Specialties that will be hot in the future

[rs2006]

Hi all,

I hope everything is going well for everyone in the forum. I just wanted to ask everyone's opinion as to which specialties they believe will be big in the future given the REALITY of the changes that are likely to come in our health care system (due to aging of population-- in 5 years all the baby boomers will start turning 65 and will thus become eligible for medicare, the rising cost of health insurance, etc)? Any thoughts would be much appreciated!! Thanks.

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[cyanocobalamin]

Hi all,

I hope everything is going well for everyone in the forum. I just wanted to ask everyone's opinion as to which specialties they believe will be big in the future given the REALITY of the changes that are likely to come in our health care system (due to aging of population-- in 5 years all the baby boomers will start turning 65 and will thus become eligible for medicare, the rising cost of health insurance, etc)? Any thoughts would be much appreciated!! Thanks.

Geriatrics, maybe? - I think it's only a 2 year fellowship after IM or FM
Rheumatology
Psychiatry

 

[futuredo32]

Geriatrics!

 

[Mumpu]

Geriatrics and all related fields (hospitalists, palliative care, etc.)

 

[DrBowtie]

Ortho. That's a lot of hips and knees to be replaced.

 

[bla_3x]

I would think that most of the IM....well all medical specialties should be in high demand in the future as the population ages. GI, neph, ortho, you name it, the poulation in the future will need it.

 

[TX515]

Geriatrics!

I think I heard there will be a huge shortage of geriatric doctors in the future.

 

[(nicedream)]

I don't think a specialty being in high demand will make it "hot" though. What makes a specialty popular and desired, generally, is a high reimbursement:hours ratio. The demand for any medical specialty is high and will only get higher. I don't think the reimbursement for geriatrics will increase though (it's rather low now and reimbursements for everything will probably decrease).
I think dermatology and plastic surgery will continue to be the biggies.

 

[Nikiforos]

Neurology--hot in terms of demand (not necessarily dollars.) The incidence of many neurological diseases increases with age. Could it be that the circuitry just plain wears out? There is a lot of exciting research going on in neuroscience which eventually will yield tangible benefits for patients.

 

[robotsonic]

Look around. It's all about bariatric surgery, baby

 

[futuredo32]

Maybe optho too? The incidence of macular degeneration and cataracts increases with age.

 

[JR]

Definitely ophtho . Demand for cataract surgery will jump up 50% by year 2020- THE highest demand jump of ANY medical procedure!

 

[neilc]

all specialties that will deal with diseases of the elderly. so, basically everything but peds...path will get more specimens, derm will do more biopsies, IM and all subspecialties will have more old folks wearing down, surgeons will have more old parts wearing down or filled with cancer to cut out, us in ob/gyn will have a lot of uteri (pl of uterus??) to remove...maybe the peds will have proportionally less, and that is it i would think.

but, again, busy does not equal well reimbursed, and well reimbursed=hot.

 

[Finally M3]

Demand for most medical fields will be going up. The $1,000,000 question is which field will be able to retain the most compensation. There is no way our current health care model will be sustainable with a 2-3x increase in visits/procedures with a similar amount of reimbursement for hospitals and physicians.

I would go with Derm & Plastics, many visits/procedures people are willing to pay for out-of-pocket. Ortho's compensation will fall with increasing volume, and you are seeing pricing pressure from hospitals v. manufacturers already.

 

[cytoskelement]

You can pick any specialty. If you want a hot specialty, all you have to do is move to mexico! It gets really hot there.

 

[LADoc00]

Hot=in demand is not the same as high paying....

Yes we will need more geriatrics docs, but that doesnt mean they make crap.

Plastics and derm. Cash up front is the way to go.

 

[medgrad]

Hot=in demand is not the same as high paying....

Yes we will need more geriatrics docs, but that doesnt mean they make crap.

Plastics and derm. Cash up front is the way to go.

Why isnt anyone talking of interventional radio or Med Onc ( they are fellowships ofcourse: I am a PGY 2 in IM)?

