Medical specialties on the rise

[chiriyan]

"A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be." - Wayne Gretzky

Hello all, I am a first year medical student and am curious as to what medical specialties have the brightest future. I understand almost every field has ongoing innovation and improvement, but 20-30 years from now which medical specialties are going to be the hottest, most in-demand, technological, most fulfilling, best compensated, etc. In essence which ones are the most "on the rise"?

I don't have too much experience but I think the follow have the brightest futures (in no specific order):

1) Urology - interesting and growing field, already seeing the most applications of robotic surgery, sexual/transgender medicine will be huge, have a highly competitive residency already
2) Plastic Surgery - more people caring about aesthetics, facial transplantation, plastic surgeons are increasingly involved with other surgical cases, competitive residency
3) Preventive Medicine - population health, controlling costs, improving the system - overall very impactful
4) Family Medicine - U.S. is facing a re-emphasis on primary care
5) IR - minimally-invasive procedures are preferred, better imaging being developed, competitive residency

I think the unifying concept is that I can see a vastly increased demand for all of these. Am I wrong? Is there any other notable inclusion and why?

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[Rekt]

Did you really just start a post with a quote?

 

[lagbydesign]

There's really no way to predict this.

 

[deleted407021]

Did you really just start a post with a quote?

Maybe they’re floating it for their personal statement.

 

[Entadus]

1. OP's first post? check.
2. whacky writing style? check.
3. ridiculous, generic, overplayed question? ...check.

I love SDN. I'd have to go with oncology (based on your criteria), then rheumatology, interventional radiology, neurovascular

 

[stickgirl390]

I gotchu fam:

Family med
Peds
OBGYN
Psych
Family med again

 

[mrbreakfast]

Depends what you mean. For example, neurology is exploding in terms of medical understanding, patient population, technology/treatments...but likely won't explode in compensation.

In a general sense of the word, the most "cutting-edge" fields are IR, neurovascular (which covers multiple residencies), then maybe spinal rehab stuff (PM&R).

If you want demand, you're basically looking at FM, other primary care-like fields (peds, OBGYN), then things like psych and neuro, which are all fields that are already under-manned. Alternately, bariatic surgery and nephrology, if as a population we keep getting fatter...

It's impossible to say. In 30 years we might have artificial kidneys, robotic limb replacement, (more) central nervous implants, a pill that makes you lose 30 lbs, etc. Just go into what you think is cool.

 

[CyrusHabs7695]

Buddy take step 1 then your score will tell you what "specialties on the rise" are even possible for you

 

[sunshinefl]

Did you really just start a post with a quote?

“ ‘A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.’ - Wayne Gretzky” -Michael Scott

 

[operaman]

I think psych may be uniquely positioned for such a rise. Incredibly prevalent diseases with current demand for docs incredibly high. It’s also still a field where diagnosis is basically “yeah most people with that list of symptoms has this disorder.” And treatment is incredibly variable and unpredictable. I always wonder if fMRI and other neuroimaging techniques may ultimately start finding their way into diagnosis which would be a huge jump. One would suppose this might also help better guide medical therapy as well. There are also a number of interventional tools still in the research pipeline that have potential to make big changes and provide new revenue sources for physicians.

Beyond that my take is that the future may be less about the rise of some fields as much as the decline of many others. I think the mid level + AI juggernaut is going to hit within that 20-30 year window. We will have to think carefully about what it is we as doctors can do that nobody else can do - not even an NP with an iPad connected to a Watson-like machine that listens to the whole encounter and calculates likely diagnoses, recommends workup, and suggests evidence based treatment options. Because that’s coming.

I think procedural fields are safest since the inherent variation and unpredictability of many invasive procedures will make them more immune to AI and mid level creep. If anything, midlevel-AIs might provide a better way to see surgical referrals and funnel the truly operative ones to the MD, thus increasing revenue. Currently this would potentially offend referring docs, but when a big enough chunk of referring docs are midlevels anyhow it probably won’t matter.

 

[puahate]

Rad onc is on the decline, that is for sure

 

[piii]

Radiology. More people will need imaging. AI will advance the scope of radiologist but won't replace them for a long time.

