how worried are you about the future?

[Brahnold Bloodaxe]

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

Wut?

 

[Bearcat74]

OK, here's the future of medicine from where I see it. My mental health clinic near Dayton, Ohio used to be staffed w/ all physicians. Now is it 2 physicians, and 4 NPs. They pay us 1/2 of what they pay the MDs.

The VA is going to do away w/ physican collaboration requirements, so the move there will be to the lower cost NPs.

As w/ everything, "just follow the money". MDs have much better training, but after several years of clinical experience, most NPs are quite good at handling the routine stuff, and when we can't, we are quick to refer to our collaborating MDs.

The only way I would enter the medical field is to go into a subspecialty. NPs are NOT going to do surgery, although I know one who works in radiology now.

And finally, before you knock me for being an NP, I was accepted at two MD schools, and one DO school in Ohio. Did the whole pre-med curriculum, and did very well w/ it.

 

[ProfMD]

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

Yeah - that's crazy. If your state school is well regarded, definitely don't pay more for a mediocre private med school.

 

[Taddy Mason]

Wut?

Well, I could've done the same with your previous post. Didn't realize you were into the whole brevity thing.

 

[Brahnold Bloodaxe]

Well, I could've done the same with your previous post. Didn't realize you were into the whole brevity thing.

Here's my post that you're referring to:

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.

What specifically is wrong with it? Your original response to this very same post was a total non sequitur. When faced with a non sequitur, the only possible response is "Wut?"

 

[darklabel]

....
Medicine won't be a threat 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.

Yeah, for AI I would never worry as a physician. If we get to the point that a robot can replace a physician then >50% of jobs out there would be replaced easily by then. We wouldn't really have any patients that can pay at that point since there would literally be no jobs so our economy would have to fundamentally change. I'm more worried about the middle class workers being replace relatively soon since most middle class jobs tend to be office based and are the easiest to be automatized.

 

[Taddy Mason]

Here's my post that you're referring to:



What specifically is wrong with it? Your original response to this very same post was a total non sequitur. When faced with a non sequitur, the only possible response is "Wut?"

I wonder why "wut?" was never a choice on the verbal reasoning section of the MCAT...

 

[Brahnold Bloodaxe]

All right Walter Lance, this conversation isn't going anywhere. See ya mate.

 

[lymphocyte]

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 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.

The actual doctors in this thread are saying that you have no clue what you're talking about. Medicine is actually quite hard in a way that computers simply can't grok.

The actual healthcare consultant in this thread is saying that you have no clue what you're talking about. Medicine is actually quite hard in a way that midlevels can't cheaply takeover.

The actual data scientist that's worked with big data at companies like Google and Goldman Sachs is saying that you have no clue what you're talking about. Medicine is actually quite hard in a way that can't be solved by just getting a bigger hammer.

But no, you're the one trying to "shake the naivete that plagues the pre-med/ med student culture." Might I instead suggest that you have no clue what you're talking about?

 

[Spikebd]

Ok. But the overwhelming majority of clinical medicine is associ...........

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?........

I'd think accountants, pharmacists, teachers, would be extinct long before physicians.

 

[sloop]

I'd think accountants, pharmacists, teachers, would be extinct long before physicians.

Aren't pharmacists practically extinct anyway? I mean I still think they serve a valuable role, but most of them never actually get to fulfill that role. The whole world of retail pharmacy seems very sad . . .

 

[deleted746658]

The actual doctors in this thread are saying that you have no clue what you're talking about. Medicine is actually quite hard in a way that computers simply can't grok.

The actual healthcare consultant in this thread is saying that you have no clue what you're talking about. Medicine is actually quite hard in a way that midlevels can't cheaply takeover.

The actual data scientist that's worked with big data at companies like Google and Goldman Sachs is saying that you have no clue what you're talking about. Medicine is actually quite hard in a way that can't be solved by just getting a bigger hammer.

But no, you're the one trying to "shake the naivete that plagues the pre-med/ med student culture." Might I instead suggest that you have no clue what you're talking about?

all i'm saying is this: when - not if - a reliable computer diagnostic machine is developed, MDs will lose a lot of their value (as well as salary and respect). sure, certain fields will be more immune to this (anything procedural), but most of the workload in medicine at that point can be done by laborers with much different (and much less) training.

and i don't think this is as far away as some people think. you literally have the biggest companies in the world (microsoft, google, facebook, IBM) and some of the brightest minds in the world working on it.

and how can docs resist this? by that point private practices are gone by the wayside, we are all employees working for the man.

pre-med/ med students/ docs that are aghast to this idea - that is the naivete i'm referring to.

 

[lymphocyte]

.

 

[Psai]

all i'm saying is this: when - not if - a reliable computer diagnostic machine is developed, MDs will lose a lot of their value (as well as salary and respect). sure, certain fields will be more immune to this (anything procedural), but most of the workload in medicine at that point can be done by laborers with much different (and much less) training.

and i don't think this is as far away as some people think. you literally have the biggest companies in the world (microsoft, google, facebook, IBM) and some of the brightest minds in the world working on it.

and how can docs resist this? by that point private practices are gone by the wayside, we are all employees working for the man.

pre-med/ med students/ docs that are aghast to this idea - that is the naivete i'm referring to.