 

[Von Hohenheim]

Aerospace medicine will become much more popular as mankind succeeds in colonizing the galaxy.

 

[Mirror Form]

Hot=in demand is not the same as high paying....

They're clearly linked . . . afterall, supply and demand still play a part in pricing. Why do you think dermatologists and urologists make so much? One of the big reasons is that they keep their numbers low! And Anesthesia is another good example. Its reimbursement has gone up a lot lately due to higher demand to supply ratio.

I agree with the above posters that most medical specialties will do well as the population ages. Expect a large increase in certain types of surgery: cataract, open heart, etc. So those fields will benefit. PMR may do very well also.

 

[Mirror Form]

Why isnt anyone talking of interventional radio or Med Onc ( they are fellowships ofcourse: I am a PGY 2 in IM)?

Well interventional rads is already pretty hot! Med Onc is well reimbursed, but I don't think it will ever be considered a "hot" field due to the morbid nature of it. I know I couldn't ever enter a field where my patients didn't get better.

 

[medgrad]

Well interventional rads is already pretty hot! Med Onc is well reimbursed, but I don't think it will ever be considered a "hot" field due to the morbid nature of it. I know I couldn't ever enter a field where my patients didn't get better.

Well , may be ten to 15 years down the line cancer will be treated as more of a chronic disease than a disease wherein u wait for ur last breath.Chronic disease= more reimbursement( though I am all up for Cards: by 2020 Heart disaese shd be the biggest Killer ACROSS the world; may lord bless Macdonalds , Pizzahut etc: the next big killers after HIV!)

How about fetal surgery, though it is quite obscure and not very well established thruout the country.

 

[medgrad]

Well , may be ten to 15 years down the line cancer will be treated as more of a chronic disease than a disease wherein u wait for ur last breath.Chronic disease= more reimbursement( though I am all up for Cards: by 2020 Heart disaese shd be the biggest Killer ACROSS the world; may lord bless Macdonalds , Pizzahut etc: the next big killers after HIV!)

How about fetal surgery, though it is quite obscure and not very well established thruout the country.

And yes, geriatrics shd be hot; Almost 40% of pts I have seen till now in my all rotations have been more than 60.So you bet it will be hot.

 

[Mumpu]

I would argue that derm, ortho, urology, etc. make so much not because of the numbers but because the f-ed up medicare reimbursement structure strongly favors specialties that do procedures. If all you do is think, make diagnoses, and offer non-procedure treatments, you will make zilch.

 

[JKP]

minimally invasive vascular surg... HOT!

 

[CameronFrye]

I would argue that derm, ortho, urology, etc. make so much not because of the numbers but because the f-ed up medicare reimbursement structure strongly favors specialties that do procedures. If all you do is think, make diagnoses, and offer non-procedure treatments, you will make zilch.

You nailed it. And it's not just procedures, but quick procedures.


I would also point out that dermies don't make a huge amount of money compared to some of the other specialties (unless they are practicing mostly cosmetic derm). This seems to be a common misconception among a lot of med students.

 

[GoPistons]

what will be a "hot" field I think depends more on innovation... new therapies/procedures = new economic opportunities... just look at the internet and how many companies have spun off of it...

I think the #1 for the future in that department would be medical oncology... new cancer treatments... people surviving for years with common cancers...

next, I would say would be Radiology... imaging is certainly exploding right now, and I don't see much of a decline in the future... in the last 30 years... CT and MRI and PET... who knows what's in the years to come...

next maybe neurology/pain medicine... new treatments in pain and maybe new treatments for dementia and the like...

I don't see that much new coming from the surgical specialties... there are only so many ways you can remove a gallbladder...

for any field that is stagnant expect medicare cuts until your blue in the face for the next 30 years... to overcome that, you will need to be in an innovative field...

 

[rs2006]

Hi all,

Interesting responses. It is interesting to read how the different
people here feel about which specialties will be hot in the future, but it seems that not too many people have commented on how the changes that will have to happen to our health care system in the next few years (to accommodate the increased demand on medicare -- baby boomers start turning 65 in approx 5 yrs!) and how that will impact compensation in the future. Any thoughts would be much appreciated. Thanks and happy Holidays!! Happy New Year too!!

