Which medical specialties are most in danger of becoming obsolete?

SDN Members don't see this ad. (About Ads)

Anesthesia: As more states are granting CRNAs independent practice rights, it seems hard to believe that hospitals will continue to pay double for anesthesiologists. Especially when the research (scant and underpowered as it is) shows that there is no difference in morbidity and mortality. Unless anesthesiologists find a way to separate themselves from CRNAs, this medical specialty may disappear from the US.

Psychiatry: Unfortunately, psychiatry has become a field in which the only financially feasible model for the MD is to write scripts all day and send the patients to therapists and psychologists for "talk therapy." Now that psychologists are gaining prescriptive powers, the role of a psychiatrist is becoming less clear. Sure, no psychologist is going to be managing a frankly psychotic patient with haldol any time soon, but who knows how far this trend will continue.

Radiology: Globalization is the biggest threat to this highly lucrative specialty. It's not hard to imagine hospitals sending their images to India or China where radiologists would read them for 5 cents/hour. The quality of the read might not be as good, but it beats paying a radiologist $900K/year or whatever they are making these days. Of course the lawyers would fight this change tooth and nail, since they can't sue an impoverished radiologist on the other side of the world. But with a rising national debt and sky-rocketing medical costs, I'm not so sure they would be successful in this fight.

Ophthalmology: The danger for ophthalmology is that there is already a well-established field in place called optometry that seems ready to take over. A couple states have already passed laws allowing optometrists to perform certain laser procedures. Will optometry continue to fight for more surgical rights? Who knows? Some optometrists think optometry should follow the "dentistry" model and perform all surgeries on the eye without going to medical school, while others are content doing primary care and refracting. For now the future relationship between these 2 fields is uncertain.

Family Medicine: This specialty has faced competition from all sides for a long time now. Midwives, OB/GYNs, pediatricians, and internists all take a share of the Family Medicine doctor's plate. Now the final nail in the coffin might be the independent nurse practitioner. As healthcare costs soar, these lovely practitioners might just take what's left.

PM&R: Now that physical therapy is almost exclusively a doctorate-level field, this might be another case of the lower-paid provider supplanting the "over-paid" physician. Time will tell.

Pathology: Patient interaction in pathology is basically nil. So why pay a medical school graduate $200K/year when a PhD in pathology could do it for half the cost?

Emergency Medicine: There will always be a role for them but with the rise of the mid-level practitioner, that role is shrinking. A level 1 trauma center will always have an EM physician on staff, but I could potentially see EDs in smaller more rural hospitals being stocked entirely by mid-levels in the not-to-distant future.

note: this thread is significantly different from the "which ones can be best done by machines" thread.

Clearly, medicine as a field is now obsolete

all of medicine will be obsolete once they perfect the memory transfer process of cloning.....

You're in danger of becoming obsolete.

You're crazy if you think someone without a US medical license is going to be a final read on an imaging study. Oh sorry our institution missed that cancer, now you get to sue us for 20 million dollars because we were too cheap to pay for a real MD.

We need a "what specialties _____ " forum.

Originally Posted by ijn

You're crazy if you think someone without a US medical license is going to be a final read on an imaging study. Oh sorry our institution missed that cancer, now you get to sue us for 20 million dollars because we were too cheap to pay for a real MD.

there is actually a lot of truth to this. Since mid-levels with privileges are still a minority their screw ups are washed out in the screw ups of doctors. Once we are at a level where there is no MD to pass the buck to the tides will turn rather quickly.

PM&R? I thought the DPT degree was only one more year than a master's (three years instead of two). DPTs don't have a license to practice medicine. Please elaborate on how they could take over the field and make PM&R obsolete.

Originally Posted by MiBicicleta

Radiology: Globalization is the biggest threat to this highly lucrative specialty. It's not hard to imagine hospitals sending their images to India or China where radiologists would read them for 5 cents/hour. The quality of the read might not be as good, but it beats paying a radiologist $900K/year or whatever they are making these days. Of course the lawyers would fight this change tooth and nail, since they can't sue an impoverished radiologist on the other side of the world. But with a rising national debt and sky-rocketing medical costs, I'm not so sure they would be successful in this fight.

haha, no self-respecting physician would bet their license and clear anyone for discharge based on a prelim dictated by someone, somewhere in the 3rd world. they dont even rely on prelim reads by people in this country.

radiologists are here to stay

Originally Posted by sandstone

PM&R? I thought the DPT degree was only one more year than a master's (three years instead of two). DPTs don't have a license to practice medicine. Please elaborate on how they could take over the field and make PM&R obsolete.

