Does pharmacy over saturation parallel what could potentially happen in medicine?

[aegistitan]

I was reading an article recently (http://www.newrepublic.com/article/119634/pharmacy-school-crisis-why-good-jobs-are-drying) and was wondering whether or not any type of physician over saturation could occur in the future. In the past there was a shortage of pharmacists, and many PharmD programs opened, and the pharmacy job market is oversaturated. It seems as though the number of residency spots provides a bottleneck for the increasing number of medical schools opening. But what would happen after there are more US MD/DO graduates than residency positions? Would there be people with MD/DO who are forced to work in Missouri?

Regardless, if there is currently a physician shortage, why are new residency spots not opening up? Could it be possible that some specialties in the future will face what is currently happening to the pathology job market? Why is the pathology job market so bad right now?

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[mik30102]

Idk much about the pathology markets. Residency spots are not opening up since the government does not want to increase spending. All that is occurring though is FMGs will be pushed out of the match over time with near 100% of all matched physicians being US MD/DOs. Part of the reason for the pharmacy market debacle is that it has been assumed that the role of the pharmacist would change where more pharmacists would be seeing patients and moving out of the dispensing role. This however has simply not occurred. Physicians do not face this problem. There potentially may be over-saturation in a few decades in my opinion though when the baby boomers die off and we are then left with current levels of physicians for a lower % of the elderly.

 

[Mr Roboto]

Because no one in Congress would get re-elected on the platform of "Let's pay doctors money!"

Regardless, if there is currently a physician shortage, why are new residency spots not opening up?

 

[darklabel]

Even if new Residency programs open, they will only be for primary care positions.

Each specialty is different and have their own challenges associated with employment, so I won't touch that.

As for more US grads than positions, that won't happen for a while because despite the doom and gloom you read here, new positions do open up each year, just not at a fast rate compared to the number of new schools and growing seats.

For 2014, there were 29,671 positions available to apply for. Now there were 34,270 vying for a spot but lets go ahead and remove the IMGs and FMGs since the goal of the growth of medical schools was to remove them and replace them with US grads. So 17,374 US MD grads applied and 2,738 DO students applied (An all time high) for a total of 20,112 US grads applying for 34,270 positions. Remember that the number of residency positions isn't static and still grows at a small rate. 540 more positions were offered vs. 2013 match. Remember that DO's have their own residencies so not all DO grads apply for ACGME.

Basically, as a US grad, if your priority is to just match somewhere, I wouldn't worry for a while. Now if you're talking about competitive specialties, thats a whole 'nother story.

Source: http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf

 

[HinduHammer]

No, the pharmacy "over-saturation" could not happen in medicine for a variety of reasons. One is residency spots. This artificial barrier to entering the market changes the game completely. Two is that when supply starts to exceed demand (as in pathology), salaries will go down and people will stop going into medicine. I doubt there will be a time when there are more MD/DO graduates from the US than residency spots, because educated market participants will not be willing to pay $400K for med school education without a very high likelihood of getting a residency. Never say never, but the short answer to your question is No.

 

[aegistitan]

For 2014, there were 29,671 positions available to apply for. Now there were 34,270 vying for a spot but lets go ahead and remove the IMGs and FMGs since the goal of the growth of medical schools was to remove them and replace them with US grads. So 17,374 US MD grads applied and 2,738 DO students applied (An all time high) for a total of 20,112 US grads applying for 34,270 positions. Remember that the number of residency positions isn't static and still grows at a small rate. 540 more positions were offered vs. 2013 match. Remember that DO's have their own residencies so not all DO grads apply for ACGME.

Interesting, thanks for sharing that. I was unaware that half of those vying for spots right now are immigrants.

 

[SkipJunior]

Interesting, thanks for sharing that. I was unaware that half of those vying for spots right now are immigrants.

well not really immigrants. Most of them are US citizens who studied in foreign medical schools (IMGs) and some of them are foreign citizens who studied in foreign medical schools (FMG)

 

[boltedbicorne]

Hopefully, it'd be a good of way culling a lot of people from pursuing medicine who are only interested in $$$$$

 

[SkipJunior]

Hopefully, it'd be a good of way culling a lot of people from pursuing medicine who are only interested in $$$$$

what a silly thing to say. when someone has to take 300-400 k of loans and give up several productive income generating years of their life, then yes, they do have to worry about fair compensation.

