Specialty with a good future

[Jiminy Cricket]

---

Members do not see this ad.

what is stopping fp or im from creating a derm fellowship?

are there cosmetic fellowships in im and fp?

these guys need to wake up.

i know of a few fp's that have ventured into the derm market already.

 

[8744]

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 😉

Nurse midwives, who I love and respect because of their kindness and charm when they precepted me on my OB rotation at a certain Eastern academic medical center/craphole which we will only call "Earl" to avoid the usual wailing and gnashing of teeth in the face of my usual tomfoolery, will never take over OB. I have an idea that if they even threatened to take it over, the OB/Gyns would say,"Here, take the mother****er and good riddance."

As talented as they are and as expert in vaginal delivery and normal obsterics, even the typical medically uneducated citizen knows enough to want a residency trainied OB riding heard on things. In fact, it's usually only the hyper-educated professional couples who want midwives for both the coolness and crunchiness factor. They usually want a doula involved too.

So rest easy. If OB/Gyns are targets for lawsuits, imagine the exposure of a nurse midwife practicing without supervision.

No offense to midwifery, a career that I respect immensly.

 

[QuantumMechanic]

i know of a few fp's that have ventured into the derm market already.

can they read their own pathology slides?

 

[YupGypsy]

So umm... we shouldn't be scared about radiology outsourcing??

Which has a better lifestyle, radiology or anesthesiology? I heard that radiology residents study like crazy in all those five years. How long is an anesthesiology residency?

 

[Taus]

People will never stop getting spinal cord injuries, brain injuries, strokes,etc and the aging and active population will be seeking more and more conservative/minimally invasive treatments for musculoskeletal/sports/spine/pain disoders = a bright future future for PM&R

 

[angel80]

Many PT programs are moving towards elimainating the Masters degree altogether and only offering Ph.Ds in Physical Therapy. They hope to get more autonomy and be able to evaluate and treat patients with musculoskeletal, neurological...etc problems without needing a prescription from a physician. If that one day comes to be, it may eat away at the business of PM&R.

 

[OHMAN0125]

So umm... we shouldn't be scared about radiology outsourcing??

Which has a better lifestyle, radiology or anesthesiology? I heard that radiology residents study like crazy in all those five years. How long is an anesthesiology residency?

I really don't see it happening. I've brought it up to a number of radiologists and they all say they know how to protect the field. Just like other specialties. I mean there will be some business taken away, but you'll be fine in rad (my opinion). I think rad has better lifestyle than anes, but i'd choose anes over rad any day. I think it takes a unique person to want to read xray,cts, MRI, etc scans all day long and have VERY minimal patient contact. Even interventional rads has very limited contact. This was told to me by a radiology residency director. Basically you have to be realistic, if you need patient contact then don't do radiology. But if you dont go for it...they make a sh@t load, more than anesthesiology for sure.

 

[MadameLULU]

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.

Don't quite agree with this. GI seems to have a very good lifestyle. They can generate quite a bit of money on a colonoscopy which can take an experienced physician ~15 minutes. Plus they don't have to take care of many emergencies since most GI emergencies are surgical cases.

 

[MD Wiggy]

So, CT surgery ... since only about 50% of fellowships are filled each year the supply of CT surgeons will be dropping off quite drastically in the next 10 years or so. This means increase in security.
It is true that the role of the cardiac surgeon has shifted from CABG to other procedures but a similar shift took place previously. Historically the CT surgeon was a Tb surgeon. With the evolution of bypass/medical treatment of Tb their role shifted to CABG. Interventional Cards have largely taken over this role, but not completely.
Robotic surgery is revolutionizing surgery especially CT. The Da Vinci is now being used for CABG. Angioplasty and stent placement may not be the best fix for CAD.
Additionally CT surgeons are evolving new procedures, thoracoscopic valve repair. Effective A-fib procedures ... Maze>Mini-Maze>Wolf Mini-maze. Who knows what is next.
CT surgery is a field where technology is not irradicating the specialty it is opening new doors for these surgeons.

