Health Humanities Grand Round with Dr. Tania Jenkins

“Doctors’ Orders: How Status Hierarchies in Medical Education Can Shape Approaches to Patient Care”

Every year, the US relies on osteopathic and international medical graduates (non-USMDs) to fill around one-third of post-graduate residency positions because there is a shortage of American graduates (USMDs). Non-USMDs, however, are often informally excluded from top residency positions and disproportionately tend to train in lower-resource environments, while USMDs tend to fill the most prestigious and well-resourced residencies. Nationwide, this has resulted in highly segregated programs, with more than half of all community internal medicine programs almost exclusively staffing non-USMDs, and over one-third of university programs almost exclusively staffing USMDs. How does the residency training of non-USMDs in community hospitals compare to USMDs’ in university hospitals? Drawing on 23 months of ethnographic fieldwork and 123 interviews, Jenkins compares training at two internal medicine programs: a community hospital staffing 90% non-USMDs and a university hospital staffing 99% USMDs. The community program’s structure lent itself to a hands-off approach resulting in “inconsistent autonomy.” In contrast, the university hospital supervised its residents much more regularly, resulting in “supported autonomy.” Jenkins concludes that medicine may be stratified in unexpected ways between USMDs and non-USMDs, and that stratification may matter for patients.

About the speaker:

Tania M. Jenkins is an assistant professor of sociology at UNC-Chapel Hill. She is also a faculty research fellow at UNC’s Cecil G. Sheps Center for Health Services Research and the book review editor at Social Forces. Her research examines how and why status hierarchies are (re)produced in the medical profession and how they impact both doctors and patients. She recently published Doctors’ Orders: The Making of Status Hierarchies in an Elite Profession with Columbia University Press.

How to attend:

Health Humanities Grand Rounds events will be held via Zoom this fall. These events are free and open to the public, but pre-registration is required. Click here to register or visit bit.ly/HHGRJenkins.

If you have questions, please contact the HHIVE Lab at hhive.unc@gmail.com.