Doctors' Orders

The Making of Status Hierarchies in an Elite Profession

By: Tania M. Jenkins

Narrated by: Ginger White

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.

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.

The book is published by Columbia University Press. The audiobook is published by University Press Audiobooks.

©2020 Tania Jenkins (P)2022 Redwood Audiobooks

Critic reviews

"A major contribution to our understanding status hierarchies within medicine and their impact on patient care." (Charles L. Bosk, author of Forgive and Remember: Managing Medical Failure)

"An insightful examination of the forces that drive status inequality in medicine." (Sandeep Jauhar, author of Intern: A Doctor’s Initiation)

"The book is a must-read for scholars interested in medical sociology and the sociology of professions as well as practitioners." (Lauren A. Rivera, author of Pedigree: How Elite Students Get Elite Jobs)

Objective description of culture but biases evident

Phenomenal description of cultural and professional stratification that accurately points to differences I’ve witnessed in both US MD and non-US MD clinical settings. Although she makes a valiant attempt to be neutral, weighing the pros and cons of cultural differences and differences in worldview rather than assuming superiority/ inferiority, I felt she did not extend the same level of balanced objectivity to her own worldview (ie challenging her own assumptions which appear to be rooted in critical theory’s framing of hierarchies in the over-simplified oppressor vs oppressed narrative). This was most obvious in her continued language like subjugation with its implied morality and emphasis on structural factors that was often at odds with the emphasis communicated by residents on individual choice.

TL;DR- She does an excellent job describing Chesterton’s proverbial fence but her analysis of why it is there / why it should or should not be there is limited by her presuppositions and worldview that is overly reliant on the reductive narrative of oppressor vs oppressed in her analysis of Medicine’s hierarchy. Despite this criticism I highly recommend this book to anyone interested in understanding the segmentation of the medical workforce.