Ranking prestige of medical diseases

Among medical specialties, some are more prestigious than others. You can generally tell which ones are more prestigious by how well they pay. Surgery and cardiology, for example, rank at the top of the prestige scale. Psychiatry and dermatology are near the bottom.

One can also ask if some diseases are considered more prestigious than others, in the opinion of doctors.

A Norwegian doctor, Dag Album, has been investigating the prestige of both diseases and medical specialties for many years. In one study, he asked a cross-section of physicians and medical students to rank the prestige of 38 specific diseases, as well as specialties. He found that certain diseases consistently ranked at the top (myocardial infarction, leukemia, brain tumors) and others at the bottom (fibromyalgia, anxiety neurosis).

Among medical specialties, neurosurgery and thoracic surgery ranked highest. At the bottom were geriatrics and dermatovenerology (the treatment of skin diseases associated with venereal diseases).

What makes a disease or specialty more prestigious?

One relatively objective way to view the ranking of specialties is to consider their urgency. The aim of primary care physicians, pediatricians, and psychiatrists is to keep their patients healthy. Although some of their patient encounters surely do make the difference between life and death, those are generally the exception. On the other hand, a patient only sees a brain or heart surgeon when his or her life depends on undergoing a successful operation.

Dr. Album draws a similar conclusion from his study. The more highly ranked specialties and diseases involve vital organs. Those ranked lower involve chronic conditions. But he also points out that age and the bodily location of disease contribute to high and low prestige:

Our interpretation of the data is that diseases and specialties associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged. At the other end, low prestige scores are given to diseases and specialties associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients.

As Vaughan Bell comments on Mind Hacks:

It’s interesting that doctors who specialize in working with people who have the least status in society (children, the ‘mad’, the ‘old’) also have the least status in medicine.

Status-wise, it’s reminiscent of how typically female professions — nurses, school teachers, secretaries — have less prestige and are poorly paid. It’s a decision that our particular society makes at this particular time based on what we agree to regard as valuable.

How diseases stack up

Here’s the complete list of diseases, ranked from most prestigious to least. Note that 38 is a small number of diseases, so there are conspicuous omissions, such as breast cancer.

Myocardial infarction [heart attack]
Leukemia
Spleen rupture
Brain tumor
Testicular cancer
Pulmonary embolism [usually a blood clot in main artery of lung]
Angina pectoris
Extra uterine pregnancy
Thyroid cancer
Meniscus rupture [knee cartilage tear]
Colon cancer
Ovarian cancer
Kidney stone
Appendicitis
Ulcerative colitis [type of inflammatory bowel disease]
Kidney failure
Cataract
Duodenal ulcer [ulcer in upper part of small intestine]
Asthma
Pancreatic cancer
Ankle fracture
Lung cancer
Sciatica [injury or compression of sciatic nerve]
Bechterew’s disease [ankylosing spondylitis, spinal arthritis]
Femoral neck fracture [top of the thigh bone]
Multiple sclerosis
Arthritis
Inguinal hernia [abdominal protrusion through inguinal canal]
Apoplexy [bleeding of internal organ]
Psoriasis
Cerebral palsy
AIDS
Anorexia
Schizophrenia
Depressive neurosis
Hepatocirrhosis [cirrhosis of the liver]
Anxiety neurosis
Fibromyalgia

Jan Henderson is a historian of medicine who blogs at The Health Culture.

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  • paul

    wait… what? dermatology doesn’t pay well and is at the bottom of the prestige scale? that doesn’t sound right…

    • Becca

      Yeah, I am not sure where that came from…my classmates who are now dermatologists are certainly looking at giant salaries as attendings and they had to compete harder to get their residency spots than nearly anyone else.

      I’m also not sure what apoplexy did to end up so far down the scale, except that perhaps the word is rarely used by doctors; honestly, the whole list of diseases looks…off. There’s pretty little prestige in asthma; certainly less than treating pancreatic cancer with a Whipple.

      I wonder how much of the difference is accounted for by the author being Norwegian?

  • http://www.naplesimaging.com PAUL DORIO

    There’s something strange and sad about characterizing medical specialties and diseases according to a level of “prestige,” in my opinion.

