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What if a specialty becomes obsolete?

Discussion in 'Pre-Medical - MD' started by MyStiKxFury, May 3, 2007.

  1. MyStiKxFury

    MyStiKxFury 2+ Year Member

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    Hey Im just a premed but I think you guys would know more abou this than those in the pre-med forums. So what if a specialty, like anesthesiology, becomes obsolete because it can be done by mid-levels or be automated to machines. What happens to these doctors, do they train in something else and start another residency?
     
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  3. DoctorFunk

    DoctorFunk Get down with the boogie 7+ Year Member

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    How many specialties can you think of off the top of your head that have become obsolete altogether instead of just shifting the scope of practice/procedures with changing technology?

    Yeah, me either.
     
  4. Critical Mass

    Critical Mass Guest

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    phrenology

    Here I got all of this advanced training, and all I have to show for it is this certificate. :thumbdown:

    :laugh:
     
  5. lilnoelle

    lilnoelle Moderator Emeritus 7+ Year Member

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    The question is sort of valid though. For instance, I've heard cardio thoracic surgeons coming straight out of residency have trouble finding jobs because there just isn't a huge need. There are quite a few threads questioning the future of Anesthesiology, Radiology, and family medicine due to the encroachment of mid level providers or outsourcing.

    If a field was made obsolete, I doubt it would happen overnight. Physicians that are currently in the field will probably (wisely) keep their jobs rather than try to find the same position elsewhere, there will be less open jobs for new residents out of residency, but probably fewer residents completing that specific residency due to its instability. A few individuals will have a hard time finding employment in that field but can probably find something else to do.
     
  6. NonTradMed

    NonTradMed Perpetual Student 7+ Year Member

    Like any job, most people keep up and acquire new skills so that as the field changes, they change with it. No speciality is going to disappear overnight, it would be a slow, evolutionary process so that people who are in those fields can train to do other procedures and/or prepare in other ways. Out of the top of my head, I can't think of any speciality that is seeing unemployment b/c of midlevels or changing technology. Certainly fields have changed in the scope of practice and type of procedures done but people in those fields are not staying static in what they've learned.
     
  7. naegleria brain

    naegleria brain 2+ Year Member

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    this is not exactly correct. cardiothoracic surgery isn't making millions like in the past, but they are still the highest paid surgeons out there, out of any doctor. they saw the biggest hit in salaries however thanks to interventional cardiology.
    the natural dynamics of any profession is that when it becomes obsolete, people dont go into it. last year there were two spots for every applicant in cardiothoracic fellowships. the numbers are now largely equallized, and all this new talk of CABG vs. stent will likely see a resurgence, albeit small, in their business/income, though most likely not as high as before.
    the thing is, pediatric CT surgery will never go away; coarctations, valve replacements, etc. will not go away for a while, and can't really be treated medically, so the CT will be needed.

    an interesting historical tidbit - when fleming discovered penicillin, infectious disease physicians committed suicide in record numbers fearing their entire life's work is now lost with no future prospects.
    looking around today, we still require ID specialists, as we will with most other specialists out there.

    a more realistic situation is that your field is no longer in high demand, but your job will most likely never disappear. after all, history has shown us that no one field will reign supreme, and a new field (generally a surgery) becomes the new high paying king. but it doesnt happen overnight.

    one good point is that doctors do protect their own fields. an example is neurosurgery; neurosurgical residencies train their residents in endovascular neuroradiological techniques. this protects them from losing all their vascular patients to neuroradiologists and starving off the neurosurgeons. but what about interventional neuroradiologists? well for now it seems that they are both in such few supply that wherever you go you wont be starving for patients. but doctors aren't stupid, and will always ensure that they will have work. and not just work, but 6-figure salary work, so it shouldnt be a HUGE concern to you.
     
  8. dutchman

    dutchman 7+ Year Member

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    Bartending.
     
  9. Law2Doc

    Law2Doc 5K+ Member Physician Moderator Emeritus 10+ Year Member

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    Agree with the previous posts, there are no specialties in imminent thread of obsolescence and to the extent it ever does happen, it doesn't happen overnight and people have plenty of time to land on their feet. Worst case scenario is you do a fellowship and become proficient in something else.
     
