What Are the Worst Jobs for a Doctor?

Mary Black, a public-health physician in Serbia, offers her ideas in the current issue of the British Medical Journal (abstract only). [Yes, I know: two posts in two days from BMJ — but hey, it’s interesting stuff.]

Black’s criteria: “[T]hese are jobs that seriously compromise ethical and moral standards, are difficult to justify to your children, and are likely to be a source of regret on your deathbed.”

Here is Black’s list:

1. Head of medical services at Guantanamo Bay.

2. Research scientist at any major tobacco company.

3. Biochemical weapons developer.

4. Surgeon in the commercial kidney transplant trade.

5. Sports doping doctor.

I would also be interested to hear from physicians about their ideas of the hardest jobs in medicine. Personally, I don’t know how anyone can be a pediatric oncologist. But thank goodness for individual preferences, and that lots of other people feel different than I do.


I don't know why any MD would choose a specialty other than proctology.


Black's List or The Blacklist?


As a child psychiatrist-in-training, I often have this discussion with my vascular surgeon-in-training buddy. We're very glad that each of us exist, because if either of us had to do the other's job, we'd run away like crazy.

I can't imagine anything more miserable than pathology. He can't imagine anything more miserable than rheumatology. My wife is seriously considering pathology. Go figure.

Pediatric oncology is actually a great field, because so many pediatric cancers are treatable. One of my most memorable patients of my third year was a little girl we worked up on the Peds GI service, only to discover that she had a pretty significant lymphoma. She transferred to the Hem/Onc service, and is doing great a year later. Not to say that devastating things don't happen, because they of course do.

The literature on medical specialty selection is superficial at best, and for folks so interested in complex incentives, it'd be a field wildly open to some good Freakonomics.


Connie H.

FWIW, I've heard one of the toughest jobs in medicine is burns unit nurse, since they have to debride the wounds again and again, causing incredible pain each time. But if it isn't done, the patient may well die....


What sanctimonious PC BS.

"Head of medical services at Guantanamo"? So prisoners should have no medical care? So maybe all "ethical and moral" physicians should refuse to work at prisons where there might (and I emphasize might) be some innocent being held? What about being the personal physician to Mugabe or Kim Jong-Il or Castro? Then your ministrations have the direct effect of keeping millions of innocent people in misery.

"Research scientist at any major tobacco company"? I can just see the mind turning--"well pharmaceutical companies do a little good; what big business can I slam?" The fact is that research scientists and doctors are generally different people with different training. Is there any evidence that tobacco companies are doing clinical research on human beings? If not, there is no need for a MD, and I doubt there are any on staff.

"Biochemical weapons developer". Oh yeah, here is a thriving medical specialty. I suppose somewhere (probably working for the dictators mentioned previously) there are warped physicians doing dastardly experiments on people with biochemical weapons, but really...

"Surgeon in the commercial kidney transplant trade". As opposed to surgeons who do kidney transplants for free? What is she slamming, the fact that surgeons get paid well for doing good surgery to help people? Or is she insinuating that people who pay for kidneys are somehow equivalent to muggers in the night, and that surgeons are complicit?

"Sports doping doctor". I will grant that giving athletes chemicals to boost performance is ethically problematic. But at least the athletes are informed and consenting. Much more ethically challenging, IMO, is the witch hunt against athletes, like Floyd Landis, where every safeguard and procedure for quality testing is violated in the rush to convict.

Hardest jobs? How about an OB-Gyn who is doing abortions? Lots of people think you are a murderer, and no matter how much you rationalize the needs of the mother, you are still killing a living being.



I'm no fan of the Bush Administration and I do think they've done bad things at Guantanamo Bay, but I really can't see how providing medical care there is in a class with the other items. This is political opinion overriding medical opinion.


I think the premise of "1. Head of medical services at Guantanamo Bay" is that you'd likely have extreme pressure from your superiors to not provide good care. I think y'all might be reading it backwards.

A physician would be ethically required to provide standard of care, while military personnel might order you to alter that care. For an ethical physician, that's a personal disaster.


How about the doctors who perform (or oversee) "lethal injection" in death penalty cases? The states and courts are divided over whether or not lethal injection is cruel and unsual punishment. Also, supervising lethal injection appears to go against the Hippocratic oath.


...and no matter how much you rationalize the needs of the mother, you are still killing a living being.

No your not.


"No your not."(sic)

Fine, you are preventing something that would live from doing so.


doctor feelgood would also be a hard sell to da kids


No your (not sick) not.

You are killing a mass of cells that the mother has a right to choose to become a baby or not.

That's the law of the land.


"Fine, you are preventing something that would live from doing so."

So you must be a vegan.


I believe the Guantanamo reference refers to the allegations - published by, for example, the New England Journal of Medicine - that Guantanamo doctors turned over patients' medical records to interrogators knowing that they would be used for torture, failed to report injuries caused by torture to higher authorities, and falsified death certificates.

NEJM article: http://content.nejm.org/cgi/content/full/351/5/415


Guantanamo doctors are helping to force feed prisoners by shoving plastic hoses through their noses while they are secured to chairs. It's reported in the mainstream press. It's also possible, but I haven't seen credible reporting, that the doctors aid with the torture there. Certainly the torture is credible.


Does that make them as bad as Mengele?

Or just clueless neocon hacks like Aberto Gonzales, appointed to the job for their compliance? Or maybe graduates of Messiah College? ORU?

Does ORU have a medical school?


Good to see the thread has gotten so far off track. We've already veered into Nazi allusions. So, I thought I'd put in my $0.02 before it goes completely buggy.

To get back on a previous thread -- my son underwent cancer treatment for several years at some of the best oncology centers in the world (Johns Hopkins, Childrens of Philly, and Sloan Kettering). I've never seen a more amazing group of people than the medical staff at these places. The way they maintain their cheerfulness even when dealing with terminally ill children is truly amazing. God bless em.

There's obviously some serious self-selection going one here. The characteristics of the pediatric oncology and surgical staffs makes you wonder whether they came from the same species.


I didn't know Alberto was a nazi?

I recently met a kid that wants to be a pediatric oncologist. She volunteered at the local children's hospital in the cancer ward from age of 13. She saw great success stories and some deaths of kids she met there.

Now she's in pre-med. So yes, some people seem to be attracted to it.

Never really understand people who knew what they wanted to be from an early age. Are they burned out by 30?


Yes, ORU does have a med school, I also got my MD in proctology from this finest of fine institutions.


My guess is it's public-health physician in Serbia.

Of course, it appears you get lots of time to be sactimonious, well now that Milosevic is gone anyway.