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I'm sure this has been discussed b4, but I thought I'd start up a newer thread... Which fields of medicine do you guys think are the most up and coming?
 

scotties123

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chiropractics. theyre finding new ways to F**K people up every day.
 
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sirus_virus

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I'm sure this has been discussed b4, but I thought I'd start up a newer thread... Which fields of medicine do you guys think are the most up and coming?

With the new political climate, I will say Primary care.
 

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I had a primary care doc tell me neurology is the Hot New Thang.

No it's not. And anyone who's remotely thinking about it shouldn't really consider it until after 2011 when I match :smuggrin:
 

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shhh neuro is supposed to be diagnose and adios and boring...dont let people think otherwise

Neurology and Interventional Neurology for me
 

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I'd imagine otolaryngology will grow in the next few decades due to people with hearing loss due to portable music players.
 
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scotties123

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Family Practice will be the new Dermatology.
thatll happen when the extent of a primary care physician's job is popping zits, yet still getting the highest physician salary around (i.e. never). Ima say orthopedic surgery because of all the new technology surrounding it.
 

masterofmonkeys

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pain medicine...because understanding neuromusculoskeletal physiology and pathology is too hard for doctors. And drugs are better than hard work where patients are concerned.
 

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I swear that every person I interview wants to be Heme/Onc so I am gonna say that.
 

Tiger26

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because you know allopathic medicine has such a good handle on back/neck pathology, prevention, and treatment. Glass houses, buddy.

Yeah, maybe chiropractics is on the upswing. With the increase in geriatric pts, stroking them out with their "neck manipulation" has excellent potential for pain management of their other comorbidities . . . .
 

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With the new research in immune modulation, rheumatology might be a new big thing.

With some of the other research developments, cosmetic psychiatry and geriatric ob/gyn wil be hot topics in the years to come.
 

masterofmonkeys

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Yeah, maybe chiropractics is on the upswing. With the increase in geriatric pts, stroking them out with their "neck manipulation" has excellent potential for pain management of their other comorbidities . . . .

1-3 strokes per million adjustments...what a HUGE risk.

In just another 3,332-9,998 years of going to see my chiropractor I might sustain a stroke! Oh the humanity!

Oh what's that? There are several schools of chiropractic that DO NOT practice rapid rotational adjustment and thus bear no risk of cervical arterial dissection? Sorry, you must've rendered that little factoid unrecognizable with your overly broad brush strokes.

How're we allopathics doing with spine pathology again?

Can we arrest facet syndrome, rib dysfunction syndrome, degenerative disk disease, spinal arthritis, and osteophytic nerve impingement?

We can't? But I thought doctors were all powerful and all knowing?

Can't we at least slow it down? Sort of. anti-inflammatories in massive doses do ****** the destructive processes at work. Corticosteroids can reduce osteophyte production and ossification of connective tissue structures...But they can also increase the rate of degradation of that same connective tissue.

Can we intervene? Spinal fusions sure do make a lot of orthos and neurosurgeons rich. But the increased load on the adjacent joints usually means that one fusion leads to more. And nothing says 'healthy' like a person with half the range of motion of someone with no back trouble.

Well, can we at least make people feel better?

Score one there. We can cover up symptoms, and we can manage pain. Yay for opiates?

Can we restore function in a biomechanically appropriate way? Nope.

Maybe it's time to admit a little humility. How much training do we get in neuromuscular physiology? None? How much training do we get in biomechanics? None? In nutrition? A meager and mostly wrong-headed and biased amount.

What is the quality of research we do in musculoskeletal pathology and intervention? Some of the worst I've seen. If i'd submitted a thesis that looked like most of the papers out there, I'd have been thrown out of grad school and asked to never, ever even think of breeding for fear of loosing even more stupidity into the gene pool.

We have no basic understanding of neuromusculoskeletal processes because it isn't taught. Is it any wonder that we are woefully pathetic in treating these ailments?
 
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masterofmonkeys, you should have went to osteopathic medical school where they have a class focused on the musculoskeletal system and its relationship to one's health, OMM.
 

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I was just thinking this.

You know, allopathic medicine has made it a point to remove any trace of non-allopathic treatment modalities from the planet. Ever wonder why every single Indian immigrant you've med is a an MD? (forget the store clerks) Its because when the British empire ruled India, they tweaked things around (opened many schools, closed others, changed curriculum) to wipe out the traditional medicine out there. Recently traditional Indian medicine has resurfaced in the form of Aveda skin lotion...

Too far away? Dr. Krebs... of the Krebs cycle.... what a tedious contribution to our curriculum.... Well, a lot if his other contributions were burned because they were about NUTRITION, and its impact on disease.

OK, I'll stop.

But yes, DO might have been good for you, and unfortunately a vast majority of the DO students and residents that Ive rotated with dont give a hoot about OMM.