You know who would be helped most by this kind of technology? Doctors. As I go farther into medicine, I notice that there's so much that we don't know. Computers are good with certainties, with calculations. What is the percent chance that this lung mass on xray is a tumor? What should we do about it? A computer can't guide a patient through that. A patient is much more than a checklist that will spit out a diagnostic answer. There will always be a role for the doctor. Doctors are much more than the data input specialist that administrators seem to think we are.

 

[MrChance2]

I actually went to a required meeting on this for doctors at a hospital I was rotating at. It was on telemedicine. It was not on whether this will happen. It was telling the doctors this is the direction the hospital is going and asking for doctors to sign up. One point the presenter (an MD) made was a study that showed NP+computer had equivalent care of prison inmates as physician. He said the stethoscope was once rejected by physicians in the same way that this is being rejected but ultimately will be the new norm. It was hard to sit through. The future of the ER is going to be 1 physician to handle the 10-20% of severe acute or complicated issues and a bunch of NPs with a computer telling people that use the ER as their primary care they just have a URI.

I think there is going to be 2 classes of care. 1. What most families living on $40-50K/year or less get which will be primarily NP+computer. 2. People that are willing to pay cash for physicians and non robotic/entirely algorithm based care.

Obviously this is a forum and I'm not going to write a book so there are shades of gray but that's the general direction I see it headed.

I think there will ultimately be a backlash when NP+computer starts giving a higher morbidity/mortality but routine health care will absolutely go this way and for pretty much anyone in power it is in their best interest ($$$$) to see it go this way.

 

[Psai]

I actually went to a required meeting on this for doctors at a hospital I was rotating at. It was on telemedicine. It was not on whether this will happen. It was telling the doctors this is the direction the hospital is going and asking for doctors to sign up. One point the presenter (an MD) made was a study that showed NP+computer had equivalent care of prison inmates as physician. He said the stethoscope was once rejected by physicians in the same way that this is being rejected but ultimately will be the new norm. It was hard to sit through. The future of the ER is going to be 1 physician to handle the 10-20% of severe acute or complicated issues and a bunch of NPs with a computer telling people they just have a URI.

I think there is going to be 2 classes of care. 1. What most families living on $40-50K/year or less get which will be primarily NP+computer. 2. People that are willing to pay cash for physicians and non robotic/entirely algorithm based care.

Obviously this is a forum and I'm not going to write a book so there are shades of gray but that's the general direction I see it headed.

I think there will ultimately be a backlash when NP+computer starts giving a higher morbidity/mortality but routine health care will absolutely go this way and for pretty much anyone in power it is in their best interest ($$$$) to see it go this way.

Those studies are obviously bull****. Why would you study something like that unless you were looking for something to prove? The fact that NPs are trying their darndest to prove their worth with nearly 30,000 published studies and can't find a single area where they are better than physicians should tell you something. In what other field would you have such interest and effort going into an area with nothing to show? No one else publishes negative studies even when they're useful and yet these crap studies are supposed to prove something? Absence of evidence is not evidence of absence. Quality matters.

Don't listen to the paid shills who are selling out the profession. NPs don't have the background, the education or drive to match physicians. The powers that be are depending on you to lay down and let yourself get run over by these charlatans. Don't train them and let them fend for themselves. No one can predict the future but there's a lot of money to be made in healthcare and the pie is only getting bigger. These people want to take advantage of your years of study and hard work to line their own pockets. The healthcare system depends on doctors and nurses, the rest are just vultures who are waiting for you to die of your own accord so they can pick at your bones.

 

[MrChance2]

Those studies are obviously bull****. Why would you study something like that unless you were looking for something to prove? The fact that NPs are trying their darndest to prove their worth with nearly 30,000 published studies and can't find a single area where they are better than physicians should tell you something. In what other field would you have such interest and effort going into an area with nothing to show? No one else publishes negative studies even when they're useful and yet these crap studies are supposed to prove something? Absence of evidence is not evidence of absence. Quality matters.

Don't listen to the paid shills who are selling out the profession. NPs don't have the background, the education or drive to match physicians. The powers that be are depending on you to lay down and let yourself get run over by these charlatans. Don't train them and let them fend for themselves. No one can predict the future but there's a lot of money to be made in healthcare and the pie is only getting bigger. These people want to take advantage of your years of study and hard work to line their own pockets. The healthcare system depends on doctors and nurses, the rest are just vultures who are waiting for you to die of your own accord so they can pick at your bones.

I wasn't listening to the guy in terms of his scientific validity and of course the studies are bull****. He was talking to a room full of physicians that wanted to strangle him. Regardless, it happened, the hospital approved it, and required physicians to attend.

 

[Psai]

I wasn't listening to the guy in terms of his scientific validity and of course the studies are bull****. He was talking to a room full of physicians that wanted to strangle him. Regardless, it happened, the hospital approved it, and required physicians to attend.

There's a reason why the hospital made it required. But wtf are they going to do if no one goes? They need the doctors more than the doctors need them. That's why they're trying to inculcate this insidious propaganda as if there were any merit to any of it.

 

[MrChance2]

There's a reason why the hospital made it required. But wtf are they going to do if no one goes? They need the doctors more than the doctors need them. That's why they're trying to inculcate this insidious propaganda as if there were any merit to any of it.

I agree but you don't think software engineers were pissed off and tried to band together when they were told their jobs were going to India? I don't see how this is different.

