Research
My scholarship is situated at the intersections of medical sociology, the sociology of professions and work, and stratification, and focuses specifically on three interrelated areas: (1) job satisfaction and wellbeing in medicine; (2) professional inequality; and (3) medical education.
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Professional Job Satisfaction and Wellbeing
This broader research stream uses the case of physicians to explore the structural drivers of burnout, distress, and dissatisfaction among American professionals.
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By most accounts, doctors are struggling. One in five is clinically depressed. One in ten has considered suicide. An estimated 50% are burned out (i.e. feel emotionally exhausted, disengaged, and/or professionally ineffective), and about 15% report such high burnout that they are ready to quit medicine altogether. The COVID-19 pandemic certainly intensified these troubling patterns, but physician wellbeing has long been tenuous, despite being an extremely well-educated and well-resourced group. What is it about the profession that might be driving these outcomes? After all, healthy and satisfied physicians are critical for high-quality healthcare, as burnout and distress have been shown to contribute to higher turnover, preventable errors, and increased bias against patients.
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Between 2017-2024, with funding from the Canadian Institutes of Health Research and the U.S. Health Resources and Services Administration, I gathered a large mixed-methods dataset examining the societal, professional, and organizational-level factors shaping physician wellbeing and satisfaction. This included a 15-month comparative ethnography of general pediatricians and pediatric surgical subspecialists, nearly 200 interviews with respondents from across the career span, from pre-meds to late-career attending physicians, and quantitative burnout and satisfaction measurements. Broadly, I find that high levels of burnout and distress in physicians stem from a broken social contract between medicine and society. To earn the promised rewards of respect and autonomy that come with a career in medicine, physicians in training dutifully put up their end of the bargain; they master specialized knowledge and technical skills and pledge to act ethically and altruistically. But when they enter clinical practice, many experience a kind of bait-and-switch. Instead of autonomy, physicians often face bureaucratic hurdles and third-party interference. Instead of respect, they tend to feel unvalued and ignored by employers. Instead of societal trust, many face skepticism and consumerism from patients. The result is an ideal setup for distress among professionals who feel they have been sold a bill of goods. This was especially true for the general pediatricians who effectively served as shock absorbers, routinely absorbing countless, often conflicting, bureaucratic and professional demands (“shocks”) and converting them into competent medical care, at a significant cost to their mental health. Yet, I also found hope in doctors who experience greater agency. Those who were structurally positioned to deflect conflicting demands—either because of their seniority or specialty—were better able to align career expectations with lived reality, making them happier and more satisfied. I conclude that the key to reducing burnout and distress in medicine is to bring the symbolic promises of physicianhood and the structural realities of medicine into closer alignment.
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Findings are currently being published in article form, including recently in Social Science & Medicine. I am also working on a book manuscript tentatively titled Broken Promises: Why So Many American Physicians are Sick and Tired, where I link physicians’ experiences to the broader decline of American professions since the 1970s. The book calls for a re-imagination of professional work and training in the 21st century and a broader reckoning of how current systems set so many of us up for disappointment and exhaustion.
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In addition to these independent project, I am also a co-investigator on the Study To Examine Physicians’ Pandemic Stress (STEPPS). With funding from the Greenwall Foundation and an R21 grant from the National Institute of Occupational Safety and Health (NIOSH), STEPPS integrates qualitative interviews with conceptual analysis to investigate moral stress experienced by physicians working on the front lines of COVID-19 care in four American cities. Results are emerging, with findings already published in The Annals of the American Thoracic Society, the Journal of General Internal Medicine, Perspectives in Biology and Medicine, American Journal of Industrial Medicine, and forthcoming in the Journal of Health and Social Behavior and The American Journal of Bioethics.
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Professional Inequality
My first book, Doctors’ Orders: The Making of Status Inequalities in an Elite Profession (Columbia University Press: 2020), examines the construction and implications of status inequalities among medical residents. The US relies on osteopathic and international medical graduates (non-USMDs) to fill residency positions due to a shortage of American graduates (USMDs), but non-USMDs are often excluded from top residency positions, sometimes resulting in fully segregated residency programs. How do international and osteopathic physicians end up so marginalized in medicine, despite the U.S. importing some of the world’s best and brightest? And how do these status hierarchies shape USMDs and non-USMDs’ education and mobility in the profession? I draw on 23 months of fieldwork, including more than 1,200 hours of participant observation and over 120 interviews, to reveal the unspoken, taken for granted mechanisms that lead to these hierarchies among supposed equals in medicine. My book introduces a theory of status separation to describe the process by which physicians are differentiated by pedigree into various strata according to their social and professional worth. The colloquialism, ‘the cream of the crop,’ is often used to describe the best of a group, and meritocracy is often assumed to be the process that separates out the elite. I complicate that assumption by showing how informal social forces, such as (1) broader class inequality, (2) professional sponsorship, (3) status beliefs, bias, and stigma, (4) structural inequality between training programs, and (5) eventual differences in merit borne from the above inequalities, all contribute to status separation in medicine.
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These findings help reorient sociological thinking about the medical profession, which until now has largely overlooked the role of non-USMDs, as well as the informal mechanisms that contribute to horizontal stratification between doctors in the same specialty according to pedigree. They also advance the literature on health disparities by shedding light on how professional inequalities may contribute to patient inequalities.
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Aside from Doctors’ Orders, I have published 6 peer-reviewed articles from this area of research, which can be accessed here.
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Medical Education
The aforementioned projects build on my ongoing research agenda in medical education, a field which is currently experiencing a resurgence in sociology. In a shared first-authored article with Kelly Underman (and other coauthors) in the Journal of Health and Social Behavior (2021), we trace this resurgence of the sociology of medical education since 2000 and propose an ambitious research agenda for the coming decades. At the moment, I am working on a study (currently under review) focusing on the very earliest stages of the physician career course—the socialization of pre-medical students. In collaboration with two Ph.D. students, Grace Franklyn (first author) and Savannah Salato, we conducted a content analysis of 38 guidebooks aimed at aspiring physicians, to critically examine how the messaging in such books promulgates a highly classed, gendered, racialized, and able-bodied ideal of the profession. We conclude that these guidebooks may serve to suppress diversity within the applicant pool and perpetuate inequality within the profession; however, with careful revision, such books have the opportunity to serve as agents of change. This manuscript joins three other articles I've published about specialty choice after medical school (Medical Science Educator), medical student wellbeing (Advances in Health Science Education, 2018), and gender bias in residency training (Journal of Graduate Medical Education, 2017). All three of these aforementioned publications involved collaborations with physicians, thereby allowing my research to extend beyond sociology, and have an impact in the world of healthcare and medicine. I am also an executive member of The Sociology of Health Professions Education Collaborative, a national interest group of 150+ sociologists studying health professions or medical education. As a collaborative, we have organized sociological conferences, published a syllabus and exam reading list, and are currently editing an upcoming special issue in SSM-QRH--all on the resurgent field of the sociology of health professions education.
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Together, these efforts build on my robust research trajectory in medical sociology and the sociology of professions over the past fifteen years. I look forward to continuing this trajectory and producing high-impact work from these new projects in the near future.