That's the point. Many providers these days are writing orders, performing procedures, and prescribing drugs independently without a license to practice medicine.

Pretty much everything besides Plastics and Derm.

Originally Posted by MiBicicleta

Anesthesia: As more states are granting CRNAs independent practice rights, it seems hard to believe that hospitals will continue to pay double for anesthesiologists. Especially when the research (scant and underpowered as it is) shows that there is no difference in morbidity and mortality. Unless anesthesiologists find a way to separate themselves from CRNAs, this medical specialty may disappear from the US.

If you think CRNAs will be handling complex cases, then you are most certainly a pre med with pretty much zero medical knowledge. As for the overall result of this, no one knows.

Psychiatry: Unfortunately, psychiatry has become a field in which the only financially feasible model for the MD is to write scripts all day and send the patients to therapists and psychologists for "talk therapy." Now that psychologists are gaining prescriptive powers, the role of a psychiatrist is becoming less clear. Sure, no psychologist is going to be managing a frankly psychotic patient with haldol any time soon, but who knows how far this trend will continue.

And how many "clinical psychologists" do we have in comparison to psychiatrists/psych residents ?

Radiology: Globalization is the biggest threat to this highly lucrative specialty. It's not hard to imagine hospitals sending their images to India or China where radiologists would read them for 5 cents/hour. The quality of the read might not be as good, but it beats paying a radiologist $900K/year or whatever they are making these days. Of course the lawyers would fight this change tooth and nail, since they can't sue an impoverished radiologist on the other side of the world. But with a rising national debt and sky-rocketing medical costs, I'm not so sure they would be successful in this fight.
This is the worst thing you said in your post. It is beyond idiotic to suggest that reliance will be put on an imaging read from someone in a 3rd world country. But people have already explained that in this thread.
Ophthalmology: The danger for ophthalmology is that there is already a well-established field in place called optometry that seems ready to take over. A couple states have already passed laws allowing optometrists to perform certain laser procedures. Will optometry continue to fight for more surgical rights? Who knows? Some optometrists think optometry should follow the "dentistry" model and perform all surgeries on the eye without going to medical school, while others are content doing primary care and refracting. For now the future relationship between these 2 fields is uncertain.
Optometrists do not have the training required to handle many things involved with the eye/surgeries/etc. They wont be able to fight for things they do not know how to do.
Family Medicine: This specialty has faced competition from all sides for a long time now. Midwives, OB/GYNs, pediatricians, and internists all take a share of the Family Medicine doctor's plate. Now the final nail in the coffin might be the independent nurse practitioner. As healthcare costs soar, these lovely practitioners might just take what's left.
People will still want to see a doctor, not a nurse. Sure some idiots in the general public wont care but over a large number of people there will be tons of growing concerns if nurses suddenly get the doctor role. The reality is... they wont. Most arent competent enough to make any sort of clinical judgement in many cases and if their numbers went up... so would a large number of idiotic misdiagnosed cases.
PM&R: Now that physical therapy is almost exclusively a doctorate-level field, this might be another case of the lower-paid provider supplanting the "over-paid" physician. Time will tell.
Physical therapy will never replace PM&R

Pathology: Patient interaction in pathology is basically nil. So why pay a medical school graduate $200K/year when a PhD in pathology could do it for half the cost?
Do you know the knowledge base of a pathologist vs. a someone with a phd in pathology?
Emergency Medicine: There will always be a role for them but with the rise of the mid-level practitioner, that role is shrinking. A level 1 trauma center will always have an EM physician on staff, but I could potentially see EDs in smaller more rural hospitals being stocked entirely by mid-levels in the not-to-distant future.

This is the stupidest thing to ever suggest. Yes lets bring in mid levels to do a job where excellent clinical judgement is key, and we'll just ignore the 5 times greater mortality rate.

OP, from the sound of it you're a pre-med or maybe a med school reject.

And I see all medicine paying 1000% more across the board. I have nothing to back up my speculation, but neither do you so they are equally true.

A lot of people are throwing around the term "third world" when referring to China and India and suggesting that it is some kind of uncivilized wasteland. That term is pretty much outdated. China and India have some impressive academic institutions and produce many brilliant minds.

