I know that radiology is supposed to take a big pay cut in the future and some of the other procedure-based fields (ophtho, ortho, cards) are set to take a hit in reimbursements as well. On the other hand, I've heard that primary care specialities are supposed to stay about the same or even get a bump up in pay. What are you all expecting for psych?
I've talked about this before, but psychiatry is only going up. Here is the world as I see it:
1. Feds have a huge budget crisis looming. Huge. They can't afford to keep paying the rates they're paying for hip replacements, CT scans, primary care ER visits, etc. Unnecessary medicine must be cut to save money.
2. Around half of all ER visits are primary care, non-emergent complaints. To save money, sometime in the next 10-20 years, EMTALA will be scraped and replaced with something that allows triage of complaints. The need for ER docs will be sliced in half overnight. Job market will get tighter for them, pay might drop a bit. Won't be too bad, but ER is the youngest and fastest growing specialty. They're producing much too fast and not retiring fast enough. We will one day have an oversupply of ER docs, which will eventually impact salary, especially if budget cutting needs to happen.
3. Anesthesia will suffer much the same fate. CRNA's and midlevels will have an expanded role, with anesthesiologists supervising more mid-levels. It's cheaper and the budget crisis will demand this. Budgets will be cut and in an effort to save money and maximize profit, hospitals will start using the cheaper help. Same end effect as ER. Drop in salary, oversupply. Also a young, fast-growing field.
4. The extra ER and Gas docs will now decide to do fellowships to make themselves more marketable in the job market. Most will want to do Critical Care, which will suddenly become Rads-like competitive to get into, but salaries will likely stay the same...until "death panels" happen, and end-of-life interventions are decreased, which MUST happen in a budget crunch.
5. Radiology will face pay cuts, but what will really hurt them more is the anti-radiation backlash as more research comes out showing the harm in repeated scanning. Malpractice reform (which must also happen to save money) will cut the number of scans being done = slight decrease in demand for radiologists. If you talk to the rads guys, there is already starting to be something of an oversupply of radiologists. Again, a few years ago there was this terrible shortage, they increased the number of spots, and now there's not a shortage. Same thing happened in dental hygiene.
6. Derm will be fine forever. They have done an excellent job of artificially limiting the supply of dermatologists, although more and more PCP-types are getting into their business...
7. Psych will be fine, and could very well go way up. Horrible shortage, especially of child psych will mean we can charge whatever we want. We won't price gouge people too much because we're nice that way, but insurance companies are another story. >55% of practicing psychiatrists are >55yo and ready to retire. That makes the shortage worse. Psych is one of the slowest growing fields. A large percentage of the new docs we're training are FMG's and a percentage of them will return to their home countries at some point. A large percentage (>50%) are women, and are, statistically speaking, more likely to work part-time. All of these things mean that it will be even harder to find a working psychiatrist, and MUCH harder to find one who is actually good. It won't do wonders for the reputation of our specialty, but as salaries rise, psych will become much more popular suddenly (which is exactly what happened to radiology and anesthesia), we'll increase the number of training spots (much to our detriment) and then we'll have our crash in 30-40 years, right as I'm retiring. All in all, good timing for me, I think.
The alternative to all this happening is that there could be no budgetary crisis. In which case, most of the fields I mentioned will probably be fine. Psych would still go up, since our situation is more dependent on the short supply and our unwillingness overall to rely on insurance payment. i don't see anyway that this won't happen. We are way overdue for a serious government budgetary crisis, which we only got a taste of when they were going to cut our credit rating. When the real crisis comes it will be much worse, and it's going to be time for some hard political decisions. The OTHER alternative is that we won't make any of these decisions, continue our current spending habits, and bankrupt our country...leading to a GreatER Depression.
This is just my crystal ball. I could very well be wrong. Regarding psych especially though, I doubt I am. Salaries have already been rising recently, and the trend is only likely to continue due to the undebatable extreme undersupply. Whatever we do though, we should NOT increase the number of psychiatrists being trained. A glut in the market would kill us.
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What am I supposed to do about her crying?!?
