What does the future of medicine look like?

[PowerOfWill]

Obviously, nobody has a crystal ball but for those who have seen the changes over the years, what would your best guess be as to where things are heading?

I know of several attending who wish they could leave for a different career, and who say it's absolutely nothing like it used to be. As a nontraditional student in my early thirties, I have to look at my finite 30-40 year future and really consider everything, and not with rose-colored glasses. The university I attend just started a DPT (physical therapy) program and although it's not my goal, it's a possibility and I really have to start making serious considerations and decisions.

Of course, practicing medicine still will be very worthwhile to some/many, even at a 70+% effective tax rate and tremendous bureaucratic hassle/interruption. But the best one can do is just that.

My concerns and wonder is about how socialized health care (and tax schemes) in America's future will affect physicians, as well as any other considerations to keep in mind.

I don't intend on a political debate, so please don't. It is germane to the discussion, though.

Private practice, family medicine/ direct primary care is my end goal, if that matters.

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[Dr. Doctor MD]

Obviously, nobody has a crystal ball but for those who have seen the changes over the years, what would your best guess be as to where things are heading?

I know of several attending who wish they could leave for a different career, and who say it's absolutely nothing like it used to be. As a nontraditional student in my early thirties, I have to look at my finite 30-40 year future and really consider everything, and not with rose-colored glasses. The university I attend just started a DPT (physical therapy) program and although it's not my goal, it's a possibility and I really have to start making serious considerations and decisions.

Of course, practicing medicine still will be very worthwhile to some/many, even at a 70+% effective tax rate and tremendous bureaucratic hassle/interruption. But the best one can do is just that.

My concerns and wonder is about how socialized health care (and tax schemes) in America's future will affect physicians, as well as any other considerations to keep in mind.

I don't intend on a political debate, so please don't. It is germane to the discussion, though.

Private practice, family medicine/ direct primary care is my end goal, if that matters.

I think there will be continued erosion of all fields of medicine with:
-Decreased reimbursement
-Increasing numbers of midlevels
-Increasing scope of practice of midlevels
-Increased Admins/Beuracracy/Paperwork
-Destruction of fields by private equity
-Shift toward more socialized medicine
-Increasing burnout
-Increasing debt
-Less opportunities for solo practice
-Consolidation into massive health care groups

That being said, despite these challenges, I still see doctors being highly relevant in society and still having jobs (likely still not making less than 200K even in years to come). Medicine will still be good and worth it if you love it, but I think we will be working the same or harder for less money.

I think the one savior will be things like direct primary care or cosmetic plastic surgery where you can bypass insurance completely and just see a small affluent patient base without the administrative burden. These doctors who are switching to DPC are very happy with their choice to enter DPC. It seems like the way to actually enjoy what you do and not deal with BS.

 

[bonedoc5576]

this was my reply to a similar question last year:

I've been in practice over 25 years and have noted the following:

Private insurance rates which follow Medicare reimbursement rates for services (e.g., joint replacements) have not kept pace with inflation. In fact current rates are SUBSTANTIALLY LESS than what they were 25 years ago!

Reimbursement for office work is now directly related to the electronic medical record with ever increasing burdens for documentation and coding which I would argue have marginal benefit to the delivery of care, but seem to be used an excuse for insurance companies and Medicare to further withhold or diminish payment.

The net effect is more tedious work for less money.

On the positive side, there is now an emerging division of labor between ambulatory and inpatient services, so physicians can focus on one or the other, and no longer have to juggle schedules as much between the office and the hospital.

Perhaps the biggest change is consolidation of providers with small private practices getting absorbed by larger and larger groups

I anticipate all physicians in the next 5 years will be employees of large corporations with less money but also less stress than the previous generation of doctors.

It is difficult to speculate where things are heading, but one trend seem fairly obvious: Medicare is going bankrupt and until physicians take a position of leadership advocating for evidence-based rationing of services to Medicare recipients, the government's way of addressing the problem will be to implement large-scale cost cutting strategies including replacing physicians with cheaper alternative providers.

