The perception of prestige differences among medical subspecialities

doi:10.1016/0037-7856(73)90045-0

Social Science & Medicine (1967)

Volume 7, Issue 5, May 1973, Pages 365-371

https://doi.org/10.1016/0037-7856(73)90045-0 Get rights and content

Abstract

Modern occupations and professions are increasingly becoming internally differentiated into specialities on the basis of skills, education, roles, and behavior. This is probably most apparent in the field of medicine. Specializations are also an important basis for intra-occupational prestige rankings. This paper provides examination of the differential prestige accorded various medical specialities by practicing physicians in a metropolitan medical community. A comparison with an earlier study of prestige is also made, and the implications of prestige differences for intra-occupational interaction and organizational change are explored.

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2019, World Neurosurgery
Citation Excerpt :
In a study of neurosurgeon portrayal in film, Florian et al.15 noted that although neurosurgery is generally well respected by the public, neurosurgical procedures are often demonized as painful or torturous in feature films. The field of neurosurgery and its quintessential pathologies in particular are ranked high in prestige among members of the medical profession.16,17 Neurosurgeons may reinforce this image through differing narratives of particular neurologic diseases, emphasizing those for which neurosurgeons can most effectively intervene.18
Textual analysis of obituaries provides insight into the shared values of a profession or community. Neurosurgeon obituaries are frequently published in both the medical literature and the lay press, but the content of these works has never been analyzed.
Using obituary pieces from Neurosurgery, Journal of Neurosurgery, and the New York Times, frequent terms were quantified through preliminary text analysis to derive the relative importance of concepts such as innovation, research, training and family. The sentiment of these obituaries was qualitatively reviewed to approximate perceptions of neurosurgical legacy within the profession and the general public.
Thirty relevant obituaries with full text available were identified in the Journal of Neurosurgery, 14 were identified in Neurosurgery, and 23 were identified in the New York Times. Both neurosurgical journals and lay press articles relied on linear narratives, with greater emphasis on professional leadership and residency training in neurosurgical journals and proportionally greater mention of family in the lay press.
Our preliminary text analysis of neurosurgeon obituaries suggest what values are shared among the professional community and general public regarding the legacy of a neurosurgeon.
Stability and change in disease prestige: A comparative analysis of three surveys spanning a quarter of a century
2017, Social Science and Medicine
Citation Excerpt :
Moreover, he discovered that, when asked, physicians could rate disease categories according to prestige. Inspired by the long-standing tradition of research on occupational prestige (Treiman, 1977) and medical specialty prestige (Matteson and Smith, 1977; Schwartzbaum et al., 1973; Shortell, 1974), Album conducted a survey in which he asked physicians to rate 38 disease categories according to the prestige they believed health personnel would in general award them. The results showed that physicians were able to rate all 38 disease categories consistently, placing myocardial infarction, leukaemia and brain tumour at the top, and fibromyalgia, hepatocirrhosis, depressive neurosis and anxiety neurosis at the bottom.
In this paper, we present a comparative analysis of three survey studies of disease prestige in medical culture. The studies were conducted in 1990, 2002 and 2014 using the same research design. In each of the three rounds, a sample of Norwegian physicians was asked to rate a set of 38 diseases on a scale from 1 to 9 according to the prestige they believed health personnel in general would award them. The results show a remarkable stability in the prestige rank order over 25 years. The top three diseases in all three surveys were leukaemia, brain tumour and myocardial infarction. The four lowest ranked were fibromyalgia, depressive neurosis, anxiety neurosis and hepatocirrhosis. The most notable change concerns apoplexy (brain stroke), which moved from a rank of 33 to 29 and then to 23 over the three rounds. We argue that the stable pattern, as well as this change, substantiate the interpretation of previous research, i.e. that the prestige of a disease is affected by the localization of the affected organ or body part, the effect and style of its typical treatment, and the social attributes of the typical patient. Analysing physicians’ shared evaluations of different diseases, the paper contributes to the cultural understanding of disease conceptions in medicine. Understanding these conceptions is important because disease prestige may influence decision-making in the healthcare sector.
Bottom-up priority setting revised. A second evaluation of an institutional intervention in a Swedish health care organisation
2015, Health Policy
Citation Excerpt :
This is an important aspect of the horizontal work, where one aim was to scrutinize resource allocation among departments and specialities by using a common analytical tool. This goal was based on the assumption that actual allocation, rather than a result of a rational decision making process built on evidence, is a result of historical social processes among healthcare decision-makers and that it expresses the current prestige order of that group [29–32]. The order is built partly on closeness to research [29].
Transparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation.
Objectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge.
An action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys.
Vertical and horizontal priority setting occurred and resources were reallocated. Participants’ attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge.
Existing health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required.
Prestige rankings of chronic diseases and disabilities. A survey among professionals in the disability field
2015, Social Science and Medicine
Citation Excerpt :
For instance, Album coined the term disease prestige (Album, 1991; Album and Westin, 2008) to investigate the informal rankings of diseases among medical doctors. The investigation is grounded in a research tradition that has occupational prestige as the main unit of analysis (Treiman, 1977), but which also deals with intra-occupational hierarchies such as the prestige of medical specialties (Matteson and Smith, 1977; Rosoff and Leone, 1991; Schwartzbaum et al., 1973; Shortell, 1974). In line with this, disease prestige is seen to derive at least in part from specialist occupational prestige.
