Although those are common fears that I have heard, and although there is certainly some substance to those fears, psychiatry is hardly alone in facing similar challenges.
Anaesthesia facing an increasingly bolde and vocal challenges from nurse anaesthetists who demand ever greater autonomy and power. According to a recent article in Yahoo Finance, NAs already make more money on average than the typical FM doctor. (
http://finance.yahoo.com/news/Specialist-nurses-paid-higher-hmoney-2327465018.html?x=0) In the article they interview the senior director of the American Association of Nurse Anaesthetists who states, "We are at the head of the patient's bed. We deliver anesthesia and we keep the patient safe [...] once nurses and physicians arrive at anesthesia training, we use the same textbooks and same cases. The training is not too different between the two groups [...] We all deliver anesthesia the same way." I cannot help but glean a tone of irreverance from her. NA are lobbying now for prescription-writing privileges. Now, I'm not discounting the vital part that NAs play in the surgical case, but it seems that a vocal minority of NAs seem to think they know almost as much as the M.D. anaesthesiologists and deserve to be given nearly equal power and autonomy. I'm sure our friends in anaesthesia disagree. Are anaesthesiologists going to become obsolete? Perhaps their numbers will decrease, as one single anaesthesiologist may supervise an entire surgical floor of NAs, I cannot say. But their field will adapt, as will ours.
Speaking of our friends in Family Medicine, they too face increasingly strong challenge from Nurse Practioners. FM docs being paid so low that few medical students choosing to go into FM (only 5 out of 160 in my class, by contrast 22 are going into general surgery, 12 into orthopaedics), but our entire healthcare system is designed with the PCPs as the medical gatekeepers. Who will see all these patients? The obvious and tempting answer is that cheaper, easier-to-train NPs will fill the need. Perhaps like in anaesthesia, one day it will be one FM supervising an entire city of NPs. But with fewer FM docs, the remaining ones will hopefully be compensated more reasonably.
Radiology faces constant fears of outsourcing, since it is a field that does not require direct presence in the hospital. There is already a group of (American-trained) radiologists in Australia who do outsourced film reading for American hosptials. Other hospitals employ group practise of radiologists perhaps a state away who offer more competitive pricing and lay off their in-house staff radiologists. The nightmare day all radiologists fear is when film reading will be outsourced to foreign countries with foreign-trained radiologists. I hate to name names, but [
cough] India [
cough].
My entire point is that all the specialties are facing identity crises (with the possible exception of dermatologists, who have it pretty freakin' sweet and are running a beautiful artificial supply/demand imbalance racket), and we are all communities of smart professionals who will rise up to the challenge and evolve with the times. With healthcare cost restructuring, our numbers and duties may change, but we'll still be here. And some of the change is unpredictable. The famous case is that a decade ago nobody wanted to go into anaesthesia, and now it is one of the most competitive fields. In another decade the pendulum may swing back the other way because of the NAs. Who knows? But you go into what you love, and you ride out the good and the bad.
