healthskier300

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Incoming M1 here, I try to ignore all the doom and gloom threads but it really seems like every specialty is coming to a head with midlevel encroachment or job saturation...

Are future/current physicians gonna be 300k in debt with no jobs at the end of 7+ years of training and education or am I just having a late night panic attack?
 
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Lmao...this is how I felt reading the Residency subreddit last night when anesthesia is my intended specialty..
 
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Definitely feel this, but I don't know what else to say other than that we can only make our decisions with the information we have at present. If MDs and DOs are out of jobs in ten years, then the country has bigger problems to worry about. Just move forward with your decisions knowing what you know right now, because what's the alternative?
 
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gonnif

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With the population living longer, becoming more active, many diseases becoming long-time chronic conditions, treatment becoming more complex, and the inability of the the government to overhaul and increase residency slots, there is low risk that doctors will be out of a job. The growth of PA/NP and other mid-levels isnt as much the lesser expense of these providers but rather the "shortage"(distribution) of existing/future doctors to fill the positions in the expanding corporate/employee model that is becoming healthcare. What is happening is the generational change where doctors are no longer the center and star of the team, but a part of the team. In many ways they are the SME (subject matter expert) on the team of providers, ultimately responsible for the patient but no longer "the boss." It is somewhat analogous to a baseball team as a pitcher or a football team as a quarterback. You need lots of teammates to win and you have a coach, a general manager, and an owner above you.
 
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KnightDoc

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Incoming M1 here, I try to ignore all the doom and gloom threads but it really seems like every specialty is coming to a head with midlevel encroachment or job saturation...

Are future/current physicians gonna be 300k in debt with no jobs at the end of 7+ years of training and education or am I just having a late night panic attack?
Late night panic attack. The sky has been falling forever, between managed care, mid levels, universal coverage, etc., etc., etc. Somehow, the Earth kept turning, and applications to med school kept rising.

Yes, the world is constantly changing, and there is always a risk that the future will not be as financially lucrative as the past (although that hasn't really played out yet), but there will always be a need and you will always be employable. Just remember, you are not doing it for the money; you are doing it because you can't imagine doing anything else.
 
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seems like a lot of healthcare professions are becoming saturated
hard to say with the doom and gloom, a lot of it is true but it's also two sided. Both the Physician Assistant and NP subreddits have a lot of posts about "not being able to find a job", "declining salary" or "market saturation". PAs are complaining about NPs stealing their jobs, and NPs are complaining about having to work as an RN
 
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Goro

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seems like a lot of healthcare professions are becoming saturated
hard to say with the doom and gloom, a lot of it is true but it's also two sided. Both the Physician Assistant and NP subreddits have a lot of posts about "not being able to find a job", "declining salary" or "market saturation". PAs are complaining about NPs stealing their jobs, and NPs are complaining about having to work as an RN
Keep in mind that some 40-50% of all US doctors are of the Baby Boom generation, and will be retiring or dying off in the next two decades.

SOMEONE has to replace them!

Source:
 
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KendallJennerSniperLady69

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Keep in mind that some 40-50% of all US doctors are of the Baby Boom generation, and will be retiring or dying off in the next two decades.

SOMEONE has to replace them!

Source:


omfg this is actually terrifying to think about cuz that also means the boomers are gonna turn old and stuff and make our health care system go OOF
 
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Keep in mind that some 40-50% of all US doctors are of the Baby Boom generation, and will be retiring or dying off in the next two decades.

SOMEONE has to replace them!

Source:
Sorry if I sound ignorant, but why can't newly minted physicians easily replace those Boomer docs? Has the number of residency slots gone down since their time?
 

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Years ago, I met a physician who graduated medical school in 1957. He told me that a member of his family who was a generation older (so maybe graduated medical school in 1927) was sure the sky was falling when Medicare, health care coverage for the elderly and disabled, became law. Instead, for the young physician just starting out in a medical subspecialty, "it was the goose that laid the golden egg". No doubt the same is happening today with gloom and doom that, in the end, will work itself out just fine.
 
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Goro

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Sorry if I sound ignorant, but why can't newly minted physicians easily replace those Boomer docs? Has the number of residency slots gone down since their time?
We only churn out some 25-29000 med students each year. They take anywhere from 3-9 years for residency.

Thus, it will take awhile to replace all those Boomers
 
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Lucca

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You have to understand that people who go to medical school are some of the most neurotic, risk-averse people on Earth. 10X more so for the sub population that hangs out on SDN and Reddit. A combination that ensures that any even imperceptibly small change in risk — whether it’s job security, finances, the match, etc — is perceived as the end of the world. This is a data and reason free zone that almost always completely ignores the context of the broader economy or the existence of other jobs.

