List of least in demand specialites?

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I don't expect physicians who are banking it right now to keep in touch with the latest technological innovations. But, AI with deep learning is already destroying the majority of radiologists in term of reading simple CXR for pneumonia. Technology moves at an exponential rate. Most of the aspiring radiology kids here won't be practicing Dx Radiology for another 6-8 years. By then, the AI threat is very real. It won't replace radiologists, but a future radiologist can do the equivalent workload as 5-6 radiologists from today, with the help of AI. Shrinking demand and increasing supply is bad for a specialty. From my personal experience at my training hospital, I already start seeing some radiologists using AI to read CXR on pneumonia. I expect the trend to be more common down the road.

I chuckle whenever radiologists talk about their clinical skills on this forum. Let's be real here. You guys have lost all of your clinical skills since intern year. When was the last time that you talk to patients and touch them again?


 
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Times are always changing. Back in the day, specialties such as ortho, rad onc, and urology used to be bottom of the barrel? Look at where they are now.

Also what's competitive and in-demand now may go the other way as well. If I were to guess, infectious disease is going to make its way up pretty soon.
 
I don't expect physicians who are banking it right now to keep in touch with the latest technological innovations. But, AI with deep learning is already destroying the majority of radiologists in term of reading simple CXR for pneumonia.

I chuckle whenever radiologists talk about their clinical skills on this forum. Let's be real here. You guys have lost all of your clinical skills since intern year. When was the last time that you talk to patients and touch them again?

I chuckle when uniformed people make assumptions about practicing clinicians. As with many radiologists, I last directly cared for and talked with patients yesterday (off today) when I spoke with multiple diagnostic mammography patients and did multiple hands on procedures. I am always amazed at how many of these patients end up in my care having been told nothing by their "clinical doctors" so I end up explaining it all. Ask a radiologist and they will say most current clinicians clinical skills consist of sending the patient for a CXR, a CT scan, etc... Surgeons don't even want to see patient without a CT or MR first.

And I am also amazed when people post an article and greatly exaggerate the findings. You got "destroying the majority of the radiologists" from this:

"Scientists trained the algorithm to detect 14 different pathologies: For 10 diseases, the algorithm performed just as well as radiologists; for three, it underperformed compared with radiologists; and for one, the algorithm outdid the experts."

Hmmm, 1 out of 14 better by computer with no data on what it was or by how much. Sure AI will get better, but you undermine your argument that way.
 
Also what's competitive and in-demand now may go the other way as well. If I were to guess, infectious disease is going to make its way up pretty soon.
Hey doc, what gives you the impression ID might go on the upswing? Has it ever been a highly coveted specialty?
 
Hey doc, what gives you the impression ID might go on the upswing?

There is now demand given that there are more resistant organisms, both bacterial and fungal, that are requiring infectious disease consults. So much that you are seeing infectious disease being combined with critical care, which is popular and competitive in internal medicine. While there are only a few of these combined fellowships, I'm sure we will see more. These I'm guessing are targeted toward more rural places.

Has it ever been a highly coveted specialty?

Not to my knowledge. But since you are seeing more resistant organisms (both bacteria and fungus) which are making headlines in the social media world, I'm sure it will be.

On top of that, you do essentially have a specialty that is Monday through Friday with normal work hours, and flexibility for either mostly inpatient or outpatient work depending on your preferences.
 
There is now demand given that there are more resistant organisms, both bacterial and fungal, that are requiring infectious disease consults. So much that you are seeing infectious disease being combined with critical care, which is popular and competitive in internal medicine. While there are only a few of these combined fellowships, I'm sure we will see more. These I'm guessing are targeted toward more rural places.



Not to my knowledge. But since you are seeing more resistant organisms (both bacteria and fungus) which are making headlines in the social media world, I'm sure it will be.

On top of that, you do essentially have a specialty that is Monday through Friday with normal work hours, and flexibility for either mostly inpatient or outpatient work depending on your preferences.
That makes a lot of sense. Haven't rotated in ID but I do have a fondness for bugs 'n drugs and critical care, esp. peds so it'll be interesting to see how the field evolves.
 
There is now demand given that there are more resistant organisms, both bacterial and fungal, that are requiring infectious disease consults. So much that you are seeing infectious disease being combined with critical care, which is popular and competitive in internal medicine. While there are only a few of these combined fellowships, I'm sure we will see more. These I'm guessing are targeted toward more rural places.



Not to my knowledge. But since you are seeing more resistant organisms (both bacteria and fungus) which are making headlines in the social media world, I'm sure it will be.

