Physicians cultivate colleagues' esteem differently at low- and high-prestige hospitals

Research Activities, April 2011, No. 368

Professionals are expected to act according to the expectations of both their clients and their colleagues. Physicians, in particular, experience conflict when determining what kinds of expertise should be used in patient care. On one hand, patients may expect them to provide treatment based on the most recent medical innovations and evidence, an ideal that may be rarely realized. At the same time, physicians feel pressured to behave in accordance with the standards cultivated by their colleagues. To understand how this tension is resolved across hospitals with different patient populations, researchers recently looked at means by which physicians in different hospitals could cultivate their reputation. They found two very different routes of cultivating esteem in low- and high-prestige hospitals.

For this study, a survey was sent to all physicians working in general medicine service at six academic medical centers. The hospitals differed in size, geographic location, and prestige. Researchers obtained extensive background information on the physicians' demographic features and social network connections. Although consulting the medical literature did not raise the esteem of physicians in high-prestige hospitals, this activity positively affected a physician's reputation in the low-prestige hospitals.

In high-prestige hospitals, esteem was reserved for physicians with elite medical school training, as well as those physicians who allocated a smaller proportion of their time to clinical work. The authors conclude that high-prestige hospitals tended to focus on innovation and the creation of evidence-based guidelines for others to follow. Individually, physicians in each knowledge strata can strive to attain and maintain esteem from colleagues, while collectively advancing their field as a whole. By so doing, they can maintain professional autonomy from the influences of insurance providers, the medical industry, patients, and State stakeholders seeking to structure the knowledge used in medical care, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS16967).

See "The cultivation of esteem and retrieval of scientific knowledge in physician networks," by Daniel A. Menchik, Ph.D. (cand.) and David O. Meltzer, M.D., Ph.D., in the Journal of Health and Social Behavior 51(2), pp. 137-152, 2010.

Current as of April 2011
Internet Citation: Physicians cultivate colleagues' esteem differently at low- and high-prestige hospitals: Research Activities, April 2011, No. 368. April 2011. Agency for Healthcare Research and Quality, Rockville, MD.