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) professional inequality, (2) job satisfaction and wellbeing in medicine; and (3) medical education.
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.
These findings help reorient sociological thinking about the medical profession, which until now has 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.
Aside from Doctors’ Orders, I have published 6 peer-reviewed articles from this area of research, which can be accessed here.
Job Satisfaction and Wellbeing in Medicine
My next major research project is a Health Resources and Services Administration (HRSA) National Center for Health Workforce Analysis-funded ethnography examining how structural factors work together to shape career satisfaction and wellbeing among American physicians and medical trainees. Roughly 1 in 2 physicians in the U.S. is burned out, with studies showing that physicians and medical trainees are consistently less satisfied with their jobs and are more burned out than workers with similar education levels and workloads. Furthermore, despite having better physical health outcomes than the general population, physicians have significantly worse mental health outcomes, including higher suicide rates. But while research on physician satisfaction and wellbeing has exploded in the last decade, much of this research has focused on individual-level causes and interventions. For its part, sociology is well-suited to understanding how social contexts can shape individuals’ experiences in the workplace but has yet to link the changing social context of medical work to individual providers’ experiences of satisfaction, and wellbeing. What is it about medicine that makes doctors so unhappy and unwell?
Data collection for this project is ongoing and builds in part on an International Association of Medical Science Educators (IAMSE)-funded pilot study (2018-21). That study investigated the unique determinants, experiences, and manifestations of burnout and poor mental health among male and female residents in the frontline specialties of emergency medicine (EM) and internal medicine (IM). Physicians in these fields are respectively among the most burnt out in their profession and report the lowest rates of happiness at work. Little is known, however, about how female residents’ unique experiences in these front-line specialties can affect burnout, career satisfaction, or mental health more generally compared to men. There is growing evidence of systematic gender inequality and bias against women throughout the medical profession, especially in some front-line work, like EM, with highly masculinized norms. Women residents therefore not only face the usual risk of burnout associated with the nature of the clinical work; they’re also training in a profession where they are systematically lower in status than men, with untold consequences for their mental wellbeing. Data analysis and manuscript writing are ongoing for both studies, with early preliminary results available here and final results expectedly shortly.
In addition to these independent projects on satisfaction and wellbeing in medicine, 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 and forthcoming in the Journal of General Internal Medicine and Perspectives in Biology and Medicine.
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. The JHSB article joins three others I recently 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 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.
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.