With engineering there is a resurgence of need for American software engineers partially because companies realized how much it costed to have highly trained engineers fix the code that the less highly trained foreign engineers wrote for $10/hr. The same thing is going happen with this I believe. Unless we just accept a higher morbidity/mortality for poor/working class people but I think it is going to take another 10+ years for the pendulum to swing the other way from the direction it is going of NP+Computer=physician.

 

[Psai]

I agree but you don't think software engineers were pissed off and tried to band together when they were told their jobs were going to India? I don't see how this is different.

With engineering there is a resurgence of need for American software engineers partially because companies realized how much it costed to have highly trained engineers fix the code that the less highly trained foreign engineers wrote for $10/hr. The same thing is going happen with this I believe. Unless we just accept a higher morbidity/mortality for poor/working class people but I think it is going to take another 10+ years for the pendulum to swing the other way from the direction it is going of NP+Computer=physician.

There is no np + computer. Computers already exist. If you think that more protocols and inside the box thinking will help midlevels, you're sadly mistaken.

 

[MrChance2]

There is no np + computer. Computers already exist. If you think that more protocols and inside the box thinking will help midlevels, you're sadly mistaken.

Ok. Just so I'm not misunderstood I'm definitely not on the side of healthcare going away from physicians. I'm just saying what I think the future will hold despite my desires. I thought this was supposed to be a "the sky is falling" thread after all.

 

[ProfMD]

I am not sure what telemedicine has to do with NP+computer.

Telemedicine, however, definitely had a role to play. Look at stroke care, for instance. Local hospital can contact neurologist at stroke center. Via telemedicine, the neurologist can examine the patient and review the images. The neurologist can then recommend tPA or not. tPA is then started while the patient is en route to the stroke center. This way, patient gets the specialist evaluation they need and treatment is started without delay.

When I was a fellow we did some telemedicine follow-ups with patients who lived 4-5 hours away. Telemedicine is a great way to get specialty care to people who otherwise would not get it. It is not good for everything, but it had its place.

There are issues being worked on, such as reimbursement and licensure (if you provide telemedicine services to another state).

 

[musclebro]

Here's a good layman's post about artificial intelligence by Wait But Why
http://waitbutwhy.com/2015/01/artificial-intelligence-revolution-1.html
The references after Part 2 are good further reading.

You'll realize, as others have alluded above, that once AI reaches the point of starting to replace doctors, it's not just our profession that will have problems. Society as a whole will have problems. And everybody will have to adjust pretty quickly. Lead AI scholars have predicted anything from adjustments to human society and culture up to extinction of the human species itself.

And AI is not just an algorithm of "input this, output this" like many think in this thread. They are becoming much more sophisticated. They can learn. They can make decisions based on incomplete data. They will be able to understand when a patient may not give a good medical history and make appropriate decisions from there, just like doctors do.

 

[sloop]

Here's a good layman's post about artificial intelligence by Wait But Why
http://waitbutwhy.com/2015/01/artificial-intelligence-revolution-1.html
The references after Part 2 are good further reading.

You'll realize, as others have alluded above, that once AI reaches the point of starting to replace doctors, it's not just our profession that will have problems. Society as a whole will have problems. And everybody will have to adjust pretty quickly. Lead AI scholars have predicted anything from adjustments to human society and culture up to extinction of the human species itself.

And AI is not just an algorithm of "input this, output this" like many think in this thread. They are becoming much more sophisticated. They can learn. They can make decisions based on incomplete data. They will be able to understand when a patient may not give a good medical history and make appropriate decisions from there, just like doctors do.

I'm aware that there are computers that can "learn." I know about Deep Blue and such. The fact remains that they don't fundamentally learn in the same way. They need to be explicitly programmed about what they need to learn. They learn in relation to specific parametric constraints. There are computers that can "learn" from playing chess how to avoid being checkmated. This is different than real life pursuits that don't have discrete "rules." Because people are people and have their own personalities, unique variations, etc., there aren't really many rules to the game of medicine.

 

[musclebro]

I'm aware that there are computers that can "learn." I know about Deep Blue and such. The fact remains that they don't fundamentally learn in the same way. They need to be explicitly programmed about what they need to learn. They learn in relation to specific parametric constraints. There are computers that can "learn" from playing chess how to avoid being checkmated. This is different than real life pursuits that don't have discrete "rules." Because people are people and have their own personalities, unique variations, etc., there aren't really many rules to the game of medicine.

Yeah but eventually AI will surpass those problems and be able to mimic human intelligence, and soon after, surpass human intelligence. I'm not talking about artificial specific/narrow intelligence to do specific tasks, but artificial general intelligence, that very much function like the human brain. It's odd to think AI could have personalities themselves too. It's a topic being thrown around. However, the timeline of such events is highly debated. It could be a century/centuries off.

But my point was in relation to OP's argument that if/when AI becomes a problem for our profession, I guarantee there will be plenty more people f*cked before us. If we really ever reach Artificial Super Intelligence, we're all f*cked. Not just our livelihood, but potentially our safety. And there are groups of researchers out there trying to make 'safe' AI (pretty gnarly to think about).

So what naturally flows from OPs argument (that us doctors should be worried) is that everyone should be worried. And therefore, relax man, because at least we're all f*cked together 😀 😀 😀 😀 👍👍👍👍

 

[deleted746658]

I mean...that's cool and all. Maybe it will happen. I'm not an expert. But if it does, then it means we will have AI capable of replacing 90+% of human labor. Doctors aren't some unique field that AI is capable of replacing...the same principles you're spouting will apply to most other jobs as well.

