Next Hot Specialty

[Chocolateagar04]

Hey everyone,

Just curious what do you think will be the next "hot" specialty? Many years ago DERM, Rads, RadOnc were not very competitive but now they are. Anesthesia is very cyclical.

Are there any specialties you guys think that aren't so competitive now will be ones to grab for the future?

Ill start by saying Medical Genetics might be one of those that no one really thinks about but will be big in the future. Also I think PMR with the versatility they have and the amount of research the government puts in to developing rehabilitation advancements and technologies for the military.

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[jdh71]

Hey everyone,

Just curious what do you think will be the next "hot" specialty? Many years ago DERM, Rads, RadOnc were not very competitive but now they are. Anesthesia is very cyclical.

Are there any specialties you guys think that aren't so competitive now will be ones to grab for the future?

Ill start by saying Medical Genetics might be one of those that no one really thinks about but will be big in the future. Also I think PMR with the versatility they have and the amount of research the government puts in to developing rehabilitation advancements and technologies for the military.

Unless medical genetics comes up with patient specific genetic treatments and they get paid CASH to do it, medical genetics will continue to be what it is.

Specialties get popular because of the hours and amount of money paid. If anesthesia made the kind of money that a primary care doc made, you'd see that specialty lose popularity real fast. Radiology is cool? Seriously? The procedural work can be interesting, but mostly radiologist get paid so damn much.

The next popular specialty will be the one that can figure out how to get FAT paid when we start running out of money.

 

[J-Rad]

This is really more appropriate for TIH-not a residency specific topic. Moving.

 

[cowme]

Radiology is cool? Seriously? The procedural work can be interesting, but mostly radiologist get paid so damn much.

Its a hell of a lot cooler than IM

 

[bronx43]

Hey everyone,

Just curious what do you think will be the next "hot" specialty? Many years ago DERM, Rads, RadOnc were not very competitive but now they are. Anesthesia is very cyclical.

Are there any specialties you guys think that aren't so competitive now will be ones to grab for the future?

Ill start by saying Medical Genetics might be one of those that no one really thinks about but will be big in the future. Also I think PMR with the versatility they have and the amount of research the government puts in to developing rehabilitation advancements and technologies for the military.

It's all about the money. Forget the talk about "cool." That stuff is tertiary at best - after lifestyle and paper. Judging from the financial situation of this country, I see parity amongst fields. There won't be any "hot" fields. People will simply go into what interests them. When that happens, some fields might fare better than others, but there won't be a ravenous race to any set of specialties like we see now.

 

[Substance]

its a hell of a lot cooler than im

qft

 

[bronx43]

Its a hell of a lot cooler than IM

Interventional? I can see the argument. Diagnostic? No way in hell.

Either way, it's entirely subjective. You couldn't pay me enough to sit in a dark room reading images all day. And the idea of being a procedure monkey doesn't spark my interest either. Finance and investing on the other hand...

 

[Doctor4Life1769]

Interventional? I can see the argument. Diagnostic? No way in hell.

Either way, it's entirely subjective. You couldn't pay me enough to sit in a dark room reading images all day. And the idea of being a procedure monkey doesn't spark my interest either. Finance and investing on the other hand...

Being the hospital's dumping service and social worker, in the name of being the "primary team" doesn't appeal much to me either.

 

[jdh71]

Its a hell of a lot cooler than IM

negative ghost rider

 

[Radonkulous]

I would still say Derm is hot since it can be cash based. GI is pretty hot right now as well. Those 2 have a good future outlook. Throw in Ortho on the surgery side. IR is bright but is too in flux right now.

 

[bronx43]

I would still say Derm is hot since it can be cash based. GI is pretty hot right now as well. Those 2 have a good future outlook. Throw in Ortho on the surgery side. IR is bright but is too in flux right now.

Who says cash based business means the road to riches in the not-so-distant future? The death of entitlement programs in the US would mean an instant decrease in aggregate demand, which will permeate the entirely of the economy - not just the health care sector. The amount of disposable income available to the generation populace to be used for non-essential, cosmetic, or comfort care will contract dramatically. And this is on top of the fact that the barrier to entry for many of the cosmetic derm services is low to non-existent, making it easy for market penetration for numerous other specialties such as FM, IM, plastics. In fact, this is already occurring on a large scale. Not saying derm is worse off than many other fields, but I don't buy the argument from the cash only aspect.

I don't know why GI has a better outlook than any other field. Once scope reimbursements drop to pedestrian levels, GI is gonna be barely better than endocrine, rheum, or ID, if at all.