 

[c diddy]

You know, every time I see or hear someone say something about geriatrics, I wonder why people consider this a separate field of IM. In my experience in med school and internship, the vast majority of IM patients are at least 50 years old, and most are over 60. What is the advantage of doing a geriatrics fellowship in the first place, since IM gives you tons of geriatric experience? Or do IM docs just focus their practices on the elderly w/o doing a fellowship?

 

[drusso]

It combines neuro/non-operative ortho/pain medicine and technical advances in assistive devices such as prosthetics, mobility devices, stem cell based therapies for neurodegenerative diseases and spinal cord injury...not to mention plenty of geriatrics...

 

[SuitsYou]

Martian medicine, you never know when you when you could be called up to deal with a bad case of red tide

 

[droliver]

I think a better and easier to answer thread may have been "What specialties & procedures will NOT be hot in the future of medicine?".

- primary care specialties (can be largely replaced by allied health practictioners @ $0.25 on the dollar)
- hard copies of imaging studies & paper medical charts
- traditional diagnostic arteriograms
- Medicare/Medicaid dependent specialties like gerontology, IM, FP, renal, Med-onc, and even large parts of orthopedic surgery unless there is some unforeseen bailout of the upcoming baby-boomer driven healthcare financing nightmare
- reconstructive microsurgery for breast CA (too much time for too little money for too little benefit in most)
- hand surgery (too much trauma & night work now involved)

I would encourage everyone to read the New York Times columnist, Tom Friedman's new book "The World is Flat" http://www.thomaslfriedman.com/worldisflat.htm about the economic effects of globalization.

It's a real eye opener on just how replacable many services are in the information age. You can apply some of the lessons to medicine as we've seen the rise of lower-educated workers providing services that were more exclusive previously (CRNA's, NP's, RN/LPN's, etc..). This certainly applies to my field (plastic surgery) as other MD lesser trained providers (ENT, Derm, FP, Gen. Surgeons, OBGYN's, ER docs, etc..) have tried to capture part of the aesthetic medicine field. This has even trickled down to the next level as a number of nurses have tried to establish practices of injectables & non-ablative laser/energy treatments.

I know American Radiologists have fits when this type of globalization has brushed up against image interpretation (which is an ideal service for being done remotely) but there's only a few hurdles keeping the floodgates open from mass outsourcing in this area and I think the large 3rd party payers in US healthcare (Industry, the states, & the feds) can overcome the potential liability & accredidation issues involved quickly if they thought the cost savings would be substancial

 

[dr_almondjoy_do]

you are very scary droliver. very very scary....

 

[footcramp]

from what i can tell, compensation is a result of how much something pays rather than how many times you do something. for example you could fill your schedule with a bunch of followup visits for hypertension and still make less than a facial plastic surgeon. i haven't yet worked anywhere that had a shortage of patients during the day. therefore although the number of people over 60 may be increasing, i don't think compensation will significantly increase unless there is greater compensation per procedure/visit/whatever for those people as well.

in the long run, the hot fields in the future will be those that continue to advance their field with innovative methods that result in 1) new treatments 2) greater convenience and/or aesthetics that thus can demand a premium. those that stick to the same old procedures will suffer much worse due to constantly decreasing pay schedules (e.g. many lap choles don't reimburse over $1000 these days, profit can be as low as $100). this is why interventional radiology with all of their endovascular innovations are doing incredibly well.

http://www.hcmsdoctors.org/Politics/HMO Reform/Reference/Non Participation in Managed Care.htm

 

[NinerNiner999]

Clearly, EM will be a high-demand and hot field in the near (next 20-30 years) future. As the elderly retire and become more dependent on medicare and medicaid, and as fewer and fewer internists, FP's, and other generalists continue to decline M and M in favor of private insurance, more patients will continue to enter the ED's, meaning higher volumes, more ED's being built, and the need for more EM physicians (currently salaries are on the rise and demand continues to grow as more experienced practitioners retire) There is a projected need for growth of at least 30 years in this field.

