Leaving the stethoscope behind: public health doctors and identity work

Public health medicine is distinct in two ways from most other forms of medical specialisation; firstly, it is predominantly non-clinical and secondly, its concern is with populations, rather than the more common individual physician-patient encounter. In spite of recent attempts to 'mainstream' public health approaches into medical training and practice, it remains a relatively low prestige medical specialty. In the face of the centrality of all things clinical in medical training, the identity work needed to think beyond this and into population health approaches is significant. In the face of public health physicians' subaltern position within medicine, this research investigates the identity work doctors did as they made the transition into public health medicine and how they understood their positioning once they were within the specialty. The inductive thematic analysis conducted on the qualitative interview data generated for this research elicited three key themes of relevance for the 19 public health physicians in New Zealand who were interviewed. The calling into question of biomedical identities was evident and concomitant with this was a sense of loss of the satisfactions of clinical medicine including contact with patients and the ability to solve discrete clinical problems. The final theme revolved around how public health physician identities were felt by the participants to be discredited. Lack of attention to the identity work required to think beyond the individual in health terms may contribute to a slow pace of change.