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New SDN Article! High Yield: One Year of "Research for the Rest of Us"
Bleak is a relative term, but yes both fields are being (or will shortly) be affected. Rads is going to especially be affected with close to -20% per read in medicare reimbursement. Anesthesiology, on the other hand, has the well-known issue of nurse-anesthetist encroachment onto scope of practice. I don't forsee x-rays being outsourced anytime soon to other countries for interpretation, due to legal medical-licensing considerations, and issues of liability. Anesthesiology, on the other hand, is harder to defend in terms of long-term job stability with regards to supply and demand, as it is much more cost effective from a business perspective to hire a number of nurse-anesthetists, while limiting the required supervising physicians (a requirement in some areas) to one or two per practice group.
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those were my two main issues of concern, for rads youve got the issue of outsourcing and for gas you've got the issue of crnas.
And everyone on these forums swears up and down that every specialty is going to disappear *cough BLADE cough*
for those of you who aren't diehard pessimists, which specialties, that are not primary care, will make it the best through this obamacare, if any?
And everyone on these forums swears up and down that every specialty is going to disappear *cough BLADE cough*
for those of you who aren't diehard pessimists, which specialties, that are not primary care, will make it the best through this obamacare, if any?
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My guesses:
Rads: Outsourced in the short term (reducing reimbursement for domestic reads), replaced by computer programs entirely in the long term. Within our generation Rads will be an academic specialty for a handful of doctors working with programers
Gas: I think they win the fight with the NPs. Or, rather, the lawyers win it for them.
EM: A casualty of Obamacare, FM docs make a push to reclaim the ER based on their lower cost. Might not be a bad thing
Ortho and Neurosugery: cuts in the short term, but long term an expanding array of possible procedures leads to a major shortage of doctors. Reimbursements soar past their current levels.
General Surgery: No change
IM/Peds/FP: NPs take their work while they in turn take a good chunk of the caseload currently managed by subspecialits and, in FM's case, EM docs. Reimbursements increase, numbers increase only slightly. Might not be a bad thing.
Optho: No change
Ob/Gyn: Loses a lot of market share to midwives under Obamacare. The midwives are completely underqualified, causing numerous scandals, and the pendulum ultimately swings backs in the other direction in the face of lawsuits and public outrage. Republicans in 2016 run on a platform of figurative dead babies. Dick Cheney continues to sleep on a bed of literal dead babies.
Plastics and Derm: Rich as ever.
All of them will make it. Specialists will just have a wider range of salaries within the specialty.
A doctor/medical center/hospital/etc. can refuse to participate in Medicare insurance, just like with any other provider and Obama can't throw non-participating doctors/hospital directors into the gulag. If a specialty is really being overpaid by medicare currently and there's no demand outside of the new lower rate medicare, too bad.
If you're worried about ObamaTax attached to the healthcare reform, well every high paying job is in the same boat.
A doctor/medical center/hospital/etc. can refuse to participate in Medicare insurance, just like with any other provider and Obama can't throw non-participating doctors/hospital directors into the gulag. If a specialty is really being overpaid by medicare currently and there's no demand outside of the new lower rate medicare, too bad.
If you're worried about ObamaTax attached to the healthcare reform, well every high paying job is in the same boat.
Definitely made me lol.
I think if you really love your field, not too much will change. Things that have elective procedures will continue to do ok if those who practice those fields choose to do them...and the economy doesn't continue to suck.
I'm not sure how you foresee FM taking over EM patients?
Do you mean that they'll send fewer patients to the ED for less serious reasons?
Do you mean that there'll be more primary providers so that more patients receive preventive care and will be in the ED less?
Either way, I think EM looks forward to that. I think the issue EM docs have with Obamacare is that there will be less reimbursement, but no reason to stop practicing CYA medicine.
But EM does have a major issue that Obamacare does not seem to help. Patient populations going to the ED is soaring and continues to soar everywhere. Nothing in the proposals so far seems intended to alleviate ED overcrowding in cities and suburbs
Do you mean that they'll send fewer patients to the ED for less serious reasons?
Do you mean that there'll be more primary providers so that more patients receive preventive care and will be in the ED less?
Either way, I think EM looks forward to that. I think the issue EM docs have with Obamacare is that there will be less reimbursement, but no reason to stop practicing CYA medicine.
