The History of the White Coat, Part 2: Why are White Coats Different Lengths?

By Sarah Bradley

Editor’s Note: At The Good Blog, we strive to be inclusive of all health care providers, many of whom wear a white coat every day. For most of us in medicine, our first introduction to the white coat began as students at our White Coat Ceremony, a significant rite of passage now conducted at numerous health professional schools. We therefore acknowledge the doctors, APRNs, physician assistants, nurses, dentists, pharmacists, students, and many other health care providers who wear white lab coats and participate in White Coat Ceremonies as part of their education and training.

You may have noticed that in today’s world of modern medicine, healthcare professionals don’t all dress alike. Many medical providers wear scrubs (think nurses, x-ray and lab technicians, emergency medicine docs, surgeons, etc.). Some medical providers dress in a professional-casual look, including those unafraid to wear pieces that reflect their personalities (like an eye-catching tie or scarf) to put their patients at ease. And some traditionalists prefer more formal attire, in some cases even a business suit.

But even among these differences in attire and among the various types of health care providers (many of whom wear a white coat on a daily basis), there is one difference in particular that isn’t just a matter of personal preference, but one of deep symbolism. It actually places the wearer in his or her proper place in the medical hierarchy, according to education and experience.

The Different Lengths of White Coats: A Longstanding Custom in Medicine

What difference are we talking about? The length of the white coat! Have you ever noticed that some health care providers wear short coats while others wear long ones? Maybe you’ve always assumed this was a stylistic choice – or one made for the sake of practicality – but it’s actually a long-standing tradition rooted in the complex journey every medical professional embarks on at the start of their education and career.

Healthcare Professional Students & The Short White Coat

According to the American Medical Association, almost all health professional schools host white coat ceremonies for medical students. (Editor’s Note: if you’re interested in learning more about White Coat Ceremonies, make sure to check The Good Coat blog in the future–we’ll be doing another three-part blog series on it in the coming months!) At medical schools, the first ceremony (which happens upon entrance), is where students receive their short, hip-length white coat to be worn throughout their schooling. When those students finally graduate from medical school several years later, they exchange their short coats for longer ones that signify their education, accomplishments, hard work, and future responsibility to their patients.

We mentioned in part one of this series that the white coat originated, in part, as a way to separate highly-educated physicians from lesser-trained “healers.” Today, the white coat is embraced by many kinds of health care professionals, from PAs to APRNs, and it still serves as a reminder that the person wearing it went through a rigorous period of preparation and practice, truly earning the right to wear the garment in the first place.

White Coat Length & The Commitment to Lifelong Learning

However, it’s worth noting that there’s no “rule” about white coat lengths that applies to all providers everywhere–and there are different opinions and perspectives on the idea of segregating physicians-in-training from fully licensed physicians by the length of their coats.

For example, at some very traditional hospitals steeped in history, all physicians wear short white coats, no matter how experienced they are (or not). In a 2011 blog post for boston.com about one particular Boston hospital, first-year resident Ishani Ganghuli wrote that the choice to have both residents and attending physicians in short coats epitomized the hospital’s “commitment to lifelong learning” and that, while a part of her still coveted the long coat, she felt it was important for all physicians to remember they will always have a lot to learn when it comes to patient care.

“In health care, we are learning every day, not only about the latest causes and treatments for disease but also about how to put that knowledge into practice and how to take care of patients more effectively,” she wrote. “At a critical juncture in American medicine, it seems more important than ever to recognize all of our roles as humble students of health and health care.”

White Coat Length & Level of Expertise

Keeping all providers in short white coats, she felt, was one way to preserve that mentality within the walls of the hospital. But it could also cause problems: many hospitals maintain the distinction between kinds of providers (as well as different levels of doctors, such as student, resident, intern, and attending) so it’s easy to assess another professional’s expertise.

In a 2010 article published in the Journal of Hospital Medicine, Jeffery H. Spiegel, M.D., chief of facial plastic and reconstructive surgery at Boston University School of Medicine, explains the white coat’s role as an important identifier.

“This traditional uniform serves a similar role to the stripes on a military sleeve,” he says. “By examining the length of a person’s coat, a nurse or other hospital employee can rapidly determine the seniority, and theoretically the increased medical knowledge, of the person inside.”

White Coat Length & Adapting to a Modern Medical World

Still, these identifiers are often viewed as divisive by the newer classes of medical students graduating and entering residency and their chosen field. Consider the case of The Johns Hopkins Hospital in Baltimore, which recently revised its policy on requiring first-year residents to continue wearing short coats instead of long ones.

According to one residency program director, Sanjay Desai, M.D., there was a shared belief at Johns Hopkins that graduating medical school didn’t make you a physician – it took some time caring for patients and working within the hospital system to fully grow into the role. Until July of 2018, residents were asked to continue wearing their short coats during their initial intern year. However, there was enough pushback from younger generations of residents to reconsider the policy.

“The recent graduates from medical school, the ones that have come to our program, [viewed the short coat as] a symbol of hierarchy, a symbol of rigidity, and not promoting the values that we intended for it to promote,” he explained in an article by the American College of Physicians. “So, it’s for that reason that we eliminated it.”

Dr. Desai says the decision was met with mixed results, with some people wishing the tradition had been preserved and others praising the program’s ability to adapt to changing attitudes.

Still, most medical schools and hospitals in the United States have preserved the tradition of bestowing different white coat lengths at different points in a health care provider’s career.

White Coat Length: Now You Know

So the next time you see a professional white coat, you can do a little detective work to figure out how far along the wearer is in their educational journey. Trust me: your provider will be very impressed you noticed!

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