  10. kakashi74

    kakashi74 2+ Year Member

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    The one specialty that comes to mind is radiology.
    What if there is some new technology that provides clear images so that anybody can read it? Or there could be new image processing algorithms that allow computers to identify things
     
  11. Law2Doc

    Law2Doc 5K+ Member Physician Moderator Emeritus 10+ Year Member

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    And what if aliens from another planet arrive and offer to cure everybody with magic pills? Technology in radiology has improved by leaps and bounds and all it has done was create more subspecialties in radiology. MRI and CT are thousands of times better than the films of yesteryear but unless you are looking at images all day every day, you are likely to miss the subtleties. So sure, anybody who wants to put in the time to get good at it can read them, but no other specialty has that time to burn. Far more likely is that with better toys, the radiologists will make further inroads into even more interventional surgery type stuff.
     
  12. Dimness

    Dimness New Member 2+ Year Member

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    Ah nuts. And I wanted to say phrenology too. :)
     
  13. Critical Mass

    Critical Mass Guest

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    Yeah I'm a little bit sick of the radiology bashing too. Since radiology has been a blue chip sort of specialty for quite some time now, my inclination is that the docs will keep each other taken care of.

    Contrary to what people say about mid-levels, I don't see the need for family med MD's declining any time in the near future either. Some of the family med programs out there get so few applicants that there simply can't be a surplus of the docs coming out of them. So while MD grads run screaming away from family med, rural America is and will continue to be starved for providers of any licensed ilk.
     
  14. cardsurgguy

    cardsurgguy Senior Member 7+ Year Member

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    This of course requires the field to recognize the change and change with it.

    This is exactly what happened (or I should say didn't happen) with cardiac surgeons when stenting and other interventional techniques came along.

    The surgeons thought the interventional techniques weren't going to catch on and were not worth pursuing or learning them so they could do it. So the cardiologists grabbed that up. Now the CT surgeons are kicking themselves.

    In fact, a vascular surgeon told me that vascular surgeons do interventional procedures and expanded their practice and training to include them because of what happened with cardiac surgeons. They saw and learned so they wouldn't have the same thing happen to them.
     
  15. Dakota

    Dakota Senior Member Physician 10+ Year Member

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    Part of the problem was many CT surgeons got their pts as referals from cards. Then cards said "Why send these people out when we can do stuff ourselves" and the stent was born. And CT surgeons never got to see pts to suggest CABG, etc (not that CABG is more effective, but even were it to be, CT surgeons never get the chance to advocate for their procedure to the pt).

    Now there are studies showing for a lot of people stents are not as effective as simply taking drugs alone, but the cards guys like doing stents because they get to make more money off of them. And they justify continued use with "Well, the brand newest stents haven't yet been run through 5-10 year outlook tests so we're going to keep using because the new stents have to be better than the drugs, right?"

    Sigh . . .

    It wouldn't have mattered if CT surgeons had picked up the interventional procedures . . . what cardiologist would have sent a pt to another physician for a lucrative procedure he/she could do themselves?
     
  16. DoctorFunk

    DoctorFunk Get down with the boogie 7+ Year Member

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    Sigh...the news reports on the latest article regarding stenting were entirely overblown. The efficacy of interventional procedures in MIs is still undisputed and my understanding is that the interventional cardiology community in general understands that stenting outside of these acute situations has never been shown to increase overall lifespan but their patients report a great deal of symptomatic relief. Considering the outpatient nature of the procedure and the acceptable risk of complications, it's no surprise that many of their patients request such procedures in order to improve their lifestyle.

    But please, continue bashing those nasty interventional cardiologists for providing procedures that help their patients. We all know they are just money-grubbing mediwhores.
     
  17. Tired

    Tired Fading away 7+ Year Member

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    Don't worry, once MDR tuberculosis really gets rolling in the U.S., CT surgery can get back to their roots: thousands and thousands of pneumonectomies.
     
  18. dilated

    dilated Fought Law; Law Won 10+ Year Member

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    Returning to the actual topic for a moment, what does happen then? Let's say a cancer breakthrough happens and the number of patients needing radiation drops by half or 75%. If the extraneous rad oncs want to go into something else, are they condemned to the fields US allo seniors don't want even though they were probably top tier med students?

    If you're a young attending and there are drastic (bad) changes in your field what can you do? Do you find a position outside the match or something?
     
  19. Tired

    Tired Fading away 7+ Year Member

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    Can you name one development in the history of medicine where this occurred? I can only think of one: syphillis specialists (this was actually the 3rd specialty to have board certification).

    From where I sit, I find such a development highly unlikely, so I'm not going to venture an opinion.
     
