Is there one? I only see Merritt Hawkins top 20 in demand.
List of least in demand specialites?
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Thats what the thread is asking for
I mean I just wish there was some objective data. The subjective thought has always been that path is bad...but how bad, and how bad in relation to other specialties? also, anyone have info about the ophtho job market?
Booze Aldrin
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Nuclear medicine
/thread
/thread
A
AnatomyGrey12
I think rads has changed a ton even in just a year or two, it's back on the upswing. Path is terrible, rad onc has rapidly become terrible, ophtho isn't great but is better than the other two if you don't want to live in a major metro.
OP the only specialties that could probably be truly classified as "not in demand" would probably be just Path and Rad Onc. Pretty much every field is in demand once you get away from the coasts and major metro type places.
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What?! I had no idea ophtho wasn’t great, I’m not really interested in it, but just really surprised. How is it still so competitive?
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It doesn’t matter. By the time you’re done with residency and potential fellowship, it could all fall apart.
Look at radiology in 2008-2010. The people finishing their training at that time came into a terrible market. But when they applied to residency six years prior it was almost as competitive as derm bc the cash was flowing and the demand was exploding. A lot of those guys/gals were ridiculous applicants that could’ve gone into anything.
Moral of the story is pick something you like (or at least hate the least) bc with the stroke of a pen any field could get turned on its head at any time.
Look at radiology in 2008-2010. The people finishing their training at that time came into a terrible market. But when they applied to residency six years prior it was almost as competitive as derm bc the cash was flowing and the demand was exploding. A lot of those guys/gals were ridiculous applicants that could’ve gone into anything.
Moral of the story is pick something you like (or at least hate the least) bc with the stroke of a pen any field could get turned on its head at any time.
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Venereology.
In all seriousness, ask yourself a) is there a major need for the specialty (in terms of # of patients) and b) is there someone who is not a physician (or not a human) who can do a large part of the job.
The path residents/faculty I've met aren't too worried about job prospects, but they also basically said a well-paying job in a major city is pretty much out of the question.
In all seriousness, ask yourself a) is there a major need for the specialty (in terms of # of patients) and b) is there someone who is not a physician (or not a human) who can do a large part of the job.
The path residents/faculty I've met aren't too worried about job prospects, but they also basically said a well-paying job in a major city is pretty much out of the question.
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Sleep medicine
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Sleep sells cpap and accoutrements to patients at greatly inflated fees
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With computers and out of country radiologists
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You need to have a US medical license to practice medicine in the US.
Computers/AI would be a huge liability until they can read and predict things at least as well as actual radiologists. And they are not licensed physicians, so until laws changed, they would not be able to do anything unless an MD were reviewing everything anyway.
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Should you outsource after-hours and weekend radiology shifts?
Read on to better understand cost, quality, and productivity considerations for whether you should keep after-hours coverage in-house or outsource these services.
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Real-time MRI analysis powered by supercomputers
Researchers have developed a new, automated platform capable of returning in-depth analyses of MRI scans in a matter of minutes, rather than hours or days. The system has the potential to minimize patient callbacks, save millions annually, and advance precision medicine.
www.sciencedaily.com
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Sunshine radiology NighthawkShould you outsource after-hours and weekend radiology shifts?
Read on to better understand cost, quality, and productivity considerations for whether you should keep after-hours coverage in-house or outsource these services.www.advisory.com
Nighthawk radiologists have completed US residencies and are licensed in the US. They could very well live overseas-they could live in France or China and read overnight ED scans from the US during their local daytime.
You cannot legally practice medicine in the US without a US medical license. I agree radiology would be the easiest specialty to outsource otherwise, but the outsourcing we’re seeing is done by US-licensed MDs.
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The money goes much farther in those countries. Cheaper to send em there. You and I are saying the same thing
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Forensic pathology
Unless you're doing research it's a very geographically limited field as a city has to be large enough with enough deaths to even be able to remotely justify hiring someone for such a position (think large and mid sized cities only, so probably less than 100 markets across the country). These locations won't need more than one, maybe two, docs other than the biggest cities like NYC or LA. So maybe a market for 300-400 docs total in the country with a basically saturated job market.
I couldn't disagree with this more. A huge percentage of my patients have significant sleeping problems, many of which are completely unaddressed. You can make a good argument that PCPs should be able to take care of most of this, but many either don't or try several options to no avail. I see a lot of people with refractory sleeping issues and refer to sleep medicine pretty frequently.
