Depending on the setting, these people may be apparently legitimate, licenced professionals carrying out illegal procedures on the side or unlicenced practitioners carrying out legal work (which might arguably make them grey market doctors). Equally they might well be unlicenced and carrying out illegal work. These people are distinct from medical practioners in a setting where no licencing applies - where there is no regulation, the whole black-white-grey thing doesn't make much sense.
Again, the nature of the work is massively variable - this character might provide perfectly decent medical care, possibly even out of a licenced doctor's practice, albiet at a cheaper rate than a legal alternative, or may be an incompetent butcher who cynically exploits those too poor for better care. Other common versions are the sort of doctor who will treat gunshot wounds, no questions asked at any hour of the day1 and the sort that provides STI control, abortions and possibly unethical plastic surgery to a pimps stable of prostitutes. Performing illegal organ transplants with unethically sourced organs is also a distinct possibility, as is the practice of performing face-changes for prominent criminals. The tamest variety simply write prescriptions to order, allowing clients to obtain controlled drugs in an apparently legitimate manner. Another option would be for a corrupt doctor to write a death certificate for someone that avoids an autopsy, Coroner's inquiry or other investigation into a death.
Black market doctors are also a key feature of cyberpunk where they patch up the characters (highly frequent) wounds and install unregistered (and/or prohibited) wetware … and perhaps strip it from any corpses they are brought as well. Other sci-fi versions can be found performing unlicenced genengineering work, including bio-enhancements, producing designer babies or clones and transforming DNA profiles to stymie forensics work. Expect also for them to perform operations to bypass biometric security measures - transplanting fingerprints, eyeballs and the like.
Since these people are, by definition, unregulated, caveat emptor applies in spades - and it might be best to have someone watch your back in case it's you that gets broken down for parts whilst you're under anesthetic. Likewise if they get access to your DNA profile and/or biometrics identity theft may take on a whole new meaning.
In settings where medical procedures are performed by robots, this one is out of warranty, running on black market software, converted from some other use or otherwise deviant from normal expectations.
In the pre-modern era, this sort of medical practice is likely carried out by a local cunning-man or wisewoman poaching on the territory of the guilded professionals or a licenced midwife or barber-surgeon overstepping the recognised bounds of their profession. Historically a physician performing surgery might have found himself in much the same position.
Game and Story Use
- PCs are likely to need access to one of these in any reasonably stringent modern campaign. Obtaining one can become an important early campaign objective.
- Useful to establish why an unlicenced doc is unlicenced - are they incompetent? Drunk? Disbarred for illegal or unethical practices? The washed out drunk is a staple of pulp/noir thrillers, whereas the bankrupt or unjustly disbarred doctor might well turn up in a more sympathetic role, working the urban poor or a destitute rural beat.
- The licenced but malpracticing doctor is also a distinct possibility - the guy patching stolen kidneys into rich queue jumpers or acting as a "tart vet" to a stable of slave-prostitutes makes a good acceptable target. Unless, of course, he's also the guy your PCs need to patch up their illicit gunshot wounds…
- Likewise the cyberpunk doc who strips the PCs victims for parts in lieu of fees (or for a share of the salvage price).
- Of course, in a suitably dystopian setting, PCs working for the right people (e.g. a Cyperpunk megacorp) may be able to get top of the line treatment as though it were perfectly legitimate (if the Corporation has a lock-hold on what happens inside its enclave, you can have a dozen federal warrants against you and it won't stop them giving you five star treatment and military grade cyberware if it suits them).
- Potentially you could also include other sorts of medical professional "cross skilling" such as veterinarians practising on humans, dentists doing non-dental surgery or non-dentists doing dental work.
- Speaking of vets, an ex-forces bush doctor could make a good medical practitioner for a poor rural community, even if what he does isn't strictly legal, as could other sub-doctor medical professionals (paramedics and nurses for example, working above their legal grade, whether or not they are above their actual competence).
- In the worst cases, these people may have little or no skill at all and work with an undergraduate medical handbook propped up next to them.