 

[Tired]

Don't quite agree with this. GI seems to have a very good lifestyle. They can generate quite a bit of money on a colonoscopy which can take an experienced physician ~15 minutes. Plus they don't have to take care of many emergencies since most GI emergencies are surgical cases.

GI = procedure based

You're right. I was referring more to Neurology, Pulm, ID . . .

 

[Taus]

Many PT programs are moving towards elimainating the Masters degree altogether and only offering Ph.Ds in Physical Therapy. They hope to get more autonomy and be able to evaluate and treat patients with musculoskeletal, neurological...etc problems without needing a prescription from a physician. If that one day comes to be, it may eat away at the business of PM&R.

Many people (even in the healthcare field) don't really understand exactly what a PM&R Physician does unless they have been directly involved w/ one or had a patient under their care. The DPT's graduating today would have to have a completely restructured and revised curriculum to attempt coming close to the broad variety of diagnostic and therapeutic/interventional procedures that Physiatrists do.

If someone you care about had a spinal cord injury or stroke I don't think you'd want them to spend the weeks/months immediately following it and the lifelong effects of it without the expert care and coordination of treatment provided by a Physiatrist.

I don't intend to discredit the work that PT's do, as they are very valuable members of the healthcare team. Also, many common injuries can probably be managed by them in the outpatient setting w/o supervision or physician clearance. Many patients come to PM&R docs when they are in that middle ground of PT not working and having nothing to operate by Ortho to fix it.

 

[NuevaYorkDoc]

What I think is going to happen in the future, maybe not too distant future, is that midlevels could really mess some stuff up, due to inexperience, lack of education and lack of oversight. Costing consumers and care providers a lot more money than it would have cost just to keep the docs around. There will be a huge media backlash and everyone will be happy to go back to doctors again.

 

[MD Wiggy]

What I think is going to happen in the future, maybe not too distant future, is that midlevels could really mess some stuff up, due to inexperience, lack of education and lack of oversight. Costing consumers and care providers a lot more money than it would have cost just to keep the docs around. There will be a huge media backlash and everyone will be happy to go back to doctors again.

Excellent thought. It would be great to see the power of the media help physicians out. Although it would be at the expense of other professionals.

 

[OHMAN0125]

Excellent thought. It would be great to see the power of the media help physicians out. Although it would be at the expense of other professionals.

There sure has been a lot of anti-midlevel sentiment these days. 🙄

 

[RxnMan]

Oz - I think it's a hit or miss with respect to the 80 hour rule. Some do, some play lip service, some don't care. Read through the surg forums for an idea of how it is.

Taus - I agree with you - whether paired with ortho surg patients or on their own, PM&R is a low-cost, lower-impact method of getting those Baby Boomers out the door to healthier and more independent lives.

Rads won't be outsourced. There always has to be someone in-hospital to read the negatives, for legal grounds if nothing else. To put it another way, there has to be someone to sue/punish if the film isn't read right.

If/when we go to a socialized system of healthcare, there will be two levels of care (just like any other socailized system). While a lot of the labor may be reorganized under the gov, the private level will still be independent to do as market forces dictate. The schools will also have thier own curriculums that won't change.

 

[MadameLULU]

GI = procedure based

You're right. I was referring more to Neurology, Pulm, ID . . .

Most pulm. physicians are also boarded in critical care, so I don't see most PCPs taking care of these types of patients as most are trained to do so. Also, given the practice of overprescribing by PCPs w/o confirming a dx or even having a clue what an infection may be, resistance to drugs, I don't see ID physicans losing their jobs any time soon.

 

[turkleton]

😎

So, CT surgery ... since only about 50% of fellowships are filled each year the supply of CT surgeons will be dropping off quite drastically in the next 10 years or so. This means increase in security.
It is true that the role of the cardiac surgeon has shifted from CABG to other procedures but a similar shift took place previously. Historically the CT surgeon was a Tb surgeon. With the evolution of bypass/medical treatment of Tb their role shifted to CABG. Interventional Cards have largely taken over this role, but not completely.
Robotic surgery is revolutionizing surgery especially CT. The Da Vinci is now being used for CABG. Angioplasty and stent placement may not be the best fix for CAD.
Additionally CT surgeons are evolving new procedures, thoracoscopic valve repair. Effective A-fib procedures ... Maze>Mini-Maze>Wolf Mini-maze. Who knows what is next.
CT surgery is a field where technology is not irradicating the specialty it is opening new doors for these surgeons.

