Rads to Anesthesia?

[Man o War]

That's mostly protectionism. Otherwise, we would just let them sit for our board exams, especially for non-patient-facing specialties like radiology.

Even then, there are more and more US board-certified docs who return to their native countries, especially given our current friendly atmosphere. Many would rather work for 30-50% of their American salary "at home" and live even better than in the US. Mark my words; this is coming, more than AI. Anything that can be offshored/outsourced for much cheaper will be. It's already happening for overnight diagnostic radiology.

If you mean protectionism as in protecting patients, I agree. Patients benefit from the standardization of our current system of medical training. Midlevels are a great example of why we need that.
I'm not familiar enough with radiology boards to say whether just passing that would be enough.

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[deleted171991]

If you mean protectionism as in protecting patients, I agree. Patients benefit from the standardization of our current system of medical training. Midlevels are a great example of why we need that.
I'm not familiar enough with radiology boards to say whether just passing that would be enough.

No, I was using protectionism in the economic market sense. Anyway, I don't want to hijack the thread.

 

[deleted171991]

With all due respect, are you a radiologist? You don’t seem to be very familiar with how radiology practice works before declaring outsourcing is taking over overnight rads

Because the whole offshore thing actually happened many years ago. A radiologists who is not in the US (even if trained in the US and boarded in the US) cannot bill for reads.

So there used to be outsourcing of overnight studies, where preliminary impressions are made (not billed) and the actual studies are read in the morning. The radiologists working during the day pay for the priviledge of not having to work at night.

As the job market worsened a few years ago, practices can suddenly afford actual night time local coverage and can no longer afford paying people to prelim studies which is a net cost (since you make less now with those studies). The whole overnight teleradiology industry then suffered.

Now, as radiology job markets get better, some rads can afford to make lifestyle related demands like night time teleradiology coverage and use that as recruitment tool. The night time preliminary read business exist to make rads’s life better, not replace them.

I am not a radiologist, obviously. But I've seen enough disruption and predatory business models in medicine. And my money is that what today "makes your lives better" tomorrow will replace (a number of) you. If not offshore teleradiology, then AI. Especially in states with malpractice caps where the corporations can budget for losses. They will hire fewer American radiologists to check, sign and bill for more and more reports. It's all a matter of money (costs vs profits vs risks). Just tell me that the average radiologist doesn't already have to read more exams daily than ever in the history of the specialty.

Quote from circa 1990: The CRNAs are here just to make our lives better...

These are obviously all just hypotheses. Nobody knows the future of medicine, no more than the stock market's. But if history teaches us anything is that it repeats itself, especially when people don't pay attention to it.

 

[pgg]

I don't think AI replacing radiologists is even in the talks right now. Everything I've read has been about using ai as a tool for radiologists. That has to come first before radiologists can get replaced. Kind of like auto driving. First it's semi autonomous, then full autonomy. So we are no where close to AI replacing docs

Disruptive technologies aren't disruptive because they change things slowly. When the threshold is reached, the world changes abruptly.

A new car built by my company leaves somewhere traveling at 60 mph. The rear differential locks up. The car crashes and burns with everyone trapped inside. Now, should we initiate a recall? Take the number of vehicles in the field, A, multiply by the probable rate of failure, B, multiply by the average out-of-court settlement, C. A times B times C equals X. If X is less than the cost of a recall, we don't do one.

We are absolutely drowning in spiraling medical costs. The economic case for cutting out as many expensive doctors as possible is here now. Anything any doctor does that's digital in, digital out, will be foisted off on computers the instant the economic math works out.

It doesn't even matter if the computer is "supervised" by a radiologist who checks the machine's work. If one radiologist can then read and sign off on 10x as many images with the expert system as an unaided radiologist, with acceptable error rates, that's still 90% of radiologists who've got nothing to do.


Think of it another way:

We get real angsty on this forum talking about how many jobs would be left for us if there was near-universal 4:1 supervision of CRNAs.

Diagnostic radiologists are staring down the barrel of 10:1 supervision of a machine.


