insurance extending to millions of new patients, there is a need for primary care practitioners. By understanding the experiences of internal medicine residents - including the opportunity structure that constrains their decisions to remain generalists or subspecialize - there can be better preparation for facing the growing need for these services.