how worried are you about the future?

[deleted746658]

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after having conversation with my classmates, i'm honestly shocked how naive most medical students are. i don't think many are aware of the challenges we will face when we reach attending status. our debt burden is extraordinary and salaries are dropping, not rising. sometimes i'm just so upset i chose this route.

those who do not feel threatened or are not worried about IBM's watson and the impact that AI will have on our field must be living under a rock. it's time to face the reality. administrators have sucked the fun out of medicine, and AI will deliver the KO when it sucks out the critical thinking/ intellectual aspect of medicine; then - at that point - we will truly be glorified data clerks.

AI will undoubtedly influence what field i choose to enter... when i bring up that concern my classmates laugh it off like it is not a big deal. it honestly shocks me. how can you be so naive about your profession's future? medicine in 2025-2030 will not be like the medicine we see practiced today. i'm shocked that so few of my classes realize this. the pre-med / med culture can be so naive and ignorant bc we are sheltered in our books and don't look up to see what is going on.

if i were not already 100k+ in debt, i would run from medicine. run as fast as i can..

i once remember reading an article on kevinMD that projected doc salaries at 90K for PC and 150K for specialists in the future. i read that and said... yea., right. but that is what we will be faced with. once AI reaches it's potential, we will not be worthy of a dime more.... bc we are not doing the real work. we are entering data, and hell, we may not even be worthy of that meagre salary

sorry to rant, but wake up med students! this is our future. choose your field wisely.

 

[Taddy Mason]

Ah, this old chestnut again.

 

[OnePunchBiopsy]

So many assumptions in this post, but I'll just mention one. You are assuming that people will tolerate the idea of having an AI as their PCP/Specialist.

Ignoring all the people who never go to their doctor and phone in all their meds using telemed (since they don't go to the doctor anyway), people who do go to the doctor want to SEE a doctor. They hate feeling like their problem is not important enough to have an MD/DO right in front of them. Heck, even the NP's where I rotated would become frustrated because patients did not feel as though seeing them was adequate enough. This is also the reason people often bypass their PCP's because they think their symptoms require a specialist, even though their PCP could have easily made the diagnosis and given treatment.

Hypothetically, if a hospital were to start using some form of AI to give treatment, it would more than likely have to be overseen by an MD/DO. Secondly, patients would more than likely not like the fact they were not seeing the physician, and go across the street to the hospital that is not using AI.

I won't even get into discussing surgery. Some patients freak out enough about robotic cases.

So, I'm not worried.

 

[ProfMD]

I think you are being unnecessarily paranoid about the role of computers in medicine. AI is no where close to being able to do the job of a doctor. I a quite certain it won't happen in our lifetimes.

It is true that there is debt and salaries are now what they used to be. However, I still would not let this disuade anyone from a career in medicine. I don't know any starving doctors.

 

[Psai]

Ai cant even read an ekg reliably, never mind replace a doctor

 

[lymphocyte]

AI will undoubtedly influence what field i choose to enter... when i bring up that concern my classmates laugh it off like it is not a big deal. it honestly shocks me. how can you be so naive about your profession's future? medicine in 2025-2030 will not be like the medicine we see practiced today. i'm shocked that so few of my classes realize this. the pre-med / med culture can be so naive and ignorant bc we are sheltered in our books and don't look up to see what is going on.

once AI reaches it's potential, we will not be worthy of a dime more.... bc we are not doing the real work. we are entering data, and hell, we may not even be worthy of that meagre salary

sorry to rant, but wake up med students! this is our future. choose your field wisely.

@Psai beat me to it, but let me know when a computer can read an EKG competently.

I'm not an expert in artificial intelligence, but I did do graduate study in statistics (which included machine learning and neural networks). You're vastly overestimating how powerful these systems are. And the barriers to artificial intelligence aren't quantitative--they won't be solved by shoving more transistors on a chip--they're very much qualitative. The only kind of paradigm for meaningful "artificial intelligence" we currently have is associative, which holds no capacity for novelty, innovation, or, most importantly, saliency. In fact, this is an area where philosophers have been way ahead of the computer scientists in predicting the resounding failure of artificial intelligence to progress beyond mere association (see the works of Heidegger, Merleau-Ponty, Dreyfus or Noe).

Also, the vast majority of doctors don't get salaried. They get remunerated. There's a big difference. And remuneration for FPs and psychiatrists is rising substantially. I can't speak to other specialities, but there's certainly a redistribution of healthcare spending toward primary prevention and mental health and away from some procedures (like PCIs or colonoscopies).

Of course, you're absolutely correct. Technology will change the way we do things. How is that different from the past 3000 years of human history?

I wouldn't lose too much sleep over it. And quit scaring your classmates. You don't want to give off a Ted Kaczynski vibe, ya know?

Garg A, Lehmann MH. Prolonged QT interval diagnosis suppression by a widely used computerized ECG analysis system. Circ Arrhythm Electrophysiol. 2013;6(1):76-83.

http://leidlmair.at/doc/whyheideggerianaifailed.pdf

 

[Brahnold Bloodaxe]

@Psai beat me to it, but let me know when a computer can read an EKG competently.

I'm not an expert in artificial intelligence, but I did do graduate study in statistics (which included machine learning and neural networks). You're vastly overestimating how powerful these systems are. And the barriers to artificial intelligence aren't quantitative--they won't be solved by shoving more transistors on a chip--they're very much qualitative. The only kind of paradigm for meaningful "artificial intelligence" we have is associative, which holds no capacity for novelty, innovation, or, most importantly, saliency. In fact, this is an area where philosophers have been way ahead of the computer scientists in predicting the resounding failure of artificial intelligence to progress beyond mere association (see the works of Heidegger, Merleau-Ponty, Dreyfus or Noe).