People who keep bringing up Sedasys as evidence that the bits-in bits-out tasks of radiologists and pathologists (no, of course that's not all they do) miss the point of why Sedasys failed. Anesthesia is too real-time, too integrated with mechanical tasks with short lead times. Sedasys didn't fail because it's impossible for a machine to control a propofol pump. It failed because it's impossible for a machine to do a jaw thrust. That kind of robotic integration is much, much farther away than machine learning, pattern recognition, natural language processing that makes a remote CXR or CT read by a machine possible.

 

[pgg]

I am not a radiologist, obviously. But I've seen enough disruption and predatory business models in medicine. And my money is that what today "makes your lives better" tomorrow will replace (a number of) you. If not offshore teleradiology, then AI. Especially in states with malpractice caps where the corporations can budget for losses. They will hire fewer American radiologists to check, sign and bill for more and more reports. It's all a matter of money (costs vs profits vs risks). Just tell me that the average radiologist doesn't already have to read more exams daily than ever in the history of the specialty.

Quote from circa 1990: The CRNAs are here just to make our lives better...

QFT.

 

[DrfluffyMD]

Disruptive technologies aren't disruptive because they change things slowly. When the threshold is reached, the world changes abruptly.



We are absolutely drowning in spiraling medical costs. The economic case for cutting out as many expensive doctors as possible is here now. Anything any doctor does that's digital in, digital out, will be foisted off on computers the instant the economic math works out.

It doesn't even matter if the computer is "supervised" by a radiologist who checks the machine's work. If one radiologist can then read and sign off on 10x as many images with the expert system as an unaided radiologist, with acceptable error rates, that's still 90% of radiologists who've got nothing to do.


Think of it another way:

We get real angsty on this forum talking about how many jobs would be left for us if there was near-universal 4:1 supervision of CRNAs.

Diagnostic radiologists are staring down the barrel of 10:1 supervision of a machine.


People who keep bringing up Sedasys as evidence that the bits-in bits-out tasks of radiologists and pathologists (no, of course that's not all they do) miss the point of why Sedasys failed. Anesthesia is too real-time, too integrated with mechanical tasks with short lead times. Sedasys didn't fail because it's impossible for a machine to control a propofol pump. It failed because it's impossible for a machine to do a jaw thrust. That kind of robotic integration is much, much farther away than machine learning, pattern recognition, natural language processing that makes a remote CXR or CT read by a machine possible.

Answer 1: overnight foreign read isn’t the same as CRNA, because unlike CRNA, an rad not living on American soil CANNOT bill at all.

Same thing with the x:1 supervision. AI cannot bill, unlike CRNA.

Answer 2: Actually I brought up sedsys to precisely illustrate the point common to both radiology and anesthesia. Radiologists are absolutely needed in real time for breast imaging, IR, neuro radiology, fluroscopy, ultrasound, etc.

Just like sedsys failed, an AI isn’t here to replace radiologist for many, many years. And when it’s here, it will also replace anesthesia and 90% of human jobs.

 

[pgg]

Maybe we can just agree to disagree and bump this thread every 5-10 years to talk about what’s happening out there.

 

[caligas]

Hey All,

Current 2nd year rads resident (PGY-3). Getting burnt out about rads now that I'm actually taking call - turns out I dislike sitting in a dark room alone at night reading stacks of unending studies, studying arcane minutiae and talking to no one. When I look back at med school, intern year and residency, the things I liked are working as part of a team, physiology & pharmacology, frequent but limited patient interaction, and minor procedures (not surgery or 6hr TIPS). I've spoken with my friends in anesthesia and they seem to continue to enjoy it into their advanced years. I'm considering exiting radiology and joining the match this year for a CA-1 spot starting 2018, which I know are few but still not uncommon. (I checked and my intern year satisfies the requirements for anesthesia residency).

My stats: Step 1 240s, Step 2 250s, Step 3 240s, Senior AOA, bunch of radiology research

Tell me why I'm an idiot.

Don’t confuse temporary suffering with burnout. Our interventional radiologists are some of the best CLINICIANS in the hospital and almost never “sit in a dark room alone at night.” Just get through it, find a subspecialty that works for you, and enjoy the work and boatloads if cash.

