What happens when an entire specialty ceases to be needed?

[theWUbear]

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With scientific advances, the field of medicine is constantly in flux. One could imagine a great decline in the amount of practitioners needed in oncology if a "cure for cancer" is found, or infectious disease medicine, if we find a way to eradicate the HIV virus.

What would happen to all the oncologists/infectious disease specialists in this situation? What would the outcome of such a scenario be for the medical field in general?

Are there precedents from the 20th century that are relevant?

EDIT: I am editing to acknowledge something I failed to acknowledge: When the cure for cancer is found, oncologists will be needed to administer it. Still, in the long run, oncology will become a smaller and smaller field as the number of people needing such a treatment lessen (assuming our ability to prevent all cancers). The administration of the treatment only provides a short term need. And yes, more infectious diseases exist besides HIV, but the eradication of HIV would certainly negatively affect the demand for ID physicians. It's not the best example, though.

Thank you all for your posts so far.

 

[organdonor]

With scientific advances, the field of medicine is constantly in flux. One could imagine a great decline in the amount of practitioners needed in oncology if a "cure for cancer" is found, or infectious disease medicine, if we find a way to eradicate the HIV virus.

What would happen to all the oncologists/infectious disease specialists in this situation? What would the outcome of such a scenario be for the medical field in general?

Are there precedents from the 20th century that are relevant?

I remember a few threads of this nature where discussion has already been posted, but I'll comment.

If a cure for cancer is found, doctors (oncologists) will be needed to administer it and monitor it. There are plenty more diseases than HIV that ID deals with. Even if we "eradicate" it, we "eradicated" smallpox, and noone is worried about that right? lol.

Another oft cited example you left out is cardiology encroaching on the traditional duties of cardio thoracic surgeons. Bypass surgeries are less popular than ever because of advanced interventional cardiologists and their stent placing. Stents have been around a while, and there are still CT surgeons around. Cardiologists pass on the more advanced cases to CT anyway. There are certain procedures that will never be taken over. A cardiologist will never do a heart transplant.

Something to consider, we have a cure (per se) for broken bones, yet ortho surgeons still have plenty of work. Mostly implementing that cure.

 

[Tin Man]

With scientific advances, the field of medicine is constantly in flux. One could imagine a great decline in the amount of practitioners needed in oncology if a "cure for cancer" is found, or infectious disease medicine, if we find a way to eradicate the HIV virus.

What would happen to all the oncologists/infectious disease specialists in this situation? What would the outcome of such a scenario be for the medical field in general?

Are there precedents from the 20th century that are relevant?

ID being wiped out? There's a lot more to deal with than HIV. That's just the one Americans are worried about. And a few months ago, we were worried about swine flu. HIV is just the most America-centric piece of the puzzle out there.

If anything's going to be "wiped out" by technology, I'm imagining it'll be surgeons. They're building better and better robots to do the kind of work that surgeons train for years to do, and they do it in such a way that makes the idea of actually cutting chest open look a bit barbaric. Yes, people are needed to work the machines, but if anything's going to be affected by technology, I'm thinking it's going to be the surgeons first...

 

[afugazzi]

Or radiology. If you can look at images from your beach house in Florida, then why not from India?

 

[Narmerguy]

I remember a few threads of this nature where discussion has already been posted, but I'll comment.

If a cure for cancer is found, doctors (oncologists) will be needed to administer it and monitor it. There are plenty more diseases than HIV that ID deals with. Even if we "eradicate" it, we "eradicated" smallpox, and noone is worried about that right? lol.

Another oft cited example you left out is cardiology encroaching on the traditional duties of cardio thoracic surgeons. Bypass surgeries are less popular than ever because of advanced interventional cardiologists and their stent placing. Stents have been around a while, and there are still CT surgeons around. Cardiologists pass on the more advanced cases to CT anyway. There are certain procedures that will never be taken over. A cardiologist will never do a heart transplant.

Something to consider, we have a cure (per se) for broken bones, yet ortho surgeons still have plenty of work. Mostly implementing that cure.

Your answer doesn't really address the crux of the problem. Propose, for example, that only doses of pills need to be taken but that it is not of a complexity that requires an entire specialty but such that an IM could handle it. In this case, oncologists (and certainly radiation oncologist) cease to be needed.

Granted, a pill will never cure cancer, but it isolates the purpose of the argument.

 

[RunningDiva]

With scientific advances, the field of medicine is constantly in flux. One could imagine a great decline in the amount of practitioners needed in oncology if a "cure for cancer" is found, or infectious disease medicine, if we find a way to eradicate the HIV virus.

What would happen to all the oncologists/infectious disease specialists in this situation? What would the outcome of such a scenario be for the medical field in general?

