Abstract
Where once the sociology of professions valorized the solo-practicing physician as paragon of the professional class, today’s doctors are more often than not salaried employees who share in the collective plight of all health care workers. In Flatlining: Race, Work, and Health Care in the New Economy, Adia Harvey Wingfield draws on a solid mixed methodology of survey data, interviews, and ethnographic observations to reveal how the burdens of these labor market changes are borne most heavily by black doctors, nurses, and health care technicians. In the “new economy,” institutional racism manifests in workplace patterns that shift the onus of equity work onto black employees. Wingfield analyzes this “racial outsourcing” as an outcome “when organizations fail to do the work of transforming their culture, norms, and workforces to reach communities of color and instead rely on black professionals for this labor” (p. 34). Black health care workers find themselves almost solely responsible for doing the uncompensated racialized labor necessary to cultivate the inclusive workplaces their employers nominally support.
As Flatlining richly demonstrates, this racialized labor is experienced differently by men and women throughout the occupational hierarchy. In Flatlining’s substantive chapters, Wingfield’s relational approach adds texture to her sharply focused analysis of the shifting configurations that generate variation in the performances and consequences of intersectional identities in interactions with superiors, peers, subordinates, and patients. Though black physicians were largely buffered from negative patient interactions by their high occupational status, black female physicians were attuned to how masculinized medical cultures limited their career opportunities. In the traditionally feminized occupation of nursing, black females were doubly disadvantaged as systemic inequalities in credentialing compounded with frequent racist interactions with white coworkers and patients, while black male nurses were cordoned off from the proverbial “golden escalator” by race. Yet it was the low-status health care technicians who most frequently bore the brunt of racial resentment from white patients and coworkers. Their responses to these pressures were markedly gendered, with men embracing equity work while women sought to exit their positions (and sometimes the health care sector altogether). Relative to doctors and nurses, technicians acutely experienced how the consequences of cost-cutting inevitably “trickle down” to differentially impact the most vulnerable workers.
Across the medical hierarchy, Wingfield finds that black health care workers are overwhelmingly committed to working in the public sector where they have an opportunity to improve the health outcomes of underserved communities of color. The missions of public hospitals, increasingly endangered as neoliberal policy squeezes public spending on social services, are buoyed by black health care workers’ commitments to eschewing profit in favor of public good. Here is a particularly insidious effect of the new economy: black health care workers’ earnings are suppressed by their commitments to equitable health outcomes, leaving them at a personal financial disadvantage vis-à-vis predominantly white private sector peers. The social distance engendered by these occupational sorting mechanisms compounds with the social distance black workers experience between themselves and their white coworkers. Black health care workers’ solidarity with black patients makes them acutely aware of the insults a racialized medical system inflicts on black bodies. Nowhere is this more apparent than when black health care workers become patients of a health care system hostile to their race.
Wingfield takes care to remind us that privatization differentially affects black workers in predominantly public hospitals, which makes the tenor of her parting prescriptions for change feel discordant with her analysis. What are the prospects of resource-starved public facilities putting their money where their mouths are on equity training when Wingfield so frequently observes them cutting corners to save costs at every opportunity? The structural solutions on offer in Flatlining—investing in public resources and strengthening more inclusive unions—seem almost retrogressive against the backdrop of the inexorable creep toward privatization in public hospital management Wingfield describes. The precarity of work in the new economy surely begs new strategies for cultivating equitable workplaces. Wingfield’s concluding remarks could have been enriched by more careful consideration of the macro-level dynamics of institutional change in contemporary health care settings of the sort she offers in her introductory history of health reform and occupational sorting.
Overall, Wingfield’s narrative is brisk and engrossing, offering a fresh perspective on the intersectional complexities of racialized labor in today’s health care system. Flatlining is a rare study that presents an immersive, compelling, and readable account that marks a solid contribution to the contemporary study of the professions that is accessible to students and nonspecialists alike.
