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Introducing the Medical Specialty Privilege Hierarchy!

Disclaimer: This post is from GomerBlog, a satirical site about healthcare.

Ever had a conversation with a colleague in another specialty and felt like they didn’t understand where you were coming from? As though they had some sort of secret advantage in life that you didn’t, preventing them from empathizing with your victimhood?

Or are you perhaps gifted with a certain amount of medical specialty privilege, and oppressing others without even knowing it?

Now you can easily figure it all out! We’ve listed the specialties in order of privilege, so you don’t have to produce independent thoughts of your own while categorizing others using only one identifying factor. Best of all, it doesn’t count as bias, prejudice, or stereotyping if you use the word “privilege!”

I don’t need to explain how important intersectionality is. If you “still don’t get it,” you need to be more open-minded and accept its obvious truths, as it is the only correct way to view the world.

So use this “medical specialty privilege ladder” to help navigate the confusing and muddy waters of medical specialty privilege! Before conversing with a colleague, whether they’re calling you for a consult or asking you to hold the elevator door, you can quickly “check your privilege” and immediately score extra points in any discussion (or be docked points if you’re unlucky enough to have medical specialty privilege). If you’re the victim and they’re the oppressor, this gives you full license to let that elevator slam shut in their face. Because privilege.

I hope you’re sitting down, because some of these may shock you:

Least Privileged (“Most Oppressed”)

Nurses: Though technically not a medical specialty, let this serve as a reminder to you that when arguing with a nurse, you are never correct. Even if your side of the argument is that the DaVinci is the greatest robot. Even if you’re not a doctor. Don’t argue online with nurses either, or rant about nurses. Big Nursing will find you and get you fired. “But doesn’t this mean they actually have a lot of power, and thus privilege?” you might ask. Careful, I think I hear them coming to get you already!

Palliative Care: All of their patients die, and the primary team ALWAYS consults them too late (or forgets about them entirely). Maximum victimhood status = UNLOCKED!

Family Medicine/Primary Care: From the time you last saw them in medical school, your colleagues who went into family medicine have been getting dumped on continuously by everyone from the ED to OB/GYN to general surgery. They deal with so much dumping that their official uniform is a hazmat suit. They work like dogs and get paid like them too. Underappreciated and underpaid, that’s their motto.

Still Pretty oppressed

General Surgery: They have more privilege than family medicine, but not by much. They slog through a grueling residency, then every surgical specialty dumps on them, and they are rapidly losing procedures to interventional radiologists and ambitious robots. This is why they’re always ornery.

Psychiatry: A specialty with no empiric testing. No preventive medicine. And, arguably, no true cures. But they have an ace in their pocket: “Rule out organic causes of delirium first,” which gives them great respect with the hospital billing and radiology departments. And residency is pretty chill.

Neurosurgery: Surprised? They have to deal with the longest residency, the highest malpractice payments, and high divorce and suicide rates. And recently got some really bad press with the whole “Dr. Death” story. Their stock is dropping faster than pot stocks. Pity the poor neurosurgeon (figuratively poor, of course). So the next time a neurosurgeon lets an elevator door slam on you, before you get mad and blame it on their God complex, pause and check your own privilege.

Pediatrics: Get to play with toys and work in bright, cheery hospitals with magical creatures, slides, playgrounds, enchanted forests etc. Get to make wide-sweeping quasi-political announcements that the media gobbles up (“Pediatricians release statement declaring Elmo to be the best Sesame Street character” etc). But they have to deal with parents. And that’s a pretty big disadvantage.

Infectious Disease: They are called to “get on board” for literally every patient in the hospital, but on the plus side, they don’t have to follow the actual patients, just the cultures.

Physical Medicine/Rehabilitation: If you ask them on the record, PM&R stands for “Plenty Money/Relaxation.” Off the record, and after a few drinks, it’s more like “Paltry Medicine/Respect.”

