UCL Medical School


When does the penny drop? Understanding how social class influences the UK Medical Profession

20 June 2023, 5:00 pm–6:00 pm

UCL main quad

When does the penny drop? Understanding how social class influences the direction of careers in the UK Medical Profession

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Asta Medisauskaite

In the UK, medicine is both socially exclusive and socially stratified as doctors from more advantaged backgrounds are more likely to train for specialities with more competitive entry. One study found for example that doctors who attended a fee-paying school are 1.7 and 1.4 times more likely to be training for speciality positions in medicine and surgery respectively, compared to general practice. The profession has recognised its overall composition should be broadly representative of the population it serves, but social stratification within medicine has been over-looked. This matters, because ensuring doctors are allocated to the ‘right’ jobs according to aptitude and skill is critical for the provision of effective healthcare.

Within the profession, a tendency for doctors from less advantaged backgrounds to take-up jobs in underserved specialities and locations has also been posited as a useful way to fill related shortages. This seems pragmatic but hints at exploitation if people with social identities constructed as ‘lower’ status are seen as a more obvious ‘fit’ for less attractive roles. In our article, we consider how social class influences speciality choice, based on a longitudinal study following thirty medical students from working-class backgrounds as they negotiate medical school and early careers. Theoretically, we draw from Bourdieu’s ‘theory of practice’ which has been widely used to show how forms of capital informing an individual’s socio-cultural outlook and dispositions internalised as habitus contribute to the reproduction of professional (dis)advantage. Bourdieu’s work has been accused of structural determinism, though we argue this is more likely where analyses draw on his core concepts in isolation, rather than interrelated, as he intended. To utilise his framework in this more inclusive sense and show trajectory over time, we present detailed analysis of the narratives of two interviewees to illustrate how class background or habitus influences and often limits speciality career, though not in a predictable or deterministic sense. In addition to proving the value of habitus as a research tool, our analysis offers important practical insights to ensure speciality positions are allocated on equitable grounds and identifies urgent questions for future research, as the UK medical profession continues to diversify while working conditions deteriorate.

About the Speaker

Dr Louise Ashley

Senior Lecturer and a Fellow of QMUL Institute for Humanities and Social Sciences at Queen Mary University of London