Are some diseases more prestigious than others?

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 the medical profession.

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 medical specialties. He found that certain diseases consistently ranked at the top (myocardial infarction, leukemia, brain tumors) and others at the bottom (fibromyalgia, anxiety neurosis). (See complete list below.) 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 (emphasis added):

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 members of stereotypically 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. If we placed a higher value on primary care, we might have less need for heart surgeons.

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

Update 10/21/10:
A physician’s worth doesn’t need a professional hierarchy (KevinMD)

Not only do some medical specialities claim to be more prestigious than others, but some in the medical profession claim to be superior to those in other professions. Here’s a reply to such a claim (emphasis added):

Has it come to this? Do we really need, as a profession, to measure ourselves against others like a bunch of schoolboys? After reading Dr. Son’s article, “Does being a lawyer or journalist stack up with being a physician?”, I feel compelled to reply.

As a practicing pediatrician, I, too, feel the nobility and privilege of my profession, and count myself lucky every day that I am able to do what I do. But to denigrate lawyers and journalists as somehow less valuable to society is beneath us as a profession. …

Furthermore, the medical profession’s high regard for itself has not translated into action on the health care reform front. Instead of arguing who is more important, physicians or lawyers or journalists, we should be leading the way on health care issues in this country. Instead, we physicians on the front lines are often the pawns, being moved around by the insurance companies, the government, and large hospitals.

I know I’m valuable as a physician. I see it in the faces of parents every day. And it’s not always in the expert diagnosis I make or the quick treatment of a sick child. Sometimes it’s in the simple caring at the end of chronically ill child’s life. In moments like these, I know my value. I don’t need to construct a professional hierarchy to prove it.

Related posts:
The esteem of the medical profession: Then and now
The doctor/patient relationship: What have we lost?
Contempt and compassion: The noncompliant patient

Resources:

Photo source: David Zimmerly, Guatemala Medical Center

D Album & S Westin, Do diseases have a prestige hierarchy? A survey among physicians and medical students, Social Science & Medicine, January 2008, 66(1) pp. 182-188.

Vaughan Bell, Disease rankings, Mind Hacks, June 1, 2010

D Album, The prestige of illnesses and medical specialties, Nordisk Medicine, 1991, 106(8-9), pp. 232-236.

Marie Norredam, Dag Album, Review Article: Prestige and its significance for medical specialties and diseases, Scandinavian Journal of Public Health, Vol. 35, No. 6, pp 655-661, 2007

Stephen M. Rosoff and Matthew C. Leone, The public prestige of medical specialties: Overviews and undercurrents, Social Science & Medicine, 1991, vol. 32, issue 3, pp. 321-326.