These findings should encourage clinicians working with homeless people to screen for gambling-related problems and disorders.

The work-related and adjustment challenges that IMGs and AMGs confronted during PGY-1 suggest that the culture of residency socializes IMGs and AMGs regarding professional expectations and responsibilities. Increased awareness of this socialization process among residency program directors, and interventions based on concrete recommendations, can help enhance PGY-1 for IMGs and AMGs across the medical specialties.

Two competing medical disciplines treat addiction in the United States: addiction medicine and addiction psychiatry. Addiction medicine seeks recognition from the American Board of Medical Specialties whereas addiction psychiatry holds this high-level medical status, a mission that suggests a substantive distinction between addiction medicine physicians and addiction psychiatrists that does not exist. As this article shows, leading addiction medicine physicians and addiction psychiatrists agree on the definition of addiction and that drug treatment is an “art” which requires a multimethod approach. Despite this extensive accord, addiction medicine physicians and addiction psychiatrists draw sharp distinctions between addiction medicine and addiction psychiatry to serve historical, economic, and professional interests, revealing the importance to both disciplines of recognition from the American Board of Medical Specialties and thus jurisdiction over the medical treatment of addiction.

Two distinct medical disciplines treat addiction in the United States: Addiction medicine and addiction psychiatry. This article argues that physicians recovering from alcoholism or drug abuse played a key role in creating the field of addiction medicine, and that the development of addiction medicine inadvertently contributed to the formation of addiction psychiatry. Addiction medicine's undercurrent of recovery, specifically questions about the knowledge that recovering physicians call on to treat addiction, remains central to an ongoing professional conflict between addiction medicine and addiction psychiatry.

Purpose: To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States. Methodology/approach: Data derive from 13 semi-structured focus groups, plus three semi-structured interviews, and were analyzed inductively consistent with a grounded theory approach. Findings: Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, non-physician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers. Research limitations/implications: Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power. Originality/value: This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.