No entirely sure about IR. IR had been a big field for 3 decades now. Embolizations have been around for a long time. Private practice IR is a lot more diagnostic reading and bread and butter cases like ports, etc. academic IR is still over 50% bread and butter technician work and then acute or complex cases. But with a surgery lifestyle. There's a reason why a LOT of residents going into radiology change their mind about IR during R1 and R2. I think you'll see a saturation in 10-20 years and then a drop when people realize what IR really is.

 

[jhamaican]

GI

sky is the future

IBD/IBS only increasing.

GI is doing what cardiology did to CVTS many years ago.

So much possibility with EUS/weight loss procedures.

 

[nimbus]

Ortho because people are always breaking s***.

 

[AsianPersuasion]

I'm biased. Vascular. EVERY DAY.

 

[sella.turcica]

Venereology

 

[FindMeOnTheLinks]

Hospital administrator

 

[TypeADissection]

OP had the wrong quote. "You miss 100% of the shots you don't take." - Wayne Gretzky.
- Michael Scott.

 

[OrthoTraumaMD]

Ortho because people are always breaking s***.

Approve.

 

[LebronManning]

Interventional Cardiology and Neurosurgery without a doubt. Heart and Brain disease are the most prevalent and most important to most people. Both of these specialties are at the forefront of cutting edge treatment for these things and neurosurgery also has the whole open surgery domain along with interventional

 

[deleted407021]

Psychiatry is only going downhill and no one should apply to it, honestly. Just do something else.

This has been a PSA by the Committee to Keep Gunners Out of Psych

 

[Horners]

Just do what you like bro, the money will come

 

[sella.turcica]

Interventional Cardiology and Neurosurgery without a doubt. Heart and Brain disease are the most prevalent and most important to most people. Both of these specialties are at the forefront of cutting edge treatment for these things and neurosurgery also has the whole open surgery domain along with interventional

*yawn*

 

[akuko2]

Look no further than Urology if you want something on the rise. In brief, the avg age of a Urologist is 55 so many docs are set to retire by the time you finish training, demand is increasing with the aging population, great mix of surgery and medicine, wide mix of big cases and smaller in office procedures, Urology adapts to new technology at a startaling rate so you are always near the cutting edge, enhancing quality of life in your patients in a significant way (honestly no one really cares if they gain 5 years of life in their 70s but they'll send you Christmas cards every year their penile prosthesis is going strong), having definitive treatments to most of your issues and then being able to have longterm followup with your patients after the fact, and finally my favorite: you get to tell everyone 'I'm applying Urology,' and after they reply, "Ah, Neurology, the brain is an incredible organ!' you get to correct them and watch them struggle to find a non-awkward way to reply.

 

[Gurby]

Look no further than Urology if you want something on the rise.

 

[thegreengreatdragon]

I've been told palliative care is on the rise, largely because people are starting to understand its value better and also because with an aging population with a lot of chronic disease, there's a large need for it.

 

[LebronManning]

*yawn*

What?

 

[MedicineZ0Z]

I think psych may be uniquely positioned for such a rise. Incredibly prevalent diseases with current demand for docs incredibly high. It’s also still a field where diagnosis is basically “yeah most people with that list of symptoms has this disorder.” And treatment is incredibly variable and unpredictable. I always wonder if fMRI and other neuroimaging techniques may ultimately start finding their way into diagnosis which would be a huge jump. One would suppose this might also help better guide medical therapy as well. There are also a number of interventional tools still in the research pipeline that have potential to make big changes and provide new revenue sources for physicians.

Beyond that my take is that the future may be less about the rise of some fields as much as the decline of many others. I think the mid level + AI juggernaut is going to hit within that 20-30 year window. We will have to think carefully about what it is we as doctors can do that nobody else can do - not even an NP with an iPad connected to a Watson-like machine that listens to the whole encounter and calculates likely diagnoses, recommends workup, and suggests evidence based treatment options. Because that’s coming.

