Allied Health Faculty Rank Medical Physicians : A Preliminary Study

 

Introduction

 

In the main, physicians are stratified by the standard sociological criteria

of  class, status, and power. Class means economic variation and inequality. Status is

the levels of prestige or honor bestowed by others. Power is the ability to control others over and above their  own potential self interest. Relative to this research project, the authors will discuss

 the subculture of American medicine, and the three dimensions of stratification. These three will not be discussed in order, because the topics germaine to this research will require a reordering. Prestige as measured by allied health college faculty will be discussed last. 

 

 

Discussion

 

The Medical Subculture

 

All of American medicine is stratified as is most other phenomena in the natural and social world. According to medical sociologists, stratification can occur along the lines of stratification by education, prestige of hospital, prominence of clientele, and stratification by peers and related phenomena.. American medical doctors are the most prestigious within the medical subculture and within American society.

 

 1. Power

 

Administrators

 

Research appears to support that the most powerful physicians are administrators of  influential, affluent, and powerful hospitals. They are also likely to have some peripheral contact with patients, control of grants and publishable manuscripts, control of personnel, and abilities to direct resources to their own careers. They may also be on the board of directors of pharmaceutical companies, health maintenance organizations, medical boards, and other medical businesses and organizations. “Stars” are there because of their position of power. The authors do not know of any empirical measures of this dimension.

 

 

Researchers

 

Studies support that the next highest level and competing physicians are research professors who have control of large grants, research studies, medical students and patients who are part of the learning process and may be subjects of their research. They are likely to author textbooks and do lucrative pharmaceutical studies relative to new medications. This area has a qualitative discussion, but no empirical measures of this area to the best of the authors knowledge.

 

Practitioners

 

These individuals are stratified by medical privileges of specialization, affiliation with

 prominent  hospitals, important clients, and  large revenue producing solo or clinic practice.

They are more likely to located in wealthy urban-suburban areas.

 

The power catalyst is organized around an “inner fraternity” of powerful, well schooled, administrators,  researchers and practitioners. They have daily/weekly contacts, social bonds, and power to manipulate the medical market.  It also includes new recruits who will replace the elders of the hierarchy. Outside the core of the fraternity lie the “friendly outsiders” who are general practitioners, minorities , and women. The third ring are practitioners who have impoverished patients, rural locations,  or who have fallen out of favor with the elite.

 

 

To the authors knowledge, there are no  direct comprehensive empirical measures of the discussion listed above. However, US NEWS AND WORLD REPORT periodically reports on the prestige of hospitals, HMO’s, and educational institutions. These could be considered indicators of the previous description.

 

 

 

2. Class

 

Class is the economic allocation of medical income, salaries, and dividends. Some  physicians make more than others. This is directly measurable. It is the following:

Radiologists, Obstetric/Gynecological Specialists, Gastroenterologists, Anesthesthesiologists, Surgeons*Opthamologists, Internists, Pediatricians, Psychiatrists, Family practitioners, General practitioners.

(*Orthopedic Surgeons have the largest  reported salaries, but there is a downward skew because of the lower pay of general surgeons. Thus “all” surgeons is much lower as an average.) Although, there are over 80 specialties certified and recognized by the American Medical Association, the listed generated above by MEDICAL ECONOMICS is the most parsimonious.)

 

Methodology

 

1.Instrumentation

 

The Snell-Allen Physician Prestige Instrument is a 11 item listing of the major positions in the medical

subculture. They are derived from MEDICAL ECONOMICS classification of  physicians.  The instrumentation is consensually validated with the 11 professions followed by 5 equal appearing interval

asking the respondent to rank each specialty by quintiles with the top 20% to the bottom 20%.

It has face reliability and has been pre-tested for efficacy. The instrument assumes ratio interval and hard numbers. Thus, means can be derived. The instrumentation is available by request and is without copyright and may be used without the permission of the authors.

 

2. Sample

 

A purposive sample of ____ allied health faculty were queried. Allied health were chosen because they are most likely to teach students (including pre-med students) and to have also been practitioners in the

field. This is a preliminary study and at a later date we would like to sample physicians and the general

public.

 

Some may dispute the above, by indicating the source of income should be involved in the measurement. As an example, the prestige of the source of income is important. A high revenue producing doctor of a vitamin supply house should not be as important as a surgeon in  a major prestigious hospital. We will leave this for others to discuss.

 

3. Status

 

It is this area, that we concern our research.  There are numerous measures of social class and comparative findings in the American society support that physicians are generally the most prestigious occupation in the society, but also among other professions involved in the medical subculture.

 

There is only anecdotal information about the prestige of various types of physicians.  One might suspect that stratification of prestige would occur along the economic hierarchy listed above. Surely, specialists are more important than generalists,  and surgeons more prestigious than general practitioners. National data does not tell us that. We are in virgin territory.