Phasing out of certain specialties?

[SchroedingrsCat]

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What specialties are most and least likely to be phased out in the next 50 years? I was wondering what would happen to Oncologists if a cancer prevention breakthrough was developed when I thought of this. Is Oncology a safe occupation to enter with all the resources being dedicated to cancer prevention? Any other fields that could be easily prone to become obsolete?

 

[TAWS]

What specialties are most and least likely to be phased out in the next 50 years? I was wondering what would happen to Oncologists if a cancer prevention breakthrough was developed when I thought of this. Is Oncology a safe occupation to enter with all the resources being dedicated to cancer prevention? Any other fields that could be easily prone to become obsolete?

I would say ER would be in trouble if more people get insured.

Uninsured people stop using ER for basic care = less ER visits = less ER doctors needed

Rads and paths are probably open to outsourcing, making them in trouble as well.

 

[johnmendes]

Peds. Older population with less kids. It's not going to stop existing, but I doubt there will be a big demand for it.

 

[Simple Jack]

Derms b/c everybody is staying indoors playing video games

 

[FIREitUP]

Derms b/c everybody is staying indoors playing video games

even the xeroderma pigmentosa folks would be fine.

 

[link2swim06]

What specialties are most and least likely to be phased out in the next 50 years? I was wondering what would happen to Oncologists if a cancer prevention breakthrough was developed when I thought of this. Is Oncology a safe occupation to enter with all the resources being dedicated to cancer prevention? Any other fields that could be easily prone to become obsolete?

Oncologist arent going to become obsolete...let me put it this way..even if we "cure cancer" granted its highly unlikely to have a 1 cure all treatment. But lets say there was, someone still has to administer that, right?

People can "prevent" most heart disease already with diet and exercise yet we have no lacking of a need for cardiologist or CT surgeons. We have know for 40 years toothpaste and floss can prevent cavities, yet people need the dentist.

I dont equate a prevention with making anything obsolete, and with the patient population rising faster than the number of doctors I think you be fine.

 

[MedPR]

What specialties are most and least likely to be phased out in the next 50 years? I was wondering what would happen to Oncologists if a cancer prevention breakthrough was developed when I thought of this. Is Oncology a safe occupation to enter with all the resources being dedicated to cancer prevention? Any other fields that could be easily prone to become obsolete?

Plastics. Nobody will be able to afford it in 50 years when the economy even worse.

Seriously though, definitely not Oncologists for the reasons the above person stated. If I had to pick one, I'd say Rehab medicine. PT, OT, and all those other allied health people can cover that with guidance from Rheum/Ortho.

 

[FIREitUP]

Plastics. Nobody will be able to afford it in 50 years when the economy even worse.

Seriously though, definitely not Oncologists for the reasons the above person stated. If I had to pick one, I'd say Rehab medicine. PT, OT, and all those other allied health people can cover that with guidance from Rheum/Ortho.

I disagree. For one, plastics have secure jobs if they want to do reconstructive breast surgery after double mastectomies, or skin grafting or fixing cleft palates. Second, I would argue that as the economy gets worse, the rich are getting richer and the poor are getting poorer (with a dissolution of the middle class into the lower class). Since rich old white ladies have more money they will pay for more facelifts, botox, tummy tucks, etc. I don't think plastics is going anywhere.

 

[TallScrubs]

Anesthesiology.

In ten years, elementary school gym teachers will be certified to give any and all anesthetics.

 

[dr zaius]

Anesthesiology.

In ten years, elementary school gym teachers will be certified to give any and all anesthetics.

It's because, much like nurses, gym teachers are so much more caring than doctors therefore provide much better treatment.

 

[Bobcat 2006]

I would say ER would be in trouble if more people get insured.

Uninsured people stop using ER for basic care = less ER visits = less ER doctors needed
.

Highly doubtful, even if all uninsured people had a PCP, they would still go to the ER when they call their PCP and find out they are too busy to seem them because everyone else who now has insurance is waiting in line to see them, if anything more people will go to the ER because now someones paying for it.

Also people will still have accidents, heart attacks etc.

