Best Specialties for the Future

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DZT

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I worked with a general surgeon as an undergrad and he told me to stay away from the field; all they do these days are colostomies, appendectomies, hysterectomies, and any noteworthy -ectomy. Basically, general surgeons are great for their overall utility but the field is dying. I was wondering what people think of the following fields in terms of the demand and prospectus in future. I just don't want to be in an obsolete specialty.

Neurosurgery
CT Surgery
Ortho
Radiology
ENT
Nephrology

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Originally posted by DZT
I worked with a general surgeon as an undergrad and he told me to stay away from the field; all they do these days are colostomies, appendectomies, hysterectomies, and any noteworthy -ectomy. Basically, general surgeons are great for their overall utility but the field is dying. I was wondering what people think of the following fields in terms of the demand and prospectus in future. I just don't want to be in an obsolete specialty.

Neurosurgery
CT Surgery
Ortho
Radiology
ENT
Nephrology

i wouldn't say that any of those are obsolete specialties.
it's just that there has been a big emphasis in "quality of life" specialities, which have increased the popularity of specialites like dermatology, radiology, anesthesiology and for the surgical specialities--ENT and urology.
General surgery is here to stay, it's just that people are looking towards more friendlier life-styles and general surgery doesn't score very well when it comes to life-style in training and practice.
in addition, general surgeons (and all doctors) aren't making the kind of money they were back in the golden days of the 80's, and there is a ubiquitous sentiment that "medicine isn't good anymore" (when essentially they are saying it doesn't pay like it used to).
if you like general surgery, go for it. you'll still be expected to make over 150,000 dollars when you are done and can have opportunities to subspecialize as well.
 
from working at a couple of hospital radiology departments i can say that radiology is a pretty promising field to get into. demand for imaging procedures isn't dropping off anytime soon and will probably increase as the technology gets better and you can get more info without having to open people up. they make a lot of money too.

also, because everything is going digital, my guess is that for a radiologist just reading films (as opposed to do interventional procedures or other stuff), this will be able to be done from the home within a few years. the technology does exist now - it's just that the monitors needed for high resolution are expensive. but within a decade i could see a radiologist sitting at his/her computer all day reading films and dictating reports - great for having a family.

i would also think nephrology to get bigger due to the insane number of diabetics in this country needing a nephrologist due to diabetic complications.
 
One promising field: sticking fiber optic tubes up people's butts every day. That's right--colorectal surgery! Haha. Unfortunately, this is a promising field. Increasing demand, high reimbursement rates for procedures, not enough docs to satisfy the rising demand, and moderately competitive admission to the field.
 
Elias is right...colon/rectal surgeries is one of the most needed and increasingly important surgeries done. Colon cancer is often described as a "near epidemic" in the US. Not only are insurance companies and medicare reimbursing well for these, there is a shortage of general surgeons trained in the newest techniques. Just look at the explosion of gastric bypass procedures. Gotta have a general surgeon to do those!

In the end, general surgery isn't a "dying breed"...its just in a period of transformation. The days were appendectomies were "a big surgery" are gone. Now the focus is on colon CA, obesity surgery, and trauma.
 
Moving to the general residencies forum.
 
Originally posted by Dr. Cuts
10 years from now I'm gonna be aboard my Gulfstream 5 reading virtual colonoscopies while flying to Bora Bora to read films at my PACS station in my over-the-water-hut.

Radiology is the future...

:cool:

Actually, some dude named Vijay will be doing it from his mansion in India for an eighth of what you would charge. ;)
 
Originally posted by edinOH
Actually, some dude named Vijay will be doing it from his mansion in India for an eighth of what you would charge. ;)

And that is the truth. It is already happening - sending images to india and australia 24/7. The radiologist at a small town hospital told that this is happening at lots of rural hospitals who can't afford to get a radiologist out there.
 
I'd say stick to the specialties w/procedures that no PA, NP or CRNA can do, and you should be fine. Also avoid specialties that some guy overseas can do for a fraction of what U.S. doctor would charge.
 
Originally posted by edinOH
Actually, some dude named Vijay will be doing it from his mansion in India for an eighth of what you would charge.
and
docuw
And that is the truth. It is already happening - sending images to india and australia 24/7. The radiologist at a small town hospital told that this is happening at lots of rural hospitals who can't afford to get a radiologist out there.

I also agree that Vijay is the way of the future.

When the virtual colonoscopy's scanning software pops a questionable result, the -ectomy surgeon's salary will increase.