 

[futuredo32]

You know, every time I see or hear someone say something about geriatrics, I wonder why people consider this a separate field of IM. In my experience in med school and internship, the vast majority of IM patients are at least 50 years old, and most are over 60. What is the advantage of doing a geriatrics fellowship in the first place, since IM gives you tons of geriatric experience? Or do IM docs just focus their practices on the elderly w/o doing a fellowship?

I believe the thinking behind geriatrics being a HUGE field is that baby boomers will want specialists. Also, from what I have heard from fp and im docs in Mich, who currently work in nursing homes, in the future, nursing homes are planning to require dr.s to have done a fellowship in geriatrics.

 

[Solideliquid]

I think a better and easier to answer thread may have been "What specialties & procedures will NOT be hot in the future of medicine?".

- primary care specialties (can be largely replaced by allied health practictioners @ $0.25 on the dollar)
- hard copies of imaging studies & paper medical charts
- traditional diagnostic arteriograms
- Medicare/Medicaid dependent specialties like gerontology, IM, FP, renal, Med-onc, and even large parts of orthopedic surgery unless there is some unforeseen bailout of the upcoming baby-boomer driven healthcare financing nightmare
- reconstructive microsurgery for breast CA (too much time for too little money for too little benefit in most)
- hand surgery (too much trauma & night work now involved)

You didn't mention Psychiatry, how do you feel that field will fare?

 

[Hurricane]

You didn't mention Psychiatry, how do you feel that field will fare?

There will never be a shortage of crazy people

I'd like to think there will be increasing demand as the stigma of mental illness is slowly chipped away. Child psychiatrists are in high demand right now. But I'm just an MS4, so what do I know. I'm going into psych because psych is what I wanna do, regardless of its hotness...

 

[droliver]

You didn't mention Psychiatry, how do you feel that field will fare?

Just off the top of my head my thought would be that Psychologists are cheaper for similar psycho-therapy services & that psychiatric-related pharmaceuticals can be dispensed by many providers, some not even MD's. I don't know much about the economics of that business, but I don't think it's poised to be "hot" as a career for both of those reasons as well as diminishing reimbursement for traditional psychotherapy & decreasing public support for psychiatric treatment & services across the board

 

[Poety]

Hmm, I'd disagree with the above since many states are moving to incorporate mental health illness into their public welfare system. It is true that many state institutions are closing, but in their place are centers that will hopefully allow those with SPMI to live independently. There has also been more outreach programs established for those that are homeless and unable to access proper psychiatric care.

What the state is finding, is that in cutting mental health care costs, they've reached a crisis so they are now attempting to revamp the systems. This is not true of all states ofcourse- but I think that a lot of public service psychs seek out these enviornments anyway.

Private practice will always be huge, and although reimbursements are cheaper for psychologists, they still have not attained RxP yet in many states. Moreover, many will not want to be treated by midlevels as many object to it now - especially in a pay for service enviornment.

I think almost all specialties will be around for a while, and if you choose one that seems to be on a downward spiral, there are always areas within a field that you can choose to further specialize in.

Do what you love! Whether it will be hot in the future or not won't matter if you hate what you do 60+ hours a week.

 

[toofache32]

Look around. It's all about bariatric surgery, baby

Yeah, right... those patients are lots of fun to put up with.

 

[certified]

Child psychiatrists are in high demand right now. But I'm just an MS4, so what do I know. I'm going into psych because psych is what I wanna do, regardless of its hotness...

Child and geriatric psych is on fire.

 

[billydoc]

Hmm, I'd disagree with the above since many states are moving to incorporate mental health illness into their public welfare system. It is true that many state institutions are closing, but in their place are centers that will hopefully allow those with SPMI to live independently. There has also been more outreach programs established for those that are homeless and unable to access proper psychiatric care.

What the state is finding, is that in cutting mental health care costs, they've reached a crisis so they are now attempting to revamp the systems. This is not true of all states ofcourse- but I think that a lot of public service psychs seek out these enviornments anyway.