Originally Posted by MiBicicleta

A lot of people are throwing around the term "third world" when referring to China and India and suggesting that it is some kind of uncivilized wasteland. That term is pretty much outdated. China and India have some impressive academic institutions and produce many brilliant minds.

They also have some pretty nasty living conditions, the equivalent of slave labor, and out of control pollution (at least China does for sure). I don't think I'd use the term 3rd world, but it's still something to keep in mind.

Originally Posted by MiBicicleta

A lot of people are throwing around the term "third world" when referring to China and India and suggesting that it is some kind of uncivilized wasteland. That term is pretty much outdated. China and India have some impressive academic institutions and produce many brilliant minds.

China was 2nd World, India was 3rd world. You are correct in that the terms are outdated, but for different reasons. The countries are still quite poor.

First World == Capitalism and NATO
Second World == USSR
Third World == Neutral

Originally Posted by MiBicicleta

Anesthesia: As more states are granting CRNAs independent practice rights, it seems hard to believe that hospitals will continue to pay double for anesthesiologists. Especially when the research (scant and underpowered as it is) shows that there is no difference in morbidity and mortality. Unless anesthesiologists find a way to separate themselves from CRNAs, this medical specialty may disappear from the US.

Thanks for that.

Originally Posted by FrkyBgStok

And I see all medicine paying 1000% more across the board. I have nothing to back up my speculation, but neither do you so they are equally true.

Student doctor network dogma right there, love it.

Here are the facts:

Radiology: first to go. Honestly how hard it it to look at a picture, been doing it since I was 3.

Gas: First come the mid level encroachment and then come the high school graduate encroachment.

Psych: it's all in their heads anyway. The gig will be up soon.

PM and R: an all but dead field. Eventually, they will rehab everyone and then what are they left with? Fighting over the scraps with PT's is what they are left with.

Family practice: with radical left wing encroachment on our traditional values, pretty soon there will be no families only 'domestic familial relationships.' No families = no family medicine

Oncology: I read somewhere they have solved cancer.

IMO the only specialty that is safe is the neurosurgeon who does boob jobs on the side.

Originally Posted by thomprya

Here are the facts:

Radiology: first to go. Honestly how hard it it to look at a picture, been doing it since I was 3.

watching porn all day will not make you a human anatomy expert.

most clinicians don't know what they're looking at most of the time.

i personally only want someone with a Step > 240 interpreting my films

Originally Posted by thomprya

Here are the facts:

Radiology: first to go. Honestly how hard it it to look at a picture, been doing it since I was 3.

Gas: First come the mid level encroachment and then come the high school graduate encroachment.

Psych: it's all in their heads anyway. The gig will be up soon.

PM and R: an all but dead field. Eventually, they will rehab everyone and then what are they left with? Fighting over the scraps with PT's is what they are left with.

Family practice: with radical left wing encroachment on our traditional values, pretty soon there will be no families only 'domestic familial relationships.' No families = no family medicine

Oncology: I read somewhere they have solved cancer.

IMO the only specialty that is safe is the neurosurgeon who does boob jobs on the side.

I love it!

Originally Posted by myhandsarecold

watching porn all day will not make you a human anatomy expert.

most clinicians don't know what they're looking at most of the time.

i personally only want someone with a Step > 240 interpreting my films

You and I are going to have to agree to disagree on this kind sir.

Good thing there are only experts giving their opinions on this thread or I would have disregarded the OP's post as opinion.

I just don't understand why people believe that all fields can't become obsolete. What's important here is to take away the fact that medicine is not an absolutely protected field. One should always be enhancing their skills and their marketability.

As I see it medicine is an art that one practices, but healthcare is a business. Business is competitive. You are also competitive or you wouldn't be here. So, since you are here, become business savvy, make yourself as indespensible as possible. But, if things changes, it will be okay. Look at all the non-doctors in our country who recently were laid off and changed careers entirely.

Don't stress about it, just be smart about it.

TL;DR: STRESSFUL RAGE INDUCING COMMENT THAT FUELS MORE UPSET, UNINFORMED COMMENTS

Originally Posted by sportsperson

OP, from the sound of it you're a pre-med or maybe a med school reject.

Beat me to it. It sounds like the OP has no clue about clinical medicine. If they are a med student they probably are a clueless M1 or M2 that has yet to set foot on the wards.

