Inequality in Medical Professionalization and Specialization

• Main Author: Madzia, Jules L
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2023
• Subjects: Educational sociology; Health sciences; Sociology
• ISBN: 9798380068581

In recent years, nearly all medical schools in the United States have made major investments in recruiting students with minoritized identities. Despite this, the students who match into the most competitive and prestigious medical specialties are predominantly straight, white, cisgender men, while students with minoritized identities disproportionately match into less competitive specialties. Building on sociological literature that frames medical institutions as racialized organizations where disparities in social, cultural, and economic capital are amplified throughout the course of medical training, I used grounded theory methodology to analyze in-depth interviews with 49 medical students in their final year of allopathic medical school. Participants’ racial and ethnic identities were: 55% Black, 26% white, 13% Asian, 4% multiracial, and 2% Latinx. Participants’ gender identities were: 68% cisgender female, 26% cisgender male, and 7% transgender/non-binary; 33% of participants identified as LGBTQ+. I present my findings in three journal article-length papers demonstrating that: 1) medical students with minoritized identities experience tension between medicine’s professionalism standards and expression of their own identities which they must navigate, often at a detriment to their mental health and academic performance; 2) medical students with minoritized identities desire mentors who can provide emotional support, career advice and advocacy, and help with navigating medical culture; however, there are racial, gender, and sexual orientation-based disparities in who can access high quality mentorship; and 3) medical students with minoritized identities are deterred from pursuing careers in surgery through their perceptions of surgical culture.While stratification in specialization is often attributed to explicit discrimination and active discouragement from pursuing competitive specialties, this dissertation furthers our understanding of the structural barriers and other underlying mechanisms that contribute to inequality in medical specialization and create a physician workforce that is not representative of the people it serves.