Specialty with a good future

[YupGypsy]

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which specialties will be the wisest to go into in the coming years? that is, good pay, stable career, and immune to invasion by midlevels (e.g., primary care), technological advancements (e.g., radiology), outsourcing (e.g., radiology), etc.? Cardiology? Surgery?
Please spare me the "go into something that you like" routine.

 

[Wizard of Oz]

which specialties will be the wisest to go into in the coming years? that is, good pay, stable career, and immune to invasion by midlevels (e.g., primary care), technological advancements (e.g., radiology), outsourcing (e.g., radiology), etc.? Cardiology? Surgery?
Please spare me the "go into something that you like" routine.

The future...uncertain it is. Difficult to see. Always in motion is future.

This is impossible for us to predict without a time machine. With invasive cards, you have to keep in mind turf wars (i.e. interventional).

When a specialty becomes lucrative or "wise," that's when you get the "invaders!" No such thing as immunity--it's the beauty of a free market economy.

Do derm. You can hire all the PA's you want--nice lifestyle and supply/demand ratio among most markets. That's why it's so hard to match.

 

[dutchman]

which specialties will be the wisest to go into in the coming years? that is, good pay, stable career, and immune to invasion by midlevels (e.g., primary care), technological advancements (e.g., radiology), outsourcing (e.g., radiology), etc.? Cardiology? Surgery?
Please spare me the "go into something that you like" routine.

Since you excluded about 80% of the specialties, you probably answered your own question.

 

[YupGypsy]

Since you excluded about 80% of the specialties, you probably answered your own question.

I'm not even sure, that's why I'm asking. Lately, I keep on hearing about NP's & PA's taking over primary care and radiology - it's not impossible to read an x-ray 8000 miles away.

 

[Arctic Char]

my money lays with either anesthesiology or EM. good hours, good pay, fun work (obviously subjective), good job security (unless you envision some miraculous disappearance of human pain), and a relatively short residency.

 

[lilnoelle]

my money lays with either anesthesiology or EM. good hours, good pay, fun work (obviously subjective), good job security (unless you envision some miraculous disappearance of human pain), and a relatively short residency.

CRNA's are a midlevel provider that might threaten anesthesiologists.
My bet is with geriatrics for job stability but probably not pay.

 

[Sol Rosenberg]

my money lays with either anesthesiology or EM. good hours, good pay, fun work (obviously subjective), good job security (unless you envision some miraculous disappearance of human pain), and a relatively short residency.

Honestly, if you're not in (or soon starting) an EM or Gas residency right now, I think you might've missed the boat at this point. There is a huge demand for those types of doctors (and, as a result, compensation packages are lucrative, hours are pretty good, etc) RIGHT NOW, but as a result of lucrative pay, and better working conditions, supply (i.e. number of medical students pursuing those specialties) has gone up too. It'll be interesting to see what the market for those two specialties will be like in ~5 years. This may be more true for gas than EM, but my understanding is that EM used to be a not very competitive residency, but has now become moderately competitive.

My picks: I agree with a previous poster that said Derm, because they are like the OPEC of doctors -- purposely aggressively limiting supply to keep prices up, etc. I also think that Orthopaedics (incl. Ortho. Surg.) will continue to be a very in-demand speciatly (we're getting better at treating disease, but after a while the physical stuff of our bodies just starts to break down, so this will become more and more relevant as we live longer and longer.)

 

[dutchman]

my money lays with either anesthesiology or EM. good hours, good pay, fun work (obviously subjective), good job security (unless you envision some miraculous disappearance of human pain), and a relatively short residency.

Too many lawsuits IMO.

 

[typhoonegator]

I quote the Simpsons:
"The wars of the future will not be fought on the battlefield or at sea. They will be fought in space, or possibly on top of a very tall mountain. In either case, most of the actual fighting will be done by small robots. And as you go forth today remember always your duty is clear: To build and maintain those robots."