On top of that, you do essentially have a specialty that is Monday through Friday with normal work hours, and flexibility for either mostly inpatient or outpatient work depending on your preferences.


I trained during the height of the AIDS crisis with all the accompanying OI’s, cryptosporidiosis, HSV, PCP, MDR TB, CMV, etc. ID still wasn’t popular then.
 
"Scientists trained the algorithm to detect 14 different pathologies: For 10 diseases, the algorithm performed just as well as radiologists; for three, it underperformed compared with radiologists; and for one, the algorithm outdid the experts."

Hmmm, 1 out of 14 better by computer with no data on what it was or by how much. Sure AI will get better, but you undermine your argument that way.

11/14 pathologies in which AI performance is just as good as a radiologist or better. This is still while AI with deep learning is still in its infancy. Yet, you're trying to make the point that the field of Radiology will be robust in 6-8 years as it is now. I just don't see it.

I'll just leave those articles out there for others to read and make an informed decision. Yours and mine won't change.
 
These prediction threads tend to be wrong. Back in 2012 there was a thread in the anesthesia forum predicting that in 10 years CRNAs will be taking over and the average anesthesia income would be 250k. When I was choosing a specialty in the early 1990’s people said anesthesia is dying. I suppose that could still happen but changes take longer than most people expect.
 
11/14 pathologies in which AI performance is just as good as a radiologist or better. This is still while AI with deep learning is still in its infancy. Yet, you're trying to make the point that the field of Radiology will be robust in 6-8 years as it is now. I just don't see it.

I'll just leave those articles out there for others to read and make an informed decision. Yours and mine won't change.
Who are you and what's your qualification for making these assumptions?
 
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 🙂
I guess the argument is that you haven't been keeping up with all the innovations to make an informed decision
 
I chuckle when uniformed people make assumptions about practicing clinicians. As with many radiologists, I last directly cared for and talked with patients yesterday (off today) when I spoke with multiple diagnostic mammography patients and did multiple hands on procedures. I am always amazed at how many of these patients end up in my care having been told nothing by their "clinical doctors" so I end up explaining it all. Ask a radiologist and they will say most current clinicians clinical skills consist of sending the patient for a CXR, a CT scan, etc... Surgeons don't even want to see patient without a CT or MR first.

And I am also amazed when people post an article and greatly exaggerate the findings. You got "destroying the majority of the radiologists" from this:

"Scientists trained the algorithm to detect 14 different pathologies: For 10 diseases, the algorithm performed just as well as radiologists; for three, it underperformed compared with radiologists; and for one, the algorithm outdid the experts."

Hmmm, 1 out of 14 better by computer with no data on what it was or by how much. Sure AI will get better, but you undermine your argument that way.

Part 1

Part 2

These articles don't have anything to do with radiology specifically but they do a fantastic job of elucidating the advancements in AI and what that means for the future of humanity. I'm curious to know what types of changes these advancements could usher into your field.
 
I will just say the radiation oncology job market is terrible and will continue to deteriorate. This is a result of residency expansion (more free labor for chairs who are then rewarded by cancer centers). As a result, it's become a perpetual cycle. You may hear other things from academic radiation oncologists or even junior residents, but just realize they have an agenda. They're all trying to move up in the academic sector and it's sort of taboo to speak about the pyramid scheme that is currently radiation oncology and was created by academia. I personally know radiation oncology residents this year who do not have jobs-by jobs I mean permanent non-fellowship jobs. This is all after 5 years of training and 4 board exams. Contrast that with hospitalist who can live in any city and make more than radiation oncologists after three years of training and one written exam:

 
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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.

No offense taken. A lot of those ive spoke. To are pretty aware of trends in the field, as they're both so obvious in psych you don't have to pay much attention to see them. For example in my city it's a 4-6 month wait for a new appointments and for certain fields (child specifically) it's an 8+ month wait to get established. This is also true in large metros like NYC where one can open a cash only practice, charge ~$400/hr and still get patients without too much difficulty. My city, which is FAR cheaper than NYC supports a few docs who charge around $300/hr and at least 2 of them aren't accepting new patients at all.

The argument I commonly hear for psych is in regards to mid-level creep. Given how awful most of the ones I've worked with in psych are (which seems to be a trend nationally), I also don't see any reason to worry there. To your point though, I know a few docs that say psych is the next derm, which I don't agree with, but who knows.

Not to my knowledge. But since you are seeing more resistant organisms (both bacteria and fungus) which are making headlines in the social media world, I'm sure it will be.