There are many other professions where someone can earn a lot more money overall than becoming a physician

 

[deleted158872]

Any other opinions?
another reason for pharmacy saturation is that their organization mostly represents corporations rather than the profession itself.
in medicine, we have the AMA, but how much longer is the AMA able to hold up and keep control of the medical school entrance (and school expansion)?

 

[Holmwood]

Seems like a lot of what pharmacists have been replaced with automation technology. . . Seems like that's part of the reason why there's less demand for PharmD.

 

[deleted158872]

Seems like a lot of what pharmacists have been replaced with automation technology. . . Seems like that's part of the reason why there's less demand for PharmD.

technology is less at fault than the loss of control of the organization hence the massive school expansion + lowering of entrance requirements + corporations keep representing pharmacists & passing regulations that are only favorable for them.
by the same token, can I say that robots will soon replace surgeons in medicine? no. Robots can do some stuff but the "brains" of the surgeons need to be there. plus, the AMA is the 'gate keeper' of med school entrance so i don't think medicine will ever be 'saturated'.
anyone with more knowledge on this, please chime in. thanks.

 

[Blue Blood]

Seems like a lot of what pharmacists have been replaced with automation technology. . . Seems like that's part of the reason why there's less demand for PharmD.

+1 This + Many New Pharmacy Schools + Massive Class Sizes

Even a small LAC can open a pharmacy program and produce competent pharmacists. With physicians, limited good academic rotation cites + a residency bottleneck keeps numbers at sustainable levels.

Automation in the next decade is going to destroy public/corporate pharmacy, who will do anything to save a buck.

Edit: Sorry @Maruko. Pretty much repeated what you said.

 

[deleted158872]

With physicians, limited good academic rotation cites + a residency bottleneck keeps numbers at sustainable levels.

but I've heard some med schools have... mediocre rotation sites; some haven't even established rotations?

 

[Blue Blood]

but I've heard some med schools have... mediocre rotation sites; some haven't even established rotations?

I think this is the exception rather than the rule for most allo schools. Most have a "home base" academic hospital. For DO schools this is hit and miss. (I.e. top schools like PCOM should be fine)

A few new medical schools have this problem as well.

 

[Dr.Zoidberg]

Speaking of automation, what about computer-based diagnosis? I can only imagine that in our lifetimes these systems will actually be operational. There will be resistance of course, but what about when the data comes back showing equal or better outcomes for patients using the computer-based care instead of real physicians?

I can imagine a system where patients answer questions and are evaluated by a computer, and a single doctor approves or flags the diagnosis given. Because he/she only has to look at a summary, he/she effectively does the job of many physicians at a time, and the number of physicians needed, as well as the role they play, will be drastically reduced. Legislation, populations, and resources will change, and there will be shortages or excesses in response to that, but I think this kind of technology represents the first true threat to the identity of the physician in modern society.

Thoughts?

 

[Blue Blood]

Speaking of automation, what about computer-based diagnosis? I can only imagine that in our lifetimes these systems will actually be operational. There will be resistance of course, but what about when the data comes back showing equal or better outcomes for patients using the computer-based care instead of real physicians?

I can imagine a system where patients answer questions and are evaluated by a computer, and a single doctor approves or flags the diagnosis given. Because he/she only has to look at a summary, he/she effectively does the job of many physicians at a time, and the number of physicians needed, as well as the role they play, will be drastically reduced. Legislation, populations, and resources will change, and there will be shortages or excesses in response to that, but I think this kind of technology represents the first true threat to the identity of the physician in modern society.

Thoughts?

From history's past predictions, humans are terrible at telling what the future will hold. Technology will certainly be more present in the future, but as to how...that's anyone's guess.

 

[Dr.Zoidberg]

From history's past predictions, humans are terrible at telling what the future will hold. Technology will certainly be more present in the future, but as to how...that's anyone's guess.

True, but it doesn't mean I don't want to argue with someone about our not-so-distant dystopian future.

 

[Mr.Zero]

Any other opinions?
another reason for pharmacy saturation is that their organization mostly represents corporations rather than the profession itself.
in medicine, we have the AMA, but how much longer is the AMA able to hold up and keep control of the medical school entrance (and school expansion)?

Just so you know, its the LCME that is in charge of (allopathic) medical school, not the AMA

 

[Blue Blood]

True, but it doesn't mean I don't want to argue with someone about our not-so-distant dystopian future.