 

[coffeebythelake]

further industrialization of medicine
worsening of two tier system
through unintended economic forces
physicians end up taking care of more socially connected and wealthier patients
mid-levels end up taking care of poor patients who don't know any better

 

[Princeton Medical Student]

A patient will arrive to a hospital via an automated Uberlance vehicle staffed by an EMT who still operates under the department of transport, makes 12 an hour (not adjusted for inflation) and has 2 full days of education. Upon arrival he will be moved to a room quality of which will depend on their yearly salary. Each room will have an opiate dispenser which will provide as much pain relief as a patient needs. A physician will operate the dispenser with a pharmacy rep and a patient advocate with an MBA will supervise the physician. Any pain is no longer acceptable and the physician will not receive his daily rations if pain occurs. All patient care including surgery and anesthesia is preformed by nurses who now have a DNP in nursing practice which they obtain for coming to two five hour sessions following obtaining their RN. Calling them anything but a doctor has been outlawed by the nursing lobby. They wear patagonia fleeces. Physicians who now have 14 year residencies do all of the paperwork for the nurses and dispense opiates as they lack the heart to do anything else. Residents are paid 50k a year (not adjusted for inflation) and work 26 hours a day to preform their heartless work. The entire hospital is supervised by MBAs and lawyers.

 

[Matthew9Thirtyfive]

Moving to Topics in Healthcare.

 

[medschoolzombie]

this was my reply to a similar question last year:


I anticipate all physicians in the next 5 years will be employees of large corporations with less money but also less stress than the previous generation of doctors.

It is difficult to speculate where things are heading, but one trend seem fairly obvious: Medicare is going bankrupt and until physicians take a position of leadership advocating for evidence-based rationing of services to Medicare recipients, the government's way of addressing the problem will be to implement large-scale cost cutting strategies including replacing physicians with cheaper alternative providers.

Why would today's physicians have less stress than the previous generation? If anything, it seems like it would be more with all the things you mentioned ( Along with a possible paycut and more patient volume if socialized medicine happens).

From my understanding, medicare isn't gonna go bankrupt, it's just gonna cost more. The govts way of solving this is no doubt to raise taxes on the wealthy

 

[bonedoc5576]

Less stress for internists because they don't set foot in the hospitals and hospitalists don't worry about the office. Less stress for surgeons because increased compartmentalization. Less stress for all as employees walking into turnkey practices vs building and sustaining all aspects of private solo / group practice

Shifting demographics going to significantly change Medicare (and social security)

 

[LookForZebras]

More physicians pursuing nonclinical and otherwise unconventional jobs.

 

[Gyuji]

Universal healthcare. Can't denial it, that's the future for the United States. The proposal is going to rain hard during the 2020 campaign season once Bernie Sanders wins the Democratic nomination and be the main topic in 2021 once he get into office.

 

[Wilf]

Universal healthcare. Can't denial it, that's the future for the United States. The proposal is going to rain hard during the 2020 campaign season once Bernie Sanders wins the Democratic nomination and be the main topic in 2021 once he get into office.

Oh **** no. The liberals will be split between the reasonable (Biden and Clinton type) and the unreasonable (Bernie and Ocasio-Cortez type). Either Biden or Bernie will win the nomination, but either one will have a lot of democrats upset with the outcome. The republicans will win in 2020 and will get at least one more SCOTUS pick. The US will be ok for the next 20-30 years.

 

[Gyuji]

Oh **** no. The liberals will be split between the reasonable (Biden and Clinton type) and the unreasonable (Bernie and Ocasio-Cortez type). Either Biden or Bernie will win the nomination, but either one will have a lot of democrats upset with the outcome. The republicans will win in 2020 and will get at least one more SCOTUS pick. The US will be ok for the next 20-30 years.

How? With Trump's awful policies like that tax-cut for the super-rich and corporations and dismantling Dodd-Frank, the economy is heading for a crash. Probably going to crash in the first half of 2020. This will cause a backlash for Trump and Republicans in the 2020 election and a landslide victory for Bernie and a new wave of grassroot Millennial Democrats to step in.

If you mean."corporate Democrats," they were never reasonable in the first place- just bought out. Universal healthcare should have been implemented decades ago. Plus Biden will not win. He ran before twice already and failed miserable. He's a terrible campaigner and out-of-touch with the current growing voter generation.​

 

[gyjlp1]

grim

 

[SurfingDoctor]

The future of medicine:

Riding along the private insurance, ignorance is bliss train until we run out of track. Then,

Or the anti-vaxxers give us all measles...

Whichever comes first...