Leaving the stethoscope behind: Public health physicians and the spectre of the ‘real' doctor

Medicine has often been viewed as a relatively homogenous grouping of professionals and prestige hierarchies within medicine itself and the implications of these hierarchies for individual and population health have been underexplored. Medicine has been subject to increasing levels of specialisation over the last century. With the advent of specialisation, hierarchies have emerged. Public health medicine is distinct in two connected ways from most other forms of medical specialisation; firstly, it is predominantly non-clinical and secondly, its concern is with populations, rather than individuals. Public health medicine challenges the relationship at the heart of biomedicine – the individual physician/patient encounter and it has relatively low prestige amongst the specialties. This low status persists in spite of the awareness that addressing the wider determinants of health, which is the task of public health, is crucial to improving population health overall and reducing health inequalities. In the face of this subaltern position within medicine and drawing on interviews with public health physicians this paper will investigate how doctors make sense of the transition into public health medicine and how they understand their positioning once they are within the specialty. Three key themes will be explored; futility, loss and role perception. The subaltern positioning of public health medicine within medicine as a body of knowledge elucidates the ways that hierarchies among medical specialties may not serve the best interests of either individual or population health or the reduction of health inequalities.