Predict the future!

[optimus_prime]

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This has become a favorite past time on this site, so why not throw another question out there.
Assuming that at least some of Obama's agenda gets passed, which of the anesthesia subspecialties stands to do the best from a 1) job security and 2) financial standpoint?

My though it that peds and CT are likely to suffer the same fate as general anesthesiologists in terms of money, with maybe a bit more job security.

Pain should do fine from a job security standpoint, but maybe worse financially.

Critical care is anyone's guess.

Just my 2 cents, what does everyone else think?

 

[InductionAgent]

I'm not planning on doing a fellowship. I finish my residency this year. I believe that for the remainder of my career, I'll have a job as an anesthesia generalist, and it will pay much better than the job I currently have. I will continue to have the opportunity to do my own cases one-on-one if I prefer, although it will probably pay less per hour than working in an anesthesia care team model.

Obama's changes might not be favorable for me, but they will not by any means ruin my career or force me to live in squalor.

 

[principe]

How did you come up with your predictions?

 

[darkmansaad]

waiting for the inevitable BladeMDA and coprolalia response

 

[OB1🤙]

ZOMG ENTITLEMENT KOOL AID COMMUNISM TEABAGTEABAGTEABAG xanax

 

[Trisomy13]

 

[badasshairday]

Future: Everyone get's payed less and then we 🙁 cry.

 

[deleted50478]

My prediction: The blood thirsty trial lawyers continue to suck everyone dry while contributing little to nothing.

(That's my prediction for medicine and all other industries in the US.)

 

[optimus_prime]

I appreciate the replies, but the point of the question was to generate some discussion about the perceived advantages/disadvantages of doing a fellowship. I appreciate the feedback.

 

[Jeff05]

do a fellowship. it's 1 year. salaries have slid down far enough that you're not really losing that much money.

peds - this will always be an physician driven field
critical care - you will be in more demand than you think. your salary will NOT be lower than the other partners in your group (you'll be doing some anesthesia as well)
pain - a completely different specialty to practice, in case...
cardiac - echo and ability to do the sickest patients with ease. always in demand.
OB - mostly a huge waste of time. but, ok if you want to stay in academics.
regional - not really necessary if you have a decent residency, but since it's THE only thing happening in anesthesia right now, you are in demand.

 

[sevo85288]

pay will decrease. work load and acuity will increase. you will have a job. if you are a good doctor and easy to get along with; you'll have a job...

 

[coprolalia]

My prediction: The blood thirsty trial lawyers continue to suck everyone dry while contributing little to nothing.

(That's my prediction for medicine and all other industries in the US.)

👍

(There's my response.)

-copro

 

[BLADEMDA]

pay will decrease. work load and acuity will increase. you will have a job. if you are a good doctor and easy to get along with; you'll have a job...

Yes. I agree. Pay should still be 25% greater than a CRNA even as a generalist. Fellowship will help secure work as a Supervisor in the expanded ratio of midlevels to MD.

 

[BLADEMDA]

do a fellowship. it's 1 year. salaries have slid down far enough that you're not really losing that much money.

peds - this will always be an physician driven field
critical care - you will be in more demand than you think. your salary will NOT be lower than the other partners in your group (you'll be doing some anesthesia as well)
pain - a completely different specialty to practice, in case...
cardiac - echo and ability to do the sickest patients with ease. always in demand.
OB - mostly a huge waste of time. but, ok if you want to stay in academics.
regional - not really necessary if you have a decent residency, but since it's THE only thing happening in anesthesia right now, you are in demand.

good post. I hope you medical students understand that 2020 will not be like 2009. You must be prepared to compete in the new paradigm

 

[coprolalia]

good post. I hope you medical students understand that 2020 will not be like 2009. You must be prepared to compete in the new paradigm

Not to worry. The machines will take over by then. SKYNET goes live in 2015.

-copro

 

[deleted126335]

.

 

[coprolalia]

We missed it. SKYNET was supposed to go live 2:14 am August 29, 1997.

Bureaucratic delay...

-copro

 

[pmichaelmd]

Bureaucratic delay...

-copro

 

[coprolalia]

Seriously.

Read Atul Gawande's recount of William Osler. That was truly the "golden age" of medicine.

