future of medical specialties

[usr]

hello

many predictions have been made about the future of medicine, including the dominant role or genetics and gene therapies, minimally invasive and endoscopic surgery, drugs designed specifically for every patient, etc

how do you predict the future of medical specialties?
will some medical specialties be limited or extinct? will biologists, chemists etc have more prominent than today in healthcare and other currently prominent specialties loose their prominence?

thanks for sharing your views

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[wonderwall]

I think immunology will become a prominent specialty..

 

[usr]

what about surgical specialties?

are they going to extinct?

 

[leorl]

what ?! of course not. Surgery is very logical. Thing go bad, you take bad thing out. There's no getting around that. Although you can change the method of removing it (ie. more recent shift to doing many procedures laparoscopically). In the future, I'd anticipate nanotechnology to be an increasingly utilized resource which may change current surgical management...but still, bad thing needs to come out.

 

[usr]

I think pathologists will have the prominent role

they will be the ones who develop the drugs according to each patient

 

[cool_vkb]

I think pathologists will have the prominent role

they will be the ones who develop the drugs according to each patient

Its not pathology bro, its Pharmacology! And in USA, you dont need to have an MD to become a Pharmacologist. Its offered as a PhD program by many med schools in USA (although a lot of MDs do it). You just need to have a BS in Sciences/Engineering to enter it. I think in India, Pharmacology is strictly for MBBS grads. Not sure about it!

By the way, Pathology is the scientific study of the nature of disease and its causes, processes, development, and consequences. They have nothing to do with Medicines. They are just the diagnostic wing.

Pharmacology is the branch of science that deals with the study of drugs and their action on living systems.

 

[PathOne]

I have a hard time imagining ANY current medical specialty being made redundant for the forseeable future. As regards future job prospects, that has less to do with the development of medical knowledge and technology, and more to do with insurance and government reimbursement for patient care. And these matters are to a large degree political in nature, and thus almost impossible to predict.

 

[konkan]

I think pathologists will have the prominent role

they will be the ones who develop the drugs according to each patient

pathologists developing drugs? Have you lately eaten too many mushrooms?

 

[PathOne]

Nope, pathologists aren't developing drugs. However, they do have the final say in the diagnosis of cancers. And experience has shown, that the need for pathologists is actually increasing, not decreasing, with the introduction of more targeted treatment options. Who do you think determines if a breast cancer is Her2/neu positive, and thus a candidate for treatment with Trastuzumab, or if a colorectal cancer is EGFR-positive, so the patient can be treated with Cetuximab?

Trust me, pathology as a field is nowhere close to dying, despite attempts to declare it DOA. Of course, if residency spots suddenly increase significantly, there could be a problem for future pathologists. But other than that, there's just no clouds on the horizon.

 

[konkan]

Nope, pathologists aren't developing drugs. However, they do have the final say in the diagnosis of cancers. And experience has shown, that the need for pathologists is actually increasing, not decreasing, with the introduction of more targeted treatment options. Who do you think determines if a breast cancer is Her2/neu positive, and thus a candidate for treatment with Trastuzumab, or if a colorectal cancer is EGFR-positive, so the patient can be treated with Cetuximab?

How about pharmacists for the start?

 

[PathOne]

Well, there's two answers.
The first is that demand for pharmacists and pharmacologists, along with demand for other healthcare professionals, is unlikely to decrease, especially as demographics dictate an ever-increasing population of older people.

The second answer is, that it's probably unfortunate that clinical pharmacology in the US, unlike a lot of other places, isn't recognized as a primary medical qualification. So you can't get a residency in clinical pharmacology; there's no board examination in the field, and you cannot gain licensure based on clinical pharmacology. The closest thing would probably be clinical pathology, but that's a distant cousin at best, even though some CP-boarded MD's actually subspecialize in pharma. But overall, for physicians, going into the pharmacological side of things isn't really an option...

 

[usr]

why do we even talk about pharmacists? they arent doctors at all...

pathologists will diagnose the disease and thus determine which drug to prescribe

in the molecular future of medicine, diagnoses wont be clinical as they are now, but molecular

for instance, pathologists will determine the immunologic profile of a patient and then tell the clinician what drug to prescribe for an autoimmune disease

drugs will be patient-specific and only a pathologist will be able to "see" the differences of each patient

clinicians cannot see those differences, they only see common symptoms and signs

 

[Circumflex]

why do we even talk about pharmacists? they arent doctors at all...

pathologists will diagnose the disease and thus determine which drug to prescribe

in the molecular future of medicine, diagnoses wont be clinical as they are now, but molecular

for instance, pathologists will determine the immunologic profile of a patient and then tell the clinician what drug to prescribe for an autoimmune disease

drugs will be patient-specific and only a pathologist will be able to "see" the differences of each patient

clinicians cannot see those differences, they only see common symptoms and signs

First of all, pathologists don't know which drugs to prescribe. The majority of cases seen by a pathologist are either cancer, inflammatory, or infectious. Cancer - there are so many different treatment algorithms and indications, that only Hem/Onc docs can keep up with that. Inflammatory - steroids. Infectious - pathologists definitely aren't keeping up to date with these drugs.