Some people make the horse and buggy analogy. When the world changed and cars came to be the horse and buggy disappeared and that’s pretty scary if you think the physician is the horse, but the physician is more like the driver than the horse. The horse and buggy drivers that learned to drive cars came out just fine.

Geographic saturation is inevitable, where certain places fill up with docs because they are desirable places for high income people to live. We are about as far from saturating the entire country as is conceivably imaginable. A fact which we must remember also lies under some of the great health disparities and access inequities in this country, and which is inextricably linked to development of APP training and legislation to advance their level of independence and scope of practice.

Specialty saturation can occur. But this also ebbs and flows. Once you’re in med school you can put your ear to the ground and based on what you want out of your career you can decide what risk and what trade offs you can tolerate — more/less money, more/less competition, more/less geographic flexibility, better/worse work life integration, etc. But you will have more opportunities than you can imagine.

Hell, just by meeting the bare minimum requirements of graduating med school and passing boards you will be very well placed to earn mid to high six figures for the rest of your life in an area with almost infinite demand, very high geographic flexibility, and a very small barrier to entry in terms of competition and length of postgraduate training: family medicine and primary care.
 
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mdphd123j

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omfg this is actually terrifying to think about cuz that also means the boomers are gonna turn old and stuff and make our health care system go OOF
Sorry if I sound ignorant, but why can't newly minted physicians easily replace those Boomer docs? Has the number of residency slots gone down since their time?
My personal interpretation was that, with “making the healthcare system go oof,” the poster was referring to an influx of patients for age-related conditions (not just doctors leaving)
 
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Try to minimize the loans and if you can't be frugal at least until loans are paid off if you are worried about future earnins.
 
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My personal interpretation was that, with “making the healthcare system go oof,” the poster was referring to an influx of patients for age-related conditions (not just doctors leaving)
I agree, current evidence points to increased demand for healthcare in the coming years, healthcare legislation notwithstanding. My expectation was that enough doctors are graduating to fully take the place of boomer docs unless residency spots were cut at some point. Sure, depending on how much demand increases, these new docs may not be enough because the population of the country has increased quite a bit. In that case, I'm still not sure midlevels are the solution when increasing residency spots is an option.

This doesn't even touch on problems of distribution of healthcare. Midlevels are known to take jobs in the same coveted locations that have many doctors already. Lots of factors going into making our healthcare system "go oof" unfortunately.
 
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SpliceOfLife

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Incoming M1 here, I try to ignore all the doom and gloom threads but it really seems like every specialty is coming to a head with midlevel encroachment or job saturation...

Are future/current physicians gonna be 300k in debt with no jobs at the end of 7+ years of training and education or am I just having a late night panic attack?
I hate to say it but when all the faculty in medical school told me to go into primary care - I'm really glad I didn't. So glad I don't have to fight off all the mid-levels.

Medicine will change. Go procedural/surgical if you like it and you can get in.
 
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Medicine will change. Go procedural/surgical if you like it and you can get in.
I feel like it won't be long before we see surgical midlevels unless physicians actively prevent it. Sounds crazy, but so did replacing all anesthesiologists in a hospital with nurses lol.
 
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They’ll still need you but be assured there is no shortage and hasn’t been for many years, hence the fallout you are seeing. There won’t be unemployment but I suspect lots of underemployment with crap jobs taking advantage of you while offering no or poor benefits.
Whatever older doctors retire will be replaced by fewer newer doctors working harder for less pay with technology and midlevels plugging gaps.

In the distant past, you could get money, location, and job quality all in one job. Then it became pick two, now its becoming pick one. Some specialties you get zero.
 
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I agree with Lucca that many premeds are just way too neurotic. And given the unprecedented world we live in - seems that a fair share of the world population way too worried as well. You turn the global news - you see all this China/Russia/Iran with their military or economic expansion. You read your local news - someone got killed/raped/died in a car crash. You open pre med Reddit - and again it seems that sky is falling, doctors are out of jobs, NPs are taking over, etc. There is simply more terrifying information being produced than we physically are able to consume. To successfully deal with all of this you need to realize 2 things - 1) the world isn’t a linear system, it is extremely chaotic, but our brains are not adapted evolutionary to comprehend nonlinearity. 2) just pure fact that 99% of our fears (especially if you are prone to neurotic worries) are baseless and simply false. You may be worried for your gf getting home too late and something bad might happen to her, you heard other classmates where talking that exam was too hard and none will pass, and so many more examples. The world is indeed changing, as it always has been. But no one knows what is ahead. Of course we all want to know for sure, we feel that no-risk-seems-reasonable but we just need to understand that we simply can’t see future, and we can’t even plan for long time ahead. Just keep in mind that almost all our fears are baseless and enjoy the life.
 
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No, doctors will always be needed. PAs/NPs could never replace doctors in surgical specialties such as neurosurgery, cardiovascular surgery, etc.