Ok. But the overwhelming majority of clinical medicine is associative, and with the increasing adoption of algorithms and "evidence based" approaches it is becoming ever more so. Now that healthcare is mostly delivered by huge corporations and paid for by monopolists (insurance and government) the scope for physicians to practice in a way that utilizes non associative "intelligence" is severely curtailed. It's increasingly "patient presents with X, go to protocol Z approved by 'evidence' " and that is something far more effectively implemented by a computer than by a human physician.

That's the sad thing about medicine. Out all all the professional fields out there, it's probably the most easily reducible to algorithmic format. You can't replace the value added of a high powered corporate lawyer or consultant with an algorithm, because their value added is almost entirely contained within their social connections. What is the value added of a physician that separates him from a nurse? It is knowing that when presented with A,B and C you should do X, Y and Z. And that is all to easily replicated by even the weakest of AIs.

 

[futuremdforme]

I have many worries about the future, and compensation as a doctor due to AI is not one of them.

 

[lymphocyte]

Ok. But the overwhelming majority of clinical medicine is associative, and with the increasing adoption of algorithms and "evidence based" approaches it is becoming ever more so. Now that healthcare is mostly delivered by huge corporations and paid for by monopolists (insurance and government) the scope for physicians to practice in a way that utilizes non associative "intelligence" is severely curtailed. It's increasingly "patient presents with X, go to protocol Z approved by 'evidence' " and that is something far more effectively implemented by a computer than by a human physician.

That's the sad thing about medicine. Out all all the professional fields out there, it's probably the most easily reducible to algorithmic format. You can't replace the value added of a high powered corporate lawyer or consultant with an algorithm, because their value added is almost entirely contained within their social connections. What is the value added of a physician that separates him from a nurse? It is knowing that when presented with A,B and C you should do X, Y and Z. And that is all to easily replicated by even the weakest of AIs.

Actually, protocolization is what empowers a mid-level to act like a doctor in certain limited circumstances. What makes a doctor a doctor is using first principles to know when the protocols don't apply. Again, this requires novelty, innovation, and saliency. Maybe because I'm so fixated on critical care and psychiatry, where the data are so sparse and so difficult to individuate, but I just don't see how most treatment decisions are as clear-cut as you're making them out to be.

But in the immortal words of @Blue Dog: If you're that worried about being replaced, then maybe you should be replaced.

 

[235009]

after having conversation with my classmates, i'm honestly shocked how naive most medical students are. i don't think many are aware of the challenges we will face when we reach attending status. our debt burden is extraordinary and salaries are dropping, not rising. sometimes i'm just so upset i chose this route.

those who do not feel threatened or are not worried about IBM's watson and the impact that AI will have on our field must be living under a rock. it's time to face the reality. administrators have sucked the fun out of medicine, and AI will deliver the KO when it sucks out the critical thinking/ intellectual aspect of medicine; then - at that point - we will truly be glorified data clerks.

AI will undoubtedly influence what field i choose to enter... when i bring up that concern my classmates laugh it off like it is not a big deal. it honestly shocks me. how can you be so naive about your profession's future? medicine in 2025-2030 will not be like the medicine we see practiced today. i'm shocked that so few of my classes realize this. the pre-med / med culture can be so naive and ignorant bc we are sheltered in our books and don't look up to see what is going on.

if i were not already 100k+ in debt, i would run from medicine. run as fast as i can..

i once remember reading an article on kevinMD that projected doc salaries at 90K for PC and 150K for specialists in the future. i read that and said... yea., right. but that is what we will be faced with. once AI reaches it's potential, we will not be worthy of a dime more.... bc we are not doing the real work. we are entering data, and hell, we may not even be worthy of that meagre salary

sorry to rant, but wake up med students! this is our future. choose your field wisely.

Have you ever tried to elicit a real history from a real patient? I'm not talking about in an osce or when you go into the room and have 1.5 hours to talk to the patient. I'm talking about crunch time: multiple admissions in one day, having to keep a clinic running on time with 15 min slots. Patients are TERRIBLE at giving salient histories. It takes a lot of skill and practice to figure out how seriously to take a complaint, put it together with what you're observing, what else you know about the patient, etc.

Computers are already in healthcare and the answer they almost always give is "you may have cancer or are dying please report immediately to the emergency department". The va uses a system where you call a nurse who plugs your system into a computer to triage you. The system invariably tells everyone to go to the ED immediately if there's anything dangerous or life threatening on the differential for the chief complaint. We also know how great Dr. Google has been for patients.

As others have said I'm not worried about machines replacing (most) doctors anytime soon.

Doctors that may be replaced by a computer:
1. Anesthesia: they've already made a machine for use in developing countries with a doctor shortage that a surgeon can put on autopilot to put his patient under anesthesia.
2. Psychiatrists: I read about a recent study that showed that people with ptsd liked and were comfortable with telling an animated character on a screen all their problems. While that's good at eliciting a more complete history about sensitive topics the machine didn't interpret, synthesize or treat anything. So really this is probably an example of AI as a tool rather than a replacement.


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[lymphocyte]

.

 

[Pathman1000]

Doctors will be replaced by nurses long before they're replaced by computers.

 

[croak]

There will always be a need for qualified MDs (DOs), so I wouldn't worry too much at all.

 

[croak]

Doctors will be replaced by nurses long before they're replaced by computers.