-copro

 

[Narcotized]

Very similar to Clubber Lang's prediction: Painnnn..........

A debt death spiral in which we can no longer service the debt without high taxes, high interest rates, and money printing leading to a currency devaluation, hyperinflation, and an economic collapse. Widespread rioting will occur when Entitled America has their freebees cut off. In addition there will be massive food and energy shortages leading to crime waves and anarchy. Every household will look like an armed fort. Those smart enough to stockpile food or have farms will face constant armed attack. You will eventually lose almost all of your material wealth as it becomes worthless, stolen, or abandoned. Through it all some politician will say, "America's best days are ahead of us."

 

[frank51]

Very similar to Clubber Lang's prediction: Painnnn..........

A debt death spiral in which we can no longer service the debt without high taxes, high interest rates, and money printing leading to a currency devaluation, hyperinflation, and an economic collapse. Widespread rioting will occur when Entitled America has their freebees cut off. In addition there will be massive food and energy shortages leading to crime waves and anarchy. Every household will look like an armed fort. Those smart enough to stockpile food or have farms will face constant armed attack. You will eventually lose almost all of your material wealth as it becomes worthless, stolen, or abandoned. Through it all some politician will say, "America's best days are ahead of us."

While the situation above may not fully play out, everyone needs to understand that higher taxes and hyperinflation are coming. If you add that to the decrease in reimbursements, you can only come up with one answer, a substantial drop in the standard of living, simple.

 

[cfdavid]

While the situation above may not fully play out, everyone needs to understand that higher taxes and hyperinflation are coming. If you add that to the decrease in reimbursements, you can only come up with one answer, a substantial drop in the standard of living, simple.

Yep. We can "hope" it doesn't happen, but the facts are the facts. We can't escape the numbers. Chilling.

Watch out for "false flag" incidents, or intentional provocations, that could lead us to another war.......

 

[coprolalia]

While the situation above may not fully play out...

It will never fully play out. Americans, quite frankly, are way too f**king fat, lazy, and apathetic.

But, personally, this remains part of the reason why I stay in good physical condition and own a lot of guns... just sayin'.

-copro

 

[cfdavid]

It will never fully play out. Americans, quite frankly, are way too f**king fat, lazy, and apathetic.

But, personally, this remains part of the reason why I stay in good physical condition and own a lot of guns... just sayin'.

-copro

Nothing to support my numbers other than a rough guess, but I'd say that while I agree that most Americans ARE fat, lazy and apathetic, we probably have 20-50 million that AREN'T. These are the people that can drive a revolution if sh.t hits the fan.

As an aside, Smith and Wesson sales are at all time highs..... These are not, as a whole, criminals buying these weapons, but rather average citizens that feel, intrinsically, that these are very volatile times. We'll see what happens. We live in interesting times to say the least.

 

[RussianJoo]

Nothing to support my numbers other than a rough guess, but I'd say that while I agree that most Americans ARE fat, lazy and apathetic, we probably have 20-50 million that AREN'T. These are the people that can drive a revolution if sh.t hits the fan.

As an aside, Smith and Wesson sales are at all time highs..... These are not, as a whole, criminals buying these weapons, but rather average citizens that feel, intrinsically, that these are very volatile times. We'll see what happens. We live in interesting times to say the least.

Texas is always looking for an excuse to dissociate from the Union.

 

[coprolalia]

Texas is always looking for an excuse to dissociate from the Union.

They probably should. They're one of the few states that actually has their **** together and could probably pull it off.

California, OTOH, despite by itself having the 10th largest GDP in the world (mostly from Hollywood entertainment revenues) would be a complete and utter disaster if it tried that.

-copro

 

[cfdavid]

They probably should. They're one of the few states that actually has their **** together and could probably pull it off.

California, OTOH, despite by itself having the 10th largest GDP in the world (mostly from Hollywood entertainment revenues) would be a complete and utter disaster if it tried that.

-copro

From what I've read, they're actually a pretty diverse economy (california that is), tech, manufacturing (aerospace), agriculture etc.

I think their problem has just been out of control spending. Anyone from Cali care to comment?

 

[coprolalia]

From what I've read, they're actually a pretty diverse economy (california that is), tech, manufacturing (aerospace), agriculture etc.