So you should probably go into robotics. Seriously, though, every specialty has their "snakes in the grass". Actually, every profession in the world does. Do what feels good.

 

[IceMan0824]

Cardiothoracic Surgery. Lots of cases, and noone to steal them from you. That's what you should specialize in.

 

[OncoCaP]

Cardiothoracic Surgery. Lots of cases, and noone to steal them from you. That's what you should specialize in.

The invasive cardiologists are taking some business from the CT surgeons, and both invasive cardiologists and CT surgeons have "married to the hospital" lifestyles (you have to like that).

I'm pretty open; currently I'm interested in oncology, which seems to be ok. Maybe I'll still like that further down the road.

 

[RxnMan]

EM started hitting the radar with shows like "ER," and then with women taking over the applicant pool (majority since 2003 I think,) and the trend towards lifestyle residencies, it really took off. I'd be interested to see how EM does in the future (in terms of competitiveness). The lifestyle aspect is another reason why gas is competitive - you can schedule a shift system much more easily.

I also think it's interesting that, once the 80-hour rule came down, g surgery categoricals became popular overnight.

Babyboomers like their mobility, and they'd like it now, so I think ortho joints will become bigger and bigger. Similarly, PM&R will probably become more prominent, especially if the US goes towards universal healthcare and preventitive/rehab approaches towards medicine.

Then again, 20 years ago, it was the opinion that only meat-headed bottom-of-the-class-ers went into ortho. OP, do what you like doing, and the money will come after residency.

 

[turkleton]

CT surgery?? Are you serious?? For the past few years, only about half of the CT fellowship spots are being filled. Cath is just getting better and better and CT's main role now is backup for complications, multivessal disease, and valvular disease- although even the latter is being taken over by cardiologist and there isn't enough to make it the bread and butter of your practice. As one of the surgical residents pointed out to me- the field isn't dying. It's dead. Non cardiac stuff, exclusively thoracic, however, I'm told is getting more popular. If you're interested in surgery, that's probably gonna be a good field considering everyone still smokes like crazy.

 

[OHMAN0125]

CT surgery?? Are you serious?? For the past few years, only about half of the CT fellowship spots are being filled. Cath is just getting better and better and CT's main role now is backup for complications, multivessal disease, and valvular disease- although even the latter is being taken over by cardiologist and there isn't enough to make it the bread and butter of your practice. As one of the surgical residents pointed out to me- the field isn't dying. It's dead. Non cardiac stuff, exclusively thoracic, however, I'm told is getting more popular. If you're interested in surgery, that's probably gonna be a good field considering everyone still smokes like crazy.

I still don't think CT is good even with the pulm/thorax part. There is always room for CT but the demand is going to be very low. Cardiology is good, but ur gonna be extremely busy if you want to get paid in the top tier as a cardiologist. I think the best field for IM specialties when you look at money and lifestyle right now is gastro.

 

[OHMAN0125]

The invasive cardiologists are taking some business from the CT surgeons, and both invasive cardiologists and CT surgeons have "married to the hospital" lifestyles (you have to like that).

I'm pretty open; currently I'm interested in oncology, which seems to be ok. Maybe I'll still like that further down the road.

Do they have a good pay and lifestyle?

 

[Tired]

I also think that Orthopaedics (incl. Ortho. Surg.) will continue to be a very in-demand speciatly.

Ortho is going to continue to be huge, especially the joint stuff pointed out by another poster. As the elective shoulder and knee stuff gets better, Sports Ortho will get even bigger also. Big national shortage of Peds Ortho right now, we'll see how long that lasts.

I'm also going to vote for Urology (more old men = more old prostates), Plastics (exploding), and Oncology. Pretty much anything involving elective procedures (more insurance money, more cash business, less Medicare) and old people (growing population) will look pretty good for the next ten years at least.

Personally, I think the Medicine subspecialties are generally doomed to failure. Fewer insurance plans are going to cover an expensive office visit to a specialist who really won't do anything more than the PCP did in the first place.