Hey...why should a general surgeon pay full price for a Gulfstream when he'll be able to pick one up at a great price second-hand from a depressed radiologist?
 
Originally posted by docuw
And that is the truth. It is already happening - sending images to india and australia 24/7. The radiologist at a small town hospital told that this is happening at lots of rural hospitals who can't afford to get a radiologist out there.

I hear that outsourcing radiology services to India or other countries is going to be big in the future. I wouldn't want to see my job be shipped overseas.
 
Saw a fascinating talk by a renowned French surgeon, who has worked extensively with remote/robotic surgery. An interesting side note to the talk was some of the imaging software he is working with. 3-D scans which allow the surgeon to fully visualize and rotate images of tumors without the need for radiologists. Radiologists still clearly have a role to play, but it seems that a lot of surgeons are salivating at the chance to reclaim some of the lost revenue streams that have gone to IR.

EDIT: On a side note, there was an interesting article in Wired this month on the outsourcing of tech jobs to India. Obvious relevance to radiology. Article here.
 
So you guys heard something about Indian radiology but did not bother to look into it further.

The companies in Australia hire only board certified American radiologists, who are US residency trained. Mostly Americans who are looking for a short term change or have wanted to live in Australia take these positions . I have already gotten some of the mass mailings offering positions in Australia or New Zealand. It is intended as a night coverage system, but they do some daytime coverage as well. Not a threat since they are US TRAINED radiologists. So its just another job opportunity. Another company has US TRAINED radiologists in Isreal.

As for the Indian radiology thing. There are no companies providing the official report from India from non US board certified radiologists. Not many people that have gone through residency and board certification in the US want to live in India for a fraction of the income. So what the indian companies do is preliminary reads and 3D reformats. Again, not a threat.

As of now, less than 1% of radiologic images are read overseas. It is a non-factor in the everyday lives of radiologists. I do not see that increasing substantially. This is a specialty of medicine with complex licencing and certificatioin issues, not computer science or customer service.
 
Originally posted by RedBlanket
Saw a fascinating talk by a renowned French surgeon, who has worked extensively with remote/robotic surgery. An interesting side note to the talk was some of the imaging software he is working with. 3-D scans which allow the surgeon to fully visualize and rotate images of tumors without the need for radiologists. Radiologists still clearly have a role to play, but it seems that a lot of surgeons are salivating at the chance to reclaim some of the lost revenue streams that have gone to IR.

Its true that 3D recons assist clinicians to view and understand images better and they are becoming easier to make and better daily. However, the remainder of the images, which the clinician has neither the inclination, the time, nor the expertise to examine is the realm of the radiologist.
 
Originally posted by Dr. Cuts
10 years from now I'm gonna be aboard my Gulfstream 5 reading virtual colonoscopies while flying to Bora Bora to read films at my PACS station in my over-the-water-hut.

Radiology is the future...

:cool:

Only a G5? I'll be tooling around in my 777. Now thats a pimp ride (and a used one is cheaper than a G5)
 
I think it is quite clear that the primary specialties of the future include

1. Surgeries ON robots as we will be slaves to our metallic masters

2. Mars veterinary services...as it is quite clear that there are animals on Mars that haven't even been located yet!

3. Interstellar space satellite lunar astral nubular solar medicine...i don't really understand really what that is.

4. Being a PA for the Great Lord Doctor Ziwaar of the Planet Randarrrrl 4

5. Chiropractic
 
I believe #5 was Medicine. :laugh:
 
I wanted to add something.... I think CT surgery is going to be obsolete in the next 20 years. Interventional cards and radiology are stealing a ton of their business. The malpractice woes and stress of these operations drives many surgeons into early retirement.
 
Originally posted by lurkerboy
I wanted to add something.... I think CT surgery is going to be obsolete in the next 20 years. Interventional cards and radiology are stealing a ton of their business. The malpractice woes and stress of these operations drives many surgeons into early retirement.

Things are about as obsolete now as they ever will be. Things to consider before totally "obsolete:"

1) Lung CA
2) Trauma
3) CABG-multi vessel disease
4) Malpractice reform
5) Structural heart problems
6) esophageal CA
7) L/VADs (someday)
8) mechanical hearts (someday)
9) stent boo-boos
 
Originally posted by DocWagner
I think it is quite clear that the primary specialties of the future include

1. Surgeries ON robots as we will be slaves to our metallic masters

2. Mars veterinary services...as it is quite clear that there are animals on Mars that haven't even been located yet!

3. Interstellar space satellite lunar astral nubular solar medicine...i don't really understand really what that is.

4. Being a PA for the Great Lord Doctor Ziwaar of the Planet Randarrrrl 4

5. Chiropractic

Too good. :)
 
GI!
Lots of procedures: EGD, ERCP, placing feeding tubes, etc.
Even if virtual colonoscopy takes off, traditional colonoscopies will still be in great need for obtaining biopsies.
 