If your a physician in this country chances are good you'll have a job

 

[MedPR]

I disagree. For one, plastics have secure jobs if they want to do reconstructive breast surgery after double mastectomies, or skin grafting or fixing cleft palates. Second, I would argue that as the economy gets worse, the rich are getting richer and the poor are getting poorer (with a dissolution of the middle class into the lower class). Since rich old white ladies have more money they will pay for more facelifts, botox, tummy tucks, etc. I don't think plastics is going anywhere.

The next sentence, the one that starts with "seriously" should've tipped you off that I was joking. And if the economy keeps going the way it is, do you really think the upper class will stick around? Once the middle class has completely disappeared, who do you think is next?

 

[Shnurek]

The next sentence, the one that starts with "seriously" should've tipped you off that I was joking. And if the economy keeps going the way it is, do you really think the upper class will stick around? Once the middle class has completely disappeared, who do you think is next?

Upper class has already stockpiled their savings in diverse ways such as gold and other heavy metals. Buying real estate. Along with buying into the euro and the canadian dollar. Don't worry, they won't be hurtin' 🙂

 

[TAWS]

Highly doubtful, even if all uninsured people had a PCP, they would still go to the ER when they call their PCP and find out they are too busy to seem them because everyone else who now has insurance is waiting in line to see them, if anything more people will go to the ER because now someones paying for it.

In the short term, this might be true but once the supply of primary care doctors is enough to meet demand, ER visits will go down.

 

[DreamingTheLive]

In the short term, this might be true but once the supply of primary care doctors is enough to meet demand, ER visits will go down.

Based upon?........Doubtful, I'd argue the opposite.

Also, when is the supply of PCPs going to meet the demand considering the enormous PCP shortage currently in/looming, not to mention the fact that less and less med students are entering into primary care fields.

Then again, I cannot predict the future. ****.

 

[TAWS]

Based upon?........Doubtful, I'd argue the opposite.

Also, when is the supply of PCPs going to meet the demand considering the enormous PCP shortage currently in/looming, not to mention the fact that less and less med students are entering into primary care fields.

Then again, I cannot predict the future. ****.

I agree, its hard to predict. However, hospitals are closing ER rooms despite there being more ER visits. Why? ER visits don't make hospitals money.
http://www.nytimes.com/2011/05/18/health/18hospital.html

There might be a higher demand in ER visits but there is no incentives for hospitals to meet that demand by hiring more ER doctors if its not profitable. ER wait times will just increase

 

[Bobcat 2006]

I agree, its hard to predict. However, hospitals are closing ER rooms despite there being more ER visits. Why? ER visits don't make hospitals money.
http://www.nytimes.com/2011/05/18/health/18hospital.html

There might be a higher demand in ER visits but there is no incentives for hospitals to meet that demand by hiring more ER doctors if its not profitable. ER wait times will just increase

I still disagree with this, ER themselves do lose money but the hospital makes money via the people that get admitted through the ER not to mention its the law for a hospital to have an ER to receive money from medicare

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

I just dont think any ER physicians families will go hungry

 

[DreamingTheLive]

I still disagree with this, ER themselves do lose money but the hospital makes money via the people that get admitted through the ER not to mention its the law for a hospital to have an ER to receive money from medicare

http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act

I just dont think any ER physicians families will go hungry

Exactly.

 

[jdh71]

I would say ER would be in trouble if more people get insured.

Uninsured people stop using ER for basic care = less ER visits = less ER doctors needed

Rads and paths are probably open to outsourcing, making them in trouble as well.

ER isn't so busy for lack insurance, which, of course is a real and present problem, but more because . . . the idiots . . . we shall always have with us.

Apparently we can't just kill them outright.

 

[FIREitUP]

The next sentence, the one that starts with "seriously" should've tipped you off that I was joking. And if the economy keeps going the way it is, do you really think the upper class will stick around? Once the middle class has completely disappeared, who do you think is next?

Yeah because sarcasm translates so well on the internet. I'm such an idiot (sarcasm).

