How Beard Mandates Expose the Hazing and Hierarchies of Medical Training

As an attending physician who has worked in both private and public hospitals over the years, I have witnessed and experienced the countless unspoken rules that govern the culture of medicine. A medical student recently rotating with me re-reminded me of one glaring “rule” that always bothered me through training: the demand every now and then issued, mostly by surgeons, that medical students and residents should shave their facial hair. 

This demand, most often couched in the language of “patient safety” or “professionalism”, is often presented (though there are obviously exceptions) as a non-negotiable tenet of sterile, effective care. In reality though, the demand to get rid of a beard is not about infection control — it is a hazing ritual, a tool of social control, and just another symbol of how medical training enforces hierarchy and separation, ultimately damaging the patient-physician relationship.

The claim that shaving beards help to protect patients by decreasing the risk of infection falls apart with the slightest scrutiny. There is really no credible evidence that links facial hair to increased surgical site infections. In fact, a retrospective analysis of over 20,000 joint replacements demonstrated no statistical association. In fact, several studies suggest bearded healthcare workers may harbor less pathogenic bacteria than their clean-shaven colleagues. 

And the levels of cognitive dissonance deepen when we consider the ubiquitous white coat — a known bacterial reservoir that medical students are often forced to wear and physicians insist on wearing. While there admittedly has yet to be an exact link clearly establishing showing white coats directly cause infection, there is no question they are harborers of bacteria. 

Yet these dirty rags remain an unquestioned, almost sacred, vestment in medicine. Do I ever hear about attending physicians demanding students not wear their white coats? Exactly the opposite, medical students in particular are often forced to wear white coats on hospital rotations under the guise of appearing more “professional” (aka to give them more “authority,” or as I would argue, to further separate them from their patients). If we were truly having a data-driven conversation about infection risk, we would be debating the whitecoat long before the beard. We are not because the conversation is not about science, it is about power.

This dynamic fits precisely into the indoctrination system I described in my previous articles. Medical education is a highly efficient system that tries its best to produce technically proficient, yet politically neutered physicians who will pose as little of a threat to entrenched power as possible. It uses a various array of mechanisms to make sure folks are more likely to fall in line. The forced shaving of beards is just a microcosm of these processes.

So now that I’ve made it through the various filtering mechanisms of the medical education process, I’m going to be blunt about this shaving ritual: it’s hazing, plain and simple. 

I actually experienced this threat myself in medical school: the rumor was either you shave your beard or be given a razor and forced to shave in front of peers. These threats aren’t about sterility practices. Instead, they are a ritual of humiliation designed to instill fear and subservience. For the attending enforcing it, the mandate reinforces their position at the top of a medical hierarchy. For the student, it is a lesson: your personal identity and bodily autonomy should be subordinate to the whims of the system. (A quick thought experiment: if many of these doctors are willing to strip their colleagues of bodily autonomy, imagine the lack of respect many of them may have for the bodily autonomy of their patients, especially the poor and marginalized.) So ultimately, many learn to listen to a demand that is not even based on data because the cost of refusal — anything from public shaming, a poor mark on a rotation, a damning comment in a reference letter — is too high. 

This is also where the weapon of “professionalism” gets deployed. In modern medical training, professionalism has been co-opted from a core ethic of competence, integrity, and altruism into a malleable tool for enforcing conformity. Act a certain way, do a certain thing because it is “professional.” This construction separates the physician from the patient, erecting a symbolic wall of authority. It ultimately serves to tell the patient, “I am different from you. I belong to a separate, elite order. You need to listen to me. You should obey.” 

This separation is not an error of the healthcare system under capitalism; it is a feature. A healthcare system focused on extraction and efficiency benefits from depersonalized, transactional relationships — the goal is efficient extraction of value from bodies damaged by capitalism. 

I am a tattooed, bearded attending physician who speaks to his patients in generally the same way and, when appropriate, with the same everyday language — profanity included — that I would with anyone else. Not out of a lack of respect, but because it is authentic and, in my opinion, the foundation for connection. In my experience, as well as in the feedback from my patients, such authenticity helps forge a therapeutic alliance. It tears down the very hierarchy traditional “professionalism” seeks to enforce. 

While I accept I do not have the background of many of my patients, I do know that when a patient sees even aspects of their own reality reflected in their caregiver, trust deepens. They are more likely to share crucial information, adhere to plans, and feel respected in a system that often strips them of dignity. Demands to shave, to cover tattoos, to police language all are demands to erase these potential points of connection. They are demands to fall in line with the uniformity of the medical-industrial complex, which overall doesn’t care about patient health and well being, but instead sees patients as numbers from which monetary value can be generated.

So back to the beard stuff, we have to call this out for what it is: a pseudoscientific tradition of maintaining hierarchy, robbing trainees of their autonomy, and perpetuating a model of physician identity that is both alienating and ineffective. In a way it is tangentially akin to the way the military forces grooming standards as part of an effort to strip individuality and free thought from new recruits so they’re able to more efficiently serve the US imperialism and the military industrial complex. Such standards in medicine are part of systems of indoctrination that create the very human tools capitalists want: doctors doing their jobs quietly, without threat to power (starting with power over their very own bodily functions). 

We should give trainees the ability to say no to these archaic hazing rituals, backed by the very data their attendings choose to disregard. We need a medical culture outside of these archaic structures that are built to create conformity not for the benefit of patients, but for the bottom line of the medical industrial complex. 

So medical trainees, as your new remote “attending,” I give you permission to tell your attendings their beard mandates are nonsense. Maybe we should start questioning many more of the “mandates” or “professional standards” taught during medical training?