Where I've rotated the inpatient primary team usually just orders a c&s and then waits for the pharmacy stewardship note. Before that's it's just broad spectrum abx most of the time. If anything it give pharmacy more (unnecessary) work. Could be different in other places, idk.
 
Psych, Ortho, Neuro, should be the big players as the years go on. People want to be more active for longer periods of time and we are just starting to talk about mental health. ( This is a viewpoint from America.) The concern for Psych will be, when insurance starts to reimburse will practice revenue go down because of the payer mix split decreasing (cash v. insurance). Ortho & Neuro combined will continue to grow I think as our society ages but still wants to be able to do the things they were able to do in their 50s.

The thing that can change this is healthcare reform which, I think will lead to a shift in the amount of money but not which specialties are on top. Let's come back to this post in 10 years and see what happens.
 
I will just say the radiation oncology job market is terrible and will continue to deteriorate. This is a result of residency expansion (more free labor for chairs who are then rewarded by cancer centers). As a result, it's become a perpetual cycle. You may hear other things from academic radiation oncologists or even junior residents, but just realize they have an agenda. They're all trying to move up in the academic sector and it's sort of taboo to speak about the pyramid scheme that is currently radiation oncology and was created by academia. I personally know radiation oncology residents this year who do not have jobs-by jobs I mean permanent non-fellowship jobs. This is all after 5 years of training and 4 board exams. Contrast that with hospitalist who can live in any city and make more than radiation oncologists after three years of training and one written exam:



I will just say nobody was predicting this 5-10 years ago. We are notoriously bad at predicting the future. If people are screaming, “the sky is falling!” It probably is not falling there, but will fall someplace else.
 
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Psych, Ortho, Neuro, should be the big players as the years go on. People want to be more active for longer periods of time and we are just starting to talk about mental health. ( This is a viewpoint from America.) The concern for Psych will be, when insurance starts to reimburse will practice revenue go down because of the payer mix split decreasing (cash v. insurance). Ortho & Neuro combined will continue to grow I think as our society ages but still wants to be able to do the things they were able to do in their 50s.

The thing that can change this is healthcare reform which, I think will lead to a shift in the amount of money but not which specialties are on top. Let's come back to this post in 10 years and see what happens.
agreed. when i think about the future, i think about all the old farts we're going to be taking care of (demographic shifts). Psych, Neuro, Ortho...I can see PM&R and Cardiology blowing as well. We Americans love our fast food and sedentary, car-centric lifestyles.

I think Psych will blow up because my generation is all about the work/life balance, yo.
 
Psych, Neuro, Ortho...I can see PM&R and Cardiology blowing as well. We Americans love our fast food and sedentary, car-centric lifestyles.

I think Psych will blow up because my generation is all about the work/life balance, yo.

Having recently matched I will say the hottest fields right now are PM&R, psych, and especially EM, which is extremely popular right now. All three offer good work/life balance, pretty good pay/hour, and notably all have very light residencies. EM looks like a bubble to me, as a ton of new programs are popping up from the ground in the middle of nowhere.

Neuro is slowly getting more popular, but not keeping pace with the expanding shortage. Its biggest issues are student disinterest (neuro is "hard") and the lifestyle isn't really there, particularly during residency.
 
Having recently matched I will say the hottest fields right now are PM&R, psych, and especially EM, which is extremely popular right now. All three offer good work/life balance, pretty good pay/hour, and notably all have very light residencies. EM looks like a bubble to me, as a ton of new programs are popping up from the ground in the middle of nowhere.

Neuro is slowly getting more popular, but not keeping pace with the expanding shortage. Its biggest issues are student disinterest (neuro is "hard") and the lifestyle isn't really there, particularly during residency.

EM reimbursement will fall off a cliff if price transparency becomes a thing. If the media/great public understood how things were priced because you walked through the ER v. going urgent car or regular doctor visit. Granted certain communities will always use the ER like it's a primary care doctor so those communities may remain not impacted.
 
Having recently matched I will say the hottest fields right now are PM&R, psych, and especially EM, which is extremely popular right now. All three offer good work/life balance, pretty good pay/hour, and notably all have very light residencies. EM looks like a bubble to me, as a ton of new programs are popping up from the ground in the middle of nowhere.

Neuro is slowly getting more popular, but not keeping pace with the expanding shortage. Its biggest issues are student disinterest (neuro is "hard") and the lifestyle isn't really there, particularly during residency.

Opinion on ortho?
 