Disabled people constitute the world's largest minority; too little is known about the internal structure and valuations of that minority. We investigate whether prestige rankings of different chronic diseases and disabilities can be elicited from a community of disability non-governmental organizations (NGOs). A survey was performed in a sample of NGO professionals in Norway in late 2013 and early 2014. Two copies of a questionnaire was sent to 92 national and regional offices of disability NGOs requesting a response from either senior employees or elected officials, preferably one of each. Outcome measures were ratings on a 1–9 scale of the prestige these respondents believed most professionals in their field would accord to a sample of 38 different conditions. We find that there is a prestige hierarchy of chronic diseases and disabilities in the disability field. In this hierarchy, somatic conditions that are strongly associated with medical treatment were placed higher than either conditions that are characterized by permanence, or conditions are associated with psychosomatic etiologies. The elicited prestige hierarchy is at odds with prevalent normative positions in the disability field; there is a lack of fit between some of the field's central political goals and its internal evaluations. We propose that its structure can be explained through a) influence from the medical field, b) organization history, size, and prominence, and c) issues of credibility, shame and blame. Further research should be conducted into the structure and valuations of the disability field in general and people with disabilities and chronic diseases in particular.
The narrative (re)production of prestige: How neurosurgeons teach medical students to valorise diseases
2014, Social Science and Medicine
Citation Excerpt :
During fieldwork, he noticed implicit evaluations in doctors' talk of diseases, and he discovered that, when asked, they could rate diseases according to prestige. Inspired by a longstanding tradition of research on medical specialty prestige (Matteson and Smith, 1977; Rosoff and Leone, 1991; Schwartzbaum et al., 1973; Shortell, 1974), Album distributed a survey asking doctors to rate 38 diseases according to the prestige they believed health care workers in general would award them. The results showed that doctors were able to rate all 38 diseases consistently, placing myocardial infarction and leukaemia at the top of the hierarchy, and fibromyalgia and anxiety neurosis at its bottom.
It is well documented that doctors rate diseases in a prestige hierarchy, in which some diseases are valued more than others. However, little is known about how doctors acquire the knowledge to do this rating. Based on a fieldwork study of the teaching of neurosurgery at a Norwegian university hospital, this paper shows how notions of disease prestige are (re)produced through neurosurgeons' telling of disease narratives in medical education. The analysis presents their prestigious narrative of subarachnoid haemorrhage (SAH), a rare form of stroke, which neurosurgeons presented as an acute and potentially lethal but curable disease. In contrast to perceivably more ordinary diseases, their portrayal of SAH references heroic narratives on a more abstract cultural level, casting neurosurgeons as masculine and extraordinary lifesavers, able to act where others fall short. By shedding light on how neurosurgeons teach students to evaluate diseases, the paper lays a foundation for reflecting upon the means and conditions that (re)produce their notions of disease prestige and contributes more generally to our understanding of medical culture.
Public perception of dermatologists and comparison with other medical specialties: Results from a national survey
2014, Journal of the American Academy of Dermatology
Citation Excerpt :
The secondary outcomes included public's perception of dermatologists in comparison with primary care physicians, cardiologists, and plastic surgeons with regards to perceived responsibilities and difficulties of the profession, work hours, and income level. Primary care physicians and cardiologists were chosen because these medical specialties were perceived highly by health care professionals in previous studies.1-3 In addition, primary care physicians offered a comparable outpatient-based medical practice.
The public's perception of dermatologists in the United States is unknown.
We sought to determine the US public's perception of how dermatologists spend time professionally and to compare the public's perception of dermatologists with physicians from other medical specialties.
We administered a telephone survey to the US public using the validated random digit dialing method.
We made 2353 telephone calls to randomly selected active numbers from 10 US area codes. A total of 800 adults (34%) completed the telephone survey. Overall, 46% of participants perceived that dermatologists spend a majority of their time managing skin cancer. Of respondents, 27% perceived that dermatologists spend a majority of their time performing cosmetic procedures. Compared with dermatologists, primary care physicians were perceived to have a more critical profession by 63% of participants, a more difficult job by 54% of respondents, and work longer hours by 92% of those surveyed. Similar findings were observed when dermatologists were compared with cardiologists. The public perceived dermatologists to earn more than primary care physicians but less than cardiologists or plastic surgeons.
Potential differences may exist between responders and nonresponders.
Educational efforts are necessary to better inform public understanding and perception of dermatologists' expertise.

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The perception of prestige differences among medical subspecialities

Abstract

Health and Healing

Processes in the development of established professions

J. Hlth soc. Behav.

Professions in process

Am. J. Sociol.

Interns: From Students to Physicians

Processes of control in a company of equals

Soc. Problems

The relative social prestige of representative medical specialities

J. appl. Psy.

Medical student attitudes toward four medical specialities

J. med. Ed.

Attitudes toward medical specialities: two follow-up studies

J. med. Ed.

Development of professional attitudes and capacities

Physicians and a hospital merger: patterns of resistance to change

J. Hlth soc. Behav.