I'm up for an argument. We should be hitting the ceiling with respect to Moore's law in a few years. Silicon is set to be replaced with carbon nano tubes but they're not showing the results they were expecting in current research.

 

[Holmwood]

Speaking of automation, what about computer-based diagnosis? I can only imagine that in our lifetimes these systems will actually be operational. There will be resistance of course, but what about when the data comes back showing equal or better outcomes for patients using the computer-based care instead of real physicians?

I can imagine a system where patients answer questions and are evaluated by a computer, and a single doctor approves or flags the diagnosis given. Because he/she only has to look at a summary, he/she effectively does the job of many physicians at a time, and the number of physicians needed, as well as the role they play, will be drastically reduced. Legislation, populations, and resources will change, and there will be shortages or excesses in response to that, but I think this kind of technology represents the first true threat to the identity of the physician in modern society.

Thoughts?

I'm not talking about replacing pharmacists and physicians. Automation tech is allowing both pharmacists and physicians to handle a larger amount of patients at a time relative to the past. As the tech gets better, that number will continue to increase. The demand for more pharmacists and physicians will then decrease.

 

[Blue Blood]

I'm not talking about replacing pharmacists and physicians. Automation tech is allowing both pharmacists and physicians to handle a larger amount of patients at a time relative to the past. As the tech gets better, that number will continue to increase. The demand for more pharmacists and physicians will then decrease.

Don't forget that you have to consider as technology gets better a wider range of diagnostic and treatment options become available. That being said, there's probably going to be a pretty big expansion of molecular medicine in the next decade or two. By then the total landscape of medicine will be different.

 

[aegistitan]

Speaking of automation, what about computer-based diagnosis? I can only imagine that in our lifetimes these systems will actually be operational. There will be resistance of course, but what about when the data comes back showing equal or better outcomes for patients using the computer-based care instead of real physicians?

I can imagine a system where patients answer questions and are evaluated by a computer, and a single doctor approves or flags the diagnosis given. Because he/she only has to look at a summary, he/she effectively does the job of many physicians at a time, and the number of physicians needed, as well as the role they play, will be drastically reduced. Legislation, populations, and resources will change, and there will be shortages or excesses in response to that, but I think this kind of technology represents the first true threat to the identity of the physician in modern society.

Thoughts?

Don't think that's going to happen anytime soon. More realistically mid-level providers may start to replace physicians for less complex cases, as is happening right now in anesthesiology. Here is a very interesting thread about how much time anesthesiologists spend supervising CRNA's. http://forums.studentdoctor.net/threads/how-much-time-do-you-spend-supervising-crnas.1111877/

But speaking of over saturation, it's hit pathology, the rad-onc forum tells me rad-onc has been hit too. Apparently cardiology is also becoming over saturated. Who knows how things will turn out in a decade's time.

 

[WingedOx]

No matter what happens, a supply of physicians will continue to be unevenly distributed. Want to work in Philly? Seller's market. Want to work in Lancaster? Name your salary.

 

[Blue Blood]

No matter what happens, a supply of physicians will continue to be unevenly distributed. Want to work in Philly? Seller's market. Want to work in Lancaster? Name your salary.

Hey Lancaster isn't so bad! I hate cities though so I'm a bit biased.

 

[WingedOx]

Hey Lancaster isn't so bad! I hate cities though so I'm a bit biased.

Consider yourself lucky. You'll have a higher salary with a lower cost of living.

 

[IlDestriero]

Just so you know, its the LCME that is in charge of (allopathic) medical school, not the AMA

The AMA is worthless and doesn't represent physicians today. If you're sending them your money, you should look at what they are doing with it.

 

[IlDestriero]

Don't think that's going to happen anytime soon. More realistically mid-level providers may start to replace physicians for less complex cases, as is happening right now in anesthesiology. Here is a very interesting thread about how much time anesthesiologists spend supervising CRNA's. http://forums.studentdoctor.net/threads/how-much-time-do-you-spend-supervising-crnas.1111877/

But speaking of over saturation, it's hit pathology, the rad-onc forum tells me rad-onc has been hit too. Apparently cardiology is also becoming over saturated. Who knows how things will turn out in a decade's time.