We will all have to figure out how to live in a world where AI replaces our work force. Who knows. Brave new world. Hope we don't end up like fatties in a chair like in Wall-E.

You are a surgeon. You (hopefully) should be alright. The rest of us....

For docs, the meat of our career is in our 40-50s - when we finally pay off our loans, start to be able to afford things. I just hope we aren't doomed before then. If that's not the case, we will have worked our asses off for nil


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[ActinicKeratosis]

I just don't think this is something that we need to worry about during our career. Even if the technology mentioned is available, it would take forever to get implemented and widely used. Take the electronic medical record for example. It should be simple right? What could be simpler than having patient information uploaded to a single database where any provider can access files as needed throughout the hospital? As great as the EMR is, implementation has been a complete nightmare in many health care facilities throughout the country. Any large scale technological change takes an especially long time in fields such as medicine (too much red tape).

 

[deleted746658]

I just don't think this is something that we need to worry about during our career. Even if the technology mentioned is available, it would take forever to get implemented and widely used. Take the electronic medical record for example. It should be simple right? What could be simpler than having patient information uploaded to a single database where any provider can access files as needed throughout the hospital? As great as the EMR is, implementation has been a complete nightmare in many health care facilities throughout the country. Any large scale technological change takes an especially long time in fields such as medicine (too much red tape).

The current crop of medical students - and our massive debt - will need to be working for 35ish years (and making some damn good money). I think this will all happen well within our careers... 2030-2035


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[Mansamusa]

See, I'm more worried about

http://www.medpagetoday.com/PublicH...737?xid=nl_mpt_DHE_2016-06-24&eun=g1027439d0r
than AI.

Honestly, even if everyone agreed that AI is a threat, what would you do? Would you leave medicine in anticipation of being replaced by computers? Will you sabotage robotics research? Will you try to get anti-AI laws enacted? What will happen will happen and we will adapt to work with any technology that comes along to help us. Worrying about something that isn't currently a threat and that we couldn't do anything about even if it were a threat, is just fear mongering, imo. Don't waste energy worrying about things may not even come to fruition

 

[A P]

In my opinion, AI and future technology will only enhance medicine and the way we deal with it. I personally believe the use of new technology will make medicine more accurate and only assist us greater, not take away from our jobs. There will always be a need for humans in some way or form (at least in our lifetimes and many more after). The jobs may change in the next few decades but I find that intriguing, and I wouldn't want to be in any other time period than now.

 

[Stagg737]

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.

You're right, but hopefully being a human trains you on how to be a human. Think of how many people hate dealing with automated answering machines over the phone when they're dealing with minor stuff like the cable company or trying to get some kind of insurance quote. Now think of how tolerant those people will be when they have to deal with an automaton in a face-to-interface system with something as drastic and for some desperate as their own health. Do you really think that's going to go over well with the general public?

all i'm saying is this: when - not if - a reliable computer diagnostic machine is developed, MDs will lose a lot of their value (as well as salary and respect). sure, certain fields will be more immune to this (anything procedural), but most of the workload in medicine at that point can be done by laborers with much different (and much less) training.

and i don't think this is as far away as some people think. you literally have the biggest companies in the world (microsoft, google, facebook, IBM) and some of the brightest minds in the world working on it.

and how can docs resist this? by that point private practices are gone by the wayside, we are all employees working for the man.

pre-med/ med students/ docs that are aghast to this idea - that is the naivete i'm referring to.

If doctors every start to be replaced by computers in hospitals it will open the doors for private practice back up. As I stated before, there are a lot of people, even in the younger generation, that would much rather talk to a human when it comes to something as important as their health than deal with a machine. If that happens, it will be a great opportunity for physicians to open their own clinics back up and take all the patients that would rather deal with people than machines. Plus, there are inherently a lot of other issues with moving to a machine based system. If the computer crashes, the entire hospital would shut down if they couldn't get it back up and running quickly. That wouldn't happen with humans unless there was some kind of walk-out. There could be glitches, the software would be susceptible to hackers and viruses, or the most obvious problem that patients might not know how to interact with the machine.

If the system were to move to one like you describe, there are A LOT of issues that would have to be overcome before this is a reality, and I don't see that happening in the next 20 years like you claim.

 

[hallowmann]

The current crop of medical students - and our massive debt - will need to be working for 35ish years (and making some damn good money). I think this will all happen well within our careers... 2030-2035


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And you'd be wrong.

You just want to cover your ears and yell "la la la" while the people actually familiar with the technology are telling you we aren't close. I'm saying this as an individual with 1st degree relatives literally working on this in top 5 ce and cs institutions.

See below.

 

[lymphocyte]

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

Sorry I missed this. I actually can't speak to it as eloquently as the philosophers who have written about it. They're actually quite engaging and interesting to read (not at all obscure or obtuse like you might expect).

Below is a flavour (which I hope everybody in this thread arguing in favour of AI watches). By the way, does Hubert Dreyfus sound familiar? He's the inspiration for Professor Farnsworth from Futurama!

Here's an accompanying article: http://leidlmair.at/doc/whyheideggerianaifailed.pdf

Here's another fantastic article by Noë on using the philosophy of art to explore the limits of neuroscience and AI: http://chronicle.com/article/How-Art-Reveals-the-Limits-of/232821/

NB: Dreyfus was a professor at MIT who (successfully) predicted the failure of his computer science colleagues; Noë has made strong and verifiable predictions about AI as published in Nature and Science. Not at all armchair philosophers. (Yes, I realise that Dreyfus is sitting in an armchair in this video.)

