Doctoral Dissertation Research: Understanding Hierarchies within Internal Medicine Graduate Education

2012年，55%的内科住院医师职位是由美国医学院（USMGs）的毕业生填补的。剩下的45%是外国医学毕业生、在美国出生的外国医学毕业生和整骨医生。这篇论文通过质疑医生是一个单一的“平等社区”的普遍假设来检查这45%的经历。随着越来越多的非美国医学毕业生填补了医疗行业中不太理想的职位，有可能形成不平等的机会结构，使这些居民相对于美国培养的医学博士处于不利地位。本项目将遵循医院人种学的医学社会学传统，比较住院医师在两种类型的住院医师项目中的经验，一种是针对USMGs的，另一种是针对非USMGs的，以回答以下研究问题：1)医学教育是如何分层组织的，这个组织如何使不同培训背景的内科住院医师分层？2)研究生医学教育的职业结构如何影响内科住院医师的职业流动？这篇论文将有助于对职业分层的社会学理解，而不是像其他学者所做的那样关注性别或种族，而是关注教育谱系（学位类型和医学院的位置）作为职业地位不平等背后的驱动力。更广泛的影响：研究结果可能有助于我们理解与广泛的医疗保健政策以及患者和医生的经验相关的含义。例如，内科是一个关键的住院医师，因为它为毕业生提供了实践初级保健或继续专科的选择。随着医疗保险扩展到数以百万计的新患者，需要初级保健从业人员。通过了解内科住院医生的经验——包括限制他们决定继续做全科医生或专科医生的机会结构——可以更好地准备面对对这些服务日益增长的需求。

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.