Radiology is clearly the cutting edge of medicine and the direction medicine is going.

My hospital just bought a 64 detector CT scanner which can image the entire abdomen and pelvis is about 2 seconds. The thought of our ER docs finding out about it is scary.

Radiologists will always be the best positioned experts in medical imaging. The field is always expanding and innovating. Do we lose turf to other specialties?? Yes, but there never seems to be much of a work shortage as far as I can tell. We lose a lot of routine stuff just to come up with new and more exciting modalities.

As for outsourcing...highly unlikely it will ever be a real threat. The day they outsource the a part of the practice of medicine... ALL MDs should be worried.
 
Originally posted by Whisker Barrel Cortex
So you guys heard something about Indian radiology but did not bother to look into it further.
As for the Indian radiology thing. There are no companies providing the official report from India from non US board certified radiologists. Not many people that have gone through residency and board certification in the US want to live in India for a fraction of the income. So what the indian companies do is preliminary reads and 3D reformats. Again, not a threat.
As of now, less than 1% of radiologic images are read overseas. It is a non-factor in the everyday lives of radiologists. I do not see that increasing substantially. This is a specialty of medicine with complex licencing and certificatioin issues, not computer science or customer service.

While you are right about the current situation, I do not necessarily agree with your forecast for the future.

Regardless, some background info from the Christian Science Monitor, give me pause about the potential of outsourcing in the future:

In a small Bangalore office building, Indian radiologists are downloading CT scans done at Boston's Massachusetts General Hospital, analyzing them, and sending back three-dimensional computer models highlighting problem areas - though not providing official diagnoses.

Wipro, one of India's leading technology companies, has made the arrangement possible by building a telecommunications system that allows several gigabytes of data to be sent between Mass General and Bangalore every day.

Unlike other outsourcing ventures, the primary goal isn't to save money, but to alleviate stress on Mass General's radiology staff, particularly during night shifts.

"It's not really a cost advantage; it's a time advantage," says Sanjay Saini, head of CT services at Mass General and a professor of radiology at Harvard Medical School. "The best place to do that nighttime work is on the other side of the world, where it's daytime."

But even if there are no savings for Mass General, the hospital is still getting a good return on its investment. The Indian radiologists are doing the work of US medical technicians and earning comparable pay, though their education and training is more like that of American doctors.

Eventually, Dr. Saini hopes to bring Indians to the US to gain medical licenses so they can return to India and offer full patient care services, albeit remotely.

But, he says, that idea is meeting with resistance. Some in the American medical community question the overall quality of Indian medicine - and the privacy safeguards for medical information sent to India.
 
quote:

Originally posted by DocWagner
I think it is quite clear that the primary specialties of the future include

1. Surgeries ON robots as we will be slaves to our metallic masters

2. Mars veterinary services...as it is quite clear that there are animals on Mars that haven't even been located yet!

3. Interstellar space satellite lunar astral nubular solar medicine...i don't really understand really what that is.

4. Being a PA for the Great Lord Doctor Ziwaar of the Planet Randarrrrl 4

5. Chiropractic


easily amused...
 
Originally posted by DoctorDoom

Unlike other outsourcing ventures, the primary goal isn't to save money, but to alleviate stress on Mass General's radiology staff, particularly during night shifts.

"It's not really a cost advantage; it's a time advantage," says Sanjay Saini, head of CT services at Mass General and a professor of radiology at Harvard Medical School. "The best place to do that nighttime work is on the other side of the world, where it's daytime."

Yeah, right! Nothing to do with cost.
 
Originally posted by JBJ
Yeah, right! Nothing to do with cost.

LOL... "These aren't the droids you're looking for."
 
These arent the droids we're looking for.
 
Easy...

Go to Law School - medical malpractice. Those dudes are making a killing!:(
 
How bout geriatrics?

How does one go about specializing in this?
 
Originally posted by YoungFaithful
How bout geriatrics?

How does one go about specializing in this?

With medicare involved, could geriatrics ever be "hot"?