And just as a point of terminology: There's no such thing as a non-surgical Orthopedist. All Orthopods are surgeons, the non-op guys are Sports Medicine.

 

[Wizard of Oz]

I also think it's interesting that, once the 80-hour rule came down, g surgery categoricals became popular overnight.

Is that rule actually respected? Or is it more like the cap on college football practice hours--an "official" total plus "voluntary" time for those who actually want to play in the game.

CT surgery?? Are you serious?? For the past few years, only about half of the CT fellowship spots are being filled.

Trudat 👍

Do they have a good pay and lifestyle?

Yes, no.

 

[deleted77919]

Is that rule actually respected? Or is it more like the cap on college football practice hours--an "official" total plus "voluntary" time for those who actually want to play in the game.

From what I've heard, it really depends on the program. Some are very strict about the hour guidelines (i.e. resident wants to stay on to assist on interesting/uncommon surgery and isn't allowed to b/c he'd be over hours for the month). Others treat the rules more as guidelines (but risk getting in trouble, all it takes is a few disgruntled residents).

 

[turkleton]

From what I've read, and what other posters on SDN indicate, the 80 hours thing for surgery, while not enforced to the letter, is a good ball park. Probably closer to 90, and maybe a few more as an intern- you can't run a service of 35 patients without doing the work. A word of caution though to the OP- if there was a magical field which combined stimulating scientific/clinical variety, low stress/manageable hours, and solid pay you'd bet I'd be gunning for it. I don't think IM specialties are doomed to failure as someone pointed out- but the way compensations are going, they are certainly doomed for monotonous, bad medicine. I shadowed a private practice GI doc, who told me 1/3 to 1/2 of his appointments are for IBS (irritable bowel)... but his bread and butter are colo's and EGD's because a half hour procedure banks big cash- translation is you scope the hell out of everyone. Boring, probably not entirely ethical, but certain lucrative and good hours. Similar for cath- a NY times article earlier this year talked about a private practice outside Cleveland that had 4x the national average of doing caths. Academics, while it has its pitfalls, might be a better option to get what you're looking for. Just a thought.

 

[OHMAN0125]

From what I've read, and what other posters on SDN indicate, the 80 hours thing for surgery, while not enforced to the letter, is a good ball park. Probably closer to 90, and maybe a few more as an intern- you can't run a service of 35 patients without doing the work. A word of caution though to the OP- if there was a magical field which combined stimulating scientific/clinical variety, low stress/manageable hours, and solid pay you'd bet I'd be gunning for it. I don't think IM specialties are doomed to failure as someone pointed out- but the way compensations are going, they are certainly doomed for monotonous, bad medicine. I shadowed a private practice GI doc, who told me 1/3 to 1/2 of his appointments are for IBS (irritable bowel)... but his bread and butter are colo's and EGD's because a half hour procedure banks big cash- translation is you scope the hell out of everyone. Boring, probably not entirely ethical, but certain lucrative and good hours. Similar for cath- a NY times article earlier this year talked about a private practice outside Cleveland that had 4x the national average of doing caths. Academics, while it has its pitfalls, might be a better option to get what you're looking for. Just a thought.

I think the OP was also looking for pretty good pay. Academics is way low compared to private practice. I think they make less than half

 

[Miami_med]

Don't work in LA, San Francisco, NY, Boston, Miami, Washington, Philadelphia or Chicago. That farther away you get, the safer your future. All the new grads, even the NPs and PAs tend to flock towards these places, so the whole supply and demand thing will work in your favor if you don't.

 

[YupGypsy]

I think the OP was also looking for pretty good pay. Academics is way low compared to private practice. I think they make less than half

good pay and no immediate threats. I thought about radiology but there have been talks about outsourcing & computer taking over.

 

[Twitch]

good pay and no immediate threats. I thought about radiology but there have been talks about outsourcing & computer taking over.