Are there precedents from the 20th century that are relevant?

EDIT: I am editing to acknowledge something I failed to acknowledge: When the cure for cancer is found, oncologists will be needed to administer it. Still, in the long run, oncology will become a smaller and smaller field as the number of people needing such a treatment lessen (assuming our ability to prevent all cancers). The administration of the treatment only provides a short term need. And yes, more infectious diseases exist besides HIV, but the eradication of HIV would certainly negatively affect the demand for ID physicians. It's not the best example, though.

Thank you all for your posts so far.

A related example is psychiatry. It used to be that psychiatrists were the main providers of psychotherapy, specifically psychoanalytic therapy (think Freud). As many of the psychoactive medications were developed, these also came under purview of psychiatrists. Once psychologists entered the scene, starting in the early to mid 1900s, the face of therapy changed. Psychologists, social workers, marriage and family therapists, etc are now the main providers for psychotherapy. Some psychiatry programs still have training, but their main job consists of outpatient prescriptions, consultations, inpatient hospitalizations, and academic research. Psychiatry survived this change in the profession. I think others would adapt as well.

 

[dienekes88]

Your answer doesn't really address the crux of the problem. Propose, for example, that only doses of pills need to be taken but that it is not of a complexity that requires an entire specialty but such that an IM could handle it. In this case, oncologists (and certainly radiation oncologist) cease to be needed.

Granted, a pill will never cure cancer, but it isolates the purpose of the argument.

The demand will decrease, then spots will go unfilled, then the number of people trained will decrease, then residencies will close. Over time, the number of trained specialists in that dying specialty will decline.

That actually happened in cardiothoracic surgery. A couple years ago, only about 60% of the fellowship spots were filled. Some of the guys were facing pretty bleak prospects getting paid barely more than the PA.

If this went down over night? Then a lot of people would be screwed and out of a job. What would they do? Healthcare consulting, management, move back to their roots (internal medicine, pediatrics, etc.).

The crux of this problem might be a V1 move, but the problem is mostly V0.

 

[teenmachinery1]

With scientific advances, the field of medicine is constantly in flux. One could imagine a great decline in the amount of practitioners needed in oncology if a "cure for cancer" is found, or infectious disease medicine, if we find a way to eradicate the HIV virus.

What would happen to all the oncologists/infectious disease specialists in this situation? What would the outcome of such a scenario be for the medical field in general?

Are there precedents from the 20th century that are relevant?

EDIT: I am editing to acknowledge something I failed to acknowledge: When the cure for cancer is found, oncologists will be needed to administer it. Still, in the long run, oncology will become a smaller and smaller field as the number of people needing such a treatment lessen (assuming our ability to prevent all cancers). The administration of the treatment only provides a short term need. And yes, more infectious diseases exist besides HIV, but the eradication of HIV would certainly negatively affect the demand for ID physicians. It's not the best example, though.

Thank you all for your posts so far.

um... what? Even without HIV... are you serious?

Also, there will most likely not be "a cure for cancer." Our understanding of cancer is that there are many causes and kinds of cancer, thus, there will be many cures to cancer. For example, some cancers are genetic, some are caused by viruses, etc.

So... You should say if ALL the cures for ALL the cancers were discovered, oncologists would be in a bit of trouble. Except for, as you admit, someone will have to administer and supervise the "cures" and etc.

 

[mfrizzo3]

An Angel loses its wings.

 

[randombetch]

A cure for cancer? Riiight.

As long as DNA mutations occur, there will be cancer. About as likely as a cure for "death" or "cough."

Bottom line: oncologists will be around for a while. And when technological advances change the demands of the job, oncologists will adapt and keep up to fight cancer more and more effectively.

 

[Drrrrrr. Celty]

I think that with eventual nanotech development, where a nanobot can deliver a deathblow to cancer cells. We will see simply oncologists being very nanobot savy. Basically what the guy above me said.

 

[medicinesux]

Rather than worrying about ONE particular specialty disappearing, I would be MUCH more concerned about the further encroachment of allied health professionals. I see this as the most imminent and number one threat to ALL specialties. This has been quite the talk of the town down in the general residency forums these past two weeks.

 

[git r done]

Rather than worrying about ONE particular specialty disappearing, I would be MUCH more concerned about the further encroachment of allied health professionals. I see this as the most imminent and number one threat to ALL specialties. This has been quite the talk of the town down in the general residency forums these past two weeks.

Interesting. Please enligten us....

 

[iMedical]

Isn't nuclear medicine a good example?

 

[sonofva]

Interesting. Please enligten us....

man. doctors will never have jobs...EVER AGAIN! don't you get it?!?!

 

[medicinesux]

man. doctors will never have jobs...EVER AGAIN! don't you get it?!?!

