In her new book, Doctors’ Orders: The Making of Status Hierarchies in an Elite Profession (Columbia University Press, 2020), Dr. Tania Jenkins engages readers in readers in a ethnography where she 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 found 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. This social separation can be observed by looking at the social class of residents and practitioners; sponsorship; status beliefs, bias, and stigma; structural inequality among training programs; and differences in merit that result from these inequalities.

The United States does not have enough doctors. Each year there are residency positions available for internationally trained and osteopathic medical graduates to fill as a result of there being too few American-trained MDs. These international and osteopathic medical graduates also outperform their American MD counterparts to have the same likelihood of getting a residency position. They, however, often end up in lower-prestige training programs while the American-trained MDs tend to occupy elite training positions. Some of the most prestigious programs are even fully segregated and accept exclusively U.S. medical graduates or non-U.S. medical graduates.

Tania Jenkins, Ph.D. is an Assistant Professor at the University of North Carolina-Chapel Hill in the Department of Sociology.

Michael O. Johnston, Ph.D. is an Assistant Professor of Sociology at William Penn University. He earned his doctoral degree in Public Policy and Public Administration from Walden University. He researches place and the process of place making as it presents in everyday social interactions. You can find more about him on his website, follow him on Twitter @ProfessorJohnst or email him at [email protected].