Having recently matched I will say the hottest fields right now are PM&R, psych, and especially EM, which is extremely popular right now. All three offer good work/life balance, pretty good pay/hour, and notably all have very light residencies. EM looks like a bubble to me, as a ton of new programs are popping up from the ground in the middle of nowhere.

Neuro is slowly getting more popular, but not keeping pace with the expanding shortage. Its biggest issues are student disinterest (neuro is "hard") and the lifestyle isn't really there, particularly during residency.

265894


Also, for the hell of it:

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EM reimbursement will fall off a cliff if price transparency becomes a thing. If the media/great public understood how things were priced because you walked through the ER v. going urgent car or regular doctor visit. Granted certain communities will always use the ER like it's a primary care doctor so those communities may remain not impacted.
Honestly see hell freezing over before this happens.
However, what could hurt EM compensation is a single-payer system (which could happen) or oversaturation (which I think will happen within the decade)

Opinion on ortho?
Ortho is and will always be popular. I don't think it's getting relatively more popular, thought. The "hot" surgical subspecialty right now is urology.
 
Honestly see hell freezing over before this happens.
However, what could hurt EM compensation is a single-payer system (which could happen) or oversaturation (which I think will happen within the decade)


Ortho is and will always be popular. I don't think it's getting relatively more popular, thought. The "hot" surgical subspecialty right now is urology.

I worked in pricing at a major academic system...it's certainly something that we talked about regularly but there wasn't any pressure to do anything about it. Radiology are tons of stand alone clinics so that outside pressure drove us to decrease rates substantially over a few years.
 
Honestly see hell freezing over before this happens.
However, what could hurt EM compensation is a single-payer system (which could happen) or oversaturation (which I think will happen within the decade)


Ortho is and will always be popular. I don't think it's getting relatively more popular, thought. The "hot" surgical subspecialty right now is urology.

Why do you think this is? My school only had 1 and 2 people apply that last couple of years
 
Why do you think this is? My school only had 1 and 2 people apply that last couple of years
Based on my own research plus meetings with several faculty in the field. I almost applied to urology. They told me it's basically already more competitive than ortho.

It's never going to to be close to as popular as ortho, but relatively speaking, it's hot right now, mostly for lifestyle reasons I think.
 
Based on my own research plus meetings with several faculty in the field. I almost applied to urology. They told me it's basically already more competitive than ortho.

It's never going to to be close to as popular as ortho, but relatively speaking, it's hot right now, mostly for lifestyle reasons I think.

My general understanding is good lifestyle and an aging workforce (aka very good job market)

Yeah I guess that makes sense. I always thought of them as lower pay compared to other competitive surgical/procedural fields (Ortho, plastics, ENT, ophtho, GI, cardio) which made it not as competitive/popular among med students
 
Yeah I guess that makes sense. I always thought of them as lower pay compared to other competitive surgical/procedural fields (Ortho, plastics, ENT, ophtho, GI, cardio) which made it not as competitive/popular among med students

You can check this but I'm like 95% sure the salary is comparable to those fields, probably higher than ophtho. I don't really know for sure.

And I really think salary plays much less of a role in specialty selection (for surgical subspecialties, anyway) than people think. I don't have anything to back this up other than knowing people in these fields. Everyone who was motivated by money chose EM (due to pay/hr)
 
The American Association of Nurse Anesthetists (AANA) releases controversial statement
Recently, the AANA released a statement aiming to promote the Certified Registered Nurse Anesthetists (CRNA) model, including a name change from Anesthetist to Nurse Anesthesiologist.

The statement is seen as controversial and refuted by the American Society of Anesthesiologists (ASA)
 
I don't expect physicians who are banking it right now to keep in touch with the latest technological innovations. But, AI with deep learning is already destroying the majority of radiologists in term of reading simple CXR for pneumonia. Technology moves at an exponential rate. Most of the aspiring radiology kids here won't be practicing Dx Radiology for another 6-8 years. By then, the AI threat is very real. It won't replace radiologists, but a future radiologist can do the equivalent workload as 5-6 radiologists from today, with the help of AI. Shrinking demand and increasing supply is bad for a specialty. From my personal experience at my training hospital, I already start seeing some radiologists using AI to read CXR on pneumonia. I expect the trend to be more common down the road.

I chuckle whenever radiologists talk about their clinical skills on this forum. Let's be real here. You guys have lost all of your clinical skills since intern year. When was the last time that you talk to patients and touch them again?