 

[normtheniner]

Highly doubtful, even if all uninsured people had a PCP, they would still go to the ER when they call their PCP and find out they are too busy to seem them because everyone else who now has insurance is waiting in line to see them, if anything more people will go to the ER because now someones paying for it.

Also people will still have accidents, heart attacks etc.

If your a physician in this country chances are good you'll have a job

Not to mention a continually aging population with a plethora of chronic conditions that will usually result in an ER visit once or twice...

 

[docB]

I would say ER would be in trouble if more people get insured.

Uninsured people stop using ER for basic care = less ER visits = less ER doctors needed

Rads and paths are probably open to outsourcing, making them in trouble as well.

I agree, its hard to predict. However, hospitals are closing ER rooms despite there being more ER visits. Why? ER visits don't make hospitals money.
http://www.nytimes.com/2011/05/18/health/18hospital.html

There might be a higher demand in ER visits but there is no incentives for hospitals to meet that demand by hiring more ER doctors if its not profitable. ER wait times will just increase

I disagree. Studies of ED overcrowding have shown that while uninsured people seek primary care from them it is insured patients who contribute more volume.

http://www.acep.org/content.aspx?id=48020

Frequent users of the emergency department are predominantly white, insured and at greater risk for hospitalization due to serious illness, despite public perceptions of them as abusers of the healthcare system with minor complaints and no health insurance. This is the consensus of a systematic review of two dozen published studies of so-called "frequent flyers." ("Frequent Users of Emergency Departments: The Myths, the Data, and the Policy Implications")

"Frequent emergency department users have been proposed as targets of health care reform, but the common assumptions that their visits are frivolous or due to lack of health insurance are not supported by data," said Eduardo LaCalle, MD, MPH, of the Department of Emergency Medicine at the Mount Sinai School of Medicine in New York "These patients, who represent 4.5 to 8 percent of all emergency patients but 21 to 28 percent of all visits, defy popular assumptions. One example: the uninsured represent only 15 percent of frequent users."

Cunningham P,
Issue Brief (Center for Studying Health System Change) [2003(70):1-6]
Type: Journal Article

Visits to hospital emergency departments (EDs) have increased greatly in recent years, contributing to crowded conditions and ambulance diversions. Contrary to the popular belief that uninsured people are the major cause of increased emergency department use, insured Americans accounted for most of the 16 percent increase in visits between 1996-97 and 2000-01, according to a study by the Center for Studying Health System Change (HSC). This Issue Brief examines trends in emergency department and other ambulatory care use, focusing on differences among insurance groups. Although insured people accounted for most of the increase in emergency department visits, uninsured Americans increasingly rely on emergency departments because of decreased access to other sources of primary medical care. Emergency department waiting times also have increased substantially, which may lower both insured and uninsured patients' perceptions of the quality of their care.

So current trends would mean that "insurance" i.e. Medicaid for everyone would result in increased ED visits.

This is echoed in the NYT article you cited:

Conditions in emergency rooms may be worsened by the new health care law, several experts said. The law will expand eligibility for Medicaid, the government health plan for the poor. Often beneficiaries turn to emergency rooms for care, because many physicians do not accept Medicaid payments, said Dr. Sandra M. Schneider, president of the American College of Emergency Physicians.

EDs have closed but others have opened. Closures predominantly happen in area where the payer mix can not support the hospital (as the article noted), i.e. if all your patients are uninsured or Medicaid you will close. Better off areas will have continued service. This may not be right but it is reality. EM isn't going anywhere.

NY Comptroller study of proposed NYC ED closures:
http://www.comptroller.nyc.gov/bureaus/opm/reports/hospital-06/dec-21-06_hospital-report.pdf

 

[TAWS]

I disagree. Studies of ED overcrowding have shown that while uninsured people seek primary care from them it is insured patients who contribute more volume.

Seems to me that the problem of insured people using ER for non-serious injuries can be easily fixed. Just increase the co-pay for ER visit and refund that co-pay if they end up being hospitalized. Can you tell me why this isn't done?

