The Future of All Specialties

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wjs010

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There are a number of threads in the general residency section, but I couldn't find one in here. Assuming residents and physicians also chime in here sometimes, I think it reasonable to make the thread in pre-med. ( this post goes for all physicians, regardless if MD or DO)

If you look at some of the residency forums such as gas and pain, there are big issues about mid-level providers such as Crna's or even DNP's for family and general ( yes I know there is a current thread in here now about DNP). My question encompasses all specialties.

I would like to know which specialties will be least affected by political movements and possibly Obamacare. Obviously, surgeons will be surgeons...but, a lot of specialties may be affected soon. Would you guys like to predict about the specialties that will be most attractive in 5-7 years? People who are about to be med students will have to think about this. So, begin ( BTW, there's no need to belittle nursing...everyone knows that a doc is more knowledgeable, so let's just focus on the OP)

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There are a number of threads in the general residency section, but I couldn't find one in here. Assuming residents and physicians also chime in here sometimes, I think it reasonable to make the thread in pre-med. ( this post goes for all physicians, regardless if MD or DO)

If you look at some of the residency forums such as gas and pain, there are big issues about mid-level providers such as Crna's or even DNP's for family and general ( yes I know there is a current thread in here now about DNP). My question encompasses all specialties.

I would like to know which specialties will be least affected by political movements and possibly Obamacare. Obviously, surgeons will be surgeons...but, a lot of specialties may be affected soon. Would you guys like to predict about the specialties that will be most attractive in 5-7 years? People who are about to be med students will have to think about this. So, begin ( BTW, there's no need to belittle nursing...everyone knows that a doc is more knowledgeable, so let's just focus on the OP)

I can't say that I am knowledgeable about these issues, but what I hear from a lot of my friends who are doctors and nurses is that private practice like family medicine and such will most likely end up being eliminated and that patients when they go for check ups will be going to hospitals instead of individual practices. This ultimately will make hospitals much busier and thus, more work for healthcare providers.

I could be totally wrong, but that is one of the biggest things I keep hearing.
 
I can't say that I am knowledgeable about these issues, but what I hear from a lot of my friends who are doctors and nurses is that private practice like family medicine and such will most likely end up being eliminated and that patients when they go for check ups will be going to hospitals instead of individual practices. This ultimately will make hospitals much busier and thus, more work for healthcare providers.

I could be totally wrong, but that is one of the biggest things I keep hearing.

i think you are mostly referring to obamacare's affect on healthcare. Yes, i have heard this too. On paper it seems that more work= more people treated. But, can't this be a slippery (bad) slope to unhappy physicians and possibly merge specialties down to where they are making GP salary? It seems like it to me. I mean, aren't specialties a great thing? They specialize in their areas, meaning they are experts...so in the future if salaries are decreasing for specialists and less and less people want to go into a specialty, couldn't that mean less budget for said specialty and, thus less research/advancement for that specialty? IDK brah...I've got these things on my mind. I want to go into PMR pain, but if my future field is going to be ruined, then I have to choose something else.
 
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i think you are mostly referring to obamacare's affect on healthcare. Yes, i have heard this too. On paper it seems that more work= more people treated. But, can't this be a slippery (bad) slope to unhappy physicians and possibly merge specialties down to where they are making GP salary? It seems like it to me. I mean, aren't specialties a great thing? They specialize in their areas, meaning they are experts...so in the future if salaries are decreasing for specialists and less and less people want to go into a specialty, couldn't that mean less budget for said specialty and, thus less research/advancement for that specialty? IDK brah...I've got these things on my mind. I want to go into PMR pain, but if my future field is going to be ruined, then I have to choose something else.

Where are you getting information that leads you to suspect a merging of specialties? Hospitals are buying out groups and more physicians are leaving private practice to heal in a hospital setting. Hospitals still need neurologists, psychiatrists, hematologists, cardiologists, etc. I doubt they are going to merge all neurologists and psychiatrists into a "head doctor" section, or eliminate nephrology and pulmonology departments.

I also don't see how you can speculate about individual specialties losing money across the board. I mean, theoretically you could postulate ALL doctors will see more patients and get reimbursed less (or be forced to make better use of the funds they do get), but right now surgeons and other specialists still make a pretty penny over internists and FM docs. They will in the future too. There won't be any less of a draw in the future if salaries go down because specialist salaries will still be higher.

