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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