I'm not a CT surgeon... hell I'm not even a doctor yet... but the CT graduates from our fellowship program were struggling to find work- one was considering doing another critical care fellowship to beef up the resume- this is after a 8 year total residency! Maybe you know more about the field, but to me it looks like techology is erradicating the field. The a-fib procedures you mentioned are getting just as much attention from EP people and it looks like they're getting better and better results. And the use of Da Vinci is great- if the community hospital many will work in actually invests in one- but it still doesn't solve the problem of less patients. I could be wrong, but if I was graduating a surgical residency, I would be very leery of doing a CT fellowship. My picks for security, compensation, and to a lesser extend lifestyle based on no scientific method and entirely on grossly misinformed speculation:

1. Rad Onc- ZERO emergencies so you have more time to deposit your big ass paycheck
2. Ortho & Plastics- Tough residency, but man does it look like a sweet life.
3. Rads/IR- you can read films elsewhere, but you can't stick a catheter from Bejing.. and still havn't seen the outsource scare- 50 bucks for a CXR read!
4. Derm/ENT/Optho- Better lifestyle, but seems like lesser pay
5. Anesthesia- I'm sorry, but I still can't figure out how they're making 300K starting.
6. Cards/GI- Dependable once you get there.
7. Path- Probably should be higher, but I think its boring.

Commence telling me how I couldn't be any more wrong😎

 

[Wizard of Oz]

what is stopping fp or im from creating a derm fellowship?

Derms.

Yeah I know primary care docs who have opened botox clinics, but I also don't know any derms who don't use midlevels to carry their easy cases anyway. I think that they are plenty busy.

 

[deleted87716]

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

Well, at least you admit it. 😉

As for the original subject of this thread, we'll always need good doctors, in all specialties. Every field evolves over time (particularly technology-based specialties), as does income potential. As they say in the brokerage biz, "past performance does not guarantee future results."

So, despite what the OP wants to hear, do what you enjoy.

 

[deleted87716]

what is stopping fp or im from creating a derm fellowship?

There's no need. FPs do plenty of dermatology already. Practically anyone can do the cosmetic stuff with minimal training. It's not rocket science.

can they read their own pathology slides?

That's what dermatopathologists are for.

 

[Wizard of Oz]

That's what dermatopathologists are for.

$$$$$$

 

[AmoryBlaine]

What I think is going to happen in the future, maybe not too distant future, is that midlevels could really mess some stuff up, due to inexperience, lack of education and lack of oversight. Costing consumers and care providers a lot more money than it would have cost just to keep the docs around. There will be a huge media backlash and everyone will be happy to go back to doctors again.

Agreed, very interesting thought. I think at some point the discussion is going to be "NPs/PAs are good for 95% of cases, do you want to be in the 5% just to save a few bucks."

I also have to echo a sentiment I saw on Pandabear's blog. If as med students and residents we find our knowledge and powers of logic sorely tested on a daily basis, how can one argue that a PA with 2 years of post-grad training is just as good?

 

[YupGypsy]

😎

I'm not a CT surgeon... hell I'm not even a doctor yet... but the CT graduates from our fellowship program were struggling to find work- one was considering doing another critical care fellowship to beef up the resume- this is after a 8 year total residency! Maybe you know more about the field, but to me it looks like techology is erradicating the field. The a-fib procedures you mentioned are getting just as much attention from EP people and it looks like they're getting better and better results. And the use of Da Vinci is great- if the community hospital many will work in actually invests in one- but it still doesn't solve the problem of less patients. I could be wrong, but if I was graduating a surgical residency, I would be very leery of doing a CT fellowship. My picks for security, compensation, and to a lesser extend lifestyle based on no scientific method and entirely on grossly misinformed speculation:

1. Rad Onc- ZERO emergencies so you have more time to deposit your big ass paycheck
2. Ortho & Plastics- Tough residency, but man does it look like a sweet life.
3. Rads/IR- you can read films elsewhere, but you can't stick a catheter from Bejing.. and still havn't seen the outsource scare- 50 bucks for a CXR read!
4. Derm/ENT/Optho- Better lifestyle, but seems like lesser pay
5. Anesthesia- I'm sorry, but I still can't figure out how they're making 300K starting.
6. Cards/GI- Dependable once you get there.
7. Path- Probably should be higher, but I think its boring.