I think their problem has just been out of control spending. Anyone from Cali care to comment?

So does Texas, which buries California on many other fronts, despite having similar problems with illegal immigration.

According to The World Factbook published by the CIA, if California were an independent state, it would have had the tenth largest economy in the world in 2007.

http://en.wikipedia.org/wiki/Economy_of_California#California_as_an_independent_nation

Texas has an economy that was the second largest in the nation and the 15th largest in the world based on GDP (nominal) figures.

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

Another thing is that the Gub-a-NA-tor in CA, arguably a Democrat Wolf in a Republican Sheep's clothing, has made some bad budget decisions - and now even more worrisome policy decisions - and is running that State even further into the ground.

Texas wins hands-down in my opinion.

-copro

 

[coprolalia]

But, don't worry all you Californians...

Arnold is going to FIX YOUR BUDGET DEFICIThttp://en.wikipedia.org/wiki/California_Assembly_Bill_390 the "green" way...

This should've been named "Assembly Bill 420"... haha.

-copro

 

[pgg]

I think their problem has just been out of control spending. Anyone from Cali care to comment?

All I have to say about California is that my unexpected relocation from gun-friendly Virginia to the Peoples Republic meaned that I had to leave a bunch of "high capacity" magazines and a big scary evil black "assault" rifle with my brother, who lives in a state that still mostly respects the Constitution.

However, the improvement in the quality and availability of Mexican food, compared to the Mexican-culinary-cesspool that is Virginia, is some consolation.

But, personally, this remains part of the reason why I stay in good physical condition and own a lot of guns... just sayin'.

That's right, when the zombies come or civilization collapses, there'll be at least two well-armed groups with top notch anesthesia coverage. 🙂

Somewhat more seriously though, this is occasionally an interesting read - http://ferfal.blogspot.com/

Haven't read hsi book, but the blog is written by a guy who's lived in Argentina through their own economic disaster. Plenty of weird borderline crazy survivalist stuff, but also an indication of what can happen when a 1st world country encounters massive unemployment, the corrupt leading sheeple people, currency devaluation, and a government that mismanages nationalized services like the power grid or just fails to fund trivialities of civilization like police/sanitation.

What surprises me most about Argentina is how almost-normal he says it still is: "People still live their lives, tourists come visit, kids mostly go to school (well, they closed because of the flu for several weeks and strikes are fairly common) but there are the problems I mention such as collapsed infrastructure in nearly all aspects, an inefficient and highly corrupt government, and crime problems that, even though more or less obvious depending where you are located, is out of control and out of charts." It's hard to read that, look at what's going on here, and think it's all just going to be OK.

This nation's standard of living has been unsustainable for a long time. We produce little and export hundreds of billions of dollars of our wealth every year to buy oil and disposable consumer goods. I used to think the global recalibration wouldn't happen in my lifetime - no longer.

 

[Narcotized]

.

 

[coprolalia]

This nation's standard of living has been unsustainable for a long time. We produce little and export hundreds of billions of dollars of our wealth every year to buy oil and disposable consumer goods. I used to think the global recalibration wouldn't happen in my lifetime - no longer.

I will say it again: If Obama (or his legacy) ultimately proves to be successful at turning this country into Western Europe, I'm going to move there.

With the EU (or, as I like to call it, the "United States of Europe") continuing to grow and get stronger and stronger with each passing year (just look at the history of the Euro against the U.S. Dollar), we will not be able to continue to meaningfully compete on the world economy in no small part to some of the reasons you mention.

Yeah, we're really going to be f*cked in the not-too-short run (next 15-20 years) no matter what we do. But, adding TRILLIONS of dollars to the deficit with Obama's vision of "change" is only going to expedite things.

I'm squirreling away money now. And, much of it will be going into a foreign bank account (and not necessarily Switzerland with their recent sunshine laws).

(Don't get me wrong. This country still rules. More people want to come here than anywhere else in the world. We're still way ahead of Europe in comparison to their out-of-control taxes, average per capita amount of take-home pay, and living in what is essentially tantamount to a soft, more modern version of classic Socialism. My fear is that Obama, despite what he says, is going to ultimately level the playing field believing that we need to be more like them.... and that's the impression he's given me from Day 1.)