Originally Posted by myhandsarecold

watching porn all day will not make you a human anatomy expert.

most clinicians don't know what they're looking at most of the time.

i personally only want someone with a Step > 240 interpreting my films

I only want someone who understands sarcasm doing my reads.

Originally Posted by badasshairday

Beat me to it. It sounds like the OP has no clue about clinical medicine. If they are a med student they probably are a clueless M1 or M2 that has yet to set foot on the wards.

It's rather funny how some people are attacking their own imagined identity of the OP rather than commenting on the subject. Argumentum ad hominem imaginacium.

Originally Posted by badasshairday

Beat me to it. It sounds like the OP has no clue about clinical medicine. If they are a med student they probably are a clueless M1 or M2 that has yet to set foot on the wards.

I think failed pre-med is the most likely thing since OP seems to have some bitterness about doctors

Originally Posted by MiBicicleta

It's rather funny how some people are attacking their own imagined identity of the OP rather than commenting on the subject. Argumentum ad hominem imaginacium.

The points you brought up have already been brought down.

Originally Posted by sportsperson

I think failed pre-med is the most likely thing since OP seems to have some bitterness about doctors

That's an interesting take on it. The OP's comments seem to be more hostile to mid-levels for taking over medicine. I think someone might be showing their insecurities rather than facing and challenging hard facts.

Originally Posted by MiBicicleta

That's an interesting take on it. The OP's comments seem to be more hostile to mid-levels for taking over medicine. I think someone might be showing their insecurities rather than facing and challenging hard facts.

1) You are the OP. Someone who is the OP in a thread doesn't normally say something like "The OP's comments." This leads me to believe this is maybe your second account made for the purpose of trolling. Meaning you probably forgot to change back to your original account.

2) You did not present any "hard facts" in fact nothing you said even made any sense. Feel free to come back when you bring along any actual evidence.

Originally Posted by MiBicicleta

It's rather funny how some people are attacking their own imagined identity of the OP rather than commenting on the subject. Argumentum ad hominem imaginacium.

So does your face.

Originally Posted by sportsperson

1) You are the OP. Someone who is the OP in a thread doesn't normally say something like "The OP's comments." This leads me to believe this is maybe your second account made for the purpose of trolling. Meaning you probably forgot to change back to your original account.

In the third person, Blais speaks in it and so does OP.

Originally Posted by MiBicicleta

Anesthesia: As more states are granting CRNAs independent practice rights, it seems hard to believe that hospitals will continue to pay double for anesthesiologists. Especially when the research (scant and underpowered as it is) shows that there is no difference in morbidity and mortality. Unless anesthesiologists find a way to separate themselves from CRNAs, this medical specialty may disappear from the US.

Psychiatry: Unfortunately, psychiatry has become a field in which the only financially feasible model for the MD is to write scripts all day and send the patients to therapists and psychologists for "talk therapy." Now that psychologists are gaining prescriptive powers, the role of a psychiatrist is becoming less clear. Sure, no psychologist is going to be managing a frankly psychotic patient with haldol any time soon, but who knows how far this trend will continue.

Radiology: Globalization is the biggest threat to this highly lucrative specialty. It's not hard to imagine hospitals sending their images to India or China where radiologists would read them for 5 cents/hour. The quality of the read might not be as good, but it beats paying a radiologist $900K/year or whatever they are making these days. Of course the lawyers would fight this change tooth and nail, since they can't sue an impoverished radiologist on the other side of the world. But with a rising national debt and sky-rocketing medical costs, I'm not so sure they would be successful in this fight.

Ophthalmology: The danger for ophthalmology is that there is already a well-established field in place called optometry that seems ready to take over. A couple states have already passed laws allowing optometrists to perform certain laser procedures. Will optometry continue to fight for more surgical rights? Who knows? Some optometrists think optometry should follow the "dentistry" model and perform all surgeries on the eye without going to medical school, while others are content doing primary care and refracting. For now the future relationship between these 2 fields is uncertain.

Family Medicine: This specialty has faced competition from all sides for a long time now. Midwives, OB/GYNs, pediatricians, and internists all take a share of the Family Medicine doctor's plate. Now the final nail in the coffin might be the independent nurse practitioner. As healthcare costs soar, these lovely practitioners might just take what's left.

PM&R: Now that physical therapy is almost exclusively a doctorate-level field, this might be another case of the lower-paid provider supplanting the "over-paid" physician. Time will tell.

