The struggle for legitimacy: A study of contingencies and constraints in emergency medicine

This paper explores the organizational structure and the social work world of an emerging medical specialty area, the emergency medicine practitioner. In‐depth interviews were undertaken with a number of physicians practicing emergency medicine in an attempt to come to some understanding of the problems encountered by a new specialty area as it attempts to gain credibility with more traditional and well established specialty areas in medicine.

Key elements that appear to be critical in the struggle for legitimation by emergency room physicians revolve around such issues as income, power, autonomy, the referral system, specialized knowledge and commitment levels of active participants. The nontraditional organizational structure of emergency medicine was also found to be a factor in strained social relationships between emergency room physicians and their peers. This paper also documents the more commonly used interactional strategies employed by emergency room practitioners in their day‐to‐day interactions with physicians practicing in other specialty areas.