I was amazed to hear that there are some plans with ER co-pays of only $100

 

[Sheldor]

Seems to me that the problem of insured people using ER for non-serious injuries can be easily fixed. Just increase the co-pay for ER visit and refund that co-pay if they end up being hospitalized. Can you tell me why this isn't done?

I was amazed to hear that there are some plans with ER co-pays of only $100

$100? The last few insurance companies we've used have been $50.

 

[Shnurek]

Seems to me that the problem of insured people using ER for non-serious injuries can be easily fixed. Just increase the co-pay for ER visit and refund that co-pay if they end up being hospitalized. Can you tell me why this isn't done?

I was amazed to hear that there are some plans with ER co-pays of only $100

Ya my insurance is $50 and I have HIP. I say MAKE a co-pay for medicaid patients. They use ambulances as taxis by faking a cough and sniffling. Or instead of going to see their PCP they just go to the ED with the slightest problem. Orrr just to drug-seek. There's ya prob.

 

[valkener]

The next sentence, the one that starts with "seriously" should've tipped you off that I was joking. And if the economy keeps going the way it is, do you really think the upper class will stick around? Once the middle class has completely disappeared, who do you think is next?

It'll be like in India, a fine elite and the rest lives in the stone age.

 

[chronicidal]

anesthesia, undermined by nurse anesthetists.

 

[mmmcdowe]

anesthesia, undermined by nurse anesthetists.

Nah, they aren't going anywhere soon.

 

[DoctwoB]

Fields based on a specific modality and/or procedure are more likely to be phased out then a field based on a region of the body.

For example, nuclear medicine is all but a dead field and has been largely absorbed into radiology.

As for future specialties, it's not hard to imagine a time when targeted chemotherapeutics greatly reduce the need for external beam radiation, greatly reducing the need for rad-oncs.

Obviously if you "cure" something that is central to a specialty, that means less business, but these magical cures people talk about almost never seem to happen, especially for chronic disease w/ major lifestyle contributions. if anything, we develop medications that improve survival but require constant tinkering/management. You could have argued that anti-hypertensives and statins would kill cardiology, but first off someone has to administer these meds, alter regimens, etc, and secondly people still get cardiovascular disease, just a bit later then they would have without the meds.

 

[calvnandhobbs68]

What specialties are most and least likely to be phased out in the next 50 years? I was wondering what would happen to Oncologists if a cancer prevention breakthrough was developed when I thought of this. Is Oncology a safe occupation to enter with all the resources being dedicated to cancer prevention? Any other fields that could be easily prone to become obsolete?

You have a fairly limited understanding of cancer biology if you're even using the phrase "cancer prevention breakthrough" as if there's an overall "cancer" than can get cured by some magic pill if we only look hard enough...like most of the population.

In short, oncology isn't getting phased out anytime soon. Lots of very smart people have spent their entire lives making incremental steps in this field.

 

[docB]

Seems to me that the problem of insured people using ER for non-serious injuries can be easily fixed. Just increase the co-pay for ER visit and refund that co-pay if they end up being hospitalized. Can you tell me why this isn't done?

I was amazed to hear that there are some plans with ER co-pays of only $100

Good question. They can't raise the copays too much for a few reasons. First insurance companies still have to sell their products. If no one will buy their insurance, or contract with them for their group plans, they will go out of business. And customers hate copays. If the copays get too high the customers will bail out and go to a competitor.

They also can't raise the copays for ER visits to "excessive" levels because sooner or later someone will avoid going to the ER because they are afraid of the copay and they'll die. The bad publicity will hurt the company.

 

[michaelrack]

Seems to me that the problem of insured people using ER for non-serious injuries can be easily fixed. Just increase the co-pay for ER visit and refund that co-pay if they end up being hospitalized. Can you tell me why this isn't done?

Seriousness often doesn't equal need for hospitalization- fractures, new onset seizures (sometimes).

Also, a policy like this might lead to increased hospitalizations (borderline cases pushing for inpt treatment), although this could be controlled for by appropriately setting the copay for inpt tx.

 

[Mace1370]

Good question. They can't raise the copays too much for a few reasons. First insurance companies still have to sell their products. If no one will buy their insurance, or contract with them for their group plans, they will go out of business. And customers hate copays. If the copays get too high the customers will bail out and go to a competitor.

