Dermatology or Diagnostic Radiology

[LarryRad]

i did, I was interested in radiology at one time.

I may be discounting the complexity involved in reading a scan, however you might be discounting the technological capabilities of AI.
Do you think AI can drive a car, surely there are limitless possibilties of nuance that need to be interpreted while doing that.
How about trade stocks? There are complexities involved in that as well.

Why do you think all imaging modalities are immune. I linked a paper earlier in the discussion that provided better reads compared to a radiologist for the same images for a number of conditions. Sure it isnt perfect but I am surprised that it doesnt give anyone pause.

Don't get me wrong, technology is a major part of radiology. We probably use it more than any other specialty- it's brought up at every conference we go to!
Speaking as someone who works as a radiologist and understands what the job entails I sleep very comfortably at night with the current progress of AI. Who knows, I may revise this position in the future? But definitely not now. I certainly wouldn't discourage anyone from entering what I consider to be the most exciting medical specialty.

It's all a question of trust- would you let a driverless car take you to work on the motorway/highway without some sort of mechanism whereby a human could override/oversee?

The same way I would prefer a cardiologist to read my ECG rather than a machine or a radiologist report my scan rather than a machine.

That reminds me I am on call today and should get some sleep. Godspeed.

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[radsisrad]

The horror.

But rads are the only ones who need to try to convince others how smart they are or how 'draining' the work is.

Rads also have been exposed to either IM or surgery by dint of having to do a prelim year, so their perspective does benefit from somewhat diverse experiences. Take IM, for instance. The medicine is equally challenging to radiology; there's no competition here. But, in the hospital, lots of time is spent talking to patients about non-medical issues, charting, consulting, etc. In surgery, there's lots of time spent prepping patients, waiting for the whole team to arrive, and so on. Radiology and dermatology are probably the most continually-mentally-demanding fields in medicine at this time given workflow dynamics. Every radiology resident to whom I've spoken has said that Rads is far more exhausting than their intern year was. Yes, I understand that interns don't "have to think", so to speak - except, by the end of intern year, they really do. If they're not active physicians by then (instead of order-entering monkeys), they earn scorn from senior residents, fellows, attendings, and even nurses.

Again, this is not a competition. It's a recognition of workflow reality.

 

[ChrisMack390]

Don't get me wrong, technology is a major part of radiology. We probably use it more than any other specialty- it's brought up at every conference we go to!
Speaking as someone who works as a radiologist and understands what the job entails I sleep very comfortably at night with the current progress of AI. Who knows, I may revise this position in the future? But definitely not now. I certainly wouldn't discourage anyone from entering what I consider to be the most exciting medical specialty.

It's all a question of trust- would you let a driverless car take you to work on the motorway/highway without some sort of mechanism whereby a human could override/oversee?

The same way I would prefer a cardiologist to read my ECG rather than a machine or a radiologist report my scan rather than a machine.

That reminds me I am on call today and should get some sleep. Godspeed.

Just curious, what do you see as the future of AI in radiology? Obviously the role will expand, and to say it won't is foolish, but to what degree?

 

[abefromann]

As a practicing (busy) dermatologist - there are only two issues that make the decision easy from my perspective.

You wrote:

- I have pretty bad hands and don't enjoy procedures
- I'm an introvert, and I would prefer seeing 5 patients a day to 40 patients per day

You will be miserable in derm if this is the case. There are A LOT of patient conversations during the day and this can be a real grind, believe it or not. Also, many patients try to sneak in extra complaints and this can also be a real drag on energy levels in a 5-10 minute appointment.

 

[Lnsean]

The problem is that the radiology job market has always been most vulnerable...to the economy...to efficiencies...teleradiology...or whatever may happen next. It isn't rock solid like derm...so if you had a choice between derm or rads...go derm.

 

[Gurby]

The problem is that the radiology job market has always been most vulnerable...to the economy...to efficiencies...teleradiology...or whatever may happen next. It isn't rock solid like derm...

Is not derm looking very vulnerable to disruption by midlevels and deep learning?

By my limited M1 understanding of the specialties, it seems like diagnosis in derm is actually much more vulnerable than rads.

 

[PhillyMed777]

Is not derm looking very vulnerable to disruption by midlevels and deep learning?

By my limited M1 understanding of the specialties, it seems like diagnosis in derm is actually much more vulnerable than rads.

Nope

 

[Dr. Doctor MD]

The problem is that the radiology job market has always been most vulnerable...to the economy...to efficiencies...teleradiology...or whatever may happen next. It isn't rock solid like derm...so if you had a choice between derm or rads...go derm.

Not even close, Radiology is fine for quite a while. The only real threat is AI, which will increase incomes long before it decreases them. They also took their biggest reimbursement hits in the 2000s and still make bank.

Derm is also safe from AI as well and likely will be for a long time, but has other serious threats such as midlevel encroachment, reimbursement slashes, and private equity.

Derm and Rads are both amazing fields, and not going anywhere in the next 10 years. 20 years from now, no one knows. But derm is most definitely not rock solid.

 

[CherryRedDracul]

With volume of imaging I read on call, I wish AI would hurry its ass up and help me.

 

[Ho0v-man]

No one can predict anything so just do what you want.

I.e. the sky has been falling in anesthesia for ~20 years and it’s still a high paying field

Radiology was ridiculously competitive until ~10 years ago when fellows were running into a bad job market despite being some of the most competitive med students when they graduated.

In the past 10 years EM went from being non-competitive, to competitive bc med students thought it was a “lifestyle specialty” lol, to “ermahgerd the midlevels and administrators are coming”.

The list goes on and on. No one has any idea what’s coming or how anything will change. Heck when ct first came out the sky was falling in rads bc the prevailing thought was everyone would be able to read their own images and not need radiologists anymore. That’s a laughable idea now.

By the end of our careers there could be some crazy development that makes Peds pay better than surgery for no reason. We just don’t know. Screw all this nonsense and just do what you want.

 

[Crayola227]

yeah tired of how certain specialties get trotted out for being "easy" or something

being a doctor is a lot of work, period, and how much that sucks to you, depends a great deal on you as an individual, which is why people continually urge looking for what you're good at/like doing, rather than shoehorning into derm or rads because "it's easy"

 

[Roadhouse]

Interesting how so many are convinced that AI will overrun radiology but don’t seem as concerned about AI impacting derm career stability.

If AI can so easily read thousands of MR images with different pulse sequences/ contrast phases, ignore the artifacts, and also make reasonable comparison with other modalities (CT, US, nuc med), how couldn’t it provide the same robust analysis for skin lesions based on appearance, distribution, and history?

I’m sure an army of midlevels (chaperoned by 1 dermatologist) would love to get to play doctor with their hi res camera that can be uploaded and compared with a database of millions of known skin conditions.

 

[Angus Avagadro]

Ok, I have insight and some age. I remember when cell phones were in bags as large as a laptop. That was years ago. Now, we have pax, voice recognition, out sourcing to India and Australia, and early computer reading. If you think AI wont be a major factor in imaging in 20 years, you are willfully ignoring the past. If you love anatomy and wish to be a clinical anatomist, then diagnostic radiology is for you