Private practice will always be huge, and although reimbursements are cheaper for psychologists, they still have not attained RxP yet in many states. Moreover, many will not want to be treated by midlevels as many object to it now - especially in a pay for service enviornment.

I think almost all specialties will be around for a while, and if you choose one that seems to be on a downward spiral, there are always areas within a field that you can choose to further specialize in.

Do what you love! Whether it will be hot in the future or not won't matter if you hate what you do 60+ hours a week.

I know several Psych NPs in totally independent, and free-standing private practice. They provide both psychological (therapy, behavior modification etc) and psychopharm (Rx privellege) support. They seem to be doing so well financially, some even went on "cash only" type of practice. I have yet to hear any patients object to being treated by "midlevel." May be it's a local thing. I'm in NY

 

[Poety]

I agree it must be an area thing, I actually have never met a psych NP! Great that they have a good income though

 

[billydoc]

I agree it must be an area thing, I actually have never met a psych NP! Great that they have a good income though

Well, NYC never had a shortage of very, very qrazy ppl, and those who are just hypochondriac types with bunch of psychogenic disorders. They seem to somatize every emotion I get them a lot in my acupuncture practice too

 

[Poety]

Eastern medicine - now theres a hot specialty for the future! I know an FP doc that is leaving his practice to do it full time - and there is nothing like accupressure Give discounts?

 

[billydoc]

Eastern medicine - now theres a hot specialty for the future! I know an FP doc that is leaving his practice to do it full time - and there is nothing like accupressure Give discounts?

Just sent you a pm.
As far as practicing Orintal Medicine...it's very Geo-dependent."Location x 3"
But if you build your practice right it sure could be very rewarding, and profitable.But...ppl don't like to spend out of pocket. If it's a health profession they feel they are entitled. And it's the biggest drawback this field.Although, some ppl specialize in "NO FAULT" only.Many have paid dearly, even if everything waqs legit.
Anyway, gotta run
Have a good night

 

[Whodathunkit]

Clearly, EM will be a high-demand and hot field in the near (next 20-30 years) future. As the elderly retire and become more dependent on medicare and medicaid, and as fewer and fewer internists, FP's, and other generalists continue to decline M and M in favor of private insurance, more patients will continue to enter the ED's, meaning higher volumes, more ED's being built, and the need for more EM physicians (currently salaries are on the rise and demand continues to grow as more experienced practitioners retire) There is a projected need for growth of at least 30 years in this field.

I would think that more "non-urgent/non-ER" visits would be a bad thing?

Yet EM docs seem to bank on it(better salaries), without the healthcare field really addressing it. Especially if you can see this being a problem well into 2036...

Same thing with Radiology. People say that radiology is currently being overutilized however no one seems to want it to stop(the result being a decrease in salary/demand/etc).

Seems odd to me. Some things don't add up. But then again, medicine never did seem to be too good at math.

 

[APACHE3]

How can we get more "procedures" into hospitalist work??

 

[sophiejane]

I would encourage everyone to read the New York Times columnist, Tom Friedman's new book "The World is Flat" http://www.thomaslfriedman.com/worldisflat.htm about the economic effects of globalization.

The book I'd really like to read instead is "The World Is Fat" (and poor and old). But on the other hand, I don't need a book to tell me that. All I have to do is go hang out at a mall or my county hospital. And old, fat, and poor spells s-i-c-k. They need us all...well, except for aesthetic medicine/plastics, maybe.

The sky is not falling, Chicken Little. Primary care docs are not going to be replaced by NPs and PAs in our lifetime.

What will change is people going into medicine with high hopes of making tons of cash AND "helping people." (If you consider helping people making their boobs artificially bigger and giving them their Botox fix, I guess you could convince me otherwise). The rest of us have to make a decision between the two, most of us settling for a nice income balanced with meaningful work. I don't see that changing about medicine for some time to come.

 

[schutzhund]

The sky is not falling, Chicken Little. Primary care docs are not going to be replaced by NPs and PAs in our lifetime.

That's what the T-rex said to the mouse.