Combined with an undesirable patient population (in terms of length, complexity, and uncertainty of many geriatric cases) that many docs want nothing to do with (at least the ones I've spoken with), I'm curious why you think it would become "popular"?
 
What about oncology? with the advances in the future in CA Tx I would think itwould be exciting.
 
Rads will prove to be a case study in medical economics in the next 10 years.

THe number of studies ordered has exploded in the last 5-7 years. CT scans, MRI, and the various special protocols for these studies make them WONDERFUL diagnostic tools.

The technology of radiology is increasing operative volume for certain specialties. Thoracic surgery is an example where the number of incidental lung nodules is starting to increase the number of wedge resections, and thoracoscopies. As a future surgeon (currently pgy-1), I am reassured by the advances in radiology. I order CTs daily, and MRIs about once a week. I love the CT scan. Pancreatic protocol CTs, liver protocol CTs, delayed phase CTs... They are all integral to providing outstanding surgical care to patients. It really makes surgery easier when the CT is hanging in the OR and you can use it to help plan your surgery.

Having said that, I think that economically speaking, radiology is currently experiencing it's "golden age" right now as far as reimbursement. The U.S. spends so much on health care, and the fed govt. is always examining ways to cut costs. For the fed, the no-brainer move is to slash medicare revenues. In fact, the HCFA (health care financing administration) has specific guidelines for calculating reimbursements based on available cash to spend, and the number of billable procedures. For surgeons, this is a familiar guideline.

For radiologists, this is not talked about much. However when the HCFA periodically revisies reimbursements every 5 or so years, the tendency in the future will probably be to cut reimbursements for radiology fees. Overnight, rads reimbursements could fall significantly. It happened to pathologists (yes, believe it or not path used to be a bug money field). It has happened to physicians performing colonoscopies- From 700-1000 bucks per scope to 150-250 per scope. It has even happened to radiologists with plain films... And it has happened to surgeons as we all know.

The potential down side for radiologists is that the current high pay is driven by a few different reading fees... CT mainly, followed by MRI, and other special protocols. As soon as the fed drops reimbursement for CT scans +/or MRI, we will see a big hit for rads salaries. Radiologists will have to pare back their vacation time, and work longer, and read more films to try to keep their reimbursement up. I don't think it's too far-fetched to say that in 5-10 years, a CT scan will get reimbursed 100 or so dollars, and an MRI maybe 150.

Furthermore, the supply of radiologists is only going to increase. Each year for the past 5 years or so, slots in rads training have increased. This increase is an attempt to meet the demand for radiologist services which is at an all-time high right now. But if slots keep getting added, and the supply continues to increase, rads is going to lose out on the supply/demand side as well.

Having said all of that, just remember that if you really like radiology, go for it. You will probably always make a comfortable salary, and you will have a neat job. I just would make provisions to travel first class on Delta, instead of flying on your "G5", just in case what I have described actually comes to pass.

Good luck all.
 
Things are about as obsolete now as they ever will be. Things to consider before totally "obsolete:"

dry dre, you forgot about heart, lung, heart/lung transplants for CT surgeons. I think the one field in gen surg that has promise for the future is transplant. I mean, if you think about it, organ transplantation is still pretty primitive, I mean, some organs all you got is a blood type match because ischemia time doesn't allow for a thorough matching process. Then, the patient has to suffer a lifetime of horrendous immune suppression, but hey, the quality of life is still better than before. Cloning technology and immune modulation will probably blow the field wide open. Some of the most rewarding work you can do as a doctor, but talk about a CRAPPY lifestyle...
 
So why doesn't anyone mention radiology when speaking of lifestyle specialties? I love interacting with patients, but lifestyle is #1 for me. So with the previous posts in mind, maybe I will go into radiology. WHat do you think the salary would be of a rad that worked 30 hrs/week?

Don't radiologists have a high rate of suicide among the physician population?
 
Originally posted by bla_3x
What about oncology? with the advances in the future in CA Tx I would think itwould be exciting.

exciting yes, but profitable in the future, i don't know b/c there's a bill that's looking to dramatically cut medicaid reiumbursement for chemotherapy, which can make up a significant amount (up to 60%) of an oncologists salary.
 
Talking about doctor-entrepreneurs, I have had the priviledge of working with Adam Brochert for one month. Currently, this guy is a pgy 5. Man he is going to be on of those super assets for the field of Radiology. I believe he is going for an MRI fellowship at Hopkins.
 
