A shortage of physicians in some medical specialties is a global issue, including many Western countries. Challenges with recruiting and retaining specialists seem to be most frequent in primary care (Pfarrwaller et al. 2017), psychiatry (Mahoney et al. 2004) and geriatrics (Curran et al. 2015; Maisonneuve et al. 2014). According to previous research, social prestige and status play a vital part in medical doctors’ selection of a specialty (Creed et al. 2010; Luke 2003). Norredam and Album conducted a literature review in 2007 to examine the relationship between prestige and specialty choice. They concluded that there is a hierarchical status of specialties in the perceptions of medical students and medical doctors, with surgery at the top and psychiatry at the bottom (Norredam and Album 2007). Prestige and status are essential to the French sociologist Pierre Bourdieu’s theoretical framework. According to Bourdieu, agents within a field struggle for different forms of capital (i.e. cultural, economic, social or symbolic) to gain the prestige required to be successful within their field (Brosnan 2010; Bourdieu 2011). The agents—in this case, medical doctors—fight over assets to gain attractive positions in the medical field. The hierarchy of medical specialties can be seen as indicators of social prestige. Therefore, Bourdieu’s concepts can be used to investigate physicians’ specialty choices to understand the meanings of prestige and status within the medical field (Hindhede and Larsen 2018).

Sweden has a relatively egalitarian educational system; indeed, there is no cost for higher education (Börjesson et al. 2016). Specialty choices take place after medical school, and the licence to practise makes it possible to apply for any specialty. Specialty training is undertaken within a framework of employment, and there are almost no differences in salary due to one’s specialty. Accordingly, we were interested in investigating if perceptions of status and prestige affected specialty choices in an egalitarian system like Sweden’s. Therefore, we (Olsson et al. 2018) conducted a quantitative study in which we measured the perceived status of eight specialty groups among Swedish medical doctors (n = 262) using a Likert scale-type question ranging from very high status (1) to very low status (6). The statistical analysis revealed major perceived status distinctions for the eight specialty groups included in that investigation. Surgery was valued as having high status by 69% of respondents. Only 6–7% of respondents considered geriatrics, psychiatry and laboratory specialties to have high status. We also found that high status was associated with one’s choice of specialty. However, the results of that work did not contribute to a deeper understanding of what constitutes status and prestige within the medical field and its influence on specialty choice. Consequently, we decided to continue our investigation with the present study.

Extensive research has targeted medical doctors’ choice of specialty, but most studies have used quantitative methods and a research approach that does not focus on the process of how choices are made (Pfarrwaller et al. 2017). One early attempt to problematise the process of choice with a theoretical framework of choice itself was conducted in 1997 by (Burack et al. 1997) They concluded, ‘Little attention has been paid to how choosers choose’ (Burack et al. 1997, p. 534). In addition, they found that choice should be considered an ongoing process, both conscious and rational and simultaneously unconscious and hard to assign to a certain moment in time (Burack et al. 1997).

Bourdieu’s educational sociology

From Bourdieu’s theoretical framework, three entwined concepts will be the lenses in our analysis: field, habitus and different forms of capital. Each concept will be explained subsequently in the sections that follow.

Field

A field, like the medical field (Balmer et al. 2017; Luke 2003), should be understood as a social space. It is the context in which agents act and invest to be successful within a specific area (Carlhed 2007, 2011). Agents within a field fight over assets and positions using various forms of capital (Witman et al. 2011).

Habitus

People’s experiences become embodied in habitus, which can be defined as systems of dispositions that enable individuals to act, think and navigate in the social world. As Collyeret al. (2015) put it: ‘The habitus, for Bourdieu, is an explanatory tool that shows how our actions are always historical, for our individual history shapes our thoughts and actions into “durable dispositions” that guide future behaviour’ (Collyer et al. 2015, pp. 205–206). Habitus is shaped in relation to context (i.e. the fields to which a person belongs). Even though family background and upbringing play an important part in the creation of habitus, it should not be considered static and unchangeable. For instance, the education system plays a particular role in developing habitus (Bourdieu and Passeron 1977, 1979). Balmer et al. (2017) revealed that habitus changes as high in the education system as medical school. Habitus provides a means of understanding agents’ possibilities and limitations within the medical field. Accordingly, ‘Habitus can be used as a research tool to form a part of an empirical analysis about the culture and formation of dispositions. Habitus interacts with the medical field and ultimately shapes the dispositions and preferences of junior doctors’ (Luke 2003, p. 55 [Our Italics]) [Emphasis added].

Forms of capital

Bourdieu used three main forms of capital when analysing the social order of a field: economic capital, social capital (networks, groups) and cultural capital. For this study, to better understand the influence of perceived status and other forms of cultural capital in specialty choices, the Swedish egalitarian educational system is a fitting research context since economic capital can almost be ruled out. In Sweden, the economic factors (i.e. salary, benefits) are quite the same, regardless of specialty.

Most interesting for this study is, however, the role of symbolic capital (Bourdieu 2011). Symbolic capital reveals the contextual nature of cultural capital, meaning that an asset (e.g. taste, manners or cultural knowledge) must be given value within a specific context to be meaningful. In other words, what is recognised as important within a specific field evolves to constitute symbolic capital and indicates prestige or high status for those within that field (Chernilo et al. 2013; McDonald 2014).

The medical profession can be considered ‘closed’; that is obtaining access to the profession requires formal competences and a licence to practise (Lindgren et al. 2011). This fact contributes to the feeling the medical profession is a ‘world of its own’ where investments and power struggles within the profession are what count (Bourdieu 2013). In other words, to regard the medical field as a field of power in a Bourdian sense allows us to investigate which assets are important to physicians (Brosnan 2010).

The aim of this study, then, was to obtain a deeper understanding of processes that precede medical doctors’ choice of specialty and to investigate the influence of perceived status and other forms of symbolic capital on that choice.