LoL on computers taking over.

And ladies & gents, here it is finally: The RadReader3000. Get your ct's/x-rays read and a dx in 10 minutes or less.

 

[vtucci]

There is always pathology- people will always die. The hours and pay are decent.

 

[turkleton]

You know, they've been saying that entire shipping radiology films overseas for years and it hasn't happend- and it's not as though we're waiting for some huge technological breakthrough. The intranet was invented by Al Gore like 15 years ago. I'm not a radiologist, but I'm having a hard time buying that argument- they're doing something to protect their field, and they seem to be doing it quite well. Salaries are through the roof and more and more imaging modalities are coming out- they're in demand big time... not a bad choice. As for academics, yea you definitely take a hit on the salary. Although I've heard cardiologists starting at 150-180 in academics... granted it's not the 300 of prviate practice, but you'll still be able to feed your family, drive a high class toyota or a low class lexus, and have a couple bucks left over.

 

[Gut Shot]

which specialties will be the wisest to go into in the coming years? that is, good pay, stable career, and immune to invasion by midlevels (e.g., primary care), technological advancements (e.g., radiology), outsourcing (e.g., radiology), etc.? Cardiology? Surgery?
Please spare me the "go into something that you like" routine.

Geriatrics and anything ICU.

 

[turkleton]

Geriatrics is so depressing though... ICU is no cup of tea, but at least you get a few saves there.

 

[humuhumu]

Can't think of anything more secure than pathology, and as far as I can tell, they have the most sane residency training.

I think neurology is a good bet too. Given the pace of neuroscience breakthroughs, and the increasing geriatric population, the field has a very bright future.

 

[indo]

I recommend going into something with old people and fat people. They're not going away any time soon.

 

[turkleton]

I recommend going into something with old people and fat people. They're not going away any time soon.

 

[Sol Rosenberg]

I recommend going into something with old people and fat people. They're not going away any time soon.

....but too general. FP's deal with lots of old and fat people, and you don't see anyone here recommending FP.

 

[OHMAN0125]

Geriatrics is so depressing though... ICU is no cup of tea, but at least you get a few saves there.

I thought about ICU in the past. Good pay >290K on average. But lifestyle is pretty dam bad. To me if u like that critical stuff i'd so ER. Maybe less avg pay but lifestyle rocks.

 

[Skialta]

old.....fat.....smokers = vascular surgery👍

 

[QuantumMechanic]

what about RadOnc?

 

[ForbiddenComma]

As people have mentioned, primary care is going to be obsolete for M.D.s after the midlevels take over. (Why should an HMO hire an FP when they can get an NP for half the cost?)

I'd also add Derm to that list. One reason derm is so lucrative is because of how well they've limited their residencies. But after PAs flood the market to a sufficient degree, it will stop being the Holy Grail of the match.

Don't forget that psychologists are increasingly moving in on psychiatrists' turf.

And there's nurse-midwives taking over the OB field. Can't blame MDs for moving away from deliveries though, what with the insane malpractice situation...

Plus, gas is already largely in the hands of the CRNAs. Between that and all the people who have flooded into gas residencies lately, expect to see the market for anesthesiologists to crash.

Finally.. yes, Rads will be outsourced to India. There's still RadOnc and IntRads but I wouldn't be surprised if they becomes IM subspecialities at some point.

Therefore my list of M.D.-safe fields would be
- Surgery (all specialties)
- Neuro
- Cards
- Pulm/CC
- Heme/onc
- GI
- Path
- Neonatalist pedes
- Rheumatology
- EM (maybe)
- Hospitalist IM (maybe)

of course, like most of the other opinions in this thread, this is just from a dumb med student who has no clue 😉

 

[Pinner Doc]

People have discounted primary care specialties for the most part, but what about Psychiatry? Research-wise, in conjunction with neurology, I think there might be a boom.... thank about all the things we DON'T know, still.

 

[makushin]

I recommend going into something with old people and fat people. They're not going away any time soon.