But EM does have a major issue that Obamacare does not seem to help. Patient populations going to the ED is soaring and continues to soar everywhere. Nothing in the proposals so far seems intended to alleviate ED overcrowding in cities and suburbs
I def think rads and anes will be hit. I still dont have that bad of a feeling as most.
Geriatrics is where the $ will be! All those old folks hopped up on Viagra!!! lol
Derm and Plastics will still be king I think. We Americans are so vain!!
Geriatrics is where the $ will be! All those old folks hopped up on Viagra!!! lol
Derm and Plastics will still be king I think. We Americans are so vain!!
n Thomas Friedman's book, The World is Flat, he cites examples where radiology images are already being outsourced internationally. He also makes a comment that medical credentials, licensing, etc are verified for those who read these images outside the US.
American lawyers get too much of a hard-on suing radiologists for missing breast cancer (10-30%) to allow it to be outsourced to India.
There's too much liability with a computer. Not because it won't be more accurate than an actual radiologist, but because it'll lose every case because a jury considers it "unsympathetic" when a malpractice lawyer like John Edwards calls it to the stand.
There's too much liability with a computer. Not because it won't be more accurate than an actual radiologist, but because it'll lose every case because a jury considers it "unsympathetic" when a malpractice lawyer like John Edwards calls it to the stand.
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Keep in mind, we are talking about a CHANGING system here. We can't assume all else will change EXCEPT legal liability.
If the government decides that medicine will function within a certain framework, it will presumably alter the laws that stand in their way.
I admit it seems like this is pretty doomsday. Then again, who knows. Especially if things get desperate enough with health care.
Just look at the g*ddamn clip with Obama stroking a bunch of nurses. "We have Dr. Mary Wakefield...who's a nurse..." And everytime Obama flashes that smile, everyone chuckles in dazed lockstep agreement. It's frightening.
[YOUTUBE]http://www.youtube.com/watch?v=jLJYy4jQ3wM[/YOUTUBE]
Every specialty has potential to be hit, for different reasons. For PC, it's NPs. Anesthesia, CRNAs. Rads, outsourcing. Derm/plastics, elective visits/procedures go down in economic crises.
I still think it isn't a bad idea to do something general like IM or GS and then do a fellowship, depending on where the winds blow. Having that general thing lets you have your feet in both waters. If GI takes a huge hit and they stop scoping everyone, well then you can do a bit more general internal medicine, if that somehow pays better.
The other possibility is to do something that requires a level of expertise no midlevel can fill. Of course, this is susceptible to reimbursement slashing. But I have a hard time believing people will want their neurosurgeon or cardiologist to be paid poorly or have any part of their brain or heart manipulated by a midlevel.
I still think it isn't a bad idea to do something general like IM or GS and then do a fellowship, depending on where the winds blow. Having that general thing lets you have your feet in both waters. If GI takes a huge hit and they stop scoping everyone, well then you can do a bit more general internal medicine, if that somehow pays better.
The other possibility is to do something that requires a level of expertise no midlevel can fill. Of course, this is susceptible to reimbursement slashing. But I have a hard time believing people will want their neurosurgeon or cardiologist to be paid poorly or have any part of their brain or heart manipulated by a midlevel.
This is great. I like your "take" on the future... But you neglected neuro, path, and psych... which are my current top interests. What's the opinion with those?
To attain a medical license in the US currently you have to do your residency here. Thus, I'm pretty sure the radiologists that read abroad are American trained and licensed physicians, which I don't technically consider outsourcing.
Path will be significantly affected. We're looking at a 21% reduction in medicare reimbursement for biopsy interpretations proposed to begin in 2010. Most hit by this change will be anatomical path, wherein biopsy reads make up a significant portion of the practice.
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Not what I mean, I'm talking about FM docs who work in the Emergency Room itself. This is one of the less publicized turf wars in medicine. Right now, when you walk into an ER, there is about a 50% chance that the doc your seeing is not actually EM boarded, but an FP. It might be an FP who did an EM fellowship, but not necessarily. Legally an FM residency is all you need, and there are a significant number of ERs out there that don't employ a single EM boarded doc. FP doc are fighting to take over the ER on the basis of the same argument that NPs are using to take over the primary care: they're a lot cheaper and studies show they have similar outcomes. Right now FM docs generally work in less desirable (rural) ERs, but I think that one of the ways medicine is going to push to cut costs is to push to make FPs the major care providers at all ERs, even at top hospitals. Eventually I think it might get so uneconomical to to an actual EM residency vs. an FM residency that either the training pathway will shorten to three years or the specialty will disapear entirely.