One of the reasons there is so much supervision is that anesthesiologists decided a while back that they would rather make $600k+ supervising 3-4 rooms than doing their own cases for $350. That worked out great for them and their vacation homes. It's not looking so great for those just graduating.

No matter what happens, a supply of physicians will continue to be unevenly distributed. Want to work in Philly? Seller's market. Want to work in Lancaster? Name your salary.

That is the truth. You can have a great job as little as 30 miles outside of many oversaturated cities.

 

[Greenberg702]

I was reading an article recently (http://www.newrepublic.com/article/119634/pharmacy-school-crisis-why-good-jobs-are-drying) and was wondering whether or not any type of physician over saturation could occur in the future. In the past there was a shortage of pharmacists, and many PharmD programs opened, and the pharmacy job market is oversaturated. It seems as though the number of residency spots provides a bottleneck for the increasing number of medical schools opening. But what would happen after there are more US MD/DO graduates than residency positions? Would there be people with MD/DO who are forced to work in Missouri?

Regardless, if there is currently a physician shortage, why are new residency spots not opening up? Could it be possible that some specialties in the future will face what is currently happening to the pathology job market? Why is the pathology job market so bad right now?

This has already happened to several specialties for a variety of complex reasons (demand for services is declining, a large and increasing number of residency spots which is essentially the last barrier before practicing, and lack of retirement due to the overall economy). Pathology, radiology, and cardiology all have abysmal job markets. Rad-onc is getting bad too. After the boom in imaging demand in the early 2000s, tons of residents got pumped out each year. Now, when volume has stabilized/declined you basically have an equal number of jobs per graduating resident (which doesn't include those who are underemployed and want to move). Older partners are also refusing to retire. Ophthalmology is similarly super saturated in desirable areas.

Each specialty needs to look out for itself. Strong lobbying and tight controls are key to maintaining a favorable job market for physicians in your specialty. Everyone should learn from derm, GI, and ortho.

 

[Greenberg702]

what a silly thing to say. when someone has to take 300-400 k of loans and give up several productive income generating years of their life, then yes, they do have to worry about fair compensation.

There are many other professions where someone can earn a lot more money overall than becoming a physician

At least some pre-meds still think like responsible adults.

 

[aegistitan]

This has already happened to several specialties for a variety of complex reasons (demand for services is declining, a large and increasing number of residency spots which is essentially the last barrier before practicing, and lack of retirement due to the overall economy). Pathology, radiology, and cardiology all have abysmal job markets. Rad-onc is getting bad too. After the boom in imaging demand in the early 2000s, tons of residents got pumped out each year. Now, when volume has stabilized/declined you basically have an equal number of jobs per graduating resident (which doesn't include those who are underemployed and want to move). Older partners are also refusing to retire. Ophthalmology is similarly super saturated in desirable areas.

Each specialty needs to look out for itself. Strong lobbying and tight controls are key to maintaining a favorable job market for physicians in your specialty. Everyone should learn from derm, GI, and ortho.

So it seems as though the pathology job market is completely dead as evidenced by the number of FMG's at certain mid-tier pathology programs: http://www.bumc.bu.edu/busm-pathology/residency-program/resident-profiles/

Do you guys think that the amount of FMG vs. USMD within residency programs are a good indicator of job market/saturation?

The same thing that is happening in pathology is not happening in rad-onc, but rad-onc still somewhat competitive, do you guys see this changing anytime soon? Greenberg do you have any predictions as to what fields will be hit next?

 

[Greenberg702]

So it seems as though the pathology job market is completely dead as evidenced by the number of FMG's at certain mid-tier pathology programs: http://www.bumc.bu.edu/busm-pathology/residency-program/resident-profiles/

Do you guys think that the amount of FMG vs. USMD within residency programs are a good indicator of job market/saturation?

The same thing that is happening in pathology is not happening in rad-onc, but rad-onc still somewhat competitive, do you guys see this changing anytime soon? Greenberg do you have any predictions as to what fields will be hit next?

That's only one of the metrics you should be looking at. A lot of the time job market fluctuations are cyclical, and overall competitiveness doesn't change. The FMG/US MD ratio would probably be one of the last things to change, is indicative of a systemic problem, and is also a product of the number of spots available for a given specialty. That being said, the most important thing you should be looking at is whether you actually like the specialty itself since you'll be doing that for the rest of your life. Even the most elite schools send several people into pathology every year. If you love the work then go for it.