Ortho, I would argue is one of the worse surgical subspecialties to be in. It's only propped up by its unreasonably high reimbursement rates. Compared with its GS counterparts, they do the most elective procedures, as well as those with the lowest cost effectiveness. In any political milieu, it's far easier to cut coverage for elective arthroscopies and joint replacements in the Medicare population than it is to cut coverage for the higher acuity cases done by GS. The same goes for private insurers.

 

[Slack3r]

I would still say Derm is hot since it can be cash based. GI is pretty hot right now as well. Those 2 have a good future outlook. Throw in Ortho on the surgery side. IR is bright but is too in flux right now.

LOL, wait until they cut scope reimbursement (again).

 

[bronx43]

LOL, wait until they cut scope reimbursement (again).

Bingo

 

[Radonkulous]

In relative terms, I still think GI will fare better than endo, rheum, id. It's a high throughput field since it's very procedural based. It may be the next rads (in terms of getting hammered), but rads still fares a lot better than say peds. I agree with you on the ortho one. With regards to Derm, in the US at least ppl will pay to look good. Maybe not anywhere else but in the US they will. I just don't see salaries equalizing unless the RVU system is completely done away with. Not saying it won't happen.

 

[bronx43]

In relative terms, I still think GI will fare better than endo, rheum, id. It's a high throughput field since it's very procedural based. It may be the next rads (in terms of getting hammered), but rads still fares a lot better than say peds. I agree with you on the ortho one. With regards to Derm, in the US at least ppl will pay to look good. Maybe not anywhere else but in the US they will. I just don't see salaries equalizing unless the RVU system is completely done away with. Not saying it won't happen.

They don't have to do away from the RVU system. They simply have to revise the fee scheduling to make procedures relatively on par with E&M, which means that whatever advantages a procedure-heavy specialty has will be gone. They can still make more money, but it'll have to be based on volume and hours worked.

 

[RadOncDoc21]

They don't have to do away from the RVU system. They simply have to revise the fee scheduling to make procedures relatively on par with E&M, which means that whatever advantages a procedure-heavy specialty has will be gone. They can still make more money, but it'll have to be based on volume and hours worked.

I'm interested to see what your thoughts on rad onc? I'm kinda afraid to know but in the end I still couldn't see myself in any other field.

p.s. How do you know so much about the business side of medicine? I'm interested in learning more even though it may already be too late.

-R

 

[bronx43]

I'm interested to see what your thoughts on rad onc? I'm kinda afraid to know but in the end I still couldn't see myself in any other field.

p.s. How do you know so much about the business side of medicine? I'm interested in learning more even though it may already be too late.

-R

The problem I have with rad onc is that it's anchored in a single treatment modality. That inherently puts it at risk in an environment where technological advances dictate markets. Especially with the small size of the specialty, it would be hard to gain much market share against larger fields like medical oncology should new technology come out that isn't entirely within the realms of radiation oncology (or simply if new combinations of existing approaches offer comparable or better outcomes.) CT surgery knows this all too well, as by their own complacency, didn't grab hold of the heart cath market. They were the king of the cardiac world in the 80s and 90s, but look at them now.
Rad onc is ridiculously competitive now, due to its limited number of positions and its unreasonably high reimbursement rates, but I simply don't think it has the strongest of fundamentals. Remember that it's all about market share. Even if some can argue that new treatments are unlikely for some of the more radiosensitive cancers, it only takes changes to a few money-makers for the specialty as a whole to feel the pain.

My background is in business, so it was easier for me to apply that knowledge to what I see in medicine. But, it's never too late to learn about business aspects of medicine. In fact, if you're a resident, I would say it's the perfect time. You can get a MBA after you're done, or if you want to get ur feet wet a bit, just keep an eye on what goes on daily in the business world. All my banker and consultant buddies have their home page as WSJ, Reuters, etc. It takes a long time, but after awhile, you begin to get a basic idea of how things outside of medicine work. Most people in medicine don't have this understanding. You can also pick up some good books about the current health care system. A couple that come to mind are Clayton Christenson's Innovator's Prescription and George Halvorson's book on health care reform.

 

[RadOncDoc21]

The problem I have with rad onc is that it's anchored in a single treatment modality. That inherently puts it at risk in an environment where technological advances dictate markets. Especially with the small size of the specialty, it would be hard to gain much market share against larger fields like medical oncology should new technology come out that isn't entirely within the realms of radiation oncology (or simply if new combinations of existing approaches offer comparable or better outcomes.) CT surgery knows this all too well, as by their own complacency, didn't grab hold of the heart cath market. They were the king of the cardiac world in the 80s and 90s, but look at them now.
Rad onc is ridiculously competitive now, due to its limited number of positions and its unreasonably high reimbursement rates, but I simply don't think it has the strongest of fundamentals. Remember that it's all about market share. Even if some can argue that new treatments are unlikely for some of the more radiosensitive cancers, it only takes changes to a few money-makers for the specialty as a whole to feel the pain.