 

[Brahnold Bloodaxe]

You're right, but hopefully being a human trains you on how to be a human. Think of how many people hate dealing with automated answering machines over the phone when they're dealing with minor stuff like the cable company or trying to get some kind of insurance quote. Now think of how tolerant those people will be when they have to deal with an automaton in a face-to-interface system with something as drastic and for some desperate as their own health. Do you really think that's going to go over well with the general public?



If doctors every start to be replaced by computers in hospitals it will open the doors for private practice back up. As I stated before, there are a lot of people, even in the younger generation, that would much rather talk to a human when it comes to something as important as their health than deal with a machine. If that happens, it will be a great opportunity for physicians to open their own clinics back up and take all the patients that would rather deal with people than machines. Plus, there are inherently a lot of other issues with moving to a machine based system. If the computer crashes, the entire hospital would shut down if they couldn't get it back up and running quickly. That wouldn't happen with humans unless there was some kind of walk-out. There could be glitches, the software would be susceptible to hackers and viruses, or the most obvious problem that patients might not know how to interact with the machine.

If the system were to move to one like you describe, there are A LOT of issues that would have to be overcome before this is a reality, and I don't see that happening in the next 20 years like you claim.

You're misinterpreting the concern. I don't think anyone is worried about actual robots replacing physicians on a 1 to 1 basis. Patients aren't going to go to the hospital and talk to the computer direct.

It's going to be a slow evolution. In the initial stages, "smart EMR" will have templates and macros for common clinical scenarios. We are already at that stage, today.

The next step is refining the macros and making medicine "process driven." This step is 1 part technology and 9 parts corporitization of medicine. If you've ever worked in a large organization, you will know that there is nothing corporate culture abhors more than leaving decision making to the discretion of lowly cogs in the machine. Doctors are just such lowly cogs, and the trend to treat certain common clinical presentations in a standardized way has been extant for years now. As technology evolves and EMR systems grow more sophisticated, and as ever more clinical interactions are codified into algorithms, this trend will gather pace.

Further along the timeline, EMRs will grow so sophisticated that the day to day role of the physician will consist of seeing the patient and inputting the data into the EMR, which will spit out diagnosis and treatment suggestions for the doc to quality control. Eventually, confidence in the algorithms will grow sufficiently so that the seeing of the patient and the inputting of data will be entrusted to nurses/PAs. There will still be docs around to put out fires or deal with situations for which the EMR-nurse combo is not suitable, but their number will be greatly reduced. Instead of a hospital needing 1 doc for 5 patients, technology will allow the hospital to get away with 1 doc for 20 patients.

And so on. The sad truth of the matter is, we as physicians have become commoditized and employed. We work for the Man now. Technology, midlevels, and other trends in healthcare will inevitably lead to increasing physician productivity, and these productivity gains will be captured not by physicians but by the organization that employ them. We can argue as to the exact extent to which the role of the physician will be marginalized in the coming years and decades, but the general picture is clear: technology is coming, midlevels are coming, corporization is coming, reimbursement cuts are coming. If you're not worried and think it's all gonna be rosy, then you've also got disappointment coming.

 

[hallowmann]

...And so on. The sad truth of the matter is, we as physicians have become commoditized and employed. We work for the Man now. Technology, midlevels, and other trends in healthcare will inevitably lead to increasing physician productivity, and these productivity gains will be captured not by physicians but by the organization that employ them. We can argue as to the exact extent to which the role of the physician will be marginalized in the coming years and decades, but the general picture is clear: technology is coming, midlevels are coming, corporization is coming, reimbursement cuts are coming. If you're not worried and think it's all gonna be rosy, then you've also got disappointment coming.

You've described a state that doctors have been in for 1-2 decades already. This motion is happening regardless, and I'd hope all of us realized this when we set out for medicine in the first place 1-4+ yrs ago. The more doctors work for companies, the more they are subject to this. The further removed doctors are from patients, the more they are subject to this. The more doctors rely on organizations to provide them with patients (and in turn RVUs), the more they are subject to this. This also doesn't mean the end of the world as we know it. Physician run UC, DPC, and a host of other systems have come about because physicians are dissatisfied with being cogs, and what results is the modern day equivalent of private practice.

We aren't in the age (and haven't been for some time) of hanging up shingles and being set for life, that doesn't mean options don't exist. It may just mean that its easier for us not to worry about it, and to just be someone's employee. I don't think anyone disagrees that we are losing ground in autonomy and strength, what we disagree with is the speed and degree with which that ground is lost.

 

[NWwildcat2013]

So I have to ask...

What specialties will be relatively safe from this? Surgery?


Sent from my iPhone using SDN mobile

 

[ProfMD]

So I have to ask...

What specialties will be relatively safe from this? Surgery?


Sent from my iPhone using SDN mobile

All of them for the foreseeable future.

 

[TiredOfBeingAnIntrovert]

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.

You know, I have been trying to tell my classmates the same things and am also shocked with their level of naiveness as you put it.
However, I think you're thinking WAY too far into the future. The way I relax about it (did you get the IBM Watson idea from the Cleveland Clinic ad?) is that I realize they still haven't even replaced the employees at clothing stores and restaurants yet...and like we do very intimate things like hold hands, show emotions, etc.

