Featuring: Tania M. Jenkins, Ph.D.
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 nearly half of community internal medicine programs almost exclusively staffing non-USMDs, and nearly half of university programs almost exclusively staffing USMDs. How do these programs end up so segregated on the basis of medical training background?
To answer this question, I draw on three years of ethnographic fieldwork to explore recruitment processes at two segregated internal medicine programs: a community hospital staffing 90% non-USMDs, and a university hospital staffing 99% USMDs. I find that segregation in graduate medical education is the result of complex decision-making processes which are deeply imbued with notions of merit when, in reality, the Match is not an open competition. By contextualizing recruitment practices at these two hospitals within the broader field of residency programs, it becomes apparent that recruitment decisions—and their segregated outcomes—are at least partly shaped by the programs’ social positions within that field, and their desire to maximize prestige while minimizing risk. These findings help challenge the myth of meritocracy in medicine and shed light on how institutional preoccupations with status shape recruitment decisions.