“Much of What You Do Goes Unrecognised”: Professional Identity, Power, and Recognition in Anaesthesia across Italy and Malawi

Abstract Professional identity formation has gained increasing attention in health professions due to its implications for job satisfaction, work engagement and team cohesion in complex multidisciplinary environments. In anaesthesiology, a well-developed professional identity has been linked to providers’ well-being and improved teamwork within perioperative settings. However, the professional identity of anaesthesia providers remains underexplored. This gap is especially relevant in the context of a global shortage of anaesthesia providers, affecting both high- and low-income countries and limiting access to safe surgical care. Utilising Bourdieu’s framework, this study explored how anaesthesia providers construct and negotiate professional identity across contrasting healthcare settings. A qualitative study based on semi-structured interviews was conducted with 32 anaesthesia providers (16 per site) at Queen Elizabeth Central Hospital (Malawi) and Padua University Hospital (Italy). Data were analysed through inductive thematic analysis and interpreted through the Bourdieu’s concepts of habitus, capital, and field. A shared professional habitus emerged across both settings, reflecting common values and professional traits. However, context-specific configurations of capital and field shaped how identity was constructed and negotiated. Notably, a persistent misalignment was identified between high levels of cultural capital and limited symbolic and economic recognition, reflecting embedded power imbalances within surgical environments. By applying Bourdieu’s framework across contrasting contexts, this study highlighted how structural conditions shape professional identity and revealed enduring tensions between professional habitus and the distribution and conversion of cultural and symbolic capital. These findings underscored the need to strengthen not only technical capacity, but also professional recognition to rebalance power and the distribution of capital within anaesthesia.