 

[Stagg737]

You're misinterpreting the concern. I don't think anyone is worried about actual robots replacing physicians on a 1 to 1 basis. Patients aren't going to go to the hospital and talk to the computer direct.

It's going to be a slow evolution. In the initial stages, "smart EMR" will have templates and macros for common clinical scenarios. We are already at that stage, today.

The next step is refining the macros and making medicine "process driven." This step is 1 part technology and 9 parts corporitization of medicine. If you've ever worked in a large organization, you will know that there is nothing corporate culture abhors more than leaving decision making to the discretion of lowly cogs in the machine. Doctors are just such lowly cogs, and the trend to treat certain common clinical presentations in a standardized way has been extant for years now. As technology evolves and EMR systems grow more sophisticated, and as ever more clinical interactions are codified into algorithms, this trend will gather pace.

Further along the timeline, EMRs will grow so sophisticated that the day to day role of the physician will consist of seeing the patient and inputting the data into the EMR, which will spit out diagnosis and treatment suggestions for the doc to quality control. Eventually, confidence in the algorithms will grow sufficiently so that the seeing of the patient and the inputting of data will be entrusted to nurses/PAs. There will still be docs around to put out fires or deal with situations for which the EMR-nurse combo is not suitable, but their number will be greatly reduced. Instead of a hospital needing 1 doc for 5 patients, technology will allow the hospital to get away with 1 doc for 20 patients.

And so on. The sad truth of the matter is, we as physicians have become commoditized and employed. We work for the Man now. Technology, midlevels, and other trends in healthcare will inevitably lead to increasing physician productivity, and these productivity gains will be captured not by physicians but by the organization that employ them. We can argue as to the exact extent to which the role of the physician will be marginalized in the coming years and decades, but the general picture is clear: technology is coming, midlevels are coming, corporization is coming, reimbursement cuts are coming. If you're not worried and think it's all gonna be rosy, then you've also got disappointment coming.

And you don't think this is going to happen with mid-levels before technology? I'd also be far more worried about being replaced by technology as a mid-level than as a physician.

So I have to ask...

What specialties will be relatively safe from this? Surgery?

Psych. Try telling a patient with schizophrenia or paranoid delusions that a machine will be helping decide their treatment and see how well that goes...

 

[TiredOfBeingAnIntrovert]

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.

Hey man,

I used to think this too (did you get the IBM Watson idea from the recent ad that's been airing on the Internet lol?).
First of all, if you're like me, you're not really knowledgeable about this kind of technology and understand the big picture more than the details.
Once I talked to an actual Math major though and a couple former Engineers, they set me straight and told me that this kind of stuff is light years away from replacing medicine.

I myself at the time was more worried on the implications Big Data would have on treatment protocols.

 

[thorloco]

All of them for the foreseeable future.

Saw this today: http://www.npr.org/sections/money/2...ign=npr&utm_term=nprnews&utm_content=20160624

Physicians are at 0.4%, which is right around the lowest. We train to interact with people in a way many humans can't even get right. If you ask the patient the difference between a good doctor and a bad one, they won't tell you about productivity or M&M scores. They'll speak pretty much exclusively on how their physician interacts with them, how they present information, how they approach choice. We don't even let computers operate trains unsupervised.

We used to think that technology would usher in a utopian era where the common laborers would send their machines to work for them. Obviously, this didn't happen. The corporations ran the machines, and the utilization value of the worker fell. I think there is a legitimate point there. You won't get paid for things that increase your productivity (PAs, technology, whatever) unless you control it.

 

[Tenk]

Don't worry. Once Skynet reaches its full potential John Connor will come and save physician salaries.

 

[bertino]

i am worried about present

 

[chipwhitley]

I honestly want computers to take over the medical field. I would trust a well-designed computer way more than the average human. Besides, computers already autonomously manage critical elements of our world's infrastructure and we don't even realize it.

 

[jeffk805dent]

Don't worry. Once Skynet reaches its full potential John Connor will come and save physician salaries.

but what if John Connor is a terminator himself (like in Terminator Genysis)

 

[Brahnold Bloodaxe]

Funny, The Economist this week features discussion on automation, and the lead article starts out talking about automation in medicine:

SITTING IN AN office in San Francisco, Igor Barani calls up some medical scans on his screen. He is the chief executive of Enlitic, one of a host of startups applying deep learning to medicine, starting with the analysis of images such as X-rays and CT scans. It is an obvious use of the technology. Deep learning is renowned for its superhuman prowess at certain forms of image recognition; there are large sets of labelled training data to crunch; and there is tremendous potential to make health care more accurate and efficient.

Dr Barani (who used to be an oncologist) points to some CT scans of a patient’s lungs, taken from three different angles. Red blobs flicker on the screen as Enlitic’s deep-learning system examines and compares them to see if they are blood vessels, harmless imaging artefacts or malignant lung nodules. The system ends up highlighting a particular feature for further investigation. In a test against three expert human radiologists working together, Enlitic’s system was 50% better at classifying malignant tumours and had a false-negative rate (where a cancer is missed) of zero, compared with 7% for the humans. Another of Enlitic’s systems, which examines X-rays to detect wrist fractures, also handily outperformed human experts. The firm’s technology is currently being tested in 40 clinics across Australia.