I disagree. The breadth and depth of knowledge differs. The approach to patient care differs, and cannot foresee 'nurse surgeons' or 'nurse specialists' -

 

[Mansamusa]

I was definitely shocked about how ignorant fellow incoming med students are about the field and finances and I even spoke with an attending whose advice I had to throw right out because she obviously didn't know what she was talking about. I am also concerned about the future of medicine.

AI is the least concerning issue by a far far shot. So many assumptions need to made to envision an AI controlled medical field. The concerns would be flooding the job market with more doctors and devaluing the degree by having so many grads, increasing practice rights of nurses (specialists aren't protected), admins sucking the life out of providers, and the fact that no one is putting their foot down about debt

 

[ProfMD]

Ok. But the overwhelming majority of clinical medicine is associative, and with the increasing adoption of algorithms and "evidence based" approaches it is becoming ever more so. Now that healthcare is mostly delivered by huge corporations and paid for by monopolists (insurance and government) the scope for physicians to practice in a way that utilizes non associative "intelligence" is severely curtailed. It's increasingly "patient presents with X, go to protocol Z approved by 'evidence' " and that is something far more effectively implemented by a computer than by a human physician.

That's the sad thing about medicine. Out all all the professional fields out there, it's probably the most easily reducible to algorithmic format. You can't replace the value added of a high powered corporate lawyer or consultant with an algorithm, because their value added is almost entirely contained within their social connections. What is the value added of a physician that separates him from a nurse? It is knowing that when presented with A,B and C you should do X, Y and Z. And that is all to easily replicated by even the weakest of AIs.

Actually, protocolization is what empowers a mid-level to act like a doctor in certain limited circumstances. What makes a doctor a doctor is using first principles to know when the protocols don't apply. Again, this requires novelty, innovation, and saliency. Maybe because I'm so fixated on critical care and psychiatry, where the data are so sparse and so difficult to individuate, I just don't see how most treatment decisions are as clear-cut as you're making them out to be.

But in the immortal words of @Blue Dog: If you're that worried about being replaced, then maybe you should be replaced.

Protocols lend themselves well to certain aspects of patient care - think ACLS, ATLS, PALS, etc.

However, to say that medicine in general lends itself well to algorithms is not true. There are many reasons for this, including the fact that patients often don't present in text-book fashion. However, it is also important to realize that while evidence-based medicine is the goal, there is a lot of what we do not that is not strictly evidence based. Either we are extrapolating from evidence that does not apply directly to the situation we are dealing with, working from imperfect evidence, or working from experience.

I was definitely shocked about how ignorant fellow incoming med students are about the field and finances and I even spoke with an attending whose advice I had to throw right out because she obviously didn't know what she was talking about. I am also concerned about the future of medicine.

AI is the least concerning issue by a far far shot. So many assumptions need to made to envision an AI controlled medical field. The concerns would be flooding the job market with more doctors and devaluing the degree by having so many grads, increasing practice rights of nurses (specialists aren't protected), admins sucking the life out of providers, and the fact that no one is putting their foot down about debt

I do not see much devaluation due to flood the market with new grads. This is mainly because residency spots are not expanding as quickly. So, what is happening is that there are more MD/DO grads who may be left without residency spots. There is a problem with distribution of physicians (geographically and across specialties). Certainly there needs to be more value placed on primary care - new graduates need to be incentivized to enter primary care fields.

Administration can suck the life out of providers, but does not have to. This depends on physician leadership. Physicians need to make sure they take the time to get on committees and interact with their administrators. I can tell you from personal experience, this goes a long way. A good administrator will listen to physicians, but those physicians need to be willing to be engaged.

The debt issue is a harder one. There is no doubt that medical school tuition is high. I am sure the reasons for this are numerous and I am not sure how best to address it.

I am curious what advice this physician gave that was so off-base.

 

[Pathman1000]

I disagree. The breadth and depth of knowledge differs. The approach to patient care differs, and cannot foresee 'nurse surgeons' or 'nurse specialists' -

It ain't about knowledge kid. It's about cost.

 

[lymphocyte]

It ain't about knowledge kid. It's about cost.

I've done cost consulting for a large ACO.

From a primary care perspective, there's simply no cost advantage as patients get sicker with more and more medical comorbidities--which is exactly what's happening with the aging population.

Cost advantage only exists where medicine can be protocalized. This is actually fairly uncommon and still requires a tremendous amount of planning, training, and time. Think followup diabetes clinics, lowrisk midwife antenatal clinics, etc. And you didn't go to medical school to do that sorta routine stuff anyway...

 

[TheFutureFatMan]

Ai cant even read an ekg reliably, never mind replace a doctor

Lol had one miss an MI at 4:00 am. Whomp.

 

[TheFutureFatMan]

Doctors will be replaced by nurses long before they're replaced by computers.

lol

 

[NWwildcat2013]

I don't think OP is worried about being replaced completely. OP is worried about the very real possibility of being relegated to simply approving/agreeing/double checking the treatment plan that big data will be able to generate for simple patients/problems.

I think that is a real concern.

 

[Goro]

Go dig up some of the posts by the wise bc65 on dealing with debt.

All new endeavors are fraught with anxiety. You'll be fine.

after having conversation with my classmates, i'm honestly shocked how naive most medical students are. i don't think many are aware of the challenges we will face when we reach attending status. our debt burden is extraordinary and salaries are dropping, not rising. sometimes i'm just so upset i chose this route.

those who do not feel threatened or are not worried about IBM's watson and the impact that AI will have on our field must be living under a rock. it's time to face the reality. administrators have sucked the fun out of medicine, and AI will deliver the KO when it sucks out the critical thinking/ intellectual aspect of medicine; then - at that point - we will truly be glorified data clerks.