Your typical canned reponse...YAWN....But don't you worry, there will be jobs for doctors! There will be plenty of primary care drudge work to go around as soon as Obamacare kicks in full force by 2014. That is, as long as doctors are willing to be compensated within 10% of those with a quarter of the training and knowledge!

What is to come of this? It is not rocket science, but elementary ECON 101 .......Supply and Demand my friend....supply and demand..... The neighborhood is about to go down the ****ter when the rats start moving in.

 

[LizzyM]

This has happened in the past and will happen again. Prior to 1955 both polio and TB were very common and very serious diseases and the treatment often required years of institutionalized care. Pulmonologists were employed in large numbers to monitor both conditions. With the polio vaccine and effective drugs for TB, many of those docs found themselves looking for something else to do and they found it in other areas of medicine and public health. We can not predict what will happen 10, 20, 30 years from now but you can expect that the demand for some specialties will wane and others will grow. There is a reason why we stress "life long learning" in medicine.

 

[skiddoc]

A cure for cancer? Riiight.

As long as DNA mutations occur, there will be cancer. About as likely as a cure for "death" or "cough."

Bottom line: oncologists will be around for a while. And when technological advances change the demands of the job, oncologists will adapt and keep up to fight cancer more and more effectively.

This. The "cure" for cancer will probably never be found. In reality, oncology is probably one of the most future-proof professions.

 

[muhali3]

I think the problem with advancement in oncology is that the FDA will allow experimental treatments on humans only after chemotherapy has been tried. I find this sort of stupid because after chemotherapy, you've basically destroyed their immune system and tumor suppressor genes in their cancer cells, so that most experimental treatments would be rendered ineffective since the chemo has disabled many natural defense systems of the body. But this is a whole other discussion in a whole other thread...

 

[Slack3r]

man. doctors will never have jobs...EVER AGAIN! don't you get it?!?!

Btw, you think it can't/won't happen, but it already is. Look at the job market for pathology, the death of pure nuclear medicine (check out the residency forums), DNP's replacing primary care docs, CRNAs lobbying to practice independent of MD anesthesiologists, derm "residencies" for DNPs.

 

[siliso]

I think it is interesting to wonder, what if it turns out that the bread and butter of a particular specialty is actually not effective? Maybe angioplasty, or spinal surgery for back pain. The answer so far seems to be, keep doing it anyway.

 

[johncalvin]

A cure for cancer? Riiight.

....

As long as DNA mutations occur, there will be cancer. About as likely as a cure for "death" or "cough."

Bottom line: oncologists will be around for a while. And when technological advances change the demands of the job, oncologists will adapt and keep up to fight cancer more and more effectively.

This. The "cure" for cancer will probably never be found. In reality, oncology is probably one of the most future-proof professions.

What about Radiation Oncology? With more and more advancements in medical approaches to oncological treatment (like that new pancreatic cancer "vaccine"), I'd say Rad Onc has a pretty uncertain future.

Currently, about 40% of cancers get treated through the radiation route...what happens if/when that percentage steadily drops?

 

[sivar1215]

A cure for cancer? Riiight.

I read this comic everyday outside of my lab while I'm eating my breakfast and it never gets old...

 

[theWUbear]

I feel the need to address this since the thread hasn't died yet:

I brought up cancer solely as a (not well thought out) attempt to exemplify my questioning regarding the possible outcome of a major, sudden, decrease in demand for a specific specialty on the physician population makeup.

Those of you who are denouncing the probability of finding a cure for cancer are not addressing the question at hand, admittedly most likely due to my poor posing of the question. The comic was informative, though.

 

[theWUbear]

The demand will decrease, then spots will go unfilled, then the number of people trained will decrease, then residencies will close. Over time, the number of trained specialists in that dying specialty will decline.
If this went down over night? Then a lot of people would be screwed and out of a job. What would they do? Healthcare consulting, management, move back to their roots (internal medicine, pediatrics, etc.).

This has happened in the past and will happen again. Prior to 1955 both polio and TB were very common and very serious diseases and the treatment often required years of institutionalized care. Pulmonologists were employed in large numbers to monitor both conditions. With the polio vaccine and effective drugs for TB, many of those docs found themselves looking for something else to do and they found it in other areas of medicine and public health. We can not predict what will happen 10, 20, 30 years from now but you can expect that the demand for some specialties will wane and others will grow. There is a reason why we stress "life long learning" in medicine.

I appreciate everyone's input. These two have addressed the crux of my hypothetical as I intended. Quite the scenario indeed.

 

[teenmachinery1]

Your typical canned reponse...YAWN....But don't you worry, there will be jobs for doctors! There will be plenty of primary care drudge work to go around as soon as Obamacare kicks in full force by 2014. That is, as long as doctors are willing to be compensated within 10% of those with a quarter of the training and knowledge!