Unless you're doing research it's a very geographically limited field as a city has to be large enough with enough deaths to even be able to remotely justify hiring someone for such a position (think large and mid sized cities only, so probably less than 100 markets across the country). These locations won't need more than one, maybe two, docs other than the biggest cities like NYC or LA. So maybe a market for 300-400 docs total in the country with a basically saturated job market.
I couldn't disagree with this more. A huge percentage of my patients have significant sleeping problems, many of which are completely unaddressed. You can make a good argument that PCPs should be able to take care of most of this, but many either don't or try several options to no avail. I see a lot of people with refractory sleeping issues and refer to sleep medicine pretty frequently.
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Pathology
Rad onc
Nuclear med
Pediatric interventional cardiology
Pediatric CT surgery
Rad onc
Nuclear med
Pediatric interventional cardiology
Pediatric CT surgery
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Aerospace medicine.
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Ah, I get it.
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I'm seriously considering this, but not for the economics of it, moreso because I always wanted to be an astronaut and it sounds ****ing cool.
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I’ve never understood why people think computers will make radiology obsolete anytime in the foreseeable future. We’ve had computers reading ECG’s since the 1970’s, yet we still pay cardiologists to read the ECG’s.
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Based on what I've heard/observed:
1) Rads isn't going anywhere and is far from being automated, especially because imminent clinical decisions are based on the interpretation. As noted previously, we still don't rely on computers to interpret EKGs. Even a simple chest radiograph has substantially more information, let alone when asked to be compared to a previous film. The human ability to ignore the fact that the patient is positioned slightly differently on a subsequent film, for example, is a computing challenge.
2) Pathology is actually much more vulnerable to AI; it's two-dimensional, you don't compare features over time, and some features are easily identified. One could imagine a program that would simply scan slides looking for a defined area with, for example, a blue pixel density of >X, and alert the pathologist if it finds any. You could set the parameters low enough to catch anything remotely suspicious; the pathologist would just have to read those slides to confirm. This might already be a thing, I have no idea.
3) Any field in which patient BMI is a significant factor will always be in demand until our society changes. That includes sleep.
1) Rads isn't going anywhere and is far from being automated, especially because imminent clinical decisions are based on the interpretation. As noted previously, we still don't rely on computers to interpret EKGs. Even a simple chest radiograph has substantially more information, let alone when asked to be compared to a previous film. The human ability to ignore the fact that the patient is positioned slightly differently on a subsequent film, for example, is a computing challenge.
2) Pathology is actually much more vulnerable to AI; it's two-dimensional, you don't compare features over time, and some features are easily identified. One could imagine a program that would simply scan slides looking for a defined area with, for example, a blue pixel density of >X, and alert the pathologist if it finds any. You could set the parameters low enough to catch anything remotely suspicious; the pathologist would just have to read those slides to confirm. This might already be a thing, I have no idea.
3) Any field in which patient BMI is a significant factor will always be in demand until our society changes. That includes sleep.
D
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End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography - Nature Medicine
A convolutional neural network performs automated prediction of malignancy risk of pulmonary nodules in chest CT scan volumes and improves accuracy of lung cancer screening.
www.nature.com
I think people misunderstand machine learning as opposed to hard coded algorithms. The ECG readings are bad because they are hard coded algorithms, not because computers can’t analyze a 2D graph. I work in molecular dynamics research and let me tell you, computers are not bad at looking at 3D images/ analyzing complex data. We have methods now that can analyze protein structure changes that I would not be able to do if you gave me a century. The issue is you need lots of data to make a computer good at a task, much more data than a human would need to be equally good. The lucky thing for the robots is radiographic images are already on a computer, so they have all of the data in the world. I’m not saying DR will be completely outsourced to computers but increasing the efficiency of practicing radiologists (meaning more $$ for those who do this) using neural networks means fewer radiologists will be needed. You don’t have to automate every part of the job to destroy the radiology job market.
D
deleted103644
You also can’t bill for final reads outside of the US, even as a board certified, US licensed radiologist.
Out of country can only provide prelims for peanuts.
D
deleted103644
John Oliver Eviscerates Eviscerations
It was only a matter of time before Last Week Tonight dissected our system of medical dissections.
D
deleted103644
TLDR: They trained a neural network to detect lung cancer on chest CT. Fewer false positives and negatives than human radiologists.End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography - Nature Medicine
A convolutional neural network performs automated prediction of malignancy risk of pulmonary nodules in chest CT scan volumes and improves accuracy of lung cancer screening.