A computer that dispenses expert radiology advice is just one example of how jobs currently done by highly trained white-collar workers can be automated, thanks to the advance of deep learning and other forms of artificial intelligence. The idea that manual work can be carried out by machines is already familiar; now ever-smarter machines can perform tasks done by information workers, too. What determines vulnerability to automation, experts say, is not so much whether the work concerned is manual or white-collar but whether or not it is routine. Machines can already do many forms of routine manual labour, and are now able to perform some routine cognitive tasks too. As a result, says Andrew Ng, a highly trained and specialised radiologist may now be in greater danger of being replaced by a machine than his own executive assistant: “She does so many different things that I don’t see a machine being able to automate everything she does any time soon.”

The last bolded sentence is a point I've made here on SDN before: the value added of a physician is extremely susceptible to automation. You're not going to replace a minimum wage retail worker who on an average shift needs to talk with angry customers, stock shelves, take out the garbage, answer phone calls from customers to check inventory, return carts from parking lot, and drive sales numbers. Replacing this would take AI and robotics technology that is decades away, and the capital costs would be far greater than the $9/hour that a human worker costs. Because you would literally need to replace the full spectra of human ability, and we are nowhere close to that.

In medicine, you do not need to replace humans. You just need to replace that particular role played by physicians. Physicians serve as a reservoir of information and analysis, everything else in medicine can be done by nurses and other lesser trained and lesser paid human workers. And it really just isn't that hard for computer code to provide information and analysis of routine, repeatable scenarios. You're not asking the code to innovate or advise the CEO on corporate strategy. You're asking to code to analyze shapes on images, and to create statistical models around symptoms and other parameters input into an EMR. Those are things algorithms excel in.

Are those things easy in absolute terms? No. But they are way, way easier than replacing a retail worker or the HR lady, and the high salaries of physicians make that replacement cost effective. You might want to make yourself feel better by thinking doctors will be the last to lose their jobs, but in reality we will be among the first. Diagnostic radiology is set to suffer far worse job losses in the medium term than commercial drivers, because productivity is much easier to implement in radiology. A truck either has a driver, or it doesn't. It's a big leap to cross that binary threshold into doing away with the driver completely. With rads, it's much easier. If you can help 1 radiologist read 10 times the images, then you can get rid of 90% of radiologists without fundamentally crossing into "no humans involved" territory.

 

[ProfMD]

Funny, The Economist this week features discussion on automation, and the lead article starts out talking about automation in medicine:



The last bolded sentence is a point I've made here on SDN before: the value added of a physician is extremely susceptible to automation. You're not going to replace a minimum wage retail worker who on an average shift needs to talk with angry customers, stock shelves, take out the garbage, answer phone calls from customers to check inventory, return carts from parking lot, and drive sales numbers. Replacing this would take AI and robotics technology that is decades away, and the capital costs would be far greater than the $9/hour that a human worker costs. Because you would literally need to replace the full spectra of human ability, and we are nowhere close to that.

In medicine, you do not need to replace humans. You just need to replace that particular role played by physicians. Physicians serve as a reservoir of information and analysis, everything else in medicine can be done by nurses and other lesser trained and lesser paid human workers. And it really just isn't that hard for computer code to provide information and analysis of routine, repeatable scenarios. You're not asking the code to innovate or advise the CEO on corporate strategy. You're asking to code to analyze shapes on images, and to create statistical models around symptoms and other parameters input into an EMR. Those are things algorithms excel in.

Are those things easy in absolute terms? No. But they are way, way easier than replacing a retail worker or the HR lady, and the high salaries of physicians make that replacement cost effective. You might want to make yourself feel better by thinking doctors will be the last to lose their jobs, but in reality we will be among the first.

Has this data been published in a rigorous format? Usually when results sound too good to be true (zero percent false negative rate) they are. One must consider if the radiologist interpretation was based on historical data or were part of this study. We're the radiologists interpreting the same scans as the computer. What was considered "truth?" Did all patients undergo biopsies? What was the false positive rate? False positives are also bad since they can lead to unnecessary and potentially risky treatment.

While your quote from the Economist is intriguing, it sounds like we are a long way off from radiology being replaced by computers.

 

[Mansamusa]

Funny, The Economist this week features discussion on automation, and the lead article starts out talking about automation in medicine:



The last bolded sentence is a point I've made here on SDN before: the value added of a physician is extremely susceptible to automation. You're not going to replace a minimum wage retail worker who on an average shift needs to talk with angry customers, stock shelves, take out the garbage, answer phone calls from customers to check inventory, return carts from parking lot, and drive sales numbers. Replacing this would take AI and robotics technology that is decades away, and the capital costs would be far greater than the $9/hour that a human worker costs. Because you would literally need to replace the full spectra of human ability, and we are nowhere close to that.

In medicine, you do not need to replace humans. You just need to replace that particular role played by physicians. Physicians serve as a reservoir of information and analysis, everything else in medicine can be done by nurses and other lesser trained and lesser paid human workers. And it really just isn't that hard for computer code to provide information and analysis of routine, repeatable scenarios. You're not asking the code to innovate or advise the CEO on corporate strategy. You're asking to code to analyze shapes on images, and to create statistical models around symptoms and other parameters input into an EMR. Those are things algorithms excel in.