AI will undoubtedly influence what field i choose to enter... when i bring up that concern my classmates laugh it off like it is not a big deal. it honestly shocks me. how can you be so naive about your profession's future? medicine in 2025-2030 will not be like the medicine we see practiced today. i'm shocked that so few of my classes realize this. the pre-med / med culture can be so naive and ignorant bc we are sheltered in our books and don't look up to see what is going on.

if i were not already 100k+ in debt, i would run from medicine. run as fast as i can..

i once remember reading an article on kevinMD that projected doc salaries at 90K for PC and 150K for specialists in the future. i read that and said... yea., right. but that is what we will be faced with. once AI reaches it's potential, we will not be worthy of a dime more.... bc we are not doing the real work. we are entering data, and hell, we may not even be worthy of that meagre salary

sorry to rant, but wake up med students! this is our future. choose your field wisely.

 

[sloop]

I've said this before and I'll say it again. Computers will not replace doctors until the entire way computers fundamentally operate changes. Computers are awesome for data storage, accession, and algorithmic calculation within specified parameters. They are good at generating an output based on what they are told is relevant. They are not good at understanding a scenario and initiating a search for what might be relevant.

Most medicine is not deductive reasoning, which is what computers are good at. It's abductive reasoning. The problem with abductive logic is that it is not strictly parametric and, unlike deductive logic, the difficulty with it is mostly the result of the requirement for a highly sophisticated and adaptive basic interpretive function rather than the ability to crunch an enormous data set with some relatively simple and constrained basic functions.

Medicine won't be threatened until computers begin to learn and intuit as well as human beings. At that point, the threat isn't unique to doctors—that will pretty much subvert everybody.

 

[Ho0v-man]

Much more concerned about NPs taking an online correspondence course and becoming certified to do orthopedic surgery because they did a research paper on the history of knee arthroplasty.

I can see it now. " Nurse practitioners will be able to apply their already extensive nursing experience to the operating room and perform only the most routine surgeries to allow underserved areas to receive basic orthopedic care."

Then they all open spine practices in big cities only.


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[deleted746658]

I don't think OP is worried about being replaced completely. OP is worried about the very real possibility of being relegated to simply approving/agreeing/double checking the treatment plan that big data will be able to generate for simple patients/problems.

I think that is a real concern.

this. exactly this. big data is the future of medicine (and the future of pretty much every other industry). computer aided diagnostics will make us simply double checkers... aka there will be less of a need for MDs, and we will not be able to demand the salaries that we need to be earning to pay off our absurd student loan tabs. think about it... right now, what is valued most about an MD? what separates an MD from their NP/PA/RN/CRNA/MA counterparts? our database of knowledge. once AI creates a better, faster, more vast database, we lose our distinction. we lose what separates us from the pack. we don't offer much more than a skilled NP/PA. yes, of course there will be complex cases. of course there will be cases/ diseases/ presentations that AI will miss and an MD will be there to catch. but we don't need a robust workforce of MDs to serve this purpose. we are already continuing to be diluted by mid-levels. MD school expansion/ class size expansion needs to stop. there is no shortage of MDs. we are being duped. i cannot stand the naievte of the med culture, from top down. we are so consumed by our training that we don't look up to realize what is going on. we are disrespected left and right, physicians have no unity, no solidarity, no leadership. it is so disappointing. nurses are the face of healthcare now. for goodness sakes they lobby so well they can take a freaking online course and practice independently.

it's time to step up, (future) docs. we need to carefully approach the next decade or so, or else the profession that was once ours will be run by 25 yo MBA grads and mid-levels and a shiny new world-renowned diagnostician computer

 

[Ho0v-man]

this. exactly this. big data is the future of medicine (and the future of pretty much every other industry). computer aided diagnostics will make us simply double checkers... aka there will be less of a need for MDs, and we will not be able to demand the salaries that we need to be earning to pay off our absurd student loan tabs. think about it... right now, what is valued most about an MD? what separates an MD from their NP/PA/RN/CRNA/MA counterparts? our database of knowledge. once AI creates a better, faster, more vast database, we lose our distinction. we lose what separates us from the pack. we don't offer much more than a skilled NP/PA. yes, of course there will be complex cases. of course there will be cases/ diseases/ presentations that AI will miss and an MD will be there to catch. but we don't need a robust workforce of MDs to serve this purpose. we are already continuing to be diluted by mid-levels. MD school expansion/ class size expansion needs to stop. there is no shortage of MDs. we are being duped. i cannot stand the naievte of the med culture, from top down. we are so consumed by our training that we don't look up to realize what is going on. we are disrespected left and right, physicians have no unity, no solidarity, no leadership. it is so disappointing. nurses are the face of healthcare now. for goodness sakes they lobby so well they can take a freaking online course and practice independently.

it's time to step up, (future) docs. we need to carefully approach the next decade or so, or else the profession that was once ours will be run by 25 yo MBA grads and mid-levels and a shiny new world-renowned diagnostician computer

I really do think the people entering med school now are going to be the generation of docs that have to tell mid levels to back off.


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[coffee-doc]

after having conversation with my classmates, i'm honestly shocked how naive most medical students are. i don't think many are aware of the challenges we will face when we reach attending status. our debt burden is extraordinary and salaries are dropping, not rising. sometimes i'm just so upset i chose this route.

those who do not feel threatened or are not worried about IBM's watson and the impact that AI will have on our field must be living under a rock. it's time to face the reality. administrators have sucked the fun out of medicine, and AI will deliver the KO when it sucks out the critical thinking/ intellectual aspect of medicine; then - at that point - we will truly be glorified data clerks.