Although, this is not related, I think their should be more states like Missouri for doctors that couldn't match.
 
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PAs, NPs, and other mid level providers have had so much success because they have been fantastic at lobbying state governments to give them more privileges and greater levels of independence. You would think doctors with more money (read as political capital) would come together to lobby to stop it, but surprisingly, they haven't. Many have actually been complicit by using the word "provider" to refer to doctors, NPs, and PAs, implying a false equivalence of level of experience. Interestingly in some states, the standard of care for midlevel providers apparently isn't the same for physicians as physicians are not allowed to testify as to what the standard of care is for a midlevel provider in medical malpractice cases.
 

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Qualitatively, everything is getting worse in Medicine. It's tougher to get in. It's tougher to match. The training in many cases is longer. The reimbursement is expected to fall. In some specialties, the job market has completely collapsed.

It's really tough to complain because a lot of occupations have it pretty bad. Nonetheless, I can't think of another field that asks you to block twelve years of your life on the blind faith that "it will all work out because it always has." RadOncs learned this the hard way. Every premed should ask themselves whether they're willing to lock themselves into a fairly inflexible, long, and costly training system in light of all this uncertainty moving forward. Sadly, the leaders of our profession seem to be innovative only about finding new ways train you more, whether that be more residencies or god forbid, more fellowship "opportunities."

Honestly, the rise of mid-levels just tell me that doctors are just overtrained. You frankly don't need an MD to do many of the things we are trained to do, and even less if/when they figure out how to further reduce adverse events through AI.
 
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PAs, NPs, and other mid level providers have had so much success because they have been fantastic at lobbying state governments to give them more privileges and greater levels of independence.
ironically, if you read the Physician Assistant forum, there is a lot of doom and gloom about their profession, as their own lobbying and required supervision can't compete with the independent NPs, leading to NPs getting hired over PAs

some PAs even consider their profession has an "expiration date"...always interesting to read perspectives from different sides
 
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Qualitatively, everything is getting worse in Medicine. It's tougher to get in. It's tougher to match. The training in many cases is longer. The reimbursement is expected to fall. In some specialties, the job market has completely collapsed.
Legends say that if you move out of big cities everything is more than fine. And if you dare to move to Dakotas...
 

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Legends say that if you move out of big cities everything is more than fine. And if you dare to move to Dakotas...
I took a pathology job in the rural arctic after residency and fellowship in a top program in a big east coast city. Sure I had some low-paying (~150k) academic options in some inner cities (not the one i spent 5 years training in) but I’m married with children and needed a decent school system. Life is good although we can’t leave our house much for 6 months out of the year and Arby’s is one of the more exotic options we have as far as restaurants. I’m sure this applies to pathology more than most specialties (yet) but i’m not sure most people would be alright with this after sinking more than a decade of their life into training. My residency classmates were not and that’s why they were PGY-6s/7s in second and third fellowships.

It’s been like this for years now and some of the EM and rad-onc threads are starting to sound suspiciously familiar to me. Our leadership also said years ago if we can’t get 7 figure partnership jobs in San Francisco it must be our autistic personalities and not the “robust” market.
 
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Melchizedek

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Legends say that if you move out of big cities everything is more than fine. And if you dare to move to Dakotas...
I think the point is that after 4 years of undergrad, 4 years of med school, and at minimum 3 more years of residency, no doctor should have to “move out of the big cities” (or any desirable place) because of being displaced by people with far less training.

If there’s a disparity in the distribution of healthcare, and MLP’s arose from that, then they should be the ones moving out to where the need is, not doctors.
 
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ironically, if you read the Physician Assistant forum, there is a lot of doom and gloom about their profession, as their own lobbying and required supervision can't compete with the independent NPs, leading to NPs getting hired over PAs

some PAs even consider their profession has an "expiration date"...always interesting to read perspectives from different sides
It's interesting that you mention this. I have also heard that many new grads have to move out of state to find a job. Some have been unemployed for a long time. But, midlevel providers should be the ones to move out of state not the physicians.
 

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I think the point is that after 4 years of undergrad, 4 years of med school, and at minimum 3 more years of residency, no doctor should have to “move out of the big cities” (or any desirable place) because of being displaced by people with far less training.

If there’s a disparity in the distribution of healthcare, and MLP’s arose from that, then they should be the ones moving out to where the need is, not doctors.

this seems fine and dandy but u cant have ur cake and eat it too. Let's say we force PAs/NPs to go to places with very little access to care. Well to be able to actually function, they need independent practice rights. So we give it to them in high-need states, which by the way are all of them because almost every state has geographies with physicians in the single digits per X amount of ppl. Then the health systems they work for notice that theres increased access, more utilization, more revenue from insurance / medicare / medicaid and more jobs created and PA/NP independence continues to expand. Well this is precisely the "nightmare scenario" on Meddit/SDN where APPs can now increasingly function independently. *Eventually* PAs, CRNAs and NPs are going to be competing for jobs with PCPs / EM / Anesthesiologists because from the perspective of the healthcare system they are now a well proven resource and at cheaper cost. So now many practices will have 3 PAs/NPs for every MD/DO in private practice / community care and MDs / DOs will be more concentrated in tertiary, quaternary and academic medical centers, which obviously changes the job landscape.