Pathology: Patient interaction in pathology is basically nil. So why pay a medical school graduate $200K/year when a PhD in pathology could do it for half the cost?

Emergency Medicine: There will always be a role for them but with the rise of the mid-level practitioner, that role is shrinking. A level 1 trauma center will always have an EM physician on staff, but I could potentially see EDs in smaller more rural hospitals being stocked entirely by mid-levels in the not-to-distant future.

A PhD in pathology cannot do what a pathologist does other than supervising a lab. PhDs cannot diagnose biopsies, do cytology and hematopathology. You must be premed.

getting his PhD in skeletonology as a back door into ortho.

Originally Posted by myhandsarecold

watching porn all day will not make you a human anatomy expert.

most clinicians don't know what they're looking at most of the time.

i personally only want someone with a Step > 240 interpreting my films

No sense of humor? Figures.

Originally Posted by MiBicicleta

Anesthesia: As more states are granting CRNAs independent practice rights, it seems hard to believe that hospitals will continue to pay double for anesthesiologists. Especially when the research (scant and underpowered as it is) shows that there is no difference in morbidity and mortality. Unless anesthesiologists find a way to separate themselves from CRNAs, this medical specialty may disappear from the US.

Psychiatry: Unfortunately, psychiatry has become a field in which the only financially feasible model for the MD is to write scripts all day and send the patients to therapists and psychologists for "talk therapy." Now that psychologists are gaining prescriptive powers, the role of a psychiatrist is becoming less clear. Sure, no psychologist is going to be managing a frankly psychotic patient with haldol any time soon, but who knows how far this trend will continue.

Radiology: Globalization is the biggest threat to this highly lucrative specialty. It's not hard to imagine hospitals sending their images to India or China where radiologists would read them for 5 cents/hour. The quality of the read might not be as good, but it beats paying a radiologist $900K/year or whatever they are making these days. Of course the lawyers would fight this change tooth and nail, since they can't sue an impoverished radiologist on the other side of the world. But with a rising national debt and sky-rocketing medical costs, I'm not so sure they would be successful in this fight.

Ophthalmology: The danger for ophthalmology is that there is already a well-established field in place called optometry that seems ready to take over. A couple states have already passed laws allowing optometrists to perform certain laser procedures. Will optometry continue to fight for more surgical rights? Who knows? Some optometrists think optometry should follow the "dentistry" model and perform all surgeries on the eye without going to medical school, while others are content doing primary care and refracting. For now the future relationship between these 2 fields is uncertain.

Family Medicine: This specialty has faced competition from all sides for a long time now. Midwives, OB/GYNs, pediatricians, and internists all take a share of the Family Medicine doctor's plate. Now the final nail in the coffin might be the independent nurse practitioner. As healthcare costs soar, these lovely practitioners might just take what's left.

PM&R: Now that physical therapy is almost exclusively a doctorate-level field, this might be another case of the lower-paid provider supplanting the "over-paid" physician. Time will tell.

Pathology: Patient interaction in pathology is basically nil. So why pay a medical school graduate $200K/year when a PhD in pathology could do it for half the cost?

Emergency Medicine: There will always be a role for them but with the rise of the mid-level practitioner, that role is shrinking. A level 1 trauma center will always have an EM physician on staff, but I could potentially see EDs in smaller more rural hospitals being stocked entirely by mid-levels in the not-to-distant future.

Surgery is untouchable!

Originally Posted by myhandsarecold

watching porn all day will not make you a human anatomy expert.

most clinicians don't know what they're looking at most of the time.

i personally only want someone with a Step > 240 interpreting my films

The trolling is strong in this one.

Originally Posted by myhandsarecold

watching porn all day will not make you a human anatomy expert.

most clinicians don't know what they're looking at most of the time.

i personally only want someone with a Step > 240 interpreting my films

Thats right, you should PERSONALLY go into the reading room and asking each radiologist what their step score is.

Now I remember why I love going to this forum. Priceless.

Originally Posted by MiBicicleta

Anesthesia: As more states are granting CRNAs independent practice rights, it seems hard to believe that hospitals will continue to pay double for anesthesiologists. Especially when the research (scant and underpowered as it is) shows that there is no difference in morbidity and mortality. Unless anesthesiologists find a way to separate themselves from CRNAs, this medical specialty may disappear from the US.