    Perhaps I’m not in tune with the connotation of the word, which Webster’s lists as “1 : standing or estimation in the eyes of people : weight or credit in general opinion
    2 : commanding position in people’s minds” (http://www.merriam-webster.com/dictionary/prestige)

    Perhaps the reason for the majority of the diseases listed is because they rightly deserve appropriate high-end attention. The first six items, for example – “Myocardial infarction [heart attack], Leukemia, Spleen rupture, Brain tumor, Testicular cancer, Pulmonary embolism” – are life-threatening ailments.

    To amplify the example given of a “low-prestige” specialty, I’m pretty sure that Dermatologists relish the non-emergent and non-life-threatening nature of their specialty. Whether that relegates them to a “less prestigious” choice of practice is rather irrelevant.

    Interesting commentary though. Thanks kevinmd.

  • docguy

    the surgeons I know do not do that well financially and have terrible lives so I guess they are prestigious but not doing well financially but I don’t think that’s the point of this article..

  • Doctor in Boston

    There may be some geographical variation in prestige, in the U.S. v. in Europe or elsewhere. Dermatology is not “near the bottom” in terms of compensation, or certainly not in the U.S. (e.g. http://en.wikipedia.org/wiki/Specialty_(medicine)). And judging by the match, dermatology is probably one of the most competitive subspecialties, reflecting its desirability for its combination of “lifestyle” and compensation.

  • Christine

    It would be interesting to take these results and see if the level of social media engagement (e.g., patient forums) is correlated to the prestige ranking of these diseases… A disease that has more “prestige” (e.g., cancer) might have more engagement than a disease with “little or no prestige” (e.g., osteoporosis).

  • Jen

    Testicular cancer ‘beats’ ovarian cancer? And a Meniscus rupture is that high on the list?

    That’s pretty sad.

  • Doc99

    There is the apocryphal saying going around that the reason folks pursue a career in psychiatry is to save money on therapy.

  • http://darwinconspiracy.com Jay Goff

    Meniscus tears above ovarian cancer? Unbelievable.

    I work on leukemia and it is difficult to handle due to the complexity of the disease (diseases? what are we up to, 38 subtypes and counting?) but I am very surprised that it comes up right below MI.

    Brain tumors have for a long time been a death sentence, although perhaps the use of 5-aza drugs on solid tumors could make a difference for at least one subtype of GBM.

  • http://astridvanwoerkom.wordpress.com/ Astrid

    It is not surprising but sad that psychiatric disorders and invisible chronic illnesses have the lowest status. People with these conditions are most often marginalized and disbelieved about their health status.

    • Mike

      I used to have the same sympathy for psychiatry until I realized that its entire foundation is the DSM, a text conceptualized, created and sold by people and organizations that make enormous amounts of money from pharma. The very criteria used to diagnose conditions in psychiatry were essentially developed by pharmaceutical companies by way of paying physicians and scientists large sums of money to influence their decisions, consciously or unconsciously. And why would pharmaceutical companies want to be involved in the creation of diagnostic criteria? The answer is obvious. Now, I question the entire existence/relevance of psychiatry and I, too, put the specialty at the bottom of the “respect” list, just for different reasons than for those who practice medicine. I have more respect for therapists, who actually address the root of a person’s problem, than for psychiatrists who don’t bother to even consider the root of the problem.

  • http://nostrums.blogspot.com Doc D

    Derm can make up the difference by seeing 60 patients a day. :)

  • Doc99

    Who speaks for the paronychiacs?

  • http://bittersweetmedicine.com DrLemmon

    Priapism should be number one, just my humble opinion.

  • http://www.nourishourselves.blogspot.com Marie

    Dr. Lemon, thanks for raising that issue. It’s one that’s hard to ignore.

    lol Sorry, couldn’t resist.

    This is a very interesting collection of data. It reveals so much about how people think. And woo-hoo! I made the cut, having Multiple Sclerosis. It is the gift that keeps on taking, so I am pleased that even though it has devastated my life, at least I have prestige.

  • http://twitter.com/herbalkesehatan Herbal Kesehatan

    Bismillah. Hi, I’m Denny from Indonesia. Hm, kinda interesting to read this article and to give more comment, just a little. Because many diseases that appear in my country: Tuberculosis, and it does not include the 38 disease in the article. Want to laugh bitterly, lest the disease appears most in my country is a disease that is not enough prestige. Why? hehe