Rad Onc is getting hit in a similar way to ophtho. It's a very "niche" field and connections mean a lot in terms of both matching and getting jobs. There are a lot of perks including very high compensation, excellent lifestyle, and interesting work so I don't see it becoming noncompetitive any time soon unless the job market completely collapses.

Nobody can really predict the future. Some people say that GI could get slaughtered if scoping reimbursements drop significantly, but at the same time they're well-protected because they restrict the number of spots relative to cardiology and other IM subspecialties (I've heard of GI fellows getting 8+ offers with partnership tracks). I'd honestly advise to do what you like instead of trying to game the market and potentially end up very unhappy (like the people who wanted to become interventional/EP cardiologists for the money 5-6 years ago and are now getting hit hard).

 

[Law2Doc]

... Remember that the number of residency positions isn't static and still grows at a small rate. 540 more positions were offered vs. 2013 match. Remember that DO's have their own residencies so not all DO grads apply for ACGME...]

Just keep in mind that some of the allotted residency spots are not funded so they aren't actual spots. Also bear in mind that there was a jump in matched positions over the last few years as som program put their residency slots into the match (instead of "prematch") as part of the "all in" rule, so those might not actually represent new spots, just spots that are new to the match. the number of residencies has been fairly stagnant and hasn't come close to the rate of increase in US graduates (by design -- the AAMC wants US education to fill US healthcare needs).

As mentioned it unlikely that there will be much of an increase in residency slots because it's very hard for a politician in the setting of rising healthcare costs to justify to his constituents that he wants to allocate millions to subsidize the training of more "rich doctors".

 

[pithy84]

I think physicians are much less likely to have this problem for several reasons. The situation is really bad for law school graduates, it is somewhat bad for pharmacy graduates, but med school graduates are relatively shielded.

1. Notice that the number of pharmacy schools almost doubled, from 72 to over 130. In contrast, the number of med schools is growing slower than the US population. When you consider that the US population is getting much older on average, the numbers look even more favorable for physicians. All these retiring Baby Boomers will need doctors, and they will need a lot more medical care as they age.

2. Physicians have a lot more roles to play than pharmacists. If one role gets saturated, then physicians can take their degree and license and do something a bit different. Lawyers also seem to have this flexibility, but it is wiped out by the sheer oversupply of law school graduates.

3. The AAMC and most of the various medical specialty accreditation organizations (but not all) function like Medieval guilds. These organizations purposefully limit the number of slots available to keep salaries high. The organizations that accredit law schools and pharmacy schools do not have this stance, they allowed a rapid increase in schools and seats.

4. Med schools generally lose money, especially new med schools. Law schools rake in money hand over fist, because they have 200-student lectures and the papers are graded by TAs. This means universities love to start law schools, but they hesitate to invest in new med schools.

For physician supply to outpace demand, it would take some unlikely changes in the ecosystem, and it would take at least 10 or 20 years. Here are some unlikely factors that might cause this: A huge surge in the number of DO schools, new federal laws giving nurses a lot more autonomy to prescribe drugs and order X-rays and such, a massive shift in immigration policy that allows citizenship to be sold at auction without regard for country of origin (thousands of Indian doctors would invade).

 

[GaiusOctavius]

True, but it doesn't mean I don't want to argue with someone about our not-so-distant dystopian future.

Dystopian for who? I prefer to focus on the what could go right rather than on what could go wrong. I could definitely see a computer algorithm aiding in the process of differential diagnosis. I don't foresee a completely autonomous system any time in the near future. You'd need a very sophisticated AI system for that. A system that asks patients about their symptoms and severity, and then orders appropriate tests, and generates an EMR could be GREAT for patients and doctors.

Too be honest, it's a billion dollar idea and I'm kind of sad I just gave it away on SDN.

 

[WingedOx]

Dystopian for who? I prefer to focus on the what could go right rather than on what could go wrong. I could definitely see a computer algorithm aiding in the process of differential diagnosis. I don't foresee a completely autonomous system any time in the near future. You'd need a very sophisticated AI system for that. A system that asks patients about their symptoms and severity, and then orders appropriate tests, and generates an EMR could be GREAT for patients and doctors.

Too be honest, it's a billion dollar idea and I'm kind of sad I just gave it away on SDN.

I know plenty of physicians who would be a downgrade to such a system...