Commence telling me how I couldn't be any more wrong😎

anesthesiologists start off making $300k/year?? Like right out of residency?

How many hours do they work on average? And how much will they make in say, 10 years?

 

[Wizard of Oz]

anesthesiologists start off making $300k/year?? Like right out of residency?

How many hours do they work on average? And how much will they make in say, 10 years?

Time machine, people, time machine. No way to know. Relative salaries fluctuate based on reimbursements, technology, and laws among other things.

I know internal med docs who start with $250K offers as hospitalists with 80 hr./week schedules and $140K offers with 40 plus 20 call, so it just depends on how much you want to work. I'm just using general IM as an example because people think that it is low-paying. It doesn't have to be.

Plenty of threads/websites are available on this topic. None of them can predict the future. Every specialty has a reason to be lucrative in the future. They all have reasons why physician compensation is dropping too.

Wanna make money? Be a provider that charges cash only before services rendered. Set your prices, and let your customers go back to their private insurance for whatever reimbursement THEY will get (not you). Plenty of all-stars out there do this and make over a million a year. The trick is you can only serve patients with the dough to afford you, and you have to be good enough to merit the asking price. But you'll get paid that way if you have the customer base to support you.

http://www.newyorker.com/fact/content/articles/050404fa_fact

 

[YupGypsy]

Time machine, people, time machine. No way to know. Relative salaries fluctuate based on reimbursements, technology, and laws among other things.

I know internal med docs who start with $250K offers as hospitalists with 80 hr./week schedules and $140K offers with 40 plus 20 call, so it just depends on how much you want to work. I'm just using general IM as an example because people think that it is low-paying. It doesn't have to be.

Plenty of threads/websites are available on this topic. None of them can predict the future. Every specialty has a reason to be lucrative in the future. They all have reasons why physician compensation is dropping too.

Wanna make money? Be a provider that charges cash only before services rendered. Set your prices, and let your customers go back to their private insurance for whatever reimbursement THEY will get (not you). Plenty of all-stars out there do this and make over a million a year. The trick is you can only serve patients with the dough to afford you, and you have to be good enough to merit the asking price. But you'll get paid that way if you have the customer base to support you.

http://www.newyorker.com/fact/content/articles/050404fa_fact

so how much did he end up embarrassly making?

 

[Tired]

anesthesiologists start off making $300k/year?? Like right out of residency?

Yeah right, they wish.

 

[sistermike]

What I think is going to happen in the future, maybe not too distant future, is that midlevels could really mess some stuff up, due to inexperience, lack of education and lack of oversight. Costing consumers and care providers a lot more money than it would have cost just to keep the docs around. There will be a huge media backlash and everyone will be happy to go back to doctors again.

I disagree with this statement in a vareity of different aspects. Mid-levels are more than capable of providing primary care. In fact, I would prefer to see an NP or PA when going to a general walk-in primary care clinic. The NP's and PA's are usually the ones who enjoy providing primary care and enjoy spending more than one minute with their patient. I think mid-level practitioners have all of the proper experience and education to efficiently and effectively treat patients with primary care issues.

However, I do disagree with mid-levels providing any type of care that is non-primary related. I think new grad NP's working in a specialists office is a farce. Although, an NP who worked as an RN in a speciality field for a number of years has great potential work in a specialty area as an NP.

Furthermore, NP's are some of the only primary care providers willing to serve extremely rural areas.

 

[OldPsychDoc]

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

Don't forget to add crazy people to the mix!
And our patients mate with each other to ensure a subsequent generation of patients!

