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The physician's white coat can be a godsend to any indecisive dresser; the doctor has a set uniform each day, not giving it a second thought. However, it can get complicated in the hospital with the variety of choices, as each article of clothing has its own symbolic meaning—short coat, long coat, no coat, tie, no tie, and scrubs.

The politics of the iconic white coat runs deep in most institutions' hierarchy and tradition.

"At most places, your coat length increases with seniority," said Jeffrey H. Spiegel, MD, FACS, chief of facial plastic and reconstructive surgery, medical director of head and neck otolaryngology, and associate professor at Boston University School of Medicine.

According to Spiegel's recent article, "Wearing White—Right or Wrong? A Satirical Analysis of Medical Attire," published in the February issue of the Journal of Hospital Medicine, the white coat length is akin to the military stripes, representing a badge of rank.

In most institutions—although not at all—shorter white coats denote a student status, including medical student, intern, and sometimes, resident, depending on the institution. The longer white coats are reserved for a senior physician, such as an attending physician on staff.

And in many academic institutions, such as Boston University, students undergo their "white coat ceremony," a robing ritual marking students' official welcome to medicine, according to Spiegel.

The purpose of the white coat isn't simply to reinforce the pecking order. Perhaps most importantly, the white coat serves as an identifier.

"Those of us who work there can identify quickly who is and is not qualified," Spiegel said. "At my institution, if you see someone in a short coat, it's going to be a student; you wouldn't expect them to take a responsibility role in patient care, [but] more of a learning role," he says.

Despite its practical value, there has been a backlash against the white coat. For example, the Mayo Clinic has a no-white-coat zone, instituting business attire for its physicians, according to Spiegel.

In recent years, the white coat has been criticized as a mean of transmitting infections.

"You go into one patient's room and you lean over to listen to them or look in their mouth, your coat might drag against the bed, and you go into the next patient's room and drag it against their bed, and then you hang it up in your office and put it on again the next day," said Spiegel about its potential hazards.

Just as medical professionals might resist the white coat for safety reasons, patients sometimes have shown physical distain for it as well. Known as "white coat hypertension," patients sometimes show falsely elevated blood pressure at the sight of a white coat.

"For patients, the white coat has mixed reactions. Sometimes, people like it because it's professional and clean. Other times, people feel it's distancing [and] creates a barrier."

Spiegel, who works in clinical, administrative, teaching, and research settings, chooses to opt out of the white coat tradition.

"I think the white coat would look too intimidating; it would imply disease too much," he says about his work in his facial and reconstructive surgery. "A lot of the people that I see are there for issues sometimes they are uncomfortable talking about. … A white coat would probably increase those feelings. For me, a more casual professional dress than a white coat makes sense."

Should administration implement a dress code?

With the highly charged debates that revolve around what the white coat represents—involving a hierarchy, a germ-breeding safety risk, a patient's hypertension—who should make the ultimate decision whether doctors will don the white coat?

At Boston University, it's up the individual preference. But at other institutions, the administration has the final say.

Spiegel, who still prefers his sports coat and tie, says, "I see a value in a dress code. It's important. There's a certain amount of confidence that comes with the uniform; there's a certain amount of security that provides. It doesn't necessarily have to be a white coat."

Spiegel says some physicians wear bowties instead of neckties. In institutions that do choose the white coat dress, hospitals also might want to provide laundering services to reduce the risk of infections, he says.

"I think, from observation, [white coats] aren't laundered too frequently. If they were laundered regularly, it would add an expense, but it might contribute to a professional atmosphere and even reduce infection," he says.

"For now, I'll stick with whatever is clean and professional and make sure my belt and shoes match," wrote Spiegel in the article.

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Karen M. Cheung is an associate editor for HCPro, contributing writer for HealthLeaders Media, and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.

After searching for more than a year, the Schneider Regional Medical Center board has hired Alice Taylor, who served most recently as COO of Broward General Medical Center and Chris Evert Children's Hospital in Fort Lauderdale, FL, to be its new CEO. Taylor's salary will be $310,000, a substantial increase from her pay at Broward General. She also will receive a moving stipend of up to $40,000 and a government-issued vehicle as part of her three-year contract with the hospital. She was selected from a field of more than 80 candidates. The board paid the Atlanta-based executive search firm Tyler & Company just over $100,000 to vet the applicants and whittle the field down to eight finalists. On April 5, Taylor will take over for Interim CEO Elizabeth Harris, who has run the hospital for more than a year since a corruption scandal led to the installation of new executives and board members at the hospital.