 

[DrfluffyMD]

Maybe we can just agree to disagree and bump this thread every 5-10 years to talk about what’s happening out there.

I can disagree on the prediction on radiology made by nonradiologist and agree that such predictions are made due to extreme ignorance due to the nature of our clinical work and billing.

It would be consider trolling for me, a radiologist, to start posting grossly false statements about your field like machine take over, for example, so please extend the same professional courtsey.

 

[pgg]

OK.

 

[anbuitachi]

Don’t confuse temporary suffering with burnout. Our interventional radiologists are some of the best CLINICIANS in the hospital and almost never “sit in a dark room alone at night.” Just get through it, find a subspecialty that works for you, and enjoy the work and boatloads if cash.

Agree with boatload of cash...

 

[nimbus]

Don’t confuse temporary suffering with burnout. Our interventional radiologists are some of the best CLINICIANS in the hospital and almost never “sit in a dark room alone at night.” Just get through it, find a subspecialty that works for you, and enjoy the work and boatloads if cash.

I agree. Like anesthesia, there’s a whole lot of knowledge, experience, judgement and technique that go into IR that non IR folks don’t appreciate. Wire skills, image acquisition and interpretation skills, etc. I’ve worked with great ones and average ones, and there is a HUGE range in skill level. The great ones make every procedure look easy with no drama. To say that mid levels can replace them is beyond insulting.

 

[Twiggidy]

Hey All,

Current 2nd year rads resident (PGY-3). Getting burnt out about rads now that I'm actually taking call - turns out I dislike sitting in a dark room alone at night reading stacks of unending studies, studying arcane minutiae and talking to no one. When I look back at med school, intern year and residency, the things I liked are working as part of a team, physiology & pharmacology, frequent but limited patient interaction, and minor procedures (not surgery or 6hr TIPS). I've spoken with my friends in anesthesia and they seem to continue to enjoy it into their advanced years. I'm considering exiting radiology and joining the match this year for a CA-1 spot starting 2018, which I know are few but still not uncommon. (I checked and my intern year satisfies the requirements for anesthesia residency).

My stats: Step 1 240s, Step 2 250s, Step 3 240s, Senior AOA, bunch of radiology research

Tell me why I'm an idiot.

Bold: talk about the dream call......

Italic: have you read much of this forum?

 

[urge]

Stephen Hawking says artificial intelligence robots will replace humans COMPLETELY

Stephen Hawking gives warning about rise of robots and we should be very worried

Radiologists are first in line.

 

[GA8314]

Stephen Hawking says artificial intelligence robots will replace humans COMPLETELY

Stephen Hawking gives warning about rise of robots and we should be very worried

Radiologists are first in line.

I do not think in any of our careers, that we will be replaced by any form of AI... Things will change, but remember how long it takes for basic medicine to catch up with the evidence..... Change happens very slowly in medicine. Staying close to patient care, in an iatrogenic induced state of critical care is a great way to hedge against things like telemedicine and automation.

Tubing a patient, then flipping for a lateral or prone lung biopsy in radiology is well protected from most forms of automation....

We won't even see something as simple as a vecuronium infusion which is servo driven with digital/analog feedback from a TOF sensor. This has been explored academically, but the real world challenges (and cost) are myriad. I've given it some thought..... Not going anywhere. Technically? Absolutely easy.

Think of the obese patient with terrible IV access who can't even transfer his/herself over to an OR table. You think a robot is going to help with that?? Not so fast. The variables are too vast. Automation does very poorly with high amounts of variation.

Automation (I realize this is an AI and not automation conversation but I digress) is highly applicable to high levels of standardization and little change in variability which can't be anticipated (thus programmed) into the system, and foreseen in advance via a sensor or vision system. Just not happening in our daily lives caring for patients.

 

[deleted171991]

I do not think in any of our careers, that we will be replaced by any form of AI... Things will change, but remember how long it takes for basic medicine to catch up with the evidence..... Change happens very slowly in medicine. Staying close to patient care, in an iatrogenic induced state of critical care is a great way to hedge against things like telemedicine and automation.

