The Persistence of Specialty Disrespect: Student Perspectives

Michael Alston, MD | Jeanne Cawse-Lucas, MD | Lauren S. Hughes, MD, MPH, MSc | Tyler Wheeler, MD | Amanda Kost, MD, MEd

PRiMER. 2019;3:32.

Published: 1/11/2019 | DOI: 10.22454/PRiMER.2019.570487


Purpose: One aspect of the hidden curriculum of medicine is specialty disrespect (SD)—an expressed lack of respect among medical specialties that occurs at all levels of training and across geographic, demographic, and professional boundaries, with quantifiable impacts on student well-being and career decision making. This study sought to identify medical students’ perceptions of and responses to SD in the learning environment.

Methods: We conducted quantitative and content analysis of an annual survey collected between 2008 and 2012 from 702 third- and fourth-year students at the University of Washington School of Medicine. We describe the frequency of reported SD, its self-rated impact on student specialty choice, and major descriptive categories.

Results: Nearly 80% of respondents reported experiencing SD in the previous year. A moderate or strong impact on specialty choice was reported by 25.9% of respondents. In our sample, students matching into family medicine, obstetrics/gynecology, and emergency medicine were most likely to report exposure. Content analysis identified two new concepts not previously reported. Internecine strife describes students distancing themselves from both disrespecting and disrespected specialties, while legitimacy questions the validity of the targeted specialty.

Conclusions: SD is a consistent and ubiquitous part of clinical training that pushes students away from both disrespecting and disrespected specialties. These results emphasize the need for solutions aimed at minimizing disrespect and mitigating its effects upon students.


The authors thank Doug Shaad, PhD, and Laura-Mae Baldwin, MD.


The University of Washington School of Medicine Medical Student Research Training Program supported this work. The funding institution had no role in the study design, in collection, management, analysis, and interpretation of data, in the preparation, review, or approval of the manuscript, or in the decision to submit the manuscript for publication. The views expressed in this article are those of the authorship team and not an official position of the institution or funder.


Alston MT. Specialty Disrespect at a Primary Care School: Student Perspectives. Presentation at the Western Student Medical Research Forum, Carmel, CA, January, 2013.

Kost A, Cawse-Lucas J. The Impact of Specialty Disrespect on Primary Care Residency Choice. Presented as a Work-in-Progress at the 47th Society of Teachers of Family Medicine Annual Spring Conference, San Antonio, TX, May 6, 2014.


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Lead Author

Michael Alston, MD

Affiliations: University of Washington School of Medicine, Department of Pediatrics, Seattle, WA


Jeanne Cawse-Lucas, MD - University of Washington School of Medicine, Department of Family Medicine, Seattle, WA

Lauren S. Hughes, MD, MPH, MSc - Pennsylvania Department of Health, Harrisburg, PA

Tyler Wheeler, MD - Family Practice Center, Atlanta, GA

Amanda Kost, MD, MEd - Department of Family Medicine, University of Washington School of Medicine, Seattle, WA

Corresponding Author

Jeanne Cawse-Lucas, MD

Correspondence: University of Washington School of Medicine, 1959 NE Pacific Street, Box 356390, Seattle, WA 98195. 206-543-9425. Fax: 206-543-3821

Email: cawse@uw.edu

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