If you want to prevent that scenario and maintain what is more or less the status quo across the country currently, you need to get physicians into "undesirable" parts of the country. The way to do that in my opinion is to have a sustained national effort to make every part of this country more desirable through investments in infrastructures, new mid-size city hubs distributed across the country, high speed and public transit, education and culture, etc. but that is beyond a pipedream in the current political landscape obviously.

Also, I think its important we step out of our perspective as physicians. PAs / NPs / CRNAs are also human beings in this country trying to work and sell their labor on the market. By what justification can we "force" them to work in one place while physicians get to choose? You can rant about training, quality, education etc until you're blue in the face but in the eyes of cold hard economics, politics, and certainly ethics there is no justifiable reason for this kind of draconian allocation IMO. That said, I would be very supportive of all providers, including physicians, being required to work in an underserved area for X years in exchange for free education + living stipend throughout medical school.

Like you, I believe physicians and PAs specifically have the most consistent and best training to be engaged in patient care. Many NPs are great but the training is too inconsistent across programs. But this is not a justification for essentially subjecting them to discriminatory treatment in the job market where they are not allowed to simply work wherever they are able to find it like any other person living in the us.
 
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Melchizedek

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this seems fine and dandy but u cant have ur cake and eat it too. Let's say we force PAs/NPs to go to places with very little access to care. Well to be able to actually function, they need independent practice rights. So we give it to them in high-need states, which by the way are all of them because almost every state has geographies with physicians in the single digits per X amount of ppl. Then the health systems they work for notice that theres increased access, more utilization, more revenue from insurance / medicare / medicaid and more jobs created and PA/NP independence continues to expand. Well this is precisely the "nightmare scenario" on Meddit/SDN where APPs can now increasingly function independently. *Eventually* PAs, CRNAs and NPs are going to be competing for jobs with PCPs / EM / Anesthesiologists because from the perspective of the healthcare system they are now a well proven resource and at cheaper cost. So now many practices will have 3 PAs/NPs for every MD/DO in private practice / community care and MDs / DOs will be more concentrated in tertiary, quaternary and academic medical centers, which obviously changes the job landscape.

If you want to prevent that scenario and maintain what is more or less the status quo across the country currently, you need to get physicians into "undesirable" parts of the country. The way to do that in my opinion is to have a sustained national effort to make every part of this country more desirable through investments in infrastructures, new mid-size city hubs distributed across the country, high speed and public transit, education and culture, etc. but that is beyond a pipedream in the current political landscape obviously.

Also, I think its important we step out of our perspective as physicians. PAs / NPs / CRNAs are also human beings in this country trying to work and sell their labor on the market. By what justification can we "force" them to work in one place while physicians get to choose? You can rant about training, quality, education etc until you're blue in the face but in the eyes of cold hard economics, politics, and certainly ethics there is no justifiable reason for this kind of draconian allocation IMO. That said, I would be very supportive of all providers, including physicians, being required to work in an underserved area for X years in exchange for free education + living stipend throughout medical school.

Like you, I believe physicians and PAs specifically have the most consistent and best training to be engaged in patient care. Many NPs are great but the training is too inconsistent across programs. But this is not a justification for essentially subjecting them to discriminatory treatment in the job market where they are not allowed to simply work wherever they are able to find it like any other person living in the us.
You’re working under the assumption that NO doctors want to move/work in locations with healthcare disparity. Outside of the personalities that SDN draws, there are a fair amount of people who want to grow up to be primary care docs back in their hometowns (to be close to family, to be close to spouse’s family, etc). Some of them might be choosing it because they didn’t do so well on boards, but some also actually want to go back home. There aren’t NO doctors in the high-need locations, there are just too few. Send them MLP’s to supervise (without giving the MLP’s independent practice) and you’ve boosted their impact on the community, while still retaining the value of the doctor.

I agree with you that economics is a driving force and that the “healthcare system” (read: redundant number of administrators) is going to value profits over efficacy/training/etc. but that’s a whole other issue. Why even be a clinician if you can go make 200k with 4 years of nursing and a 2 year MBA?
 
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I think the point is that after 4 years of undergrad, 4 years of med school, and at minimum 3 more years of residency, no doctor should have to “move out of the big cities” (or any desirable place) because of being displaced by people with far less training
In ideal world - yes.
 
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