I think people misunderstand machine learning as opposed to hard coded algorithms. The ECG readings are bad because they are hard coded algorithms, not because computers can’t analyze a 2D graph. I work in molecular dynamics research and let me tell you, computers are not bad at looking at 3D images/ analyzing complex data. We have methods now that can analyze protein structure changes that I would not be able to do if you gave me a century. The issue is you need lots of data to make a computer good at a task, much more data than a human would need to be equally good. The lucky thing for the robots is radiographic images are already on a computer, so they have all of the data in the world. I’m not saying DR will be completely outsourced to computers but increasing the efficiency of practicing radiologists (meaning more $$ for those who do this) using neural networks means fewer radiologists will be needed. You don’t have to automate every part of the job to destroy the radiology job market.
If you can dodge a wrench, you can dodge a ball.
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Just because the cheap machine your hospital uses isn’t great doesn’t mean the tech doesn’t exist, just that there’s no incentive for your hospital to do that as long as a cardiologist still needs to sign off on the final read.
The reason for the hype about machine learning in imaging is that until ~7 years ago, this was considered almost impossible.
(This comic is from 2014 and was actually already a bit out of date, Flickr responded a few months later with a tool that could do this.)
Now it looks like many things will actually be solvable, but there will need to be a lot of research and testing first.
And it won’t necessarily even be coming for radiologists or pathologists first.
I would be far more concerned for my job in any non-procedural subspecialty that doesn’t involve imaging, particularly if there’s a “tele-“ option.
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deleted407021
The docs over on the pediatrics sub seem to support the idea that peds interventional cardiology is hard to find jobs in, given that there just aren’t that many patients that need that kind of specialist.
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I just did a weekend at the medical examiner in West Palm Beach as part of my M2. They have 7 full-time forensic pathologists, not to mention the tech assistants, and the detectives who work from their office for information gathering.
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Don't really care about the non-docs, but 7 in west palm is far more than I would have guessed considering I've talked to a forensic pathologist in a large room city that hasn't fewer than that.
Will still stick to my point that it's a low-demand field in general though as this was the consensus among pathologists I talked to when I asked about it.
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Kind of proves the point; what other medical field needs just 7 providers to cover 1.5 million people?
that's because an ECG is like a minuscule part of a cardiologist's work while reading and interpreting films is the bread and butter of radiology. I keep hearing this analogy and it's stupid.
And also, AI doesn't need to replace radiologists for radiology to take a big dump; all it needs to do is improve the efficiency of image interpretation and you could see the whole radiology market collapse for new grads (I'm sure the old timers are good).
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Which provider school did you attend?
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I am not sure why optho is considered a bad market?
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I kid you not, I heard a physician refer to physicians as “medical practitioners”. I can never unhear that phrase.
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How is it a low demand field? People die everyday and I'm pretty sure even those 7 providers can't possibly give out death certificates in a timely manner especially in a place like Florida. In any case, I would bet money that an enterprising individual with training in Forensic Pathology can do very well carving into the coroner's pie if it came down to it.
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Bad market in medium/large city areas but there are plenty of jobs in rural areas if that's your cup of tea.
Bad market in medium/large city areas but there are plenty of jobs in rural areas if that's your cup of tea.
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Definition of MEDICAL PRACTITIONER
a person who is skilled in the science of medicine : a doctor… See the full definition
www.merriam-webster.com
Not sure why that bothers you as the definition says it's just another word for doctor.
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Bad market in medium/large city areas but there are plenty of jobs in rural areas if that's your cup of tea.
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I concur. The younger ophthalmologists are not busy...at all. In my area, it’s only the older 45-50+ yo guys who are doing 10+ cataracts in a morning. The younger ones generally have much lower surgical volume.
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To clarify it is not a “low demand job.” Many cities have openings and are always hiring. Down here in Miami the ME office does a lecture every year to try and convince people to go into the field.
The problem is it’s a remarkably poor paying job, and not really what most path people want to do. Of the few that do, many leave actual forensic path after a few years to become expert witnesses for the criminal justice system and make more money.
Last I hard starting salary for a forensic pathologist in the city of Miami was ~90k. Which is god aweful for a fellowship trained attending.
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Then Miami is grossly underpaying their MEs, as I've been told irl and seen on SDN (and just googled) ME positions pay well into the 100's. Not nearly as much as other fields and like you said, pretty poor for someone with a multi-year fellowship. But 90k is the bottom of the barrel. Looking into it more it seems I was wrong on FP. Apparently there are only about 500 MEs in the country and the US gov wants there to be ~1,500, so I guess the demand in terms of pure numbers are there. I guess it depends on how we're truly defining demand and what factors we're looking at though.