 

[C.S. Peirce]

A system that asks patients about their symptoms and severity, and then orders appropriate tests, and generates an EMR could be GREAT for patients and doctors.

Too be honest, it's a billion dollar idea and I'm kind of sad I just gave it away on SDN.

I don't think you're the first person to have this idea; the idea of automating history/physical is probably the first thing somebody tried to do with a computer. The problem is history-taking relies on processes that, as of now, computers are pretty bad at.
It would be an easy problem to solve if a physical exam consisted only of questions about symptoms and severity (as well as a history), and followed a decision-tree based on answers. But from my (admittedly naive) understanding of the process, examination plays into the process as well, as do fuzzy, difficult-to-program variables like 'judgment.' Shortness of breath is an easy symptom to report, for example, but few patients will be reliable indicators of whether their SOB is due to wheezing or stridor. A person with a trained set of ears can make that determination pretty quickly and reliably, and adjust her hypotheses accordingly. A computer is forced to ask more questions, and rely on the patient's (dubious) responses. Furthermore, computers are likely to be limited to the patient's complaints, which are not always commensurate with the patient's symptoms; reports from patients often drive providers to look for other, non-reported symptoms that sometimes accompany certain diagnoses but not others. If you want to get a computer searching for patient's symptoms, you're back into the realm of a sophisticated AI system that can integrate spoken, visual, and auditory information with a diagnostic program.

This diagnostic program will also need some reliable 'judging' component that is able to include certain likely explanations for the finding but exclude others: you don't want a computer in Omaha ordering tests based on the suspicion that a patient has Malaria...except when you do. Recognizing when something is plausible is pretty easy for a trained, experienced person, but formalizing this knowledge is very complicated and it's not the sort of ability that's easily transferred from one field to another. Plausibility of diagnoses isn't maintained across age, environment, condition, or case...how do you tell a computer the relevant information? I don't want to be the person who has to write the code that tries to formalize this sort of judgment.

I'm sure computers will play a larger and larger role in medicine in the coming decades (and I think that this is an exciting prospect), but don't fall prey to the computer geek's tendency to underestimate the abilities of a human being.

 

[darklabel]

Just keep in mind that some of the allotted residency spots are not funded so they aren't actual spots. Also bear in mind that there was a jump in matched positions over the last few years as som program put their residency slots into the match (instead of "prematch") as part of the "all in" rule, so those might not actually represent new spots, just spots that are new to the match. the number of residencies has been fairly stagnant and hasn't come close to the rate of increase in US graduates (by design -- the AAMC wants US education to fill US healthcare needs).

As mentioned it unlikely that there will be much of an increase in residency slots because it's very hard for a politician in the setting of rising healthcare costs to justify to his constituents that he wants to allocate millions to subsidize the training of more "rich doctors".

Good point, but I still think we're no where near the point where a significant number of US MD or DO will start going unmatched. From the MD perspective (not sure about DO), the number of new schools and increase in class sizes is starting to slow down.

 

[GaiusOctavius]

It would be more useful in automating the ROS/HPI/family history etc. All of these enable simple yes/no response. For example:
Computer: What is the primary reason for your visit here today?
Patient: (Selects "Chest Pain.")
Computer: Please select if you have been experiencing the following: Shortness of breath, nausea, vomiting....
Computer: Do your parents or grandparents have a history of heart problems?....

Based on responses, computer then orders appropriate tests. This would also work wonders for medical-legal! Then doctor reviews note, meets with patient, types up an HPI or modifies note, interprets tests, approves diagnosis, and decides on treatment plan.

I don't think you're the first person to have this idea; the idea of automating history/physical is probably the first thing somebody tried to do with a computer. The problem is history-taking relies on processes that, as of now, computers are pretty bad at.
It would be an easy problem to solve if a physical exam consisted only of questions about symptoms and severity (as well as a history), and followed a decision-tree based on answers. But from my (admittedly naive) understanding of the process, examination plays into the process as well, as do fuzzy, difficult-to-program variables like 'judgment.' Shortness of breath is an easy symptom to report, for example, but few patients will be reliable indicators of whether their SOB is due to wheezing or stridor. A person with a trained set of ears can make that determination pretty quickly and reliably, and adjust her hypotheses accordingly. A computer is forced to ask more questions, and rely on the patient's (dubious) responses. Furthermore, computers are likely to be limited to the patient's complaints, which are not always commensurate with the patient's symptoms; reports from patients often drive providers to look for other, non-reported symptoms that sometimes accompany certain diagnoses but not others. If you want to get a computer searching for patient's symptoms, you're back into the realm of a sophisticated AI system that can integrate spoken, visual, and auditory information with a diagnostic program.

