The Hidden Curriculum: Specialty Disrespect

“You’re too smart to go into primary care.”

“Call medicine and make them do it.”

“How could the ER miss this?” 

“The patient is coming from an outside hospital, so who knows what kind of care they’ve gotten.”

“I’m not sure what your prior doctor was thinking.”

“Radiology is for those who don’t like talking to people.”

Microaggressions in healthcare come in many forms. We hear about them regarding gender, cultural, and racial biases. Medical education continues to integrate training to address harmful intrinsic biases and microaggressions to right the ship of equity and inclusion throughout medical training and patient care. 

But what about the microaggressions toward other specialties? 

Specialty disrespect is a pervasive behavior in medicine. And, with the worsening of healthcare silos and the decline of face-to-face interactions, specialty disrespect is only getting worse. We dismiss the skill and expertise of other specialties with our verbal slights on hospital rounds. We criticize each other through passive-aggressive comments in clinical documentation. We joke with medical students about the pervasive stereotypes of each specialty and then question their choice when they don’t align with that image. 

Rather than face systemic challenges head-on and build collegial relationships across specialties, we continue to sideswipe each other through indirect words and actions. Meanwhile, to learners in an educational environment, this behavior has major impacts. 

A survey of third- and fourth-year medical students at the University of Washington School of Medicine reported that 80% experienced specialty disrespect in their learning environment1. In a similar survey of medical students from Georgetown University, 31% stated that comments of specialty disrespect affected their career decisions and 21% said such comments affected team dynamics in hospitals2

And patients notice too. Patient perceptions of health care have been on rocky ground in recent years for various reasons. Subtle comments about a specialty or healthcare facility – good or bad – contribute to how patients perceive the healthcare system. If our words suggest distrust of each other, can we be upset when patients lose faith in what the healthcare system can do for them? 

We seem to live in an illusion that surviving the trenches of medical training grants us the privilege of disparaging those outside of our bubble. Meanwhile, our actions exacerbate the well-being crisis and drive us further from each other. Our behaviors further the feeling of isolation and distance us from the team-based model that we so desperately need in medicine. 

Imagine instead an environment where we consistently build up colleagues – no matter their specialty or place of practice. An environment where, like that of a professional sports team, each of us recognizes a teammate’s unique position, skill, and perspective on the game – working together to create the win.

1. Alston, et al. The Persistence of Specialty Disrespect: Student Perspective. PRiMER (online). 2019;3:1. PMID: 32537572.

2. Georgetown University School of Medicine. Specialty Disrespect.


One response to “The Hidden Curriculum: Specialty Disrespect”

  1. Inderjit Singh Avatar

    Very interesting read. I will add specialty subspecialty and institution, disrespect!
    And it’s getting worse for the reason cited about.
    Thanks for bringing this out of the closet.

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