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

by Tania M Jenkins

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.

Genres: Nonfiction, Medicine

352 pages, Hardcover

Published July 21, 2020

Reviews

[natasha sanghvi]

if this mf school is going to assign me fifteen hundred texts at the same time rest assured they will end up on goodreads. this book was so repetitive it made me want to gouge my eyes out but the content was 10/10

[Maggie · Rating 4 out of 5]

book for med soc: very informative on the match process and the obstacles that IMGs face with great anecdotes but overall a bit repetitive

[Alejandra Colón López · Rating 5 out of 5]

I love Tania Jenkins and her work. This one of my top favorite Medical Sociology books.

[doria · Rating 2 out of 5]

I have mixed feelings about this book. I read it for my medical sociology class; Jenkins, through ethnographic examination, highlights a lot of important and interesting patterns reflected in the medical education system + medical labor market. While most people are aware of the vertical hierarchy that exists in medicine (doctors>nurses>technicians, etc.), there is also horizontal stratification within the same profession (USMD> DO, IMG, etc.) that arguably begins long before undergrad based on socioeconomic status. I was really interested in the unveiling of practices and beliefs in medicine that are often shoved under the rug: e.g. the fact that American-trained MDs are sometimes accepted into prestigious programs over international and osteopathic graduates who outperform them because of the informal social contract that basically guarantees allopathically trained doctors a high paying job once they are in medical school.
This book compares a high prestige program with a lower prestige program, but seemed to just find the problems with both - pretty discouraging.
I would recommend if you are interested in medical sociology and the inner workings of residency programs, but it is very repetitive and not very enjoyable - it was definitely an educational read, and didn't really leave me with much inspiration.

[Sarah · Rating 5 out of 5]

Jenkins in-depth ethnographic research gives rise to a holistic understanding of the recreation of status of an elite profession in the US. Despite having no formal policy that prioritizes USMDs, USMDs are treated to immense privilege over DOs, IMGs, and USIMGs. She does a great job sectioning off the chapters into different phases of residency, while also brining home points that build on one another.

[Amaavi Miriyagalla · Rating 5 out of 5]

this book was crazy: the status separations between USMDs and osteopathic/foreign MDs is so much more evil and nuanced than I was expecting. and the system is such that they are complicit in their subordination- thought of "what do we tell the losers to keep them playing" from a recent reading about the US K-12 education system. it's all connected

[Nathan Douthit · Rating 5 out of 5]

Everyone involved in medical education (specifically graduate medical education) should read this book.

[Savannah Wasson · Rating 5 out of 5]

Painful to get through because very research heavy, but so insightful. All pursuing medicine should read

[Hannah · Rating 4 out of 5]

Learned a lot, but also so realistically devastating