My background is in business, so it was easier for me to apply that knowledge to what I see in medicine. But, it's never too late to learn about business aspects of medicine. In fact, if you're a resident, I would say it's the perfect time. You can get a MBA after you're done, or if you want to get ur feet wet a bit, just keep an eye on what goes on daily in the business world. All my banker and consultant buddies have their home page as WSJ, Reuters, etc. It takes a long time, but after awhile, you begin to get a basic idea of how things outside of medicine work. Most people in medicine don't have this understanding. You can also pick up some good books about the current health care system. A couple that come to mind are Clayton Christenson's Innovator's Prescription and George Halvorson's book on health care reform.

I definitely agree with a lot of what you wrote. I know there are a lot of things we know how to do that a lot of other physicians can't do because of the technology and understanding of how radiation works and we are the only oncology specialty that devotes all four years of residency training to cancer. However, I do see what you mean with our numbers and vulnerability to new technological advancements. For instance, radioimmunotherapy can be an area shared by radiation oncologists, nuclear medicine docs, radiologists, and medical oncologists that can be a game changer in the future or new targeted modalities that are being invented. I think that as time goes on, treatment of cancer will be an even more highly multi-modality approach where radiation is key to local control, but only time can tell.

I appreciate your input and will look into the marketing side of things because I feel it is important not only in my field but in medicine in general. I don't think we should be making a million dollars a year but for the time and debt involved, I'm not a fan of where everything is going. Take care and thanks again!

-R

 

[aequanimitas11]

GI is pretty hot right now as well.

Hopkins is training PA/NP's to do GI scopes as we speak.

Who says cash based business means the road to riches in the not-so-distant future? The death of entitlement programs in the US would mean an instant decrease in aggregate demand, which will permeate the entirely of the economy - not just the health care sector. The amount of disposable income available to the generation populace to be used for non-essential, cosmetic, or comfort care will contract dramatically.

You are overlooking the fact that over time that money will be put back into the hands of businesses and wage-earners on all levels due to lower taxes, less distribution of wealth, etc. A healthy economy without a huge tax and debt burden would be a good thing for medicine.

Ortho, I would argue is one of the worse surgical subspecialties to be in. It's only propped up by its unreasonably high reimbursement rates. Compared with its GS counterparts, they do the most elective procedures, as well as those with the lowest cost effectiveness. In any political milieu, it's far easier to cut coverage for elective arthroscopies and joint replacements in the Medicare population than it is to cut coverage for the higher acuity cases done by GS. The same goes for private insurers.

People are willing to pay cash for many elective procedures, especially scopes. There are already ortho practices that are getting cash payments for these types of procedures. Most of these patients are relatively young and motivated. Joints would be a more difficult surgery to get remibursed for in a "cash-only" setting. This is mostly due to hospital and implant costs. However, the demand will keep growing and there will always be a group of patients that will do whatever it takes to get their joint replacements when the pain is bad enough. This group of patients is constantly increasing due to the aging and increasing obese U.S. population.

http://www.surgerycenterok.com/pricing.php

Additionally, there are always broken bones that need fixing. Unlike chronic diabetes, hypertension, obesity, etc, fractures usually need urgent treatment and demand immediate attention. There is a lot of cognitive skill that goes into reducing fractures and providing definitive fixation, as well as pure physical labor and technical skill. Patients don't ignore most fractures and want timely treatment. You could argue that more fractures would get treated conservatively if reimbursement was cut. However, a return to serial casting and splinting of fractures would lead to greatly increased office visits and volume, and the extremely high reimbursement of orthopaedic surgeons decades ago.

They don't have to do away from the RVU system. They simply have to revise the fee scheduling to make procedures relatively on par with E&M, which means that whatever advantages a procedure-heavy specialty has will be gone. They can still make more money, but it'll have to be based on volume and hours worked.

Ortho should have no problem making money then. Most people don't realize that it's not that ortho is reimbursed at obscene rates compared to other specialties. The ortho guys tend to be very efficient and see extremely high volume. The ones who really make big money have great business skills and have an ownership stake in the complete picture of their patients' orthopaedic care including imaging, rehab, and durable medical equipment (braces, etc.).

The end of the entitlement mentality in America would be a great thing for medicine. The current insurance system greatly devalues our service. Our reimbursements are dictated by 3rd parties, and not based on what the patient deems our intrinsic worth to be. Patients pay a $20 copay and associate that with the value of their visit. The profits are being funneled to the insurance companies and hospital administrators. A return to supply and demand economics with insurance for catastrophic coverage would increase efficiency, quality, and innovation.