If it were a field with a true in-demand necessity, we wouldn't see places hiring coroners for a fraction of the cost or paying experts so poorly (or just not hiring them). I guess those I have talked to irl may have been referring to their specific region, because they essentially said that if one wanted to become an ME they had better be ready to relocate.
You're assuming that physicians (specifically pathologists) are the only ones writing death certificates which isn't correct. Coroners often write death certificates outside of large cities and even in major cities non-pathologists can write them as well. I had a family member recently pass and his FM doc wrote his death certificate. When I rotated through IM the residents on the heme-onc rotation would write death certificates when patients would die. So there's no demand whatsoever for an ME from that administrative point.
To your last sentence, I think that would be nearly impossible to do unless the pathologist were able to establish him or herself as being a true expert in the field, as the only cases where someone would be likely to get hired to perform a private autopsy would be in a very high-profile case involving legal proceedings or if a wealthy family wanted to pay for a second opinion/outside examiner. Both of which would likely require someone to be at the top of their field as this seems like it's pretty uncommon, though I could be wrong with that point.
Disagree. Telepsych is becoming more and more popular and I've talked to exactly zero psychiatrists who are worried about demand in the field in the next 25 years. I'm sure plenty of other fields are the same, especially as long as the physical exam is a required part of billing in those fields.
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Booze Aldrin
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The following comment isn't necessarily a dig at psychiatry, but as a general rule the "insight" people in a given field have about that field's future is vastly overestimated by casual observers. My experience has been that most people are absolutely, contemptibly ignorant of high level trends affecting their own livelihoods and see only what's exactly in front of their noses. If they're happy with their job on May 29th, 2019 the average professional will be of the opinion that times are good and the sun will never set, or if they're unhappy then the whole field is on the precipice of disaster. If they're super duper above average, their obliviousness may be supplemented by awareness of propaganda pieces put out by self-interested third parties and in most cases they swallow that propaganda whole (exemplum: physician shortage and medical students).
It's depressingly rare that a person will deliberately pause to do their own independent research and come up with a conclusion based on indepth analysis. I've kind of learned to ignore absolutely every high level claim the average random tells me about anything and inquire only about discrete pieces of data they may be privy to that I can use to arrive at my own conclusions.
Interesting to read this as a radiologist 14 years into practice. Some thoughts on radiology: the folks who say AI will take this job in 10 years are unlikely to be correct. Yes, I am sure we can train computers to "see things", but can it then take the clinical information, old studies and ancillary findings to give a reasonable diagnosis and help formulate a treatment plan in a reasonable amount of time? Then call on critical results and discuss cases with clinicians? And do this across xray, CT, MR, US, nuclear medicine and mammography? Unlikely in my lifetime. People who offhandedly say AI will do it no problem have never actively worked in this field. It is not just seeing the abnormality, that's the tip of the iceberg. Not to mention the hands-on procedures that rads do now because hospitalists and primary docs and, sadly, even many surgeons don't like to stick needles in anything anymore, etc
But on the flip side, I say continue to bring all this speculation on. Always choose something you like. But perhaps now the better rad programs will be easier to get into because of all this angst, making other medical students and residents turn away from the field. And right now the job market is hot - we haven't been able to recruit for an open position for months. Yes, in around 2010-2014 it was bad. But not out of work, can't find anything bad. I mean, rads on a bad day make more than most physicians. I worked in teleradiology from home for a while and still made more than my brother in IM with all the issues he deals with.
Finally, people always seem to look at AI as an all or none. I hope it gets to the point of prescreening stuff that I am reading and can analyze in real time, help me focus on things that need to be looked at again. But I don't see it completely replacing what I do anytime soon. If it does, well then I'll just go into IT and help fix it when it breaks down 🙂
But on the flip side, I say continue to bring all this speculation on. Always choose something you like. But perhaps now the better rad programs will be easier to get into because of all this angst, making other medical students and residents turn away from the field. And right now the job market is hot - we haven't been able to recruit for an open position for months. Yes, in around 2010-2014 it was bad. But not out of work, can't find anything bad. I mean, rads on a bad day make more than most physicians. I worked in teleradiology from home for a while and still made more than my brother in IM with all the issues he deals with.
Finally, people always seem to look at AI as an all or none. I hope it gets to the point of prescreening stuff that I am reading and can analyze in real time, help me focus on things that need to be looked at again. But I don't see it completely replacing what I do anytime soon. If it does, well then I'll just go into IT and help fix it when it breaks down 🙂