This diagnostic program will also need some reliable 'judging' component that is able to include certain likely explanations for the finding but exclude others: you don't want a computer in Omaha ordering tests based on the suspicion that a patient has Malaria...except when you do. Recognizing when something is plausible is pretty easy for a trained, experienced person, but formalizing this knowledge is very complicated and it's not the sort of ability that's easily transferred from one field to another. Plausibility of diagnoses isn't maintained across age, environment, condition, or case...how do you tell a computer the relevant information? I don't want to be the person who has to write the code that tries to formalize this sort of judgment.

I'm sure computers will play a larger and larger role in medicine in the coming decades (and I think that this is an exciting prospect), but don't fall prey to the computer geek's tendency to underestimate the abilities of a human being.

 

[Blue Blood]

It would be more useful in automating the ROS/HPI/family history etc. All of these enable simple yes/no response. For example:
Computer: What is the primary reason for your visit here today?
Patient: (Selects "Chest Pain.")
Computer: Please select if you have been experiencing the following: Shortness of breath, nausea, vomiting....
Computer: Do your parents or grandparents have a history of heart problems?....

Based on responses, computer then orders appropriate tests. This would also work wonders for medical-legal! Then doctor reviews note, meets with patient, types up an HPI or modifies note, interprets tests, approves diagnosis, and decides on treatment plan.

Im no expert but from my experience with patients through work and shadowing, you ask them what hurts and they'll tell you 20 different body parts sometimes. A lot of patients dont fit the textbook cookiecuter presentation for some pathology. It's kind of like the algorithms that medical software companies are trying to develop for radiology. A radiologist would note one significant finding on a scan and the software reads dozens upon dozens of false positives. It's hard to beat that intuition that is ground into physicians over the years of training.

 

[Greenberg702]

Im no expert but from my experience with patients through work and shadowing, you ask them what hurts and they'll tell you 20 different body parts sometimes. A lot of patients dont fit the textbook cookiecuter presentation for some pathology. It's kind of like the algorithms that medical software companies are trying to develop for radiology. A radiologist would note one significant finding on a scan and the software reads dozens upon dozens of false positives. It's hard to beat that intuition that is ground into physicians over the years of training.

Moreover, radiologists don't simply note abnormal appearance and call it a day. They're physicians who synthesize all of the information presented to them including the patient's medical chart, knowledge of pathology, AND image interpretation. Simply designing imaging recognition software (which is very, very far away in and of itself) wouldn't replace radiologists.

 

[Blue Blood]

Moreover, radiologists don't simply note abnormal appearance and call it a day. They're physicians who synthesize all of the information presented to them including the patient's medical chart, knowledge of pathology, AND image interpretation. Simply designing imaging recognition software (which is very, very far away in and of itself) wouldn't replace radiologists.

I agree. I was just speaking generally about a case I read somewhere. There will always be a need for the physician in some capacity. The role will change but it's a slow progression.

 

[656844]

The pathology job market is oversaturated?? Where did you hear or read that? I know that the pathology assistant profession is booming (speaking from experience as a PA). I intend on going to med school for pathology (forensic pathology specifically). I find it very hard to believe that the pathology job market (for M.D. pathologists) is oversaturated.

 

[aegistitan]

The pathology job market is oversaturated?? Where did you hear or read that? I know that the pathology assistant profession is booming (speaking from experience as a PA). I intend on going to med school for pathology (forensic pathology specifically). I find it very hard to believe that the pathology job market (for M.D. pathologists) is oversaturated.

Check out the pathology forums. It's filled with threads like this: http://forums.studentdoctor.net/threads/flee-pathology-now.961504/
http://forums.studentdoctor.net/threads/the-80k-pathologist.1106634/

I don't know anything about pathology assistants, but its interesting that you mention their profession booming. More midlevel providers would eliminate more need for pathologists. The guys in the pathology forums can clarify this for you

 

[darklabel]

The pathology job market is oversaturated?? Where did you hear or read that? I know that the pathology assistant profession is booming (speaking from experience as a PA). I intend on going to med school for pathology (forensic pathology specifically). I find it very hard to believe that the pathology job market (for M.D. pathologists) is oversaturated.