AI will undoubtedly influence what field i choose to enter... when i bring up that concern my classmates laugh it off like it is not a big deal. it honestly shocks me. how can you be so naive about your profession's future? medicine in 2025-2030 will not be like the medicine we see practiced today. i'm shocked that so few of my classes realize this. the pre-med / med culture can be so naive and ignorant bc we are sheltered in our books and don't look up to see what is going on.

if i were not already 100k+ in debt, i would run from medicine. run as fast as i can..

i once remember reading an article on kevinMD that projected doc salaries at 90K for PC and 150K for specialists in the future. i read that and said... yea., right. but that is what we will be faced with. once AI reaches it's potential, we will not be worthy of a dime more.... bc we are not doing the real work. we are entering data, and hell, we may not even be worthy of that meagre salary

sorry to rant, but wake up med students! this is our future. choose your field wisely.

*tips fedora*

 

[Brahnold Bloodaxe]

To answer the broader question, I'm pretty worried. Automation is one area of concern, but unfortunately only one of many. I'm not going to enumerate them all here because I think we all know the challenges the medical profession faces in the medium to long term. It's been covered in countless threads.

The worst thing about this whole process is how much investment we have to put in and how long we have to wait to see whether that investment is going to pay off. In almost any other career, you're working hard and you face risks as well, but you're earning money throughout the process, building wealth, and have the ability to adjust course and respond to a changing world.

In medicine? When you start out in day 1 in medical school you know you will be digging a financial hole for yourself for at least the next 7 years and most likely 10. You just have to hope that all the mind numbing study and waste of youth is going to pay off at the end of this very long road over which you have zero control.

So here I am, in my pre-clinical years, doing all this work and taking on all the debt, while all around me swirl massive trends like the possibility of socialized medicine, the death of private practice, rise of the midlevels, AI, and on and on it goes. And there is nothing I can do about it. If I were in corporate, I could observe changes around me and try to steer my career in such a way as to avoid oncoming obstacles. Instead, I am like a train running along the track, without the ability to alter course and powerlessly left hoping that my journey won't end in a derailment completely outside of my control. And it takes a minimum of 7 years to find out whether any of this will have been worth it!

 

[QualityProcess]

The difference between a physician and any potential replacements isnt knowledge, its clinical skills. The difference between tenderness and being whiny. The difference between a "headache" and a HEADACHE. If knowledge was the difference then we would be immediately replaceable by electronics. Electronics cant evaluate the inputs for accuracy or meaning

 

[deleted746658]

To answer the broader question, I'm pretty worried. Automation is one area of concern, but unfortunately only one of many. I'm not going to enumerate them all here because I think we all know the challenges the medical profession faces in the medium to long term. It's been covered in countless threads.

The worst thing about this whole process is how much investment we have to put in and how long we have to wait to see whether that investment is going to pay off. In almost any other career, you're working hard and you face risks as well, but you're earning money throughout the process, building wealth, and have the ability to adjust course and respond to a changing world.

In medicine? When you start out in day 1 in medical school you know you will be digging a financial hole for yourself for at least the next 7 years and most likely 10. You just have to hope that all the mind numbing study and waste of youth is going to pay off at the end of this very long road over which you have zero control.

So here I am, in my pre-clinical years, doing all this work and taking on all the debt, while all around me swirl massive trends like the possibility of socialized medicine, the death of private practice, rise of the midlevels, AI, and on and on it goes. And there is nothing I can do about it. If I were in corporate, I could observe changes around me and try to steer my career in such a way as to avoid oncoming obstacles. Instead, I am like a train running along the track, without the ability to alter course and powerlessly left hoping that my journey won't end in a derailment completely outside of my control. And it takes a minimum of 7 years to find out whether any of this will have been worth it!

beautifully stated.

 

[osckey]

When are people going to wake up and realize that almost every job out there has its complexities and challenges while not being as rewarding as it is to be a physician?

Seriously, stop worrying all the time. Live your life and enjoy it to the fullest.

 

[Stagg737]

Ok. But the overwhelming majority of clinical medicine is associative, and with the increasing adoption of algorithms and "evidence based" approaches it is becoming ever more so. Now that healthcare is mostly delivered by huge corporations and paid for by monopolists (insurance and government) the scope for physicians to practice in a way that utilizes non associative "intelligence" is severely curtailed. It's increasingly "patient presents with X, go to protocol Z approved by 'evidence' " and that is something far more effectively implemented by a computer than by a human physician.

That's the sad thing about medicine. Out all all the professional fields out there, it's probably the most easily reducible to algorithmic format. You can't replace the value added of a high powered corporate lawyer or consultant with an algorithm, because their value added is almost entirely contained within their social connections. What is the value added of a physician that separates him from a nurse? It is knowing that when presented with A,B and C you should do X, Y and Z. And that is all to easily replicated by even the weakest of AIs.

this. exactly this. big data is the future of medicine (and the future of pretty much every other industry). computer aided diagnostics will make us simply double checkers... aka there will be less of a need for MDs, and we will not be able to demand the salaries that we need to be earning to pay off our absurd student loan tabs. think about it... right now, what is valued most about an MD? what separates an MD from their NP/PA/RN/CRNA/MA counterparts? our database of knowledge. once AI creates a better, faster, more vast database, we lose our distinction. we lose what separates us from the pack. we don't offer much more than a skilled NP/PA. yes, of course there will be complex cases. of course there will be cases/ diseases/ presentations that AI will miss and an MD will be there to catch. but we don't need a robust workforce of MDs to serve this purpose. we are already continuing to be diluted by mid-levels. MD school expansion/ class size expansion needs to stop. there is no shortage of MDs. we are being duped. i cannot stand the naievte of the med culture, from top down. we are so consumed by our training that we don't look up to realize what is going on. we are disrespected left and right, physicians have no unity, no solidarity, no leadership. it is so disappointing. nurses are the face of healthcare now. for goodness sakes they lobby so well they can take a freaking online course and practice independently.

