Hierarchy systems of the medical field in Mexico: a sociological analysis

Abstract The aim of this paper is to describe the main systems of hierarchization in the Mexican medical field (and those of other similar Latin American countries). Drawing on Bourdieu’s genetic structuralism, our hypothesis is that the structure of the medical field is closely correlated with the schemes of perception and appreciation of the medical field’s agents. These schemes are rooted in hierarchical classifications by which work is organized and the main agents’ prestige is allocated. Empirical data include focus groups, interviews and observations in hospitals, as well as images, memes and other graphic displays found in Facebook and other public internet locations. The analysis sought to identify the main systems of hierarchization that structure both the academic training and the professional practice of physicians. Four systems of hierarchization are identified: professional, by subfields, by specialties, and by division of labor. These systems of hierarchization, reciprocally entangled with one another, are part of the complex structure of positions within the medical field, as well of the agents’ schemes of perception and appreciation which are embodied under the form of habitus.

摘要 本文旨在阐述墨西哥医疗场域（及其他类似拉美国家）的核心层级化体系。本研究借鉴布迪厄的发生结构主义（genetic structuralism），提出假说：医疗场域的结构与该场域内行动者的感知图式和评价图式高度相关。此类图式植根于层级化分类体系，该体系决定了工作的组织模式与核心行动者的声望分配规则。实证数据涵盖医院内开展的焦点小组访谈、实地观察，以及Facebook及其他公共网络平台上的图像、迷因（meme）与各类视觉展示内容。本分析旨在识别构建医师学术培训与职业实践的核心层级化体系。最终共识别出四类层级化体系：按职业层级划分体系、按亚领域划分体系、按专科划分体系，以及按劳动分工划分体系。这些层级化体系彼此相互交织，既是医疗场域内复杂位置结构的组成部分，也是以惯习（habitus）为载体的行动者感知与评价图式的构成要素。