Tubing a patient, then flipping for a lateral or prone lung biopsy in radiology is well protected from most forms of automation....

We won't even see something as simple as a vecuronium infusion which is servo driven with digital/analog feedback from a TOF sensor. This has been explored academically, but the real world challenges (and cost) are myriad. I've given it some thought..... Not going anywhere. Technically? Absolutely easy.

Think of the obese patient with terrible IV access who can't even transfer his/herself over to an OR table. You think a robot is going to help with that?? Not so fast. The variables are too vast. Automation does very poorly with high amounts of variation.

Automation (I realize this is an AI and not automation conversation but I digress) is highly applicable to high levels of standardization and little change in variability which can't be anticipated (thus programmed) into the system, and foreseen in advance via a sensor or vision system. Just not happening in our daily lives caring for patients.

I agree. The danger for physicians is to be replaced by cheaper healthcare workers and better technology. That's a very real threat, especially for specialties that can be practiced remotely or are very much protocol-based (monkey see monkey do). Rads falls into the former category, anesthesiology into the latter.

Never underestimate Big Health's thirst for profits, especially when about slashing employee costs. You are just a drone, a number... a body.

 

[bullishMD]

Maybe radiologists will adapt and when the AI writes "clinical correlation recommended" ...the radiologist will be the doctor that correlates it clinically!

 

[deleted103644]

Fact 1: In 1989, the Buran orbiter flew to orbit and landed back, all controlled by AI.

Fact 2: Autopilot can land planes better than human pilots in certain conditions.

Fact 3: we still have human pilots.

Fact 4: Automation in anesthesia (unfortunately, and wrongly) have progressed beyond automation in radiology. There is already a FDA approved automated system.

This system is infact, so unpopular it got pulled off market. Not surprising as clinician prefer real people.

Fact 5: No machine or program to date have been able to replace a radiologist in the imaging chain.

Fact 6: To completely replace a human radiologist, a machine GENERAL intelligence that is self aware is needed, or a human + narrow AI will always beat out a narrow AI.

We still don't have flying cars, and I don't anticipate we'll have artificial general intelligence / machine intelligence / separate intelligent specie of machine being by 2050.

If we do, we have a bigger problem.

Meanwhile, you can convince your surgeon to accept report for machine.

I am going to IR and plan to do 100% of it. I sure as hell don't want a machine to replace my anesthesia colleagues, nor radiology colleagues.

Jim Halpert:Question. What kind of bear is best?
Dwight Schrute:That’s a ridiculous question.
Jim Halpert:False. Black bear.
Dwight Schrute:That’s debatable. There are basically two schools of thought–
Jim Halpert:Fact. Bears eat beets. Bears. Beets. Battlestar Galactica.
Dwight Schrute:Bears do not… What is going on?! What are you doing?!

I’d be careful betting on what AI can and cannot do.

Interventional radiology, much like the Internet, is just a series of tubes (and wires). AI assisted interventional would not be impossible, and a hell of a lot fewer variables to deal with than driving a car. People (even doctors) are cheaper than robots though...

 

[nimbus]

Jim Halpert:Question. What kind of bear is best?
Dwight Schrute:That’s a ridiculous question.
Jim Halpert:False. Black bear.
Dwight Schrute:That’s debatable. There are basically two schools of thought–
Jim Halpert:Fact. Bears eat beets. Bears. Beets. Battlestar Galactica.
Dwight Schrute:Bears do not… What is going on?! What are you doing?!

I’d be careful betting on what AI can and cannot do.

Interventional radiology, much like the Internet, is just a series of tubes (and wires). AI assisted interventional would not be impossible, and a hell of a lot fewer variables to deal with than driving a car. People (even doctors) are cheaper than robots though...

Nice post except the last part. AI assisted IR is akin to AI assisted MLB pitching or PGA golfing. Maybe one day but it’s a long way off. As Templechairman so eloquently stated, many of the procedural specialties are at least partly a performance art.