What is to come of this? It is not rocket science, but elementary ECON 101 .......Supply and Demand my friend....supply and demand..... The neighborhood is about to go down the ****ter when the rats start moving in.

?

stfu please

 

[HAART]

?

stfu please

 

[randombetch]

What about Radiation Oncology? With more and more advancements in medical approaches to oncological treatment (like that new pancreatic cancer "vaccine"), I'd say Rad Onc has a pretty uncertain future.

Currently, about 40% of cancers get treated through the radiation route...what happens if/when that percentage steadily drops?

Radiation has been used to treat cancer for the past 100 years or so, since it's usefulness has been discovered. It's pretty unlikely that we'd shift away from using radiation. From the people I've talked to, we'd be more inclined to use radiation in the future than disinclined.

 

[TheRadiologist]

Or radiology. If you can look at images from your beach house in Florida, then why not from India?

In order of a radiologist from India to do a final read of a case in the U.S., he has to have a license to practice medicine in the U.S. This is only possible if they have had residency training in the U.S. There is not a large supply U.S. licensed radiologists in India to eliminate the need for U.S. radiologists.

Some work is being done by Indian radiologists who are not licensed in the U.S, but this has to be signed off and approved by a U.S. licensed radiologist. The U.S. licensed radiologist doing this would be fully being liable for any malpractice.

In order for U.S. radiologists to be easily be replaced by off shore radiologists, there would have to be drastic changes in licensing and credentialing systems. I do not see this happening any time soon. If you do not require any U.S residency training to get a U.S. license, this would affect all physicians, since it would mean that you could import a large supply of any type of physician.

If a hospital allows unlicensed physicians to practice medicine, they can lose their accreditation. Also, the hospital will get sued for allowing this should any thing ever go wrong.

If my job gets off shored, I think I will become a lawyer and sue the guys doing the off shoring every time the off shore guys miss some thing. This should be a very profitable business.😀

 

[morning]

Your typical canned reponse...YAWN....But don't you worry, there will be jobs for doctors! There will be plenty of primary care drudge work to go around as soon as Obamacare kicks in full force by 2014. That is, as long as doctors are willing to be compensated within 10% of those with a quarter of the training and knowledge!

What is to come of this? It is not rocket science, but elementary ECON 101 .......Supply and Demand my friend....supply and demand..... The neighborhood is about to go down the ****ter when the rats start moving in.

It certainly is econ 101 and I don't see how anyone can support it...but the cognitive dissonance of whining about "Obamacare" and government regulation of healthcare and then turning around and whining about unregulated midlevels is stunning. And must be very confusing to you when you get around to thinking about it.

 

[thesauce]

um... what? Even without HIV... are you serious?

Also, there will most likely not be "a cure for cancer." Our understanding of cancer is that there are many causes and kinds of cancer, thus, there will be many cures to cancer. For example, some cancers are genetic, some are caused by viruses, etc.

So... You should say if ALL the cures for ALL the cancers were discovered, oncologists would be in a bit of trouble. Except for, as you admit, someone will have to administer and supervise the "cures" and etc.

No kidding. The "cure for cancer" is a term used by the uneducated masses. ID and oncology are nowhere near being in the vicinity of any conversation about specialties to be phased out.

If the OP's question is more general and these were just poor examples. The field will have steady attrition and fewer training spots until there's no one left. It almost never happens suddenly in any field of work.

 

[thesauce]

This has happened in the past and will happen again. Prior to 1955 both polio and TB were very common and very serious diseases and the treatment often required years of institutionalized care. Pulmonologists were employed in large numbers to monitor both conditions. With the polio vaccine and effective drugs for TB, many of those docs found themselves looking for something else to do and they found it in other areas of medicine and public health. We can not predict what will happen 10, 20, 30 years from now but you can expect that the demand for some specialties will wane and others will grow. There is a reason why we stress "life long learning" in medicine.

I predict that we will see a resurgence in phrenology

 

[Charles_Carmichael]

What about Radiation Oncology? With more and more advancements in medical approaches to oncological treatment (like that new pancreatic cancer "vaccine"), I'd say Rad Onc has a pretty uncertain future.

Currently, about 40% of cancers get treated through the radiation route...what happens if/when that percentage steadily drops?

Not true. As med onc becomes better, the need for radonc will likely increase, not the other way around. Chemo works best against disseminated disease. As our strategies against disseminated disease become better/more efficient, local control of the tumor becomes more important. This is where surg onc and radonc come in. Radonc definitely does not have an uncertain future. As a side note, I think it's actually more than 50% of cancer patients that get radiotherapy. Will look up citation if you want.