Ok, back to studying the allopathic treatment of lower back pain.
 

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How're we allopathics doing with spine pathology again?

Can we arrest facet syndrome, rib dysfunction syndrome, degenerative disk disease, spinal arthritis, and osteophytic nerve impingement?

We can't? But I thought doctors were all powerful and all knowing?

Can't we at least slow it down? Sort of. anti-inflammatories in massive doses do ****** the destructive processes at work. Corticosteroids can reduce osteophyte production and ossification of connective tissue structures...But they can also increase the rate of degradation of that same connective tissue.

Can we intervene? Spinal fusions sure do make a lot of orthos and neurosurgeons rich. But the increased load on the adjacent joints usually means that one fusion leads to more. And nothing says 'healthy' like a person with half the range of motion of someone with no back trouble.

Well, can we at least make people feel better?

Score one there. We can cover up symptoms, and we can manage pain. Yay for opiates?

Can we restore function in a biomechanically appropriate way? Nope.

Maybe it's time to admit a little humility. How much training do we get in neuromuscular physiology? None? How much training do we get in biomechanics? None? In nutrition? A meager and mostly wrong-headed and biased amount.

What is the quality of research we do in musculoskeletal pathology and intervention? Some of the worst I've seen. If i'd submitted a thesis that looked like most of the papers out there, I'd have been thrown out of grad school and asked to never, ever even think of breeding for fear of loosing even more stupidity into the gene pool.

We have no basic understanding of neuromusculoskeletal processes because it isn't taught. Is it any wonder that we are woefully pathetic in treating these ailments?

You may want to look into PM&R (aka Physiatry) as these topics are thoroughly taught as part of the core residency curriculum as well as being actively researched.

Needless to say, I believe that offering comprehensive non-operative care of neuro-musculoskeletal conditions will keep Physiatry on the list of specialties that will continue to grow in both popularity and demand.
 
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Neurosurgery for pituitary tumors secondary to cell phone use!
 

masterofmonkeys

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You may want to look into PM&R (aka Physiatry) as these topics are thoroughly taught as part of the core residency curriculum as well as being actively researched.

Needless to say, I believe that offering comprehensive non-operative care of neuro-musculoskeletal conditions will keep Physiatry on the list of specialties that will continue to grow in both popularity and demand.

I'm going into psychiatry. But I think physiatry is an awesome field. Regardless, I think ANY physician needs to understand the basic science neuromusculoskeletal physiology and anatomy. And needs to be at least basically competent in the assessment of their patients for these conditions.
 

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1-3 strokes per million adjustments...what a HUGE risk.

In just another 3,332-9,998 years of going to see my chiropractor I might sustain a stroke! Oh the humanity!

We have no basic understanding of neuromusculoskeletal processes because it isn't taught. Is it any wonder that we are woefully pathetic in treating these ailments?

That's an interesting rhetorical device.

1) Downplay risks of chiropractic.
2) Long rant about failure of allopathic treatment of LBP.

There's only one part missing to your argument. I can't quite put my finger on it, something to do with.. evidence of chiropractic.. actually doing anything.. no, I can't quite figure it out. Hmm.
 

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I'm going into psychiatry. But I think physiatry is an awesome field. Regardless, I think ANY physician needs to understand the basic science neuromusculoskeletal physiology and anatomy. And needs to be at least basically competent in the assessment of their patients for these conditions.

Yup. An anatomy professor told me, the most common chief complaint in just about any field is "pain in ..." If you know peripheral neuro A&P well, you'll be able to correlate the presentation, Sx, treatment, associations, complicatoins, et cetera....
gall bladder, heart, sciatic nerve, lower back, appendix, wrist, head, pancreas, aorta, mesentery, pleura... everything.
 

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That's an interesting rhetorical device.

1) Downplay risks of chiropractic.
2) Long rant about failure of allopathic treatment of LBP.

There's only one part missing to your argument. I can't quite put my finger on it, something to do with.. evidence of chiropractic.. actually doing anything.. no, I can't quite figure it out. Hmm.

Here we go...another expert on the chiropractic literature.
 

masterofmonkeys

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That's an interesting rhetorical device.

1) Downplay risks of chiropractic.
2) Long rant about failure of allopathic treatment of LBP.

There's only one part missing to your argument. I can't quite put my finger on it, something to do with.. evidence of chiropractic.. actually doing anything.. no, I can't quite figure it out. Hmm.

There's actually pretty darn good evidence for a lot of modalities in use that don't simply include "back-cracking" and their efficacy in LBP. But at the end of the day no 'treatment' will work for LBP unless the underlying muscular dysfunction is addressed. Lots of things bring symptomatic relief, but the only things that will actually stop the decline or end the interminable cycle of acute pain is working with the patient to lose weight, assessing them for pelvic tilt, and erector/abdmoinal/oblique/iliopsoas balance, and correcting the deficits. Likewise, when it comes to neck pain, how many doctors actually assess their patients' posture and know how to look for muscular imbalance with regard to the traps, strenocleidomastoids, scalenes and rhomboids?