-copro

 

[coprolalia]

Exactly. The cold hard reality leaves an underlying funk I try not to think about. I went back to residency to switch fields in my 40's, survived a gorgeous rain storm known as one big colossal natural disaster, and spent 3 years with a few of the most ungodly dysfunctional bleephole attendings on the planet, only to come out to Obamageddon.

Dude, you got a REALLY late start. I hope you're living like a monk right now and putting away as much cash - or, preferably, other tangible assets that have lasting value on the world economy - right now.

-copro

 

[pgg]

I will say it again: If Obama (or his legacy) ultimately proves to be successful at turning this country into Western Europe, I'm going to move there.

Well, by the time the US morphs into western Europe, my guess is that western Europe will have morphed into some kind of bizarro world with parallel western secular and muslim theocratic governments. Think the Islamic equivalent of Native American tribal government independence writ large and ugly, and minus any redeeming features like casinos. One problem we don't have is western Europe's ongoing demographic shift toward that broken culture.

At least our Mexican immigrants - legal and illegal - bring a work ethic and delicious tacos.

Regardless, I'm staying here. I don't know if I'll be able to handle California for the rest of my life, but I won't leave the US.

 

[cfdavid]

So does Texas, which buries California on many other fronts, despite having similar problems with illegal immigration.



http://en.wikipedia.org/wiki/Economy_of_California#California_as_an_independent_nation



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

Another thing is that the Gub-a-NA-tor in CA, arguably a Democrat Wolf in a Republican Sheep's clothing, has made some bad budget decisions - and now even more worrisome policy decisions - and is running that State even further into the ground.

Texas wins hands-down in my opinion.

-copro

Isn't Texas an income tax free state?? I'm pretty sure they are... So, that's one up on California for sure. Never been to Cali, but I heard parts are beautiful (Texas too though).

 

[cfdavid]

All I have to say about California is that my unexpected relocation from gun-friendly Virginia to the Peoples Republic meaned that I had to leave a bunch of "high capacity" magazines and a big scary evil black "assault" rifle with my brother, who lives in a state that still mostly respects the Constitution.

However, the improvement in the quality and availability of Mexican food, compared to the Mexican-culinary-cesspool that is Virginia, is some consolation.




That's right, when the zombies come or civilization collapses, there'll be at least two well-armed groups with top notch anesthesia coverage. 🙂

Somewhat more seriously though, this is occasionally an interesting read - http://ferfal.blogspot.com/

Haven't read hsi book, but the blog is written by a guy who's lived in Argentina through their own economic disaster. Plenty of weird borderline crazy survivalist stuff, but also an indication of what can happen when a 1st world country encounters massive unemployment, the corrupt leading sheeple people, currency devaluation, and a government that mismanages nationalized services like the power grid or just fails to fund trivialities of civilization like police/sanitation.

What surprises me most about Argentina is how almost-normal he says it still is: "People still live their lives, tourists come visit, kids mostly go to school (well, they closed because of the flu for several weeks and strikes are fairly common) but there are the problems I mention such as collapsed infrastructure in nearly all aspects, an inefficient and highly corrupt government, and crime problems that, even though more or less obvious depending where you are located, is out of control and out of charts." It's hard to read that, look at what's going on here, and think it's all just going to be OK.

This nation's standard of living has been unsustainable for a long time. We produce little and export hundreds of billions of dollars of our wealth every year to buy oil and disposable consumer goods. I used to think the global recalibration wouldn't happen in my lifetime - no longer.

Interesting take pgg. I'll check out the link. We can learn a lot from history. For so long, Americans had this kind of arrogance that, 'somehow', we're immune to the hardships and mega-disasters that have befallen many a great empire (sadly, we're going the way of the "sun never sets" empire) in history....

Yep, we're going to live through the great recalibration. One thing I've learned though, is that usually these types of predictions come very early. It's suprising how long the sh.t can be kept from hitting the fan, but eventually it will.

I remember some of the ultra-bears forecasting the collapse of the stock market last year. Many of them were literally 2-3 years too early in their predictions. But, it happened. I feel that the U.S. is in for a major crisis that'll make this last one pale in comparison. After all, the Soviet Union didn't collapse militarily, but rather fiscally.