it's time to step up, (future) docs. we need to carefully approach the next decade or so, or else the profession that was once ours will be run by 25 yo MBA grads and mid-levels and a shiny new world-renowned diagnostician computer

The problem with the algorithm based argument is that it's been used as a med school curriculum and provided sub-par results. Because my school uses a relatively unique curriculum, our dean gave us a speech (the same one several times) about the history of med school curriculum. Several schools in Canada attempted to use and algorithm based approach to help their students be more efficient. The results were that students who graduated from such schools sucked at critical thinking and didn't understand the underlying physiology and path well enough to differentiate the subtleties between many conditions. Even if you use a highly advanced AI, there will still be issues with variable subtleties between patients and the algorithms would have to include extremely advanced levels of fluidity to adjust to those differences.

Plus, as people have already said, patients suck at giving a decent history. AI might be able to give a solid diagnosis and treatment plan for patients who give a good detailed history and have 1 or 2 conditions, but when a patient comes in with 4+ comorbidities and is on 6 different meds and can't name 1 of them, I don't think AI is going to be able to give an effective diagnosis or treatment plan anytime soon. Even if it does have the capabilities of Watson.

 

[ProfMD]

Technology is changing medicine, for the better in my opinion. The breadth and depth of knowledge in all fields of medicine is expanding at an astronomical pace. Having this information readily available is extremely helpful. Gone are the days when doctors can be expected to have all the relevant data in their heads. In addition, technology helps us share records with other providers, perform telemedicine, and communicate with patients.

I am not at all worried about computers, midlevels, etc taking over my practice. And, I hope to be doing this for at least 20 more years.

However, I do find it interesting that all you pessimists out there with your fear and paranoia still signed up to be doctors. Why? And, if you are only 1-2 years in and the outlook is so terrible, why don't you quit before you rack up the full 4 years of debt and then start life as a resident making minimum wage?

I, for one, and happy with my decision to be a doctor and would encourage others to consider this career as well.

 

[Carol is Alpha]

What do you guys make of this? How are you supposed to practice medicine with this garbage being shoved down your throats? Everything will be standardized. Nightmare. This isn't about healthcare. It's a modernized, reinvigorated version of what IBM did back in the day.

 

[Brahnold Bloodaxe]

However, I do find it interesting that all you pessimists out there with your fear and paranoia still signed up to be doctors. Why? And, if you are only 1-2 years in and the outlook is so terrible, why don't you quit before you rack up the full 4 years of debt and then start life as a resident making minimum wage?

Because I still have dreams of working 1 month on 1 month off in BFE stacking paper and enjoying sailing the coast of Thailand in my months off. And medicine still appeals to me as a worthy and intellectually satisfying field.

Being worried about adverse possibilities is not the same as being convinced that I have correctly predicted the future and the future is bleak. Just like everyone else on this planet, I can only speculate about what is going to happen in the future. Since there is no point in preparing yourself for things turning out all rosy, most speculation necessarily focuses on the negative possibilities. It is only reasonable.

 

[deleted746658]

When are people going to wake up and realize that almost every job out there has its complexities and challenges while not being as rewarding as it is to be a physician?

Seriously, stop worrying all the time. Live your life and enjoy it to the fullest.

There is a very important difference between us and other fields! In other careers you can adapt, change your course of action, change jobs, change careers, change fields. It is much much much harder to do that in medicine bc we spend over a decade training before we actually start our career and we carry a debt burden and personal sacrifice that is unparalleled in almost every other field.

We put all of our eggs in one basket. We cannot invest until our 30s. We are subject to myriad external forces of which we cannot control. We carry a debt burden that makes it very unwise to leave the field, no matter how messed up things get. We are unlike other fields in so many aspects - it is apples to oranges my friend.




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[ProfMD]

What do you guys make of this? How are you supposed to practice medicine with this garbage being shoved down your throats? Everything will be standardized. Nightmare. This isn't about healthcare. It's a modernized, reinvigorated version of what IBM did back in the day.

This actually looks like a good thing. It not not standardizing care for every patient, just making sure that certain things are not missed. For instance, diabetics need regular A1c checks, foot checks, eye exams, etc. When you have a large panel of patients, it is easy to miss these things, especially if patients are not compliant. In addition, if a patient sees multiple providers (PCP, ophthalmologist, podiatrist, endocrinologist, etc) things like this can help to make sure everyone is on the same page.

Of course, these sorts of things do not lend themselves to all conditions. However, there are accepted guidelines for many chronic conditions and systems like this can help make sure patients get the outpatient follow-up they need and hopefully stay out of the hospital.

 

[deleted746658]

Technology is changing medicine, for the better in my opinion. The breadth and depth of knowledge in all fields of medicine is expanding at an astronomical pace. Having this information readily available is extremely helpful. Gone are the days when doctors can be expected to have all the relevant data in their heads. In addition, technology helps us share records with other providers, perform telemedicine, and communicate with patients.

I am not at all worried about computers, midlevels, etc taking over my practice. And, I hope to be doing this for at least 20 more years.

However, I do find it interesting that all you pessimists out there with your fear and paranoia still signed up to be doctors. Why? And, if you are only 1-2 years in and the outlook is so terrible, why don't you quit before you rack up the full 4 years of debt and then start life as a resident making minimum wage?