Path: Asking if Path could get bad in the future is like asking if Bill Clinton might ever cheat on his wife. It's bad NOW. It's the only profession in medicine that currently has a lot of high quality docs looking for work, and they've been at the top of everyone's cost cutting list for years. It's a trend I don't see changing.
Neuro and psych: Neuro stays the same for right now. Psych gets paid even less under the new healthcare plan, which drives them out of the hospital and into private practice, which brings their pay right back up. Long term I think that our ability to manipulate the human mind might make some major leaps forward in our lifetimes, causing these professions to expand dramatically, but maybe that's the sci-fi nerd in me talking.
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The fight has actually already been lost. Now it's more an issue of scavenging what's salvageable.
- Thread Starter
- #19
what a shame, two of the specialties I was considering might could be dismembered by the time I get there.
oh well, a lot can change in ten years, maybe ill love something else.
oh well, a lot can change in ten years, maybe ill love something else.
Umm, the training pathway for EM is 3 years at the majority (~75%) of programs. And EPs are not really giving up any ground in emergency rooms. While it may be economical in rural areas with smaller patient loads, major cities still use EMs, and are constantly in need of more and more EP's because of rapidly expanding patient population. Currently, ER's tend to seek PA's to lower costs, not FP's. I don't see this changing anytime soon unless ED's stop being overcrowded, the boards reverse their stance on not providing EM board certification for Internists and FP's, and EM stops being an attractive field for PA's, who are even cheaper than FP's.
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Haha, ok I'll tell you a true story that pertains to this.
During my freshman year I took an intro to BME class, which was basically project based. One of the assignments/projects was to come up with a "novel" treatment to solve some kind of a medical problem. The solution did not necessarily have to be realistic, I guess the idea was to just force our young minds to think out side of the box. Anyway this is what one group proposed. The group basically proposed a study that would identify as many possible neurotransmitters and hormones responsible for emotional changes via a biochip capable of detecting concentrations of specific molecules based on their binding characteristics. They actually went pretty deep in to the specifics of how this will be achieved. Any way, long story short, they were ultimately going to use this chip to continuously monitor the concentration of neurotransmitters and hormones in side the patient's body. The Biochip would also be "loaded" with a suppy of all neurotransmitters and hormones identified. This supply would allow the biochip to carry out a negative feedback mechanism i.e. if one neurotransimitter or hormone was short in supply it would release it(I think it was also supposed to counter the effects of the release of this molecule by releasing molecules that would in tern affect the side effects...i know it just got super confusing). Any way, after seeing this presentation I still remember the professor saying, "well that was creative guys, from what I understand, you have just proposed a once and for all solution to psychiatry!"
haha do you think this could be the "ability" that allows us to "control the human mind"?
It's good to know that Path is doomed. I guess I should stop day-dreaming about it. 
Now if instead of "balancing levels to be the same", we prevented levels from reaching extremities, that may be much better (like regulated capitalism). This way, we maintain enough variety to fuel innovation while capping mood levels to prevent violence/extreme-hatred (and the consequential wars)... which is especially necessary with extreme cases like Hitler. Who determines what levels are "proper" for a person? A Psychiatrist!
So psychiatrists will be necessary as long as the mind is kept as complex as it is now. I truly believe it will be the last type of doctor on the planet.
Sci-fi nerd? Your kind isn't welcome here.
"Everyone has the same balanced mood"?! Sounds like a dystopia to me... but not the regular sort of "bad" dystopia with wars and violence. This one is far more bleak, where everyone is bland... kind of like 1984 or Gattaca. The society will work for one generation or so before toppling on its head after virtually no progress comes from this so-called "society". Emotions and mood disorders give the world flavor, which drives innovation. If everyone thought with the same amount of passion and sanity, we'd severely hinder progress.
Now if instead of "balancing levels to be the same", we prevented levels from reaching extremities, that may be much better (like regulated capitalism). This way, we maintain enough variety to fuel innovation while capping mood levels to prevent violence/extreme-hatred (and the consequential wars)... which is especially necessary with extreme cases like Hitler. Who determines what levels are "proper" for a person? A Psychiatrist!
So psychiatrists will be necessary as long as the mind is kept as complex as it is now. I truly believe it will be the last type of doctor on the planet.