 

[cfdavid]

I will say it again: If Obama (or his legacy) ultimately proves to be successful at turning this country into Western Europe, I'm going to move there.

With the EU (or, as I like to call it, the "United States of Europe") continuing to grow and get stronger and stronger with each passing year (just look at the history of the Euro against the U.S. Dollar), we will not be able to continue to meaningfully compete on the world economy in no small part to some of the reasons you mention.

Yeah, we're really going to be f*cked in the not-too-short run (next 15-20 years) no matter what we do. But, adding TRILLIONS of dollars to the deficit with Obama's vision of "change" is only going to expedite things.

I'm squirreling away money now. And, much of it will be going into a foreign bank account (and not necessarily Switzerland with their recent sunshine laws).

(Don't get me wrong. This country still rules. More people want to come here than anywhere else in the world. We're still way ahead of Europe in comparison to their out-of-control taxes, average per capita amount of take-home pay, and living in what is essentially tantamount to a soft, more modern version of classic Socialism. My fear is that Obama, despite what he says, is going to ultimately level the playing field believing that we need to be more like them.... and that's the impression he's given me from Day 1.)

-copro

Australia, my friend. English speaking, natural resource rich, reasonably sound currency, and strengthening economic ties to Asia, which is were it'll be in the future.

 

[coprolalia]

Australia, my friend. English speaking, natural resource rich, reasonably sound currency, and strengthening economic ties to Asia, which is were it'll be in the future.

Too bad they're complete Global Warming nutters... but, that's an argument for another day and another thread.

-copro

 

[Narcotized]

.

 

[cfdavid]

Wow. I'm incredibly unprepared for this. I'm thinking I should buy my first weapon. Especially, now that I'm beginning to own things of value. I don't know where to start. What guns do you own? Any pics? I'm going to my first shooting range in a couple weeks. We'll see how that goes.

Keep in mind that these are just some of our individual predictions. Worst case scenarios that, unfortunately, may not be so unlikely. That being said, one can never predict a Black Swan.

And, all kinds of variables (war, global economic problems that make everything relative anyway, global cooperation to mitigate extensive financial meltdowns in any one or a few of the major economies.....etc etc.) can come into play that very few people can predict with any certainty.

But, we can't just ignore the debt load and future debt liabilities of medicare and social security. Nor can we ignore the massive inflation in monetary supply (that historically always leads to inflated prices, eventually). So, the question becomes, are we a more or less civil society today than in the 30's? (though every major downturn will be different and I'm not comparing all aspects of the Depression to future depressions).

Is petty and violent crime likely to go up or down as we experience a "jobless recovery" (as many silly pundets are calling this, which IMHO is dead wrong)?? Do we have more or less of a culture of dependency and entitlement than in the days of our great grandparents??

You decide. I think a certain amount of mental awareness of these current events (that will shape future trends to quote Gerald Celente) is a good idea. As is a certain level of preparedness. Also, responsibly purchasing a firearm (and even a carry permit) isn't a fanatical behavior, but rather a very rational one IMO.

Addressing the gun issue, I own a Springfield XD compact 9mm. I have a permit to carry, but never carry. Just my own personal preference (but would if circumstances warranted it). Lots of other dudes on this forum will have much more to offer in the realm of personal protection.

cf

 

[Narcotized]

But, we can't just ignore the debt load and future debt liabilities of medicare and social security. Nor can we ignore the massive inflation in monetary supply (that historically always leads to inflated prices, eventually).
cf

I'm impressed, you are a pretty worldly dude for being relatively young I assume. Not too many understand the economic farce of Obamanomics. When deeply in debt, you borrow money only when it's future return (ie, investing in research, technology, capital, etc) is greater than it's cost (ie, interest). The idea of borrowing massive amounts of money just to pretend you aren't in a recession/depression so you can blow it on worthless consumer junk that yield zero future return is absolutely insane.

Keep spreading the word. As people become more and more educated of the economic stupidity coming out of Washington, these idiot policies will be increasingly rejected by the masses.

 

[cfdavid]

Keep question, how strong is their military? If you are looking to hide from world chaos in a rich cushy country without a strong military, somebody is coming after your ass when it all goes to crap.