 

[makushin]

People have discounted primary care specialties for the most part, but what about Psychiatry? Research-wise, in conjunction with neurology, I think there might be a boom.... thank about all the things we DON'T know, still.

shhhh!

 

[sirus_virus]

Don't work in LA, San Francisco, NY, Boston, Miami, Washington, Philadelphia or Chicago. That farther away you get, the safer your future. All the new grads, even the NPs and PAs tend to flock towards these places, so the whole supply and demand thing will work in your favor if you don't.

You forgot to mention that because they are new graduates they don't know that those states have a hostile legal environment for doctors.

 

[IceMan0824]

The invasive cardiologists are taking some business from the CT surgeons, and both invasive cardiologists and CT surgeons have "married to the hospital" lifestyles (you have to like that).

I'm pretty open; currently I'm interested in oncology, which seems to be ok. Maybe I'll still like that further down the road.

You know I was kidding right. I chose the one specialty that's near dead that a casket has already been made. Guess I'm just not that funny today...err...yesterday.

 

[IceMan0824]

CT surgery?? Are you serious?? For the past few years, only about half of the CT fellowship spots are being filled. Cath is just getting better and better and CT's main role now is backup for complications, multivessal disease, and valvular disease- although even the latter is being taken over by cardiologist and there isn't enough to make it the bread and butter of your practice. As one of the surgical residents pointed out to me- the field isn't dying. It's dead. Non cardiac stuff, exclusively thoracic, however, I'm told is getting more popular. If you're interested in surgery, that's probably gonna be a good field considering everyone still smokes like crazy.

Kidding...come on. Someone pretend to get it.

 

[dilated]

Anything that has cash-only. Odds are the government will take over health care within our lifetimes. When that happens, the more in demand your services are the WORSE because they'll probably structure it to make you see all those people while paying the same.

Alternately, when PAs and NPs are doing peoples CABGs to save $$$ there will probably be a private health insurance system for the wealthy that pays way more (a la the UK). So fields where people would want to go to a private doctor would be good too.

 

[OHMAN0125]

Anything that has cash-only. Odds are the government will take over health care within our lifetimes. When that happens, the more in demand your services are the WORSE because they'll probably structure it to make you see all those people while paying the same.

Alternately, when PAs and NPs are doing peoples CABGs to save $$$ there will probably be a private health insurance system for the wealthy that pays way more (a la the UK). So fields where people would want to go to a private doctor would be good too.

There's always talk of other midlevels taking MDs turf. However, I think that in general MDs do know how to protect themselves. I mean look at radiology. Basically it could be dead. Just one click and the image is in India or Europe. But the field is booming and pay is up the wall! I think specialists will continue to be able to control their turf, but primary care will have a harder time in doing so. In other words dont do primary care.

 

[QuantumMechanic]

Alternately, when PAs and NPs are doing peoples CABGs to save $$$ there will probably be a private health insurance system for the wealthy that pays way more (a la the UK). So fields where people would want to go to a private doctor would be good too.

liability would probably high in those respective fields as well though

 

[asunshine]

interventional rads!
huge demand (old, fat smokers?), can't outsource it, lots of $, good lifestyle

child/adolescent psych
lifestyle & demand

nephrology
demand, lifestyle & pay to some extent, but, as an interventional radiologist told me, the Venn diagram for "cool guy" and "nephrologist" does not intersect.

surgery?
if you specialize in things like gastric bypass, urology...?

gynecology (no OB)

EM, derm, and gas, too

what does OPEC mean?

 

[DragonWell]

Ortho is going to continue to be huge, especially the joint stuff pointed out by another poster. As the elective shoulder and knee stuff gets better, Sports Ortho will get even bigger also. Big national shortage of Peds Ortho right now, we'll see how long that lasts.