I, for one, and happy with my decision to be a doctor and would encourage others to consider this career as well.

i signed up bc i was naive. i have no intention to practice clinical medicine. i'm interested in consulting, med device sales, etc. and unfortunately i am too late in the game to leave now.

and i am not trying to fear monger. i am trying to shake the naivete that plagues the pre-med/ med student culture.

 

[deleted746658]

Ai cant even read an ekg reliably, never mind replace a doctor

not yet. but it can deliver anesthesia.

http://www.ncbi.nlm.nih.gov/pubmed/19812483

 

[Carol is Alpha]

This actually looks like a good thing. It not not standardizing care for every patient, just making sure that certain things are not missed. For instance, diabetics need regular A1c checks, foot checks, eye exams, etc. When you have a large panel of patients, it is easy to miss these things, especially if patients are not compliant. In addition, if a patient sees multiple providers (PCP, ophthalmologist, podiatrist, endocrinologist, etc) things like this can help to make sure everyone is on the same page.

Of course, these sorts of things do not lend themselves to all conditions. However, there are accepted guidelines for many chronic conditions and systems like this can help make sure patients get the outpatient follow-up they need and hopefully stay out of the hospital.

What you lay out are the selling points, but if you look under the hood this pushes an ulterior agenda that dovetails with what managed care will become. Doctors will lose more and more autonomy over the "healthcare plan". This is just another step into devolving doctors into healthcare providers. Yes, for now you can advocate for treatment not on the algorithm tree after jumping thru several rings, but this will only get tougher and tougher.

 

[hallowmann]

I've said it (far more than) once and I'll say it again: From an AI, machine learning, HCI, and computer vision standpoint we are quite literally AT LEAST decades and decades away from any sort of "takeover". The technology isn't there. Its nowhere close. You're worrying about something that will likely take a century, and my "guess" is that by that time, we'll all be dead, and medicine will have adapted to make physicians still pertinent and essential to the process. Its happened multiple times throughout history.

Again back to just how little we know. Anyone saying that AI is on the horizon and will take over medicine in our lifetime has not only a far too simplistic understanding of medicine, but also of AI (and machine learning and computer vision and human computer interaction). No. Just stop.

Again, I draw back to the issue of radiology/pathology, which should arguably be the "easiest" fields to make autonomous and to that one PhD that half a century ago said, "yeah, one of my undergrads will solve that whole computer vision thing this summer" and now its a huge field with billions of dollars and thousands of people still working to "solve" it.

Dude, that anesthesia article is the same as an article saying, hey we developed a new chemo, sometime in the future everyone with cancer will be cured. Its a goal of future research. It doesn't mean its close to it. Please refer to the second paragraph above.

 

[osckey]

There is a very important difference between us and other fields! In other careers you can adapt, change your course of action, change jobs, change careers, change fields. It is much much much harder to do that in medicine bc we spend over a decade training before we actually start our career and we carry a debt burden and personal sacrifice that is unparalleled in almost every other field.

We put all of our eggs in one basket. We cannot invest until our 30s. We are subject to myriad external forces of which we cannot control. We carry a debt burden that makes it very unwise to leave the field, no matter how messed up things get. We are unlike other fields in so many aspects - it is apples to oranges my friend.




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I understand. I think I've just reached that point where I don't care anymore. How can I? I can't go through 4 years of med school anxiously worrying about if it's worth it. In my mind, I weighed the options and made a decision that this is an endeavor that's worthwhile. Do I get concerned from time to time? Yes, but there's nothing more I can do. I want this and at some point you have to stay confident in your decisions.

 

[Brahnold Bloodaxe]

What you lay out are the selling points, but if you look under the hood this pushes an ulterior agenda that dovetails with what managed care will become. Doctors will lose more and more autonomy over the "healthcare plan". This is just another step into devolving doctors into healthcare providers. Yes, for now you can advocate for treatment not on the algorithm tree after jumping thru several rings, but this will only get tougher and tougher.

This is one reason why the death of private practice is such a disaster for our profession. Physicians who own their own shops can take one look at this nonsense and tell its peddlers to eff off. Physicians who work as wage slaves for gigantic, MBA run corporate health systems have to do what the MBAs tell them to do. And there is nothing MBAs like more than implementing Byzantine "processes" to control every aspect of their operations.

 

[meurotic]

There is a very important difference between us and other fields! In other careers you can adapt, change your course of action, change jobs, change careers, change fields. It is much much much harder to do that in medicine bc we spend over a decade training before we actually start our career and we carry a debt burden and personal sacrifice that is unparalleled in almost every other field.

We put all of our eggs in one basket. We cannot invest until our 30s. We are subject to myriad external forces of which we cannot control. We carry a debt burden that makes it very unwise to leave the field, no matter how messed up things get. We are unlike other fields in so many aspects - it is apples to oranges my friend.




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I don't understand. Why can't fruit be compared?

Also, none of you are giving OP enough credit. With the death of Moore's Law and viable small scale quantum computing just a few years away, we're going to see a massive paradigm shift in the roles computers play in our lives. It'll be very hard to predict exactly how profound the effect will be in just a few years, but within the next few decades, it's not entirely crazy to say that doctors will just become AI technicians (and concurrently be compensated far less).

 

[ProfMD]

What you lay out are the selling points, but if you look under the hood this pushes an ulterior agenda that dovetails with what managed care will become. Doctors will lose more and more autonomy over the "healthcare plan". This is just another step into devolving doctors into healthcare providers. Yes, for now you can advocate for treatment not on the algorithm tree after jumping thru several rings, but this will only get tougher and tougher.

Following practice guidelines like this improves patient care. The way it is now, they are guidelines - not absolutes that must be followed.