I think procedural fields are safest since the inherent variation and unpredictability of many invasive procedures will make them more immune to AI and mid level creep. If anything, midlevel-AIs might provide a better way to see surgical referrals and funnel the truly operative ones to the MD, thus increasing revenue. Currently this would potentially offend referring docs, but when a big enough chunk of referring docs are midlevels anyhow it probably won’t matter.

Procedural referrals are only a small % of primary care visits. And how about explaining the risks/benefits in a meaningful way? Sending them to the right or preferred surgeon? Calming the anxiety when they think their lipoma (or whatever else) is cancer? There's a major customer service component to primary care that requires medical knowledge.

 

[ciestar]

Neurology, heme/onc, genetics, immunology, rheumatology

 

[Cassowary]

Neuro: most neuros are old and the demand is increasing at a ridiculous rate, stroke left and right
IR: huge tendency for minimally invasive peocedures now, and surgeons slowly losing “turf war” whatever that means
Onc: rapid rate of cancer research
Plastics/derm/omfs: instagram

 

[DoctwoB]

Look no further than Urology if you want something on the rise. In brief, the avg age of a Urologist is 55 so many docs are set to retire by the time you finish training, demand is increasing with the aging population, great mix of surgery and medicine, wide mix of big cases and smaller in office procedures, Urology adapts to new technology at a startaling rate so you are always near the cutting edge, enhancing quality of life in your patients in a significant way (honestly no one really cares if they gain 5 years of life in their 70s but they'll send you Christmas cards every year their penile prosthesis is going strong), having definitive treatments to most of your issues and then being able to have longterm followup with your patients after the fact, and finally my favorite: you get to tell everyone 'I'm applying Urology,' and after they reply, "Ah, Neurology, the brain is an incredible organ!' you get to correct them and watch them struggle to find a non-awkward way to reply.

The key for urology is that we control both the medical, endoscopic, and surgical management of urologic disease. If GI or cards comes up with a Minimally invasive way to treat disease X they take it from the surgeons or work in teams with them. If it happens in Urology (e.g going from open stone surgery to endoscopic) we are still the ones doing it.

 

[RNthenDoc]

Being a midlevel, tbqh.

jk don't hurt me

 

[NotaCop]

Look no further than Urology if you want something on the rise. In brief, the avg age of a Urologist is 55 so many docs are set to retire by the time you finish training, demand is increasing with the aging population, great mix of surgery and medicine, wide mix of big cases and smaller in office procedures, Urology adapts to new technology at a startaling rate so you are always near the cutting edge, enhancing quality of life in your patients in a significant way (honestly no one really cares if they gain 5 years of life in their 70s but they'll send you Christmas cards every year their penile prosthesis is going strong), having definitive treatments to most of your issues and then being able to have longterm followup with your patients after the fact, and finally my favorite: you get to tell everyone 'I'm applying Urology,' and after they reply, "Ah, Neurology, the brain is an incredible organ!' you get to correct them and watch them struggle to find a non-awkward way to reply.

Came here to post this. Great puns. Our work here is done

 

[OrthoTraumaMD]

Interest, compensation, and popularity rises and falls with time. The more important thing is to do something that you enjoy. You spend so much time at work, doing anything otherwise is not worth it.

People who hate their jobs are generally not happy people. We only have one life… Try to spend it being happy.

 

[premeddestiny]

Neurology / geriatics / cardiology / pallative / preventative medicine (could be more): The average age of the population is increasing, and so it is expected to have more patients requiring care for neurologic, cardiologic, or geriatric conditions. Prevention becomes more valuable in the future to reduce burden on healthcare.

 

[CherryRedDracul]

IR has a bright future with many cutting-edge procedures, but is transitioning into a more surgical type of residency at more and more places. Back in the day, they were the plumbers you hired for lines, drains, embolizations, and other things. Now, more and more places run their own service and have their own patients that they round on.

And the NRMP medical student match was ridiculously competitive this year as well.