Some elective surgeries (ie joint replacement) are starting to be farmed out to large hospitals in places like India and Thailand which are set up to cater exclusively to Western "medical tourists". Even if patients aren't crazy about traveling to India for surgery, the cost is cheap enough that insurance companies can give financial incentives to encourage patients to make the trip and still end up saving lots of money. "Outsourcing your Heart"

Who knows what the future will bring, but this makes me lean toward the specialties which provide care for emergent conditions as being more secure than those based on elective surgeries.

Personally, I'm going to follow the example of a cardiologist here in town who just quit to practice "Anti-Aging Medicine". Nobody wants to age, right?

 

[Bertelman]

I'd also add Derm to that list. One reason derm is so lucrative is because of how well they've limited their residencies. But after PAs flood the market to a sufficient degree, it will stop being the Holy Grail of the match.

PAs are flooding the Derm market? How?

And there's nurse-midwives taking over the OB field. Can't blame MDs for moving away from deliveries though, what with the insane malpractice situation...

Nurse midwives aren't a new phenomenon. I haven't heard of them wanting to scrub in on a stat section. They certainly aren't removing fibroids.

Plus, gas is already largely in the hands of the CRNAs. Between that and all the people who have flooded into gas residencies lately, expect to see the market for anesthesiologists to crash.

People "flooded" into gas residencies because statements exactly like this one 15 yrs ago, threatening the death of the species, caused a shortage of providers. Ahem, we're still here. Residencies are actually increasing the number of positions. When that older group of anesthesiologists is retired, and the specialty feels the effects of the slim years, I'll just be hitting my stride. And guess who manages the CRNAs? Most importantly, there will only be more surgeries in the future. Sure, some will have to suffer, with salaries decreasing from the 350's to the high 200's. Hmmm...I guess I can survive on that. When I worked in the OR, an older anesthesiologist complained about reimbursements. Something about "less than half a mil". He had to sell his vacation home in Aspen. That's gotta suck.

yes, Rads will be outsourced to India.

With what evidence are you basing this statement? You mean, the exact same docs who couldn't score an FP residency in the states are going to be reading our CTs in the future? The news of late has been documenting a backlash to outsourcing, particularly in the tech help industry. If Sheila Patel with her ambiguously continental accent can't help me fix my Dell, she sure can't read that MRI, either.


Overall, I found that to be full of hyperbole. Now for my own crackpot theory- In 10 yrs, the endoscopic pill will be commonplace, and GI docs everywhere will bemoan the loss of their cash cow. Back to IBS 🙁

 

[Bertelman]

what does OPEC mean?

consortium of countries which control the flow of oil.

OPEC

 

[albaniandoc]

which specialties will be the wisest to go into in the coming years? that is, good pay, stable career, and immune to invasion by midlevels (e.g., primary care), technological advancements (e.g., radiology), outsourcing (e.g., radiology), etc.? Cardiology? Surgery?
Please spare me the "go into something that you like" routine.

Here is a specialty with a great future: politician. They are always screwing the docs and the nurses and getting richer for themselves.

 

[dilated]

There's always talk of other midlevels taking MDs turf. However, I think that in general MDs do know how to protect themselves. I mean look at radiology. Basically it could be dead. Just one click and the image is in India or Europe. But the field is booming and pay is up the wall! I think specialists will continue to be able to control their turf, but primary care will have a harder time in doing so. In other words dont do primary care.

Under the current system MDs manage to protect their turf. Under socialized medicine, the government is under huge stress to cut costs and one of the first things they go for is expanding midlevel scope as far as people will tolerate. Part of Arnold's CA healthcare plan is eliminating physician oversight of PAs and NPs, same thing in PA with Ed Rendell.

Outsourcing may actually go the other way under socialized medicine. It's a lot easier for some HMO to outsource then it is for the American government to straight up say "Yeah, uh, we're going to send your tax dollars off to doctors in India". I don't expect outsourcing to be a huge problem. Of course, the government can (and will) say "X amount is going to radiologists this year, so the more procedures you do the less each one is worth".