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Can someone tell me why Anesthiology is still so competitive?

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NontradCA

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Derm and Ortho have been competitive for longer than 20 years: here's some data for Ortho dating back to 1984: http://www.ncbi.nlm.nih.gov/pubmed/24836166 which states it was just as competitive then; IIRC you have to go back to the 60s/early 70s to find easy entry into Ortho. I'm not interested enough to look up Derm; maybe @DermViser can help.

According to the AAOS, the average age of the practicing orthopedic surgeon in the US, is under 50; thus, someone who finished training fairly recently. Hardly someone at the "bottom of their class" replacing grandpa's knee.
It's the bottom of barrel FM docs who don't know how to manage osteoarthritis properly fault.

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Psai

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Anesthesia management company. Basically a bunch of suits that steal your money in exchange for a loss of autonomy
 
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DermViser

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Anesthesia management company. Basically a bunch of suits that steal your money in exchange for a loss of autonomy
Wow, loss of autonomy AND stealing my money? What a great deal. Can't believe smart anesthesiologists fell for this ****.
 

DermViser

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Derm and Ortho have been competitive for longer than 20 years: here's some data for Ortho dating back to 1984: http://www.ncbi.nlm.nih.gov/pubmed/24836166 which states it was just as competitive then; IIRC you have to go back to the 60s/early 70s to find easy entry into Ortho. I'm not interested enough to look up Derm; maybe @DermViser can help.
This is my understanding as far as Derm. Back in the 1960s/1970s, Derm was not very popular and by many was considered more a subspecialty of Internal Medicine. It's not surprising to see some Derm programs as a division under the Department of Internal Medicine.

In fact, there are quite a few "famous" Derms that did an Internal Medicine residency and then completed a Dermatology residency right afterwards. These are people who have a huge research interest in skin -- immunology, cell biology, cancer, finding new treatments in the lab or thru clinical trials, etc. and have pushed the specialty forward immensely. Interesting also that they're nearly all men, and most chairmen of Dermatology depts. in this country are men.

So anyways, Dermatology has changed largely in 2 respects: treatments - biologics, immunomodulators, lasers, but also has become MUCH more procedural in nature: Mohs for skin cancer and cosmetic dermatology (which is cash pay) that just didn't exist back in 60s/70s - Botox, Fraxel, Thermage, fillers, Coolsculpting, etc. The most "cosmetic" thing back then was Retin-A which was invented in 1969 - and only bc when it was used for the purpose of acne, patients noticed that fine lines and wrinkles also disappeared. So it's not surprising in a fee-for-service type environment that Derm would shine. It's also why the guns of CMS are after Derm esp. in cutting Mohs/Dermpath codes bc of what is considered overutilization - even with the Baby Boomers now all entering Medicare and whose underlying skin cancers are now coming to fruition

I still believe that Derm has mainly benefited from a generational shift in what your medical student these days values - which is lifestyle. Medicine back in the 1960s/1970s was considered a calling. Quite easy to say as #1 - medical school tuition was ridiculously low, #2 - all medical specialties paid well so the difference between say Derm and IM was negligible salary wise, and #3 - no midlevel encroaching to replace physicians. Most med students these days consider medicine to be a job - a job one can enjoy and be compensated for, but still just a job nonetheless.
 
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DermViser

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It's the bottom of barrel FM docs who don't know how to manage osteoarthritis properly fault.

il1jaw.gif
I'm sure that's what Pay for Performance will blame it on. Never let a good deed go unpunished.
 
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