There will come a day when the software will be objectively, demonstrably, provably BETTER than a human radiologist ... and not just a little bit better. When that day comes, the unacceptable liability will be the human.
EM will always be hopping. There is no way FP will take over EM. They supplement but they will not lead lead due to hospital by-laws.
In scheduling, you always fill the shifts with ER trained docs first. Then if there is extra time do you fill it with FP docs.
As for compensation, I believe medicare pays the same fee regardless of whether the patient is seen by an ER trained versus an FP trained MD. So there tends to be parity of pay per hour. If you are assigned a shift, you get paid the same as any other MD that does that shift. However, the ER doc will get priority for number and favorability of shifts.
I am intrigued by software taking over radiologic duties. It seems conceivable that the programs could be come very good fast. Right now simple chess programs can beat 99% of the population. The best ones can only be beaten by maybe a handful of chess grand master champions. Maybe radiology will move more towards interventions as a standard rather the exception.
In scheduling, you always fill the shifts with ER trained docs first. Then if there is extra time do you fill it with FP docs.
As for compensation, I believe medicare pays the same fee regardless of whether the patient is seen by an ER trained versus an FP trained MD. So there tends to be parity of pay per hour. If you are assigned a shift, you get paid the same as any other MD that does that shift. However, the ER doc will get priority for number and favorability of shifts.
I am intrigued by software taking over radiologic duties. It seems conceivable that the programs could be come very good fast. Right now simple chess programs can beat 99% of the population. The best ones can only be beaten by maybe a handful of chess grand master champions. Maybe radiology will move more towards interventions as a standard rather the exception.
Have you noticed all the times when you get an EKG prinout, how the computer totally screws up the interpretation? That is a why a cardiologist/primary doc always has to interpret that EKG. A computer can't even be trusted to reliably read an EKG, how can you trust it to read a complex head/neck or abd/pelvic CT?
Spend some time in radiology dept. and look at the intricacies of reading an image. It isn't that easy. For rads, the biggest threat is not outsourcing (how can you sue the doc in India if he/she screws up? Is the US govt. going to have him extradited? I don't think so). The others who read images from Sydney (Nighthawk) are American trained radiologists so I don't consider that outsourcing as they provide a decent service at night and aren't 'foreign' docs.
The biggest threat to radiology is reimbursement cuts, especially if this bill goes through. 20% is not even the brunt of it, I think rads will continue to get hit hard on a regular basis. Despite that, I still think rads is a pretty cool field.
Spend some time in radiology dept. and look at the intricacies of reading an image. It isn't that easy. For rads, the biggest threat is not outsourcing (how can you sue the doc in India if he/she screws up? Is the US govt. going to have him extradited? I don't think so). The others who read images from Sydney (Nighthawk) are American trained radiologists so I don't consider that outsourcing as they provide a decent service at night and aren't 'foreign' docs.
The biggest threat to radiology is reimbursement cuts, especially if this bill goes through. 20% is not even the brunt of it, I think rads will continue to get hit hard on a regular basis. Despite that, I still think rads is a pretty cool field.
rads all the way.. nurses cant do rads.. the money is good.. the ind contractor opportunities are great. and you are left alone while you are reading a film.. and you are insulated from the bs that goes on in the hospital a lot. more importantly, you can read films from your house in your pajamas
This is because a chess board doesn't vary. Initially the queens, rooks, pawns, etc are always at the same place. Therefore, programming around this is not immensely difficult as you can fairly easily assign values to corresponding placement and pieces. Human anatomy however is very different. Even though we're all made up of the same stuff, there are millions of extremely minor variations internally that make it hard to program script to compensate while still having good fidelity. Not saying that it won't ever happen...just saying that it most likely won't happen any time soon
Depends on your definition of "soon".This is because a chess board doesn't vary. Initially the queens, rooks, pawns, etc are always at the same place. Therefore, programming around this is not immensely difficult as you can fairly easily assign values to corresponding placement and pieces. Human anatomy however is very different. Even though we're all made up of the same stuff, there are millions of extremely minor variations internally that make it hard to program script to compensate while still having good fidelity. Not saying that it won't ever happen...just saying that it most likely won't happen any time soon
http://online.wsj.com/article/SB124751881557234725.html
In 10 years? I highly doubt it. In our lifetimes? Probably. Of course, when it happens, the entire idea of "work" would be revolutionized. Entire fields and careers would disappear. Medicine I think would be one of the last to disappear, and within medicine the more mechanical of specialties would be the first to go. Between anesthesiology and diagnostic radiology, I'd say rad would go first.