With or without these computer programs, these guidelines exist. Your management of these patients is already being measured. This software just makes it easier for the provider to keep up with the guidelines and to communicate with other providers.

Try not to be so pessimistic. Things like this actually help patient care, which is the ultimate goal.

 

[operaman]

Go stand in a busy ED any night of the week and if you can't immediately see that computers will never replace doctors, well then i don't know what to tell you. Too much crazy in the world for a computer to tolerate it. Not a day goes by in which I don't face some insane situation that requires innovative thinking to solve thanks to the general insanity and social train wrecks inherent in medicine. Lets see Watson try to manage that!

That said, tech has already changed medicine as we all have the totality of medical literature easily accessible on our smartphones. Watson will no doubt only add to this and empower us to hopefully provide better care. But what it won't do is replace the doctor patient interaction. That crucial part of what we do where the rubber meets the road. Watson may know the right meds to prescribe, but the ability to sit down and explain it to a patient and convince them it matters and is worth their money and worth the side effects - that's a human only sort of thing.

The word Doctor means teacher, not diagnostician. At least in my field, making the diagnosis is not too terribly difficult. Not many Dr. House cases out there; much more about obvious ailments, acute exacerbations of chronic conditions. Do the workup and the diagnosis reveals itself. Tech may aid in diagnosis, but it isn't all that hard to begin with.

Still, the best way to ensure some security going forward is to select a field where you learn a skill that can't be easily automated or outsourced.

 

[Brahnold Bloodaxe]

Go stand in a busy ED any night of the week and if you can't immediately see that computers will never replace doctors, well then i don't know what to tell you. Too much crazy in the world for a computer to tolerate it. Not a day goes by in which I don't face some insane situation that requires innovative thinking to solve thanks to the general insanity and social train wrecks inherent in medicine. Lets see Watson try to manage that!

That said, tech has already changed medicine as we all have the totality of medical literature easily accessible on our smartphones. Watson will no doubt only add to this and empower us to hopefully provide better care. But what it won't do is replace the doctor patient interaction. That crucial part of what we do where the rubber meets the road. Watson may know the right meds to prescribe, but the ability to sit down and explain it to a patient and convince them it matters and is worth their money and worth the side effects - that's a human only sort of thing.

The word Doctor means teacher, not diagnostician. At least in my field, making the diagnosis is not too terribly difficult. Not many Dr. House cases out there; much more about obvious ailments, acute exacerbations of chronic conditions. Do the workup and the diagnosis reveals itself. Tech may aid in diagnosis, but it isn't all that hard to begin with.

Still, the best way to ensure some security going forward is to select a field where you learn a skill that can't be easily automated or outsourced.

You don't need highly paid doctors to do all the underlined. Medical school doesn't train you to be a human, it trains you to do those things you already admitted Watson can do just as well. You don't need to know renal physiology to deal with uncooperative patients and crazy social issues, and nobody is going to pay you for knowing renal physiology if all you're doing is being a "nice human person" for patients while the computer handles the actual medicine. That's called nursing and is compensated accordingly.

 

[Mansamusa]

I am curious what advice this physician gave that was so off-base.

She was kind of the aloof academic type who advised me to pay $100K more for a non-top private school over a well-regarded state school (that actually has much higher MCAT and gpa average). After residency (with interest included) the difference will be $300K in debt vs $450K-470K (and $20K vs $28K/yr interest). She told me that within the past 10 yrs, many graduates have been carrying and paying off $500K in student loans with no problem. Which isn't true. That was the advice I ignored. She said other things that made it seem like she was in a bubble and unaware of some the problems facing younger doctors. She was incredibly nice and I'm glad I spoke with her, but it was more because of her encouragement than the advice itself.

There is a very important difference between us and other fields! In other careers you can adapt, change your course of action, change jobs, change careers, change fields. It is much much much harder to do that in medicine bc we spend over a decade training before we actually start our career and we carry a debt burden and personal sacrifice that is unparalleled in almost every other field.

We put all of our eggs in one basket. We cannot invest until our 30s. We are subject to myriad external forces of which we cannot control. We carry a debt burden that makes it very unwise to leave the field, no matter how messed up things get. We are unlike other fields in so many aspects - it is apples to oranges my friend.

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That is why you hash things out before med school starts. So you know what you are getting into, accept the negatives, and are prepared for the risks and sacrifices

 

[Yadster101]

@Psai beat me to it, but let me know when a computer can read an EKG competently.

I'm not an expert in artificial intelligence, but I did do graduate study in statistics (which included machine learning and neural networks). You're vastly overestimating how powerful these systems are. And the barriers to artificial intelligence aren't quantitative--they won't be solved by shoving more transistors on a chip--they're very much qualitative. The only kind of paradigm for meaningful "artificial intelligence" we have is associative, which holds no capacity for novelty, innovation, or, most importantly, saliency. In fact, this is an area where philosophers have been way ahead of the computer scientists in predicting the resounding failure of artificial intelligence to progress beyond mere association (see the works of Heidegger, Merleau-Ponty, Dreyfus or Noe).

http://leidlmair.at/doc/whyheideggerianaifailed.pdf

Can you give me an eli5? You eloquence makes your argument sound very strong.

 

[Taddy Mason]

You don't need highly paid doctors to do all the underlined. Medical school doesn't train you to be a human, it trains you to do those things you already admitted Watson can do just as well. You don't need to know renal physiology to deal with uncooperative patients and crazy social issues, and nobody is going to pay you for knowing renal physiology if all you're doing is being a "nice human person" for patients while the computer handles the actual medicine. That's called nursing and is compensated accordingly.

Yes, because actually caring about people is soooooo beneath physicians.