 

[LebronManning]

The highest paying fields will always be those which people are willing to pay cash for i.e. plastics, lasik etc

I don't think this has ever been true or will ever be true. The highest paying fields right now are Neurosurgery, Orthopedic Surgery, and Interventional Cardiology - none of which people pay cash for. Those are highest paying median and 90th percentile. Cash specialties such as Plastics and Derm, while can be very high paying, don't really touch the money in spine surgery. People often forget that cash specialties are much like any other business, and they rise and fall with the times. A insurance reimbursed spinal surgery and some cosmetic surgery might pay the same, but the supply of the spinal surgeries is almost infinite. Cosmetic surgeons have to market aggressively to get clientele and only their most intricate procedures will reimnburse as much as a basic spine surgery or craniotomy or TAVR, etc.

 

[Kuratz]

I don't think this has ever been true or will ever be true. The highest paying fields right now are Neurosurgery, Orthopedic Surgery, and Interventional Cardiology - none of which people pay cash for.

I cannot stress how important @OrthoTraumaMD 's advice is. Seven years of neurosurgical residency would be literal hell for anyone who isn't passionate about the field (and often is even for those who love it). It is still hard to appreciate the requisite sacrifices as someone who did a slew sub-Is, let alone a pre-med scouring MGMA data. Keep an open mind and be honest with your interests and the money will work out fine.

 

[LebronManning]

I cannot stress how important @OrthoTraumaMD 's advice is. Seven years of neurosurgical residency would be literal hell for anyone who isn't passionate about the field (and often is even for those who love it). It is still hard to appreciate the requisite sacrifices as an MS4 who did a slew sub-Is, let alone a pre-med scouring MGMA data. Keep an open mind and be honest with your interests and the money will work out fine.

100% agree with that. I was just saying that the popular idea that plastics and derm makes the most money cause they get to charge cash is kinda false.

 

[Cassowary]

I don't think this has ever been true or will ever be true. The highest paying fields right now are Neurosurgery, Orthopedic Surgery, and Interventional Cardiology - none of which people pay cash for. Those are highest paying median and 90th percentile. Cash specialties such as Plastics and Derm, while can be very high paying, don't really touch the money in spine surgery. People often forget that cash specialties are much like any other business, and they rise and fall with the times. A insurance reimbursed spinal surgery and some cosmetic surgery might pay the same, but the supply of the spinal surgeries is almost infinite. Cosmetic surgeons have to market aggressively to get clientele and only their most intricate procedures will reimnburse as much as a basic spine surgery or craniotomy or TAVR, etc.

While this is technically true, the reason its wrong is because those incomes come from private practice. Derm and plastics have much higher incomes (can make 7 figures) by opening their own med spa type practice, hiring extenders, and having ancillaries. Those hospital/group practice settings grossly misrepresent the income potential for a cash based business; and while that technically isnt the doctors “salary” from just seeing patients, its something to take account. It requires an entrepreneurial spirit though.

 

[Dr. Doctor MD]

I don't think this has ever been true or will ever be true. The highest paying fields right now are Neurosurgery, Orthopedic Surgery, and Interventional Cardiology - none of which people pay cash for. Those are highest paying median and 90th percentile. Cash specialties such as Plastics and Derm, while can be very high paying, don't really touch the money in spine surgery. People often forget that cash specialties are much like any other business, and they rise and fall with the times. A insurance reimbursed spinal surgery and some cosmetic surgery might pay the same, but the supply of the spinal surgeries is almost infinite. Cosmetic surgeons have to market aggressively to get clientele and only their most intricate procedures will reimnburse as much as a basic spine surgery or craniotomy or TAVR, etc.

Very well said, everyone needs to read this post ^^^

The business model behind cosmetics whether its surgical or minimally invasive is extremely tenuous. There is a reason why dentists, family docs, optho, and NPs all offer botox and fillers. It's not because they're good at them, its because they want a slice of the pie.

In actual medicine, Demand >>>>> Supply, and there is no shortage of patients
In cosmetics/cash pay, Supply >>>>> Demand, meaning that patients can pick one of several dozen providers.

The cash pay plastic surgeons and dermatologists bust their ass for every penny and take years if not decades to build a completely stable practice. It's a cutthroat market and you need business savvy. Terrible field for anyone who thinks that they will graduate and immediately make 500k-1 mil working 9-5 the first year out of residency. Chance are you'll be doing panniculectomies/breast-reduction/reconstructions or treating acne/eczema/fungus for the majority of your career, rather than driving Lambos in LA.