to hal9000:
I've worked on autosegmentation, and automatic interpolation as well as ICA extraction on images. I can tell you my opinion: not in our careers would we see computers replacing radiologists. No algorithm comes close, right now, to the specificty of a radiologist. Computers can get sensitive, but can't pinpoint stuff. may be DSP someday would be super efficient with extraordinary filtering capabilities. That someday is very far. Heck, radiologists themselves want computer to do half the work already for them and they work closely with phDs in developing powerful imaging softwares. Still, you'd need rads.
sorry. Rads wins.
I've worked on autosegmentation, and automatic interpolation as well as ICA extraction on images. I can tell you my opinion: not in our careers would we see computers replacing radiologists. No algorithm comes close, right now, to the specificty of a radiologist. Computers can get sensitive, but can't pinpoint stuff. may be DSP someday would be super efficient with extraordinary filtering capabilities. That someday is very far. Heck, radiologists themselves want computer to do half the work already for them and they work closely with phDs in developing powerful imaging softwares. Still, you'd need rads.
sorry. Rads wins.
They used to say the same thing about computers flying airplanes. Now we have airplanes that can't be flown by humans at all.
And - you're missing the point. The computer doesn't have to be perfect ... it just has to be better than a radiologist.
Machines have been reading pap smears and mammograms for a while. The programs are getting good enough that physicians are starting to use them as adjuncts to their own reads and as quality-control checks. Progress is inevitable.
30 years ago, computers didn't read EKGs at all. Do you really have any doubt whatsoever that 30 years from now, a computer won't be able to give a more complete, accurate EKG read than all but the best electrophysiologists? If you do, go sit in the corner with Kasparov.
It's decades away by my guess.ensuii said:just saying that it most likely won't happen any time soon
Computers win chess games mostly by brute force. Even the best algorithms still don't do much actual "thinking" ... it's all about pruning the search trees and tweaking poorly understood heuristic functions. Pattern recognition algorithms have a long way to go, but there are enormous financial incentives in virtually every industry (including and especially the military) to make them better. It's going to happen.
I wouldn't be shocked if pathologists were being soundly outperformed by histopathology software during my career, and rads won't be far behind that.
Just an academic discussion in any case, none of this will be relevant to anyone in training today.
I don't know, the tenor of some on this board about the computerizaton of rad images seems a little optimistic. Rads to take prior studies, lab tests, differences in shadowing, image quality, as well as other u/s, PETS, Xrays, etc into account when reading images. Moreover, a computer would need to know salient details of the patients history to properly interpret the images, and also suggest accurately what other studies to do and in what time frame. A shadow may mean a lot in one patient, and nothing in another. I think programming a computer to do that would be quite difficult.
Okay, so I will give you that in 30 years, maybe computers will be as good as humans in their interpretation. Heck, I will also give you radiographs. But there are just too normal many variations seen on CT and MRI for a computer to call it an abnormality and identify its nature, without understanding the circumstances of the physician ordering the study.They used to say the same thing about computers flying airplanes. Now we have airplanes that can't be flown by humans at all.
And - you're missing the point. The computer doesn't have to be perfect ... it just has to be better than a radiologist.
Machines have been reading pap smears and mammograms for a while. The programs are getting good enough that physicians are starting to use them as adjuncts to their own reads and as quality-control checks. Progress is inevitable.
30 years ago, computers didn't read EKGs at all. Do you really have any doubt whatsoever that 30 years from now, a computer won't be able to give a more complete, accurate EKG read than all but the best electrophysiologists? If you do, go sit in the corner with Kasparov.
Lets say for argument sake that even if that was possible, radiology is evolving pretty fast that they will always have something new to look forward to such as PET scan, functional MR, molecular imaging. Technology is evolving pretty fast, much faster than someone who can develop algorithms for a computer to outmatch and outwit a human rads for that new study. Not to mention, there is always IR left to do. I say it once again, the biggest threat to rads in the near future is reimbursement cuts and others 'stealing' procedures from them.
currently Medicare and medicaid reimburses anesthesia at 33% of what private insurances do. Thus it will mean a 67% income cut for anesthesiologists if the same rates are used in the national health care as they are in medicare/medicaid. also CRNA's are gaining more freedoms everyday, they can already practice without physician observation in a few states, California being the most recent state to allow this. And the number of CRNA schools is growing very fast as well. So it's a no brainer that the hospital will hire a bunch of CRNA's and not Anesthesiologists because CRNAs are cheaper. Also there are automated Anesthesia machines on the market, and I think England uses them. You just plug in the patients weight and drug allergies and it interprets vital signs and pushes the drugs needed to stabilize the patient.