I actually started seeing a chiro because the last in a long line of doctors threw his hands up and said 'well we really can't help you. Have you ever tried chiropractic?' I scoffed at him and said hell no, I don't trust the unscientific idiots. He said, unscientific they may be, but it seems to work for some people.

And I admittedly got lucky with a guy who's both a PT and a chiro and who is skeptical of the quacks in his own profession, but the guy has done wonders for me. Medicine offered me pain meds (no thanks), steroid injections (care to see what happens to connective tissue after 50 years of steroid injections?), and surgery (yay! the domino effect. Start wtih c4/c5 and start moving up and down!). Granted cervical traction has helped and got me to the point where I was at least able to start being active again.

I have never argued that chiropracty is the be all end all for spinal pathology. But the risks are tiny and the potential for improvement in symptomatic improvement is great. Cracking the back won't do much for muscle spasm, but ART is proven and sure as hell does. Especially when combined with a rehabilitative approach to underlying muscular imbalance. The gym is ultimately where the back and neck pain epidemic will meet its match, but doctors lack the basic education and knowledge to understand where to start. Many chiros do to admittedly.
 
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That's an interesting rhetorical device.

1) Downplay risks of chiropractic.
2) Long rant about failure of allopathic treatment of LBP.

There's only one part missing to your argument. I can't quite put my finger on it, something to do with.. evidence of chiropractic.. actually doing anything.. no, I can't quite figure it out. Hmm.

Here's a Cochrane review on chiropractic treatment for low back pain:

Plain language summary

Spinal manipulative therapy for low-back pain
There was little or no difference in pain reduction or the ability to perform everyday activities between people with low-back pain who received spinal manipulation and those who received other advocated therapies.

This review of 39 trials found that spinal manipulation was more effective in reducing pain and improving the ability to perform everyday activities than sham (fake) therapy and therapies already known to be unhelpful. However, it was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.

So basically if you want treatment for acute low back pain that isn't pain medication, chiropractic isn't a bad option.

And I agree with above that Neurology will be a "hot" field in the future. Likewise, Anesthesia salaries aren't sustainable at the current level.
 

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Emergency Medicine- the baby of the bunch- still growing fast
 

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And I agree with above that Neurology will be a "hot" field in the future. Likewise, Anesthesia salaries aren't sustainable at the current level.

Think so? Im not sure how they can come down without creating mass hysteria... so they just might stay up there for a while
 

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I'm not sure about fastest growing fields, but I know there will be a huge need for Neurologists in the South with the aging population over the next 10 years.
 

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That's an interesting rhetorical device.

1) Downplay risks of chiropractic.
2) Long rant about failure of allopathic treatment of LBP.

There's only one part missing to your argument. I can't quite put my finger on it, something to do with.. evidence of chiropractic.. actually doing anything.. no, I can't quite figure it out. Hmm.

Don't worry, you're not alone. A lot of doctors fail to grasp the simple concept that the patient's opinion is very important (similar to "the client is always right"). I am not talking about those drug addicts coming to the ER just to get a shot, or those patients that at least seem to waste healthcare resources. I am talking about the mainstream patients. Doctors are perhaps asleep, but for many years now there has been a major drive among the American public to seek natural products and services, be it organic honey, cosmetics that are free of possible carcinogens/toxins like parabens and sodium fluoride (including toothpaste), natural vitamins, or medical treatments. After that ignominous thread about "quacks" I decided to do a little bit of patient Q&A. It turned out that many patients trust their chiropractor more than they trust their doctor. There were several patients who really did not have anything against doctors, but thought that they were unable to treat their LBP and therefore went to a chiro. Anyway, there were many valid reasons that requires a separate thread in itself, probably titled "Meat Technicians," but my point is that when you don't have the patients on your side, you lose, even if you were to have the most valid facts on your side. Now combine that with invalid facts... Doctors have been losing for some time, but they still fail to notice the problem.
 

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Since we dont even know how these two work, I will guess that Neurology and Rheumatology will experience the most growth/breakthroughs in our lifetime.
 

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I have heard that ER is an up and coming specialty in the South as you can pretty much name your price
 

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There's actually pretty darn good evidence for a lot of modalities in use that don't simply include "back-cracking" and their efficacy in LBP. But at the end of the day no 'treatment' will work for LBP unless the underlying muscular dysfunction is addressed. Lots of things bring symptomatic relief, but the only things that will actually stop the decline or end the interminable cycle of acute pain is working with the patient to lose weight, assessing them for pelvic tilt, and erector/abdmoinal/oblique/iliopsoas balance, and correcting the deficits. Likewise, when it comes to neck pain, how many doctors actually assess their patients' posture and know how to look for muscular imbalance with regard to the traps, strenocleidomastoids, scalenes and rhomboids?

