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I'm not sure if people appreciate just how much an average person is not willing to deal with the workload of the average physician, and that's exactly what midlevels are, totally average people. They are almost universally not interested in making medicine a passion. They want to make something over $100K in a reasonable COL area, clock out at the end of the day, and plan nice vacations and family barbeques. Nothing wrong with that, and I'm all for better work-life balance for physicians, but being in charge of people's lives usually means a bit more commitment than what the typical online NP grad is willing to put in.Could just pick one of the more masochistic specialties. No midlevel would want to come deal with free air or your grandmother’s acute subdural at 1AM. Your job will be safe but your mental health may not be
Have you written your congressman, senator, representative about this? We want people who are committed taking care of us. Everyone does. How do you gauge who is committed or not? Exactly the way we are doing now. Success in undergraduate pre-med courses over a period of time, success on the MCAT, success at the interview and the ability to retain large volumes of information. All these tests character. These are vital in determining success as a physician. That system works. WHy mess with it by making NP=MD where there is zero standardization, 100 percent acceptance rates etc. It is a sad state of affairs. Identity politics at work.
Em problem is more related to huge increase in supply of residents. Hca hospitals and other for profits started large number of recent residencies to provide cheap labor.
I don’t think any fellowship out of Im is inherently risky over a long career, especially one with lots of procedures. Minor risks if screening colonoscopies are replaced by something else, but other parts of specialty will grow.
Over a 20-30 year time frame, I think they will have to. At the very least, career satisfaction will plummet. Even in the near term, Raises,promotions, and lateral mobility are already very difficult in this market. there are severe geographic restrictions.
Interesting… what would you consider the opposite, some of the least risky specialties that are growing?
That’s a very difficult question. Obviously, IM and gen surg will always be safe. (A bit under the radar but there has been some tremendous progress in endocrine over the last 10 years-)Urology has traditionally limited resident numbers, so always seems to be a shortage. This is very speculative, but I listen to the Peter attia podcast, and hope that represents the future of medicine.
I have mixed feelings about this. While certainly possible, I also think there will be an explosion of imaging as the machines are improving as well. Nuclear diagnostics may also take off.
OBgyn is always in demand, though comes with the obvious baggage. However the subspecialties (MFM, urogynecology, infertility, and gyn oncology) are relatively baggage free and are extremely well reimbursed. Urogyn especially is exploding, the stuff I do used to be done by general uro and gyn but the training in numbers of procedures done as a generalist and in training is orders of magnitude less than done by a fellowship trained person. MFM is always going to be in extreme demand and you can basically just do US and consults and never deliver a kid if you don’t want to. Onc is always in demand but in a lot of places they are also the backup for any obgyn disaster and their patients are often very sick. The fellowships also limit the number of people out in practice to maintain demand
I see huge demand for gyn sub specialties onc, fertility, uro. Gyn Onc has historically been a very selective fellowship. None of these however are my cup of tea.
I just meant in terms of match rates, it’s not really comparable to ENT, ortho, optho etc.
I do think that AI is a very real threat for newer/rarer imaging modalities, because while I think that increased imaging modalities bodes well for radiologists, it also sets the bar lower for AI. If it comes down to a complex, fairly mature algorithm being adapted to read a new imaging modality compared to a workforce of radiologists in their 50s learning the ropes on the job... I think the AI would win that battle. Then from a regulatory standpoint it would be much easier than competing for reads in a system that already works.
I don't think it's something anyone has to worry about until we're at the stage when people are saying the technology is already here. It's not here, and you've easily got a 10 year buffer between the first roll out of a fully autonomous reading system that outperforms radiologists and actual FDA approval/widespread implementation. So you're definitely safe there.
Wait what. I hear this all the time and thought it’s common knowledge
Considering I have heard multiple surgeons talk about how difficult scoping can be I doubt this happens
They’re not out to do this stuff well. They’re just wanting to bill like they did.
What I don't get is from my research fm docs in the 2000s wanted to expand their ability to scope and the GI docs somehow blocked them and now almost all major hospitals and surgery centers only allows GIs to scope, I don't see how low-levels would be immune to this
Because GI docs think they can cash in on this in the short term
Interesting, would wonder what young GI docs or those planning on pursuing fellowships feel about this potential issue, or if other fields (besides anesthesia) will do the same kind of thing. Very discouraging hearing stuff like this going on as a junior medical student, makes me feel as if I entered medicine 10 years too late.
Riskiest Doctor Specialties | Med School Insiders
Part of the appeal of becoming a doctor is job security; however, this may no longer be the case for some specialties. Here are the specialties most at risk.
Actually, supply and demand are like gravity. They can give you a big hint about scarcity. Fields that greedily increased training for cheap labor are already in trouble.
If those positions are in fact available in 5 years. My firm belief is that they won’t with present oversupply.
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Eh I dunno, not sure how prevalent this is. In the 3 states I’ve lived in there aren’t any midlevels doing scopes anywhere, even the academic centers. Hopkins is the only institution where I’ve even heard of midlevels doing scopes. Scopes are like choles, they are easy until they aren’t…
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When I hear about AI taking over/augmenting jobs, the entire focus is on pathology and radiology. Radiology gets more press because the general public is far more familiar with it, but path is equally discussed in expert circles. Also, imaging represents a massive chunk of the overall healthcare expenditure, and expertise in radiology sells for a higher value than pathology, so the idea of AI doing reads is more enticing.
The other aspect is that hospitals and private groups have much better margins on NPs performing procedures compared to MDs/DOs. They have one GI doc put his/her stamp of approval on it, pay 3 NPs to do it all day long, bill for MD/DO-level care, and pay 3 NP salaries and a GI salary instead of 3 GI salaries.
On the flipside, I think radiology is interesting BECAUSE of the advancements in technology. I can only speculate, same as anyone else. However, I like the idea of having to be on my toes while working in a specialty where the last day of work in my career is very different than the first.
Rising rates and a looming credit crunch may reduce PE entry into healthcare and could even lead to divestment.Private Equity Gloats Over A Doctor Glut
I want to say upfront I don't believe that ASTRO/SCAROP/etc had a grand plan to create oversupply the same way I believe it was done by VC in EM. Reading this article, it sure feels like you could just open "Find/Replace" in Word, plug in "RadOnc" and our numbers instead of "Emergency...
the point of the article is the concerted effort to over expand er residencies to provide cheap labor and that some docs will be left unemployed. In er, hca and private equity deliBerately overexpanded programs, butIn radonc, it was greedy academic programs. Oversupply is what tanks fields.
If indications hadn’t declined, would there have been an oversupply. Or is the oversupply only due to the fact that other treatments (ie immunotherapy) are used more often than radiation?