 

[bronx43]

Hopkins is training PA/NP's to do GI scopes as we speak.

Right. I understand this.

You are overlooking the fact that over time that money will be put back into the hands of businesses and wage-earners on all levels due to lower taxes, less distribution of wealth, etc. A healthy economy without a huge tax and debt burden would be a good thing for medicine.

No, I'm actually not overlooking this. This is what politicians use to run for office, depending on their party. Stimulating organic growth, especially in an era of global instability and decreasing natural resources, is hard. Much harder than what simple fiscal policy can fix within a reasonable time frame. And it takes time. Should entitlement programs ever collapse, I'm afraid there is already no hope for this country, as its cutting would require political ammunition that wouldn't be available until true calamity occurs - along the lines of currency collapse, which is the most likely scenario. The decrease taxation vs increasing stimulus debate both sound good on paper, but I'm afraid its effects are going to be far different in reality.

People are willing to pay cash for many elective procedures, especially scopes. There are already ortho practices that are getting cash payments for these types of procedures. Most of these patients are relatively young and motivated. Joints would be a more difficult surgery to get remibursed for in a "cash-only" setting. This is mostly due to hospital and implant costs. However, the demand will keep growing and there will always be a group of patients that will do whatever it takes to get their joint replacements when the pain is bad enough. This group of patients is constantly increasing due to the aging and increasing obese U.S. population.

http://www.surgerycenterok.com/pricing.php

Additionally, there are always broken bones that need fixing. Unlike chronic diabetes, hypertension, obesity, etc, fractures usually need urgent treatment and demand immediate attention. There is a lot of cognitive skill that goes into reducing fractures and providing definitive fixation, as well as pure physical labor and technical skill. Patients don't ignore most fractures and want timely treatment. You could argue that more fractures would get treated conservatively if reimbursement was cut. However, a return to serial casting and splinting of fractures would lead to greatly increased office visits and volume, and the extremely high reimbursement of orthopaedic surgeons decades ago.

Yes, I know that broken bones need fixing. I never questioned that it didn't. That is the one market that ortho will never lose, obviously. That isn't the point of contention. The point of contention is that elective procedures require a certain amount of disposable income from a macroeconomics standpoint (and this is really something that is often missed around here). If you believe in continued growth of the economy, then I suppose you can make this argument, but I doubt that's the case. Or if it is, then we have far deeper disagreements than simply medical business. The fundamental argument I make is that in a scenario of economic stagnation or recession for at least the medium term (if not long term, which is actually more likely), medical care will trend down market as well as towards cost effectiveness. This is simply saying that as resources dwindle, you will use them in the order of importance. On a macro level (I laugh at arguments that state "oh, patients will always want/need this... so this specialty is fine), this means a trend away from elective and less cost effective care towards cheaper alternatives and higher acuity care. For ortho, it means a general downward trend of the highly cost inefficient scoping and joint replacements on an elderly population, most of whom have little to no disposable income.

Ortho should have no problem making money then. Most people don't realize that it's not that ortho is reimbursed at obscene rates compared to other specialties. The ortho guys tend to be very efficient and see extremely high volume. The ones who really make big money have great business skills and have an ownership stake in the complete picture of their patients' orthopaedic care including imaging, rehab, and durable medical equipment (braces, etc.).

The end of the entitlement mentality in America would be a great thing for medicine. The current insurance system greatly devalues our service. Our reimbursements are dictated by 3rd parties, and not based on what the patient deems our intrinsic worth to be. Patients pay a $20 copay and associate that with the value of their visit. The profits are being funneled to the insurance companies and hospital administrators. A return to supply and demand economics with insurance for catastrophic coverage would increase efficiency, quality, and innovation.

Actually, collapse in the entitlement mentality isn't a great thing for doctors. This is absolutely ridiculous. Entitlements are what created the health care bubble that has been seen in the past several decades. The current insurance system doesn't devalue your service. There simply is not correct valuation, as it's not a free market. You have no ground upon which to argue whether it's over-valued or under-valued. Just because third party payers are paying less than what your sentiments dictate is a "fair price" doesn't mean there is true under-valuation. And a "return to supply and demand economics" you describe isn't exactly a free market. As long as there are artificial constraints placed on the supply of providers, it's simply various degrees of price fixing. A free market would allow SUPPLY and demand to both float freely based on market fundamentals. Should the law allow any organization to provide licensing and accreditation to practitioners, then I would see that as a step towards a true free market. Keep in mind this is different from the lack of quality control, so please refrain from this argument.