I actually started seeing a chiro because the last in a long line of doctors threw his hands up and said 'well we really can't help you. Have you ever tried chiropractic?' I scoffed at him and said hell no, I don't trust the unscientific idiots. He said, unscientific they may be, but it seems to work for some people.

And I admittedly got lucky with a guy who's both a PT and a chiro and who is skeptical of the quacks in his own profession, but the guy has done wonders for me. Medicine offered me pain meds (no thanks), steroid injections (care to see what happens to connective tissue after 50 years of steroid injections?), and surgery (yay! the domino effect. Start wtih c4/c5 and start moving up and down!). Granted cervical traction has helped and got me to the point where I was at least able to start being active again.

I have never argued that chiropracty is the be all end all for spinal pathology. But the risks are tiny and the potential for improvement in symptomatic improvement is great. Cracking the back won't do much for muscle spasm, but ART is proven and sure as hell does. Especially when combined with a rehabilitative approach to underlying muscular imbalance. The gym is ultimately where the back and neck pain epidemic will meet its match, but doctors lack the basic education and knowledge to understand where to start. Many chiros do to admittedly.

I actually find this interjection into this thread pretty comical. Since I have a degree in athletic training (basically PT for athletes for those of you that don't know), a long history of going to a number of chiropractors and working with numerous orthos, you comments are greatly unfounded in my experience.

One of the big things we were taught (by an allo ortho) was that with lower back pain, modalities, physical therapy and manipulations (usually done by a DO, not a chiro) are all great ways to diminish lbp. You probably have a great experience with your chiro because he is also a PT and uses many techniques that are common in PT and chiro because they are founded on sound principles and therapies; such as when you stated modalities that they use...probably more from PT than from his chiro training. Most of the chiros we deal with around here are complete idiots, trying to diagnose UTIs and other such things outside the realm of their care...but that is locally.

Also, your comment on MD's not inspecting posture, stature, muscular imbalance, pelvic tilt...is just ridiculous...I have personally witness multiple orthos do all of the above in dealing with dozens of athletes that I worked with. Surgery is the last resort with patients. But most of the patients i worked with outside the sports arena are really too lazy to do the PT and other exercises and time it takes to actually improve muscle imbalance and the like...so they just say, "give me surgery so I can do what I want (and be lazy)!" This is the biggest problem with patients that relapse, they just get tired of actually having to work to improve their situation (similarly why the US population is continuing to become more obese!) and opt for the surgical route.

Lastly your little jolt on ~50 years of corticosteroid injections in 1 location is just unfounded unless the ortho is straight up dumb. Anecdotal evidence and the literature obviously state that numerous injections will most likly cause tendon rupture, ECM degeneration, scar tissue formation and a host of other problems. Most the orthos I work with state after 3 or so injections, it is time to start a different therapy (and usually we only did 3 because it was an athlete looking for big $$$ in the future...aka MLB, NBA, and so on).

People need to understand where they fit in, in the world of healthcare, work with each other in deterimining a plan for their patient and the best overall course of action. This is exactly why multidiciplinary teams are being found to work much better and more efficiently for patient care. Many heads working together are better than just one at a time.
 

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sorry for my rant everyone...but I agree with many posters above that ED is a new area of growth, especially here in the southeast. We always seem to need more of them and they are demanding great salaries (~200-250K) for i think right around 12-16 12 hour shifts or 18-20 9 hour shifts. So they are pulling down a great salary and work about half the month.

Pretty sweet deal and you get plenty of time with your family.
 

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In the dirty south you can make more...I have friends that work half the month and pull in around $350,000. Anyways, there is a nice hospital in town that pays slightly more than $170/hr
 

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Whatever makes the most amount of money with the least amount of work.
 

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Funny, every year people keep saying Neuro is the next big thing. However, I'm meeting more M3s that are thinking about going into it, so it may be true this swing. Surgery apparently is also back on the upswing now, according to res program directors, but I don't know if it's enough to be considered one of the fastest growing. My guess though is that IM/IM-related "non-acute" specialties like Rheumatology, Geriatrics, and Oncology may be on the next upswing due to the changes that may happen in compensation and the growth of biochem/molecular biology.
 

Random Anesthesiologist

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Thanks to those that have been sticking to the OP and ignoring the chiro debates. As if there aren't 5012 threads already arguing this....

Anyway -

Elderly - neuro, ENT, ortho, geriatrics, anesthesia, and so on

PM&R - rehab and fitness

Geez - are there really any that won't be in demand? I think the issue now would be along the lines of compensation...
 
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