I see your point. But, the crisis I imagine is not necessarily a global war (small, regionals sure, but not necessarily a global one).

What I do see as being more likely is a financial collapse of a system(s), and the domestic destabilization that will succeed that. When I say watch out for war mongering and even false flag events, I mean them as ways in which to distract the public and feed the military industrial complex, as well as destabilize other parts of the world in which, say, the U.S. dollar could then be looked upon as a 'safe haven' again, in an era of hyperinflation and supsequent high interest rates that would make servicing our debt payments impossible. But, a "nice" little war could shake the global financial markets to the extent that even in the environment of reasonably high interest rates domestically, we may still be able to finance our debt at a reasonable rate given the false creation of a relative safe heaven and promotion of US debt as safe investments in a newly destabilized world (which doesn't necessarily mean WWIII).

This is an example of how desperate I think our system may become..... I "hope" I'm wrong.

 

[pgg]

Addressing the gun issue, I own a Springfield XD compact 9mm. I have a permit to carry, but never carry. Just my own personal preference (but would if circumstances warranted it).

👍 Those are nice.

Having just moved from a shall-issue state to the may-issue state of California, I'm now trying to get a CCW permit. One more thing that's wrong with this state. I don't have any intention of carrying on a daily basis ... but I figure the time to apply for the permit isn't while Katrina II is approaching, during the next round of LA riots, or after whatever flavor of social or natural disaster hits your town.

 

[RussianJoo]

Addressing the gun issue, I own a Springfield XD compact 9mm. I have a permit to carry, but never carry. Just my own personal preference (but would if circumstances warranted it). Lots of other dudes on this forum will have much more to offer in the realm of personal protection.

cf

What state are you in? I always thought it's almost impossible to get a carry permit and that you need a good reason like you transport a lot of cash or jewelry or something. Maybe that's just how thing are in my state (NJ) and I am pretty sure NY is the same way...

 

[pgg]

What state are you in? I always thought it's almost impossible to get a carry permit and that you need a good reason like you transport a lot of cash or jewelry or something. Maybe that's just how thing are in my state (NJ) and I am pretty sure NY is the same way...

Most states are now shall-issue, meaning that if you fill out the form properly, pay the fee (usually well under $100), and aren't a felon, the state is required to issue a permit. Many will require proof of competency with the firearm ... this may range from a 2-hour class to something more extensive.

The states that are still may-issue sometimes require justification and sometimes even psych evals (paid for by the applicant of course), and sadly "self-defense" usually doesn't cut it. Transporting cash/jewelry is the classic example, but I'm told that for physicians the phrases "authority to prescribe narcotics" and "potential threats from patients I decline to give drugs to" are a winning combination.

 

[RussianJoo]

Most states are now shall-issue, meaning that if you fill out the form properly, pay the fee (usually well under $100), and aren't a felon, the state is required to issue a permit. Many will require proof of competency with the firearm ... this may range from a 2-hour class to something more extensive.

The states that are still may-issue sometimes require justification and sometimes even psych evals (paid for by the applicant of course), and sadly "self-defense" usually doesn't cut it. Transporting cash/jewelry is the classic example, but I'm told that for physicians the phrases "authority to prescribe narcotics" and "potential threats from patients I decline to give drugs to" are a winning combination.

thanks for the info.

 

[pgg]

To continue the CCW threadjack, I've always liked the way they put together the map on this page. It's a couple years out of date but still pretty accurate, I think.

Also, for "may issue" states like my own California, there is a lot of regional variability in how easy/hard it is to get a permit because it's the resident's local police department or sheriff that processes the application. For example, San Francisco and Hollywood are essentially no-issue areas, but if you get out into the red counties in central/northeastern CA they're effectively shall-issue areas.

 

[August_Bier]

...We're still way ahead of Europe in comparison to their out-of-control taxes, average per capita amount of take-home pay, ...

-copro

Not so sure about the wealth anymore - do check out this:

http://www.bcg.com/Media/PressReleaseDetails.aspx?id=tcm:12-28981

 

[RussianJoo]

well vermont is always an option i guess.

 

[SexPanther]

How does one go about saving in an overseas bank? Do you convert to their currency?