it seems like virtually every field of medicine's turf is being invaded and how severe this invasion is determines how competitive the various specialties are. optho- facing intense pressure from optomotrists(i've heard of many optho complaining bitterly of this intrusion) anaesthsia- CRNA's Derm- Primary care doctors(although derm is probably always going to be a competitive field it is my understanding that most insurance companies would much rather see the gp treating skin conditions rather than a dermatologist since it's so much cheaper) pmr- pt,ot,(and for pain management it seems like their going to be battling anaestheia) IM,FP,ER and peds- PA's and nurse practioners, as much as i hate to admit it most of the preventative measures and chronic disease management(ie diabetes,ht,high cholestrol) which represents like 90% of what these guys do can probably be easily managed by PA's, nurse practioners. ob- nurse practioners, Fm, other surgeons surgeons- other surgeons(seems like their all chasing the same dime) and technology(as the trend continues towards being less and less invasive the surgeon's territory is going to dwindle even more(virtually every surgical resident i've talked to agrees with this and like 90% of them plan on pursuing specialty training because of this). radiology- technology is the only real threat i can see to this field in the short term.(ie computers reading images, otherwise no pa is going to replace the radiologist and i guess thats part of the reason why this field is so competitive now) orthopedic surgery- not to many forseeable threats to their turf although pt,ot can take some of thier bread i guess, especially if the trend continues toward less invasive treatments. I guess the conclusion i've drawn is that whenever any field starts receiving competition that field's allure starts diminishing. It's no coincidence that Ent,ortho, and radiology, the 3 fields which seem to be the least threatened by outside competition are also 3 of the most competitive residencies to secure. I also remember like 5 years ago how to get into optho you needed literally a signed statement from god. Nowadays it's alot less competive as salaries have come down and the cost of procedures has plummeted. After talking to some opthamologists my gut feeling tells me things are going to get a whole lot worse before they get better. It won't suprise in the next couple of years if IMGs start cropping up in a field that was once reserved for the all americas of med school. The field that's getting it's tail kicked in right now is surgery. After talking to some program directors earlier in the year, many told me that for the first time since as long as they can remember they don't expect to fill and in all likelyhood IMG's are going to flood this field in the coming years. Furthermore we all know what sort of ride anaesthesia has taken over the last 10 Years.(thank god for me things are starting to look up). Anyways this is very scary stuff to know that after so much hardwork your livelyhood can be taken away. Believe me when i was on the wards and everytime a PA knew an answer that i didn't i felt sweat running down the back of my spine. And this is not because i'm an insecure person but because it reminded me that alot of what i'm going to be doing another person can probably do for alot cheaper. After 4 years of med school i feel that doctors(no matter what field they're in) have an unalienable right to a minimum of 200k to start for all the bull**** they've gone through in the last 7 years of their training.(ps the people i really feel are underpaid are the surgeons, ie they should make at least 300k for the rest of their careers for hell they have to go through). Anyways i never thought that i would feel nervous about job prospects as a physician when i choose medicine as a career, but if anything medicine is like any other field in the sense that their are many scavengers willing to move in on your turf. My friends,it seems like it's jungle out there and we're not as insulated from all of these predators as i once thought we were.