 

[YupGypsy]

Time machine, people, time machine. No way to know. Relative salaries fluctuate based on reimbursements, technology, and laws among other things.

I know internal med docs who start with $250K offers as hospitalists with 80 hr./week schedules and $140K offers with 40 plus 20 call, so it just depends on how much you want to work. I'm just using general IM as an example because people think that it is low-paying. It doesn't have to be.

Plenty of threads/websites are available on this topic. None of them can predict the future. Every specialty has a reason to be lucrative in the future. They all have reasons why physician compensation is dropping too.

Wanna make money? Be a provider that charges cash only before services rendered. Set your prices, and let your customers go back to their private insurance for whatever reimbursement THEY will get (not you). Plenty of all-stars out there do this and make over a million a year. The trick is you can only serve patients with the dough to afford you, and you have to be good enough to merit the asking price. But you'll get paid that way if you have the customer base to support you.

http://www.newyorker.com/fact/content/articles/050404fa_fact

For all we know, the world can end tomorrow. But we can always speculate...

 

[OHMAN0125]

Yeah right, they wish.

www.gaswork.com

Most of them do start out at minimum around 300k/yr. Of course there's lower ones. But with all those ~300k why go for the less money?

 

[turkleton]

On an anesthesia elective one resident told me that the cardiac anesthesiologist haul in close to half a million... I was very unimpressed by general anesthesia but apparently the cardiac guys are usually very busy during the case doing some cool stuff.

 

[OHMAN0125]

On an anesthesia elective one resident told me that the cardiac anesthesiologist haul in close to half a million... I was very unimpressed by general anesthesia but apparently the cardiac guys are usually very busy during the case doing some cool stuff.

Like watching the HR? HAHA...j/k. 😀
Wow that seems like a lot though. I thought pain specialists were the top moneymakers in anesthesia field.

 

[turkleton]

Like watching the HR? HAHA...j/k. 😀
Wow that seems like a lot though. I thought pain specialists were the top moneymakers in anesthesia field.

Seriously, really can't figure it out. I didn't want to draw the fire of future gas people because then you'd really have some explosions... ba dum bum ching!

 

[drmistga]

Well I am not sure if you all are considering quality of life as well but either way I agree with psychiatry becoming the next anesthesia or radiology in terms of people thinking they will have a great lifestyle with good pay-the pay will not get up as high as those but I do think you will see a increase in people going into psych just like anesthesia went from being one of the least comp. fields to now pretty comp.

Psych done right in the private sector can be 100 percent cash pay-atleast in CA and the southwest that is almost always true in private practice. And the goverment will never intervene and pay for mental health-just will not happen.

There also will never be a shortage of mental illness-everyone and their mother is depressed or anxious or some crap.

Lifestyle is truly unbeatable even in residency. Other than the super top research heavy programs, hours are usually around 50/week for the first years and 40 for years 3 and 4-some variation but nonetheless not bad. And as a private practice psych you can work super cush hours, never take a call or weekend etc.

However the big thing-many people just are not going to do psych-whether it be because they hate the field, do not respect it, see it as a non-medical field or a joke of a speciality or whatever-but I think with the huge number of women in medicine now and even guys looking for lifestyle choices without dealing with insurance-psych offers that.

And to be honest-a job becomes a job after awhile no matter what you do. There is exceptions to every rule-a broken clock is right twice a day-but the majority of people work so they can enjoy family life, vacations, time off, weekends, having fun etc-Very few love to go to work or would not rather have more time to spend with loved ones. anyway that is my vote!

 

[francisdoss]

Do they have a good pay and lifestyle?

I'll pick onco... B4 bombing the patient with chemo, tell him and the family his chance of survival..If anything happens, just say " i told you"..

 

[fakin' the funk]

To me if u like that critical stuff i'd so ER. Maybe less avg pay but lifestyle rocks.

And, y'know, the work is completely different.

 

[cdql]

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.

toilet cleaning

the pay is decent

the career is stable

there is no invasion because people don't want the job

there will be no technological advancements: all you need is a brush

there is no outsourcing: you will need to physically be at the toilet to clean it