Bioethics Grows, But Will Jobs Follow?

Want to be a bioethicist? Don’t count on getting paid.

There simply are not enough salaried bioethics jobs to go around, says Tia Powell, MD, the director of the Montefiore Einstein Center for Bioethics and of the Einstein-Cardozo Master of Science in Bioethics program in New York City. In the 30 years she has been in bioethics, Powell has seen the discipline grow.

There are now at least 38 graduate programs in the field, one that was unknown a few decades ago, and they have produced thousands of specialists.

According to the Hastings Center, a bioethics research institute in Garrison, NY there were 2,314 bioethics and applied ethics degrees granted from 2000 through 2013, Most (1,723 ) were master’s degrees, 173 were bachelor’s degrees, and 156 were doctoral degrees—and there were 262 program certificates awarded.

But having a bioethics degrees or certificate does not mean finding a position as a bioethicist, Powell (photo, right) said in a recent interview.

Some bioethics experts working at academic medical centers volunteer to take on bioethics consultations in addition to their other duties; others have bioethics as part of their overall job description, but only some are paid for this extra service and expertise, Powell said.

Bioethics centers also don't generate billable hours, so that they often are supported by philanthropy, grants, tuition or their parent institution, she added.

It’s not that there aren’t enough issues to decide.

Being an ethical practitioner of medicine has gotten far more complex than simply following the ancient dictum of “First, do no harm.”

Physicians wrestle with end-of-life issues, genetic-engineering debates, questions related to the expense of care vs. benefits conferred, whether and when patients deserve compensation for the use of their cells or tissues, and other topics engendered by ever-developing technology and burgeoning costs.

Bioethical issues are so important, and often politically sensitive, that since 1974, US presidents have had the option of appointing a Presidential Commission for the Study of Bioethical Issues. Seven have done so, including Barack Obama.

But the formal training programs are costly. Hastings found tuitions ranging from $8,000 for a certificate program run by a hospital to $66,000 for one university’s master’s program—all for a degree that does guarantee employment.

To that end, bioethics training works better as an add-on, not a standalone.

"For me personally, the person most likely to be hired is a person with a broad range of skills including comfort in clinical areas as well as some formal training in bioethics," she added.

Someone with just a bachelor's degree in bioethics or even a master's is not going to have a career path in clinical bioethics, although they might get an entry level job doing research, she explained.

For instance, she said, in her center what she looks for in a job candidate is not someone with just a PhD in bioethics or an MD, but someone with a "depth of experience of sitting with families in distress."

In the US institutions offering bioethics training more than half of those 38 programs appear to recognize the wisdom of getting dual training.

These are the institutions offering joint degrees in bioethics along with an MD, or law degree or in some cases, divinity degrees, or advanced degrees in social work, nursing, dentistry, physical therapy of philosophy, according to a 2014 Hastings list.

The courses themselves speak to the need to address the growing complexity of medicine.

Though some offerings have a philosophical focus, they can also be highly technical.

For instance, at Montefiore (photo at left) the curriculum includes classes in "The Beginning and End of Life" and "Personhood.”

At the technically focused end of the spectrum, highly specialized training is available at places like the Johns Hopkins Berman Institute of Bioethics. Its program on Ethics and Brain Sciences has an interdisciplinary working group that, for example, focuses on "Human Trials of Cell-Based Intervention for Neurological Conditions."

Coursework in such programs can be demanding but visions of recouping the investment of time and money through a higher salary might not necessarily be realized.

So why does someone study bioethics?

Some might enroll with a goal of getting comfortable with the technological and scientific breakthroughs that are changing medicine.

Powell sees that as a "red herring," she said. In her experience, a bioethicist will usually be called in not for issues related to new technology but to tackle questions that are as old as Hippocrates: what is a good death, what is confidentiality.

"One common problem is when a patient declines recommended treatment and it's unclear whether she truly grasps the consequences," she explained.

Another is "how shall we support grieving family members as they try to settle old grievances with each other and make responsible decisions together.”

"For the bioethics student there also is the grounding in how to help people articulate their values and goals in the context of what is medically feasible,” Powell said.

That work puts many bioethicists back in touch with the reasons they became physicians or other helping professionals in the first place, Powell added.

The questions they deal with can be challenging, and they are not going away, other bioethicists agree.

For Daniel Sulmasy, MD, PhD, director of the University of Chicago's program in medical ethics and religion and a member of the Obama administration’s Presidential Commission for the Study of Bioethical Issues, bioethics is not just a field best left to the experts.

"I almost think we probably ought to start teaching bioethics in high school because some of the questions I deal with at least in clinical ethics are going to affect everybody," he says in a video posted on the site. "Everybody is going to decide at some point whether or not to continue life sustaining treatments for someone they love.”