A boom in pathology assistants is a negative for pathologists (except the few who gain to benefit from it). Why hire 5 doctors when you can hire 1-2 docs to oversee a team of assistants?

Of course, this back fires over time since eventually midlevels will begin to believe they're equal to that of a physician and believe that they don't need oversight.

 

[farm_assist]

Indeed, there are several reasons for the decline of pharmacy jobs. I am a pharmacist who is starting medical school, and I can tell you my perspective:

There is a new pharmacy school opening everytime you look. There were 3 pharmacy schools in my state while I was in school in the 2000's. Now there are 7. Also, when the economy tanked, some of the retail chains started staffing with skeleton crews, and many companies just started laying PharmD's off. Also, many retail chains and hospitals have central-order entry, where a pharmacist remotely verifies orders for multiple locations. This also lead to PharmD's being pulled back from all the more clinical roles that were predicted for us. I used to round with physicians at my hospital, and perform various other clinical tasks. But When 25% of our staff was let go, I am forced to go back to the more traditional roles of dispensing.

Then the administrators realize that we are still "doing ok" without having so many rounding pharmacists, so that's probably gone for good for most of us where I work. Physicians enter their own orders, we just verify them which takes 2 seconds if there are no issues. But amid all of these changes, our patient volume remains strong, with the same need for physicians.

 

[67552931811]

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[67552931811]

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[Greasy Pete]

The answer to the title of the thread is "Yes. It does parallel what can and will happen." This is just a fact of capitalism and economies of scale. Small practices and community hospitals are getting snatched up by large networks at a rate never before seen. These are businesses, not academic places that care about the "art" of medicine. Enterprise practice management, strategic partnerships etc et just makes huge organizations much cheaper to run and maintain.

As I type this, large companies like CVS/caremark and probably Target/walmart etc are building "remote clinics" where midlevel providers will diagnose and prescribe remotely. As the "business" side of hospitals grow more powerful there will be fewer academic MD's sitting on boards and more and more MBAs. Hiring process engineers, etc will naturally only harm the livelihoods of people doing the actual work in the long term (doctors, midlevels, RNs, etc.) Anyone who says otherwise or thinks that the "bottleneck" of residencies will save the profession does not understand what is happening in the healthcare industry. cheers.

 

[656844]

Check out the pathology forums. It's filled with threads like this: http://forums.studentdoctor.net/threads/flee-pathology-now.961504/
http://forums.studentdoctor.net/threads/the-80k-pathologist.1106634/

I don't know anything about pathology assistants, but its interesting that you mention their profession booming. More midlevel providers would eliminate more need for pathologists. The guys in the pathology forums can clarify this for you

I don't believe any of that for a second, and it sounds like mass hysteria to me. More midlevel practitioners (in pathology, that means Pathology Assistants) would NOT eliminate the need for pathologists. PAs are solely responsible for grossing the specimens and assisting with autopsies. PAs cannot read the slides (in other words, make a diagnosis). PAs are invaluable to the profession because to both gross the specimens AND read the slides would be overkill for the pathologist. I'm sure it can be done in a very tiny hospital the size of a ranch house, but not in academic teaching hospitals, by no means.

As for the suggestion about Ph.D.'s reading the slides, that's the most ludicrous thing I've ever heard. A Ph.D. cannot make a medical pathology diagnosis. That is solely reserved for a M.D. or D.O. pathologist. Period. I do believe that more FMGs are in pathology practices than AMGs (the hospitals I've worked at had predominantly South Asians as pathologists...that's the major ethnicity in my location at least, and I'm sure there are a wealth of other types of FMGs in this profession as well).

Also, taking a look at the ASCP's 2013 survey of pathology residents in the USA, a remarkable 41% of them said that they had no prior exposure to pathology in medical school, nor did they feel adequately prepared to read a broad variety of slides right after their residency. That's rather pathetic, if you ask me. I don't know what "guys" in the pathology forums you're talking about, but it sounds very fishy to me.

As far as I'm concerned, we need more AMGs in this field, and if you have the interest and a helpful background in pathology, you'll get a job. And if you're really that dissatisfied with the pathology job market in the USA, then practice it in another country. Simple as that.