So for the med students out there interested in the aforementioned “doomed specialities” (EM and anesthesia for me), what specialities are NOT doomed? Surgery? Primary care?
Also, is ACEP just propaganda? Their salary numbers this year still seem high and the number of FM/IM doctors working in EDs is shocking (>40% in many states). I scribed in the ED full-time for a year before med school and I definitely saw the...striking difference between FM/IM trained doctors and EM trained doctors. I guess that doesn’t matter if the public is naive and FM/IM is way cheaper?
I really loved my time in the ED but this website makes me already hesitant about choosing medicine
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The elements that make a specialty “not doomed” are
1) The aforementioned owning of patients. You bring referrals to the hospital, you have value. If the patients come whether you’re there or not, you have little value.
2) Generally procedure based- surgical sub specialties (ortho, Urg, ENT, CT, NSG etc.) are the best. Gen Surg and OB are ok, but less protected. Medicine wise, GI, cardiology. Basically, the more revenue you generate (billing for complicated procedures/surgeries), and the more specialized you are (I.e. the fewer people that can do your job), the safer you are.
3) Relative immunity from mid level encroachment. PA’s are not going to be doing brain surgery anytime soon. There is a push for more MLP’s in EM, IM, FP, Anesthesia, etc.
4) Are you outsourceable? Radiologists can read from anywhere. The lowest bidder may start winning those contracts. The US licensed radiologist who lives in India has a much lower cost of living than the one who lives in NYC. Pathologists can work for LabCorp in a central facility, and samples can be sent there. Neither have their own patients. (See #1)
5) can you charge cash for a relative “want” rather than a need? Derm and plastics for aesthetic procedures. Psych for therapy for rich folks who will pay cash etc.