At my institution's hospital, Tygerberg Hospital, non of the chest x-rays have any reports attached, every physician/surgeon there is expected to be able to read and identify abnormalities on a CXR, the radiologists will give reports for everything else but not CXR, its seen as something too basic for them
 
At my institution's hospital, Tygerberg Hospital, non of the chest x-rays have any reports attached, every physician/surgeon there is expected to be able to read and identify abnormalities on a CXR, the radiologists will give reports for everything else but not CXR, its seen as something too basic for them


CXRs are not easy. I’m sure many findings are missed.
 
I agree, it's just that pulmonary TB especially, lung pathologies and chest trauma are very common at our institution and CXR are cheap to order so the physicians/surgeons go crazy with ordering them and abuse radiology... radiology probably usually intervene if physicians are stumped or to make the final diagnosis etc.

I'm interested in Radiology so i was baffled when i heard that our hospital does that
 
CXRs are not easy. I’m sure many findings are missed.

This also seems like it’s asking for a lawsuit. Surgeons like myself order cxrs to look for atelectasis /pna/fluid overload /tube placement etc. We could easily miss the lytic bone lesion or other findings because that’s not what we ordered the imaging test for. Radiologists ready then in a much more systematic fashion.
 
At my institution's hospital, Tygerberg Hospital, non of the chest x-rays have any reports attached, every physician/surgeon there is expected to be able to read and identify abnormalities on a CXR, the radiologists will give reports for everything else but not CXR, its seen as something too basic for them
This seems really weird. I googled that hospital and what came up is a place in South Africa. Is that right? If so that would explain why this seems so bizarre to anything I’ve heard of before.
 
This seems really weird. I googled that hospital and what came up is a place in South Africa. Is that right? If so that would explain why this seems so bizarre to anything I’ve heard of before.
Tman507's location is Cape Town, South Africa. The story makes sense now.
 
This also seems like it’s asking for a lawsuit. Surgeons like myself order cxrs to look for atelectasis /pna/fluid overload /tube placement etc. We could easily miss the lytic bone lesion or other findings because that’s not what we ordered the imaging test for. Radiologists ready then in a much more systematic fashion.
Exaclty, the problem is that I really have an interest in Radiology and when i found out about this it was a let down, where the doctors make them sound as good as them... My interest in Radiology is still strong tho...i know this doesn't happen at private institutions, but is this happening anywhere else?
 
This seems really weird. I googled that hospital and what came up is a place in South Africa. Is that right? If so that would explain why this seems so bizarre to anything I’ve heard of before.
Guys, is this the only place where this is happening? I really want to know
 
CXRs are not easy. I’m sure many findings are missed.
I agree, it's just that pulmonary TB especially, lung pathologies and chest trauma are very common at our institution and CXR are cheap to order so the physicians/surgeons go crazy with ordering them and abuse radiology... radiology probably usually intervene if physicians are stumped or to make the final diagnosis etc.

I'm interested in Radiology so i was baffled when i heard that our hospital does that
 
Guys, is this the only place where this is happening? I really want to know
Arrogant non radiologists thinking they’re just as good as radiologists? Erryday

No policy in place to cover their butts and radiologists thinking cxr’s are beneath them? That’s new to me.
 
Arrogant non radiologists thinking they’re just as good as radiologists? Erryday

No policy in place to cover their butts and radiologists thinking cxr’s are beneath them? That’s new to me.
I haven't spoken to any of the radiologists about this...This is only what other non radiologist physicians and other students have told me. I want to shadow some radiologists due to my interest is DxR and IR and I'll try find out the real issue...as I only have the input from non Radiologists
 
I agree, it's just that pulmonary TB especially, lung pathologies and chest trauma are very common at our institution and CXR are cheap to order so the physicians/surgeons go crazy with ordering them and abuse radiology... radiology probably usually intervene if physicians are stumped or to make the final diagnosis etc.

I'm interested in Radiology so i was baffled when i heard that our hospital does that


PP radiologists in the USA would consider that a gift, not abuse.
 
The hype of AI taking over radiology is primarily driven by computer scientists and marketing departments; it's quite telling that almost no radiologist who actually understands the workflow thinks that this will come to pass anytime in this lifetime (in the distant future? Perhaps, but only at the point where many other careers have already been taken over). Non-radiologists somehow like to reduce the field to mere pattern-recognition and seem to be ignorant of the cognitive requirements of the field.

I mean, what do I care? I'm on the procedural side of things in IR, so I have no qualms about job security anyway. But having gone through residency, I know enough about the field that I realize that most of these computer scientists proclaiming the imminent demise of radiologists are blowing smoke. It's too bad that much of the laypeople are taken in by the hype.
 
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