 

[MSTPlease]

The key for urology is that we control both the medical, endoscopic, and surgical management of urologic disease. If GI or cards comes up with a Minimally invasive way to treat disease X they take it from the surgeons or work in teams with them. If it happens in Urology (e.g going from open stone surgery to endoscopic) we are still the ones doing it.

Isn't IR already moving in on prostatic artery embolizations and eating away at urology's TURPs? In women don't you already have to contend with the urogyns? Couldn't non surgical management of stones and other renal/renal pelvis disorders find their way into neprhology's hands?

 

[DoctwoB]

PAE is still experimental and less effective then TURP. It will have a role, but likely a limited one especially as Urologists control that referral pattern and procedures like Urolift can be done faster and with an excellent toxicity profile.

There is overlap between Urogyn and female urology, but hardly a turf war. They both treat prolapse and SUI (incredibly prevalent conditions) and there are a lot of those patients to go around and limited numbers of both specialists. Who does what depends on local referral patterns.

Non surgical management of stones has been a stagnant field for 50 years. Metabolic therapy is limited in efficacy and requires a lot of patient buy in (and is managed by urologists). Maybe someday we’ll hit a home run on a stone preventing drug but don’t hold your breath. It would really have to be great btw, as you’d be talking about putting young patients on lifelong meds for questionable benefit so to be worthwhile it would have to be very effective, limited side effects, and cheap. Once again; good luck.

 

[afib123]

PAE is still experimental and less effective then TURP. It will have a role, but likely a limited one especially as Urologists control that referral pattern and procedures like Urolift can be done faster and with an excellent toxicity profile.

There is overlap between Urogyn and female urology, but hardly a turf war. They both treat prolapse and SUI (incredibly prevalent conditions) and there are a lot of those patients to go around and limited numbers of both specialists. Who does what depends on local referral patterns.

Non surgical management of stones has been a stagnant field for 50 years. Metabolic therapy is limited in efficacy and requires a lot of patient buy in (and is managed by urologists). Maybe someday we’ll hit a home run on a stone preventing drug but don’t hold your breath. It would really have to be great btw, as you’d be talking about putting young patients on lifelong meds for questionable benefit so to be worthwhile it would have to be very effective, limited side effects, and cheap. Once again; good luck.

Wait female urology is a field? Sorry for my ignorance but how come urology who have so much control on their patients let Urogyn take a share of those procedures if female urology is a field in itself? Other than the fact they work in the pelvis, Urogyn and Ob/Gyn are extremely different (in my 2 week experience). Urogyn feels like a stand-alone residency

 

[Troyzle]

Space medicine.

https://www.nejm.org/doi/full/10.1056/NEJMra1609012

 

[Dr G Oogle]

Wait female urology is a field? Sorry for my ignorance but how come urology who have so much control on their patients let Urogyn take a share of those procedures if female urology is a field in itself? Other than the fact they work in the pelvis, Urogyn and Ob/Gyn are extremely different (in my 2 week experience). Urogyn feels like a stand-alone residency

Urology didn’t “let” urogyn take anything; the specialty is fpmrs and was developed together with urology and Urogynecology (the AUA and AUGS) and the difference between the two is similar the difference between ortho and neuro spine fellowships. There things urogyn can do that female urology can’t and vice versa and then there are fellowships that are combine, like mine, where gyn learn a not of urology procedures like reimplants and bladder neck closures and urology learns how to do vaginal hysts and endometriosis resection. The goal being that eventually all fellowships are combined and we all do more or less the same thing. I’ll be the first to admit obgyn surgical training is far inferior to urology residency training but coming out of fellowship I would say they are more or less equivalent. Incidentally FPMRS will also be on the rise by 2050 the number of people with incontjnence and prolapse will be more than double and is rising every year between then and now. And only a very small percentage of people with pelvic floor disease are currently seeking care but more and more are becoming aware of the problem.