Sure rads can be outsourced and it's already happening in many hospitals especially at night and on the weekends. However the same can be said for most other countries. My friends uncle made a a good amount of money reading films for Australia a few hours a night when he was younger. Still I think Rads is a much better and safer field. IR is very popular field and very lucrative.
Sure rads can be outsourced and it's already happening in many hospitals especially at night and on the weekends. However the same can be said for most other countries. My friends uncle made a a good amount of money reading films for Australia a few hours a night when he was younger. Still I think Rads is a much better and safer field. IR is very popular field and very lucrative.
Oh God, if they cut inpatient Psych anymore, we're not going to have anywhere to put these crazy people! More homelessness, more crime, more expensive imprisonments. Someone start working on that biochip quickly!!!
(Technology innovation in Rays seem to advance faster than Gas technology. Rays are fighting on the front end to keep up with technology, while Gas is fighting to fend off encroaching labor by those with less sophisticated training on the back end. Unless Gas makes a big technological break that CRNA's can't comprehend, I say Rays win.)
Well in 30 years I would say all health care providers are in trouble then. In the experience I have with computer science (though relatively little), I would say that it would be easier to program a robot with extremely advanced sensing technology to do surgery based upon a diagnosis than to interpret an MRI reading, "think", and then make a diagnosis. And if robots can do surgery without humans, god help us all.
Yeah good thing we have all these medical students around to inform us all about the future of American medicine.
As a current practicing physician (Anesthesiologist), I must say that we doctors have been under assault since the days of medicare. This is nothing new. The problem now is that all the baby boomers will be on it and medicare doesn't pay anything for majority of the specialties. So, we will all take a hit. When that point comes where my reimbursement is minute, i will just quit and so will a lot of docs. It will not be worth it.
Moral of this story: Be frugal. Don't expect a 500K house with a mercedes. And save money so that you can pay back your loans as quickly as possible.
Moral of this story: Be frugal. Don't expect a 500K house with a mercedes. And save money so that you can pay back your loans as quickly as possible.
I concur with this sentiment to the Tee. When I reach "my number", I am so out of medicine. I am completely burnt out after barely surviving through a residency and things are only getting worse. I feel like I am ready to retire and yet I am only in my early 30's!
I can't fathom doing this another 30-40 years. In order to escape from the coming Obamacare, I plan to continue to subsist at the poverty line ($10830 US a year- and yes it is doable- I am proof) while living like a pauper in the ghetto as an attending. It is not suffering when you think of the prize of freedom on the other side. You will be amazed at how much you can save over time on even a resident's salary if you are disciplined. I have come to the realization that I would rather be happy and live in some secluded cabin on the Big Island of Hawaii (http://honolulu.craigslist.org/big/reb/1305738266.html) or in the rainforests of Costa Rica than be chained to the hospital and get sh!t rained on just so I can live in some Barbie dreamhouse with a big ***** mortgage and have my gas guzzling SUV parked in the cobble stoned driveway while trying to keep up with the the Jones's or Dr. Nurse Smith that Coastie has so vividly depicted. Heck with that! This philosophy of being that I speak of is called "voluntary simplicity", you can google the term and learn more if you want. I concede it is very hard to get out of medicine but I am determined to succeed. I fully realize that you need a well executed plan in place or otherwise you risk committing financial suicide. Just dropping out of residency with no plan is akin to jumping out of a plane without a parachute. I just wish I would've known all this ten years ago and spared myself a decade of grief. But ten years is enough, I refuse to allow more precious time to slip away. Just as Andy did in the Shawshank Redemption (one of my all time favorite movies which has more meaning to me now than ever before), I will continue to chip away at the walls of my prison until I am free again.
[YOUTUBE]ElxGBKi7jMo[/YOUTUBE]
As long as you got lawyers with student loans to pay off in this country, I wouldn't fear the outsourcing of radiology. The most serious threat to radiology is other specialties like cards, neuro, etc wanting to do their own image interpretations.