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Which one has a better future outlook, although theyre both bleak.
Which one has a better future outlook, although theyre both bleak.
My guesses: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?
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.
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.
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.
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.
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?
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?
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?
My guesses:
Gas: I think they win the fight with the NPs. Or, rather, the lawyers win it for them.
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.
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.
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.
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"?
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.
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.
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 😛
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?
ensuii said:just saying that it most likely won't happen any time soon 😛
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. 🙂
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.
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.
This thread is hilarious. Please continue.
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.