As for mid-level providers, a relative of mine in the ENT field always tells me that surgery is the way to go. No matter what happens in medicine, a surgeon will always be needed to do what he or she does. No matter what machines are invented, what new technology comes out and what new PAs and nurse practitioners do, a surgeon still has to operate. Barring any "surgeon assistant" positions coming to life, it seems logical.

I'd say surgery would be a safe bet for future job security and salary, brah.
 
I'm gonna stick to my guns here...

NASA Flight Surgery will def keep its salary... brosephs.
 
I'm going to go in the opposite direction and say there is quite a bit of worry regarding anesthesiology.
 
I'm going to go in the opposite direction and say there is quite a bit of worry regarding anesthesiology.

Yea, me too. Btw, when I said merging of specialties, I didn't mean duties, I meant salaries. Not literal, but heading that way.
 
Where are you getting information that leads you to suspect a merging of specialties? Hospitals are buying out groups and more physicians are leaving private practice to heal in a hospital setting. Hospitals still need neurologists, psychiatrists, hematologists, cardiologists, etc. I doubt they are going to merge all neurologists and psychiatrists into a "head doctor" section, or eliminate nephrology and pulmonology departments.

I also don't see how you can speculate about individual specialties losing money across the board. I mean, theoretically you could postulate ALL doctors will see more patients and get reimbursed less (or be forced to make better use of the funds they do get), but right now surgeons and other specialists still make a pretty penny over internists and FM docs. They will in the future too. There won't be any less of a draw in the future if salaries go down because specialist salaries will still be higher.

As for mid-level providers, a relative of mine in the ENT field always tells me that surgery is the way to go. No matter what happens in medicine, a surgeon will always be needed to do what he or she does. No matter what machines are invented, what new technology comes out and what new PAs and nurse practitioners do, a surgeon still has to operate. Barring any "surgeon assistant" positions coming to life, it seems logical.

I'd say surgery would be a safe bet for future job security and salary, brah.

But they could be doing a lot less of it. Interventional radiology may take many of the cases. Gastroenterologists will take theirs, interventional cardiologists have already taken a chunk from the surgeons. The derms are moving on the plastic surgeons. The gynecologists (are they really surgeons? :) ) have a turf battle with urologists over incontinence. The pie may not get much bigger as attempts are made to hold down costs and everyone is going to be fighting over a bigger share of the finite pie.
 
But they could be doing a lot less of it. Interventional radiology may take many of the cases. Gastroenterologists will take theirs, interventional cardiologists have already taken a chunk from the surgeons. The derms are moving on the plastic surgeons. The gynecologists (are they really surgeons? :) ) have a turf battle with urologists over incontinence. The pie may not get much bigger as attempts are made to hold down costs and everyone is going to be fighting over a bigger share of the finite pie.

makes sense. I think there are going to be many unhappy physicians in the near future. And just to shut the people up who always have to chime in to say " well..if you're going into medicine for the money...blah blah blah, etc." I would like to recap and say the physicians will be unhappy about the salary, but they can still love the fact that they are doctors saving peoples lives.
 
Neurosurgery seems to be well positioned.

No one else does craniotomies and chemotherapy/radiation is useless or just an adjuvant therapy for most brain tumors any more.

Interventional is currently hotly contested, but the radiologists concede that when neurosurgeons make it a standard of practice they will be phased out. Meanwhile, neurologists have a pipe dream that they have a horse in this race.

Spine has more than enough patients to go around between ortho and neuro. It's requires a fellowship after ortho so the competition is limited in that respect. Likewise, neither of the respective specialties are attempting to claim absolute ownership since the patient population is generally painful (pun intended).

Neurocritical care is one area that is undergoing changes. Despite a 7 year residency, the majority of which we are actively managing patients in a dedicated neurocritical care, because neurology is making a move to turn it in to a fellowship-trained field it may become so. Again, many/most neurosurgeons out there would almost prefer this since operating is more desirable than changing vent settings and raising/lowerinv ventriculostomy drains.

Midlevels play a valuable role in patient disposition and operative assistance, but their knowledge set is so limited that they present no threat at this time, or in any foreseeable future.
 
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Neurosurgery seems to be well positioned.

No one else does craniotomies and chemotherapy/radiation is useless or just an adjuvant therapy for most brain tumors and more.

Interventional is currently hotly contested, but the radiologists concede that when neurosurgeons make it a standard of practice they will be phased out. Meanwhile, neurologists have a pipe dream that they have a horse in this race.