Sometimes Oppressed, Sometimes Oppressors:

Neurology: As the TPA Police, neuro seems like an easy one to figure out. They are in charge. Until the patient presents >4 hours after a stroke or has a hemorrhagic stroke. In which case they can tell you exactly where the lesion is, and that’s about it.

OB/GYN: Rather than having colleagues metaphorically dump on them, they have to deal with their actual patients literally dumping all over them. And getting sued when kids they delivered (uneventfully, 17 years ago) go on to do poorly on the SATs. Unless they stop taking “OB” call and just do “GYN,” because then that’s not such a bad gig.

Anesthesiology: Have the privilege of never having to hear their patients talk back to them, but also have to deal with surgeons calling them “Anesthesia!” And CRNAs are coming for their jobs faster than veterans came after Pete Davidson for his eye-patch joke.

Emergency Medicine: High burnout rates and drug-seekers are a concern, but don’t feel too bad for these life-saving physicians. They only work a few 18-hour shifts a month and then go on vacation the rest of the time. They are a lot more privileged than people think — if a patient is spending too long in the ED, they can just dispo the patient to any service they choose at random. And their lives are glorified in TV shows. And THEY DON’T HAVE PAGERS. Are you kidding me? They should arguably be even higher up.

Gastroenterology: Poop doctors. That’s a stereotype they will never get over. But as far as internists go, they get to do procedures which is pretty neat. And it’s not all bad: I hear IBS patients are really satisfying to talk to.

ENT: Privileged to do some cool procedures. Lugging around that giant suitcase full of expensive toys could make one feel like a real doctor. But paying for all that stuff out of your own pocket, worrying about losing it, and having to deal with boogers are serious disadvantages.

Mostly Oppressors

Cardiology: The royalty of internal medicine. They skate through a three-year residency, followed by a three-year fellowship, and then walk around like they own the place. They don’t even need to interpret EKGs, the machine prints out a read for them. Their gleaming pimped-out stethoscopes magnify heart sounds, and, I have heard, also diagnose patients and put in orders for diltiazem drips. They are certainly the oppressors in most hospital encounters.

Radiology: Get to sit by themselves and hang out in what’s essentially a private club, only bothered by whoever has their departmental phone number. Can work remotely from wherever they please, wearing whatever they please. See also: Pathology

Urology: When your patients love you, you get to do interesting procedures, you get paid well, and the most difficult thing about your day is deciding which penis joke to tell, you are not a victim.

Ophthalmology: Same is true when the most vexing feature of your specialty is spelling it correctly.

Plastic Surgery: Though they’re pretty high up on the hierarchy, plastic surgeons have it rougher than people think. They are expected to maintain an attractive physical appearance, even while working late hours into the night closing wounds that other surgeons decide they didn’t want to close, then coding for creative flaps and getting reimbursed pretty well. I know! Cry for them. Do you need a tissue?

Dermatology: It’s hard to be more oppressive than a dermatologist. Get to do procedures. No emergencies. No inpatient service, minimal rounding. Short residency without the need for a fellowship. Option for a cash-based cosmetic side-hustle. Everything they prescribe is either a steroid or an antibiotic. But which one? Why not both?!


Orthopedic Surgery: Find me another group of people in the world that is incessantly bombarded with insults by colleagues, yet consistently reports life and job satisfaction that is higher than any other. There’s only one explanation for that: these meatheaded, neanderthal scalpel-jockeys simply ooze privilege. They get it delivered by their implant reps daily. Cases of 20-ounce bottles are brought to the surgeons lounge, where orthopods use it to wash down protein bars in between sets. They are everything you hate about medicine — they get to be hyper-focused on the one thing they love (bones) and pawn off just about anything else (except joints, muscles, and tendons). Forget managing disease, they intentionally forgot how to spell CHF after taking Step 3. They admit patients to other services to optimize their “comorbidities” like hiccups. They have it all. Everyone is jealous of them — and isn’t that what privilege is all about?