They also can't raise the copays for ER visits to "excessive" levels because sooner or later someone will avoid going to the ER because they are afraid of the copay and they'll die. The bad publicity will hurt the company.

I think if they raise the copay slowly then they could get away with it. People will notice a jump of $50 to $400, but if they raise it by $25 every year then most people won't pay attention.

 

[AugustBurnsDan]

Here is my take on the issue.

All medical fields will become obsolete. Machines will take over. John Connor will lead a revolution. California will fall into the ocean.

But really, from what I've seen, CRNAs are really being pushed for by hospitals. I had a procedure done in the past year, I was not aware that a CRNA was putting me under, as they referred to her as Doctor. Not a problem for me, but if I was having something more serious done I would have felt a bit safer with a real md.

 

[Phelanpi]

I think that outdated medical specialties will be absorbed into other up an coming specialties. For instance, i foresee the new interventional neurology fellowship becoming to neurosurgery what interventional cardiology has become to the CT surgeon. I know a CT surgeon who was forced to retrain as a vascular surgeon because his case load couldn't support him. My philosophy is to find the specialty that you WANT to do, even if you had millions of dollars you would still find it interesting and rewarding. If that specialty is made obselete by a new therapy or technique we should be happy that the patients are having better options when it comes to the treatment of disease. You have to stay flexible and willing to change otherwise you wont make it in medicine.

 

[medicsb]

Seems to me that the problem of insured people using ER for non-serious injuries can be easily fixed. Just increase the co-pay for ER visit and refund that co-pay if they end up being hospitalized. Can you tell me why this isn't done?

I was amazed to hear that there are some plans with ER co-pays of only $100

Some (many?) conditions can be treated and discharged from the ED that could not be treated by a PCP.

As a medic I treated a number of patients who were later discharged from the ED... PSVTs, asthma, COPD exacerbations, seizures... etc.

Personally, I had a bad case of gastritis where I spent a night puking my guts up literally every 15 minutes. At 6am I drove myself to the ED and received 3L of fluid, 10mg reglan, and 25mg of phenergan. Not sick enough to be admitted, but I was sick. I don't know of any PCPs who would have taken me at 6am, and if they did, I don't know of any that would have been able to adequately treat me (especially considering that many PCPs can't seem to give chest pain patients aspirin, even after they have called 911 to have the patient taken to the ED for a MI rule-out). I think its safe to say that just because someone isn't admitted from the ED, does NOT mean they weren't sick or did not need the services of an EM physician.

 

[DoctwoB]

I think that outdated medical specialties will be absorbed into other up an coming specialties. For instance, i foresee the new interventional neurology fellowship becoming to neurosurgery what interventional cardiology has become to the CT surgeon.

Doubtful. INR has already taken most aneurysm cases, but will have a lot of trouble taking spine (neurosurgery bread and butter), most tumor cases, decompressive craniotomies/trauma cases, shunts (good luck accessing the ventricles intravascularly), DBS, etc. etc.

The difference was cardiothoracic surgery was a specialty largely built around 1 procedure. When that procedures volume went way down, there were way to many CT surgeons relative to case volume. Aneurysm clippings were a relatively minor portion of a neurosurgeon's practice, especially in private practice (mostly spine).

 

[Law2Doc]

...shunts (good luck accessing the ventricles intravascularly).

IR already do CT guided LPs so it's not really inconceivable that the ventricles or obstructions could ultimately be accessed at some point from below, ie not intravascularly. I don't think neurosurgery is too worried about this just yet. For them the bigger turf wars are with the ortho spine guys.

 

[docB]

I think if they raise the copay slowly then they could get away with it. People will notice a jump of $50 to $400, but if they raise it by $25 every year then most people won't pay attention.

I don't think so. Most insured patients don't use the ER that often. If they come in once and it's $50 and they come in again 4 years later and it's $150 they will complain to whoever contracts for their insurance.

Some (many?) conditions can be treated and discharged from the ED that could not be treated by a PCP.