Are those things easy in absolute terms? No. But they are way, way easier than replacing a retail worker or the HR lady, and the high salaries of physicians make that replacement cost effective. You might want to make yourself feel better by thinking doctors will be the last to lose their jobs, but in reality we will be among the first. Diagnostic radiology is set to suffer far worse job losses in the medium term than commercial drivers, because productivity is much easier to implement in radiology. A truck either has a driver, or it doesn't. It's a big leap to cross that binary threshold into doing away with the driver completely. With rads, it's much easier. If you can help 1 radiologist read 10 times the images, then you can get rid of 90% of radiologists without fundamentally crossing into "no humans involved" territory.

Okay. You've got it figured out. Now what are you going to do about it?

 

[Brahnold Bloodaxe]

Has this data been published in a rigorous format? Usually when results sound too good to be true (zero percent false negative rate) they are. One must consider if the radiologist interpretation was based on historical data or were part of this study. We're the radiologists interpreting the same scans as the computer. What was considered "truth?" Did all patients undergo biopsies? What was the false positive rate? False positives are also bad since they can lead to unnecessary and potentially risky treatment.

While your quote from the Economist is intriguing, it sounds like we are a long way off from radiology being replaced by computers.

Sure, we are a long way away. But this is the medical student forum, not the attending forum. A first year medical student is likewise a long way away, 10 years to be exact, from becoming a radiology attending. He's probably 13-15 years away from paying his way to zero net worth even if current salaries are still there in 10 years. So from that perspective, how can we not be worried when we read of such progress occurring in the very present?

Okay. You've got it figured out. Now what are you going to do about it?

I've got nothing figured out. I'm simply throwing what I think are reasonable concerns out here for debate, but all talk of the future is necessarily just speculation. The only thing I can do about it is keep track of developments, perform the best I can in order to keep my options open, and have the ability to select that field which seems to be in the best position to prosper by the time I'm in 4th year. That, and cross my fingers.

 

[hallowmann]

Since you seem like you have thought about this a great deal, I am curious as to your reasoning for pursuing medicine as a career in light of the fact that doctors will be among the first to lost their jobs to automation. I've been quite interested in pursuing medicine for a long time but my roommates were all compsci majors last year and while I have no personal interest in computer science, I am a little worried about the role of doctors in the future of medicine.

Doctors will not be the first to lose their jobs to automation. Certain fields will obviously suffer, but medicine on the whole will not. Diagnostic radiology and pathology are most susceptible in the near future (still decades away), but they've been at risk for a long time due to telemedicine, oversaturation, etc.

That's one of the reasons why interventional radiology has become so much more popular. It's also why fellowships have become expected of the majority of radiology graduates.

As for pathologists, every major health system I know has been trying to find ways to cut back on their general pathologists. A top 20 institution that I am acutely familiar with has just been stacking up more work for the pathologists, while letting the older ones retire. That may actually be one of the reasons for increasing popularity in forensic fellowships.

The thing is, this always happens to some degree. To imply that we are more at risk of it now, is to ignore the fact that we are always at risk of something. It's the same ebbs and flow in medicine and certain fields that has existed at least for my entire life. Thats completely ignoring the fact that as I've been saying the technology (and the culture for that matter) isn't there yet.

Has this data been published in a rigorous format? Usually when results sound too good to be true (zero percent false negative rate) they are. One must consider if the radiologist interpretation was based on historical data or were part of this study. We're the radiologists interpreting the same scans as the computer. What was considered "truth?" Did all patients undergo biopsies? What was the false positive rate? False positives are also bad since they can lead to unnecessary and potentially risky treatment.

While your quote from the Economist is intriguing, it sounds like we are a long way off from radiology being replaced by computers.

Yeah, I didn't see much in the article, and it is likely not based on a particularly strong study (if based on one at all).

I would also like to point out that some interesting parts of the article want included. I quoted them below along with a link so people can make their own decision based on a random economist article (which actually gives 2 views on the future job market).

...In a widely noted study published in 2013, Carl Benedikt Frey and Michael Osborne examined the probability of computerisation for 702 occupations and found that 47% of workers in America had jobs at high risk of potential automation. In particular, they warned that most workers in transport and logistics (such as taxi and delivery drivers) and office support (such as receptionists and security guards) “are likely to be substituted by computer capital”, and that many workers in sales and services (such as cashiers, counter and rental clerks, telemarketers and accountants) also faced a high risk of computerisation...

So it seems one thing covered was that half of US jobs are at risk, so we aren't going to be the only ones screwed when the bots take over. By the way this is still only based on this one study.

The article also concludes with:

...So who is right: the pessimists (many of them techie types), who say this time is different and machines really will take all the jobs, or the optimists (mostly economists and historians), who insist that in the end technology always creates more jobs than it destroys? The truth probably lies somewhere in between. AI will not cause mass unemployment, but it will speed up the existing trend of computer-related automation, disrupting labour markets just as technological change has done before, and requiring workers to learn new skills more quickly than in the past. Mr Bessen predicts a “difficult transition” rather than a “sharp break with history”. But despite the wide range of views expressed, pretty much everyone agrees on the prescription: that companies and governments will need to make it easier for workers to acquire new skills and switch jobs as needed. That would provide the best defence in the event that the pessimists are right and the impact of artificial intelligence proves to be more rapid and more dramatic than the optimists expect.

So yeah, we'll have to adapt... as we always have. And as I said, medicine as a whole will have more than enough time to do so, because we aren't getting fully replaced in my career time.

http://www.economist.com/news/speci...ause-mass-unemployment-automation-and-anxiety