Originally posted by Dr. Cuts
For that you'd have to sign-up with a locum tenens group, and I'd bet you could make 200K (or more?) easy. Caveat: This is in today's environment -- where Rads is in high demand... realistically speaking, things will likely be different by the time we finish residency.

So what kind of percentage salary decrease could a radiologist expect in the coming years? 30%? 50%? more???
 
Originally posted by rogersce
So what kind of percentage salary decrease could a radiologist expect in the coming years? 30%? 50%? more???

I think that's anyone's guess. There's an exploding # of studies being ordered which need interpreting which you'd think would elevate the demand. On the other hand, fees per imaging study read are surely going to be cut to some degree which is going to depress salaries. The increase in productivity that a radiologist can do is only so much. I'd guess when the dust settles it will be like surgery in that you have to work MUCH harder & longer to maintain your income. The outrageous salary & vacation packages you see now would be likely casualties

There have been other avenues of income for rads via independent imaging centers, but the future on those is murky. A number of states are putting moratoriums on any new facility for imaging, surgery centers, and specialty hospitals. If you've already missed the boat on those, the financial rewards of ownership of those facilities is gone.
 
Anyone want to comment on the future of EM? Where do you see it in 10.....20 years?
 
Originally posted by MasterintuBater
Anyone want to comment on the future of EM? Where do you see it in 10.....20 years?

EM is likely near it's peak in terms of wonderful salaries and relatively short work hour requirements per week. Many people going into EM are quite confident that the new "BE/BC in EM" hiring standard will bring them top dollars and job security well into the future as EM is a new specialty and there are a lot of emergency departments staffed by non EM board eligible/certified docs.

In the future if practice standards of care are competency-based rather than diploma-based, EM perhaps is one of the non primary care specialties most vulnerable to infiltration by docs trained in another discipline (eg IM). Many EM docs will stamp their feet demanding that EM is soooo much more dynamic than IM or FP that docs from those latter two specialties have no place in the ED.

Put it this way, in a large integrated health system (as is the future, whether it be a socialized health system or goliath health plans), there won't be the same irrational exuberance to staff EDs with only EM trained docs. Large organizations won't have to compete with the EM corporations or private practice groups...they'll staff their own EDs for less. I don't think that they'll pay a doc 200k a year for 36 hours a week.

If the EM field changes to that of an essentially emergency-intensivist specialty, this might change. In short, I don't think the system is going to keep paying EM docs twice that of FP docs for essentially the same level of knowledge and procedure ability.
 
In short, I don't think the system is going to keep paying EM docs twice that of FP docs for essentially the same level of knowledge and procedure ability.

So you don't know much about EM, do you? Aren't you a surgery resident, or are you still a student?

Casey
 
It is very unlikely that EM will contract as a specialty.
For the past twenty years, there has been a steady increase in EM residency trained physicians and a steady decrease in non-EM trained physicians practicing in EDs. The American public increasingly expects their physicians to be expert in their fields.

Modern emergency medicine goes well beyond the scope if IM, GS, or FP. An emergency physician must be very familiar with the diagnosis and treatment or medical, surgical, pediatric, OB/GYN, ENT, orthopedics, etc emergencies. Only FP has near the breadth of experiences in these other fields and their training is more focused on managing chronic problems.

Emergency physicians also need to be expert at emergency resuscitation, emergency procedures, airway management, conscious sedation, trauma management, and toxicology. Few non-emergency trained physicians have expertise in each of these important aspects of emergency care.

Finally, there is a huge difference in mentality/perspective in emergency medicine compared to most other fields. We are more apt to consider life-threatening diagnoses than physicians from other disciplines. We are used to working in a chaotic environment. We are used to managing 10+ patients simultaneously, many who may be crashing at the same time. We see patients with symptoms, rather than diagnoses.

Internists and family practitioners are more expert than I at managing admitted hospitalized patients and outpatients. Surgeons are more expert than I at surgical management. Subspecialists are certainly superior in their lines of work. But, emergency physicians are the best possible physician to manage emergency patients in the emergency departments and are the experts at what they do, emergency diagnosis and treatment.

Any ED with significant volume that is not using EM-boarded or EM-trained physicians is taking a short-cut. Specialists who have worked with ED-trained/boarded docs recognize their value compared to the alternative. Some specialist physicians feel the need to disparage physicians in other fields and that's easy to do in EM, where everyone but you has 20/20 hindsight. These physicians would gain enormous perspective if they were to spend a few shifts in a busy ED.

Mark Reiter MD MBA
UNC EM Resident
 
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