As a medic I treated a number of patients who were later discharged from the ED... PSVTs, asthma, COPD exacerbations, seizures... etc.

Personally, I had a bad case of gastritis where I spent a night puking my guts up literally every 15 minutes. At 6am I drove myself to the ED and received 3L of fluid, 10mg reglan, and 25mg of phenergan. Not sick enough to be admitted, but I was sick. I don't know of any PCPs who would have taken me at 6am, and if they did, I don't know of any that would have been able to adequately treat me (especially considering that many PCPs can't seem to give chest pain patients aspirin, even after they have called 911 to have the patient taken to the ED for a MI rule-out). I think its safe to say that just because someone isn't admitted from the ED, does NOT mean they weren't sick or did not need the services of an EM physician.

That's true but the point is not to arbitrarily punish people who use the ED. It is to make the ED a costly resource to them so that they carefully consider if they need the ED or could use a lower level of care. In the scenario you presented you presumably felt so bad that having to pay your copay would have been worth it to you to get ER treatment. That's the whole point, to make people think before they go to the ED. To make them have some skin in the game.

In EM we see the converse every day, Medicaid patients who use ambulances like taxis to come to the ER for silly complaints. They have no out of pocket expense for using the highest levels of care and so they do so without regard to whether it's appropriate or not.

 

[badasshairday]

I think that outdated medical specialties will be absorbed into other up an coming specialties. For instance, i foresee the new interventional neurology fellowship becoming to neurosurgery what interventional cardiology has become to the CT surgeon.

Interventional Neuroradiology/Interventional Nuerology/Endovascular Neurosurgery is different from Interventional Cardiology in that 3 specialties are entrenched in the development of the field. Unlike the CT surgeons of yesteryear, neurosurgeons are very involved in the endovascular treatment of cerebrovascular disorders. In fact radiologists and neurosurgeons make up the majority of trainees and practicioners in INR.

 

[cbrown1311]

I don't think so. Most insured patients don't use the ER that often. If they come in once and it's $50 and they come in again 4 years later and it's $150 they will complain to whoever contracts for their insurance.



That's true but the point is not to arbitrarily punish people who use the ED. It is to make the ED a costly resource to them so that they carefully consider if they need the ED or could use a lower level of care. In the scenario you presented you presumably felt so bad that having to pay your copay would have been worth it to you to get ER treatment. That's the whole point, to make people think before they go to the ED. To make them have some skin in the game.

In EM we see the converse every day, Medicaid patients who use ambulances like taxis to come to the ER for silly complaints. They have no out of pocket expense for using the highest levels of care and so they do so without regard to whether it's appropriate or not.

But how high is too high? I could also see stubborn/poor patients not utilizing the ER in situations that they should be because they are afraid of the cost. If you have to pay a ridiculous copay for an ambulance, you might think very carefully about driving yourself to the ER.

 

[lewstools]

It's because, much like nurses, gym teachers are so much more caring than doctors therefore provide much better treatment.

...and the caring of gym teacher's pale in comparison to the empathetic janitors. In the future getting a good janitorial fellowship may be among the most competitive.

 

[45408]

I think that outdated medical specialties will be absorbed into other up an coming specialties. For instance, i foresee the new interventional neurology fellowship becoming to neurosurgery what interventional cardiology has become to the CT surgeon.

I certainly don't. The interventional neurologist isn't going to be doing the epidural hematomas, subdurals, skull fractures, spine cases, or any of the congenital defects. They would really only be poaching things like aneurysms, AV malformations, and maybe chemoembolization of things, which is a very small portion of what the neurosurgeons at my hospital do.

 

[jdh71]

When the Singularity occurs, we'll all be obsolete as carbon based life forms. Out computer overlords will have no need of us, and therefore no need of physicians.

haha

owned

lawl

 

[dr zaius]

When the Singularity occurs, we'll all be obsolete as carbon based life forms. Out computer overlords will have no need of us, and therefore no need of physicians.

haha

owned

lawl

The only humans left with be PC repairmen.

 

[K31]

The only humans left with be PC repairmen.