Lol, so much to comment on, but I'll focus on this. The fact that you understand the research is not there is a step in the right direction, unfortunately you didn't get all the way to the point. If I did a research project on the fact that ACE inhibitors cure hypertrophic cardiomyopathy, with a study involving 3 patients, no physician in their right mind is going to use a paper on this as anything other than cleaning up after a good BM. This equates to the research done by the groups promoting their own people in these "studies". They are not a basis by any means to change policy.

Originally Posted by dd128

Lol, so much to comment on, but I'll focus on this. The fact that you understand the research is not there is a step in the right direction, unfortunately you didn't get all the way to the point. If I did a research project on the fact that ACE inhibitors cure hypertrophic cardiomyopathy, with a study involving 3 patients, no physician in their right mind is going to use a paper on this as anything other than cleaning up after a good BM. This equates to the research done by the groups promoting their own people in these "studies". They are not a basis by any means to change policy.

You missed the point of my argument. I believe anesthesioloists provide safer anesthesia, particularly in high-risk cases. I also believe that CRNAs should not be practicing independently. I was merely citing the fact that more states are allowing CRNAs to practice independently and if anesthesiologist don't want to find themselves unemployed or have their salaries halved, then they should probably do a better job of distinguishing themselves from CRNAs.

I think we are piling on the OP. Sure, he shouldn't have used the word "extinct", but there are many specialties he listed which will be in less demand than at present. For example, while complex surgeries will use MD anesthesiologists for the foreseeable future, many bread and butter surgeries are no longer staffed by MDs but by CNRAs. "In less demand" would be a more accurate, if less sexy, term to describe this phenomenon.

Originally Posted by thomprya

Here are the facts:

Radiology: first to go. Honestly how hard it it to look at a picture, been doing it since I was 3.

Gas: First come the mid level encroachment and then come the high school graduate encroachment.

Psych: it's all in their heads anyway. The gig will be up soon.

PM and R: an all but dead field. Eventually, they will rehab everyone and then what are they left with? Fighting over the scraps with PT's is what they are left with.

Family practice: with radical left wing encroachment on our traditional values, pretty soon there will be no families only 'domestic familial relationships.' No families = no family medicine

Oncology: I read somewhere they have solved cancer.

IMO the only specialty that is safe is the neurosurgeon who does boob jobs on the side.

Your optimism, I like it.

Originally Posted by sportsperson

1) You are the OP. Someone who is the OP in a thread doesn't normally say something like "The OP's comments."

Multiple personality disorder?

Originally Posted by pntgrd

I think we are piling on the OP. Sure, he shouldn't have used the word "extinct", but there are many specialties he listed which will be in less demand than at present. For example, while complex surgeries will use MD anesthesiologists for the foreseeable future, many bread and butter surgeries are no longer staffed by MDs but by CNRAs. "In less demand" would be a more accurate, if less sexy, term to describe this phenomenon.

Although, the CRNAs may be the one sitting at the head of the table in these B&B cases, I would say that a large majority (especially in academic centers, large hospitals, populated areas, etc) are still staffed by a supervising anesthesiologist.

Originally Posted by spezimdoc

Although, the CRNAs may be the one sitting at the head of the table in these B&B cases, I would say that a large majority (especially in academic centers, large hospitals, populated areas, etc) are still staffed by a supervising anesthesiologist.

That's true, but remember we are talking about specialties that are in danger in the future. Payers are always trying to squeeze the most out of a dollar, so how much longer are they going to continue to pay for MDs to administer or supervise anesthesia? Especially when there is not a shred of published evidence to my knowledge that MDs have better outcomes.

Originally Posted by MiBicicleta

That's true, but remember we are talking about specialties that are in danger in the future. Payers are always trying to squeeze the most out of a dollar, so how much longer are they going to continue to pay for MDs to administer or supervise anesthesia? Especially when there is not a shred of published evidence to my knowledge that MDs have better outcomes.

With all due respect you are either a troll (likely) or clueless (possible).

Instead of spending time with a reply...I will just reply with some buzz phrases...everyone can fill in the blanks....