Spine has more than enough patients to go around between ortho and neuro. It's requires a fellowship after ortho so the competition is limited in that respect. Likewise, neither of the respective specialties are attempting to claim absolute ownership since the patient population is generally painful (pun intended).

Neurocritical care is one area that is undergoing changes. Despite a 7 year residency, the majority of which we are actively managing patients in a dedicated neurocritical care, because neurology is making a move to turn it in to a fellowship-trained field it may become so. Again, many/most neurosurgeons out there would almost prefer this since operating is more desirable than changing vent settings and raising/lowerinv ventriculostomy drains.

Midlevels play a valuable role in patient disposition and operative assistance, but their knowledge set is so limited that they present no threat at this time, or in any foreseeable future.

thanks alot. About mid levels though..what about the mid levels who administer gas? would this jeopardize the gas specialty for the future?
 
I'd say that this depends mostly on new technology coming out. As technology/treatments get better then some specialties may not be needed as much. This is my opinion as a lowly 2nd year med student, but I think primary care is the only specialty not threatened by technology.

People will always need their doctors, but maybe there will be medicine that will fix what most surgeons do. Medicine that makes transplants, or bypasses a thing of the past. I mean isn't cutting someone open a bit barbaric? What about inpatient procedures? Obviously this is in the VERY long term future, but just something to think about :)
 
I'd say that this depends mostly on new technology coming out. As technology/treatments get better then some specialties may not be needed as much. This is my opinion as a lowly 2nd year med student, but I think primary care is the only specialty not threatened by technology.

People will always need their doctors, but maybe there will be medicine that will fix what most surgeons do. Medicine that makes transplants, or bypasses a thing of the past. I mean isn't cutting someone open a bit barbaric? What about inpatient procedures? Obviously this is in the VERY long term future, but just something to think about :)

Maybe not tech, but (much more immediately) they've got plenty of mid levels to worry about. That would concern me much more (if I was going to be a PCP).
 
I'd say that this depends mostly on new technology coming out. As technology/treatments get better then some specialties may not be needed as much. This is my opinion as a lowly 2nd year med student, but I think primary care is the only specialty not threatened by technology.

People will always need their doctors, but maybe there will be medicine that will fix what most surgeons do. Medicine that makes transplants, or bypasses a thing of the past. I mean isn't cutting someone open a bit barbaric? What about inpatient procedures? Obviously this is in the VERY long term future, but just something to think about :)

Yes, if medicine has an enemy, surely that enemy is technology. Technology makes doctors useless and kills jobs. Just look at antibiotics, anesthetics, x-rays, PET/MRI, among many, many other medical inventions and discoveries. Every single one of these slayed doctors' careers.
 
This may be kind of off topic so sorry lol but something I have been thinking about with new technology and such coming out is in regards to oncologists. If we find a cure to cancer (which I really hope will happen soon) does that mean oncologists will all be screwed? Because then all they would be doing is treating, you don't need that many oncologists just to treat patients.

It just seems like there are so many break through's that finding a cure could be just a few years away.

With other specialties like infectious diseases, internal medicine I think it is safe to say that we won't find a magic cure to every infectious disease/disorder in the next few years so it seems like they would be safe. But oncology is pretty much focused on one disease. For that reason, I kind of don't want to go into oncology lol

Does anyone have thoughts on that? Like what would happen if we find a cure?

Look at what happened to the pulmonologists who took care of patients with polio and TB in the 1950s and earlier.... many of them had to retool.
 
But they could be doing a lot less of it. Interventional radiology may take many of the cases. Gastroenterologists will take theirs, interventional cardiologists have already taken a chunk from the surgeons. The derms are moving on the plastic surgeons. The gynecologists (are they really surgeons? :) ) have a turf battle with urologists over incontinence. The pie may not get much bigger as attempts are made to hold down costs and everyone is going to be fighting over a bigger share of the finite pie.

While this is true, I meant more along the lines of people who do surgeries will always need to do surgeries essentially. Unless an advanced treatment eliminates the need for a surgery, you can rarely (if ever) have a midlevel or machine complete a surgery). Whether its derms starting to do some surgeries, or GIs taking more from other areas, someone has to do a surgery.
 
thanks alot. About mid levels though..what about the mid levels who administer gas? would this jeopardize the gas specialty for the future?

They have a fat thread about this in particular under the med student header of the forums. Basically the shift has already begun in that field.

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