Additionally, think about cardiovascular disease - a major health burden - leading cause of mortality - pathologists have no role in diagnosis or treatment. Pathologists only deal with diseases that are biopsied.

When you say that clinicians cannot see diseases - think about surgeons, gastroenterologists, pulmonologists, cardiologists, neurologists (imaging).

I love pathology and am looking forward to starting residency in a few months, but if anything, I think radiologists have a slight edge in the area of diagnostics. I'm sure that we will be seeing a lot of new tracers that target organs and more functional imaging - all less invasive than biopsies.

It is true that we will see more genome-based diagnostics, but the body is complicated and it will take a while to develop really meaningful assays. Everyone thought that knowing gene sequences would revolutionize everything, until they realized the complexities of epigenetic modifications.

 

[Seed]

what ?! of course not. Surgery is very logical. Thing go bad, you take bad thing out. There's no getting around that. Although you can change the method of removing it (ie. more recent shift to doing many procedures laparoscopically). In the future, I'd anticipate nanotechnology to be an increasingly utilized resource which may change current surgical management...but still, bad thing needs to come out.

I'd have to strongly disagree with you on that one....
If there's any specialty in the medical field that is slowly becoming less significant it's surgery. Surgery in theory may seem logical but its use in a lot of clinical settings is becoming redundant and being replaced by pharmacological and minimally invasive therapies.
For example,
1. 30 years ago gastric perforation due to acidic gastritis was one of the most common emergency medical conditions around. General surgeons were called upon to perform emergency gastro- jejunostomies all the time. Then along came H2 antagonist drugs followed by other newer drug groups and now gastric perforation is almost unheard of.
2. CABG used to be the only mode of treatment for atherosclerosis. Now only a small fraction of patients actually require surgery while most undergo angioplasties (performed by a cardiologist- a physician). As cath lab technology improves, surgery will become completely unnecessary. Besides, patients can now be treated with drugs which don't allow their coronaries to reach a state that requires intervention.

3. The paradigm for cancer treatment is shifting away from radical surgery to chemotherapy and radiotherapy.

I could go on and on with examples, but the point is that while surgery may be about "thing go bad, take thing out" the emphasis of modern medicine is to prevent things from going bad in the first place through prevention, early detection and early management.

 

[leorl]

I'd agree, they are being encroached on. But at this point, even with IR replacements, meds, etc. they still aren't going to work on 100% of people. Even within surgery itself becoming less open, you still need people to work the laparoscopes. And for heme/onc, I can't really see neos/adjuvants taking over to becoming primary therapy any time soon except in its current indications, although research will no doubt fine tune the correlation between staging and rads/chemo/surgical treatment. I don't think necessarily that surgery will experience a demise, but I wouldn't rule out a rapid shift in techniques or an expansion into other modalities (like IR).

 

[leorl]

I would say your point about prevention being key is a good one. However, I don't think surgery will necessarily experience a demise in that regard. In breast surgery, genetic testing for the BRCA gene has increased surgical prophylaxis, although medications (chemo/tamoxifen/herceptin) have existed to target positive tumors. Even with early detection of DCIS, the main treatment is surgical. Breast surgery hasn't experienced a demise even though there is early detection/screening. In other cancers, perhaps early detection and screening will decrease the numbers of cases seen, but there will always be cancers picked up late (from a host of reasons), or cancers which present late (ie. pancreatic) and would need immediate surgical relief.

 

[Seed]

I would say your point about prevention being key is a good one. However, I don't think surgery will necessarily experience a demise in that regard. In breast surgery, genetic testing for the BRCA gene has increased surgical prophylaxis, although medications (chemo/tamoxifen/herceptin) have existed to target positive tumors. Even with early detection of DCIS, the main treatment is surgical. Breast surgery hasn't experienced a demise even though there is early detection/screening. In other cancers, perhaps early detection and screening will decrease the numbers of cases seen, but there will always be cancers picked up late (from a host of reasons), or cancers which present late (ie. pancreatic) and would need immediate surgical relief.

Actually, youre quite right about the role of surgery in cancer. I think cancer is one of the only group of diseases in which surgery is the primary line of therapy. I think that has a lot to do with the fact that cancer chemotherapy really hasn't been effective in curing most cancers (leukemias and lymphomas being the exception). In my opinion this has a lot to do with the fact that we actually know very little about the way cancer functions and so know even less about curing it. I however think that most other fields of medicine are seeing a marked shift away from the radical towards the conservative.