Lawsuits
Increasing US population
Increasing chronic disease per patient
More treatments available
Aging population
When the **** hits the fan in surgery
When a politician's family member dies due to lack of supervision by a MD
Physician Lobbyists (hello AMA)
Pts refusing to see anyone but the "doctor"
Lawsuits

Originally Posted by MiBicicleta

You missed the point of my argument. I believe anesthesioloists provide safer anesthesia, particularly in high-risk cases. I also believe that CRNAs should not be practicing independently. I was merely citing the fact that more states are allowing CRNAs to practice independently and if anesthesiologist don't want to find themselves unemployed or have their salaries halved, then they should probably do a better job of distinguishing themselves from CRNAs.

Things are not what they seem... We literally had a residency fair the other day at school where Anesthesia had a booth. I asked specifically about this (it's a legit question for those interested in getting into the field). These laws are not as broad as they look. We are talking about the simplest of cases that they can do indepedently. The cases that are easy, low risk, non-money makers that MD's wouldn't want to do anyway. Also, these laws, for the most part, came about because there are about 7000 people for every 1 anesthesiologist (according to these attendings, who are big in ASA apparently). So in rural areas of some of these states (KY for instance), there are no anesthesiologists for miles. So when you need to stick a colonoscope up a rectum in eastern Kentucky, you'll gladly use a CRNA for that with no MD around. Now of course CRNAs are using these laws to get other states to do the same...but again, skewing the facts. I don't know if this applies to every single state that has passed these laws (13 is the number i keep hearing), but i was made to believe it applied to most if not all.
You will not see a CRNA handling a big open heart case without supervision, if at all. You won't see them doing transplant cases without supervision, if at all. And, they are making a ton of money, some up to 200K. The gap between their income and the MD's are narrowing. This sounds bad, and it is, but there's a silver lining. Hospitals are now seeing that instead of saving money on a CRNA, they can pay a little more and get the expertise of an MD.
Lastly, anesthesia as a field is starting to adapt, getting more involved in critical care, and starting this idea of complete perioperative care, being in charge of pre-op screening, perioperative management, and post-op care and follow up, including SICU care. The surgeons, for the most part, are solidly behind them in this. Think...CRNA's don't carry nearly the same liability, and as one doc told me "nobody wants to sue a nurse." If CRNA's get more autonomy and are taking cases by themselves...who is more likely to get sued if something goes wrong?...the surgeon! Lawyers love going after the big guns, even if they weren't truly at fault. The surgeons want the anesthesiologists involved in some way.
I've been genuinely concerned about the whole CRNA thing too, and since anesthesia is one of the possible specialties I may go into, I've been asking around. I seem to get the same answer from the young and old docs (private and academic practices): that nobody is concerned about this doomsday scenario most often seen in the SDN anesthesia forums about CRNA's taking over. It's a theoretical possibility, but not a practical one according to them. And the ASA is well aware of the situation. Don't worry, be happy.

Who knows... By the way, anyone else feeling the absurd stress of choosing your specialty already? March 15th, 2013 (the next Match Day, for you rookies) is 11 months away! 11 months of this! F%$^!

http://whatshouldwecallmedschool.tum...one-you-can-go


.

In the most abstract, philosophical, and moral sense - not one of these MD competitors are really better than or can actually compete with, in every practical sense, the MD with his years of education and training.

With that said, do not underestimate the power of idiots trying to save money.

If this has already been said, then never mind.

Originally Posted by MiBicicleta

Radiology: Globalization is the biggest threat to this highly lucrative specialty. It's not hard to imagine hospitals sending their images to India or China where radiologists would read them for 5 cents/hour. The quality of the read might not be as good, but it beats paying a radiologist $900K/year or whatever they are making these days. Of course the lawyers would fight this change tooth and nail, since they can't sue an impoverished radiologist on the other side of the world.

Yeah. That's who will be super angry if every radiologist is fired.

The lawyers.

Also, might as well throw derm into the mix - any preteen knows that if you buy a $3 can of spray air and turn it upside down, freezing liquid comes out.

Originally Posted by scarshapedstar

Yeah. That's who will be super angry if every radiologist is fired.

The lawyers.

He was on the right track, but attorneys are the main reason outsourcing will never happen in radiology. If a radiologist in India misses a lung nodule on a patient at a point when it was operable, the patient's family has nobody to sue when the patient dies from widespread cancer years later. Who do they turn their frustrations on and sue? The hospital that hired the foreign radiologist. And the hospital will lose BIGTIME. No insurance company in their right minds would cover the litigation costs of a hospital that was too cheap to pay for an American doctor.

And radiologists don't make 900K per year. Divide that number by 3, and you are closer.