  20. Law2Doc

    Law2Doc 5K+ Member Physician Moderator Emeritus 10+ Year Member

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    It won't be a cancer breakthrough that happens (since it isn't really one disease), but once the baby boomer generation passes on in a couple of decades, the average age in the US will drop significantly (as the succeeding generation is much smaller), possibly lowering the cancer rate. (since elderly have more cancer).

    The folks I have heard who have done second residencies seemed to do so through round about channels, not the match. But this whole discussion seems to suggest that if you are really worried about this kind of job security, then maybe IM, from which there are multiple paths (cards, GI, neph, etc), or general surgery, are the safest routes, because you can avoid an entirely new residency to change subspecialty.
     
  21. OncoCaP

    OncoCaP 2+ Year Member

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    Perhaps it depends on the rate of the change of the field. For example, if the change occurred slowly, the field could perhaps adapt (fewer residency slots, picking up new procedures & treatments). In the event of rapid change, perhaps physicians would need to go through the same process that someone would need to go through to change from one specialty to another (match, residency, fellowship, etc.).

    Overall, I get the impression that we are going to need more physicians in the future and that there will be more rather than less opportunities. I don't expect robotic physicians to replace the human type in the near future (e.g., da Vinci systems have a human surgeon running them). However, the quality of life in these specialities in the future is a subject of frequent debate here at SDN.
     
  22. smq123

    smq123 John William Waterhouse Administrator Physician SDN Advisor 10+ Year Member

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    I heard a story (don't know how true it is) about how one of the pediatricians at my school spent his residency gearing up to become a polio expert. The year he finished his residency was the year before the Salk vaccine came out. Obviously it wasn't that big of a deal - he just kept on being a pediatrician - but it's a similar idea.
     
  23. dilated

    dilated Fought Law; Law Won 10+ Year Member

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    I don't think it's happened yet, but I don't think it's been feasible for it to happen yet. Now that we're finally starting to get better at genetic manipulation and biotech in general, it's not crazy to think something like this could happen over the course of a 20 year career. What if RNAi pans out? Even if there's only a 10% chance of it happening, that's a 10% of a huge change in your career.

    I'm not saying I'd choose my specialty based on it, but it wouldn't hurt to have some idea of what you might do if it did happen.
     
  24. Sureshot83

    Sureshot83 Working for $10/hour 7+ Year Member

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    Totally unrelated question - what the hell was the ID specialty before penicillin?

    "Ah yes, with my expert diagnostic skills I conclude that this strange rash on your skin is a Group A strep infection. Eat this, it will reduce the pain while the little bugger disseminates through your body and consumes your soul."
     
  25. naegleria brain

    naegleria brain 2+ Year Member

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    i wondered the same thing. don't have an answer and i'm too lazy to sift through google.

    a cancer breakthrough? STOP SMOKING YOU DUMB****S. not a cure, but it'll make great strides. but people are too damn stupid.

    keep up with technology and stay with the latest. lifelong learning will guide you 90% of the time.

    someone said it earlier - get a fellowship if your field dies, but its unlikely.
     
  26. TMP-SMX

    TMP-SMX Senior Member Moderator Emeritus 10+ Year Member

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    "Enjoy this mercury. It's good for you."
     
  27. braluk

    braluk SDN Surgerynator Moderator Emeritus 5+ Year Member

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    Personally although I think that CT Surgery is on the decrease in terms of salary and demand, I think we may see a turnaround in the coming decades for a few reasons. I know I am probably echoing things said above (Im lazy), and I forgot which journals/articles I had read this, but there were studies that mentioned that the long term surgical success rate (measured in length of time before reoperation or kaplan meier survival curves) of interventional cards demonstrated lower efficacy than that of traditional CT surgery- thus forcing patients to choose between a less invasive procedure running the risk of having to do it again at an earlier time, or running an invasive procedure but not having to go through it again. Transplants, and valve replacements (although I think this is beginning to be tackled by interventional cards too) can only be done with the chest cracked open so CT surgeons will always be needed for something. I also think that CT surgeons will start to see the use of more technology in their field and take a more liberal alternative approach in the same way that interventional cards did years ago. May be a cab ride too late, but we'll see more technologies emerge in the coming years, and I'd be damned if CTs would let the same mistake happen twice. Alot of it is conjecture of course, but to address the OP, I can't imagine an overnight shift in a specialty that would force a doctor out of the job. If anything I would assume that the profession would adopt new techniques/developing & emerging roles to maintain stable income.
     
  28. Law2Doc

    Law2Doc 5K+ Member Physician Moderator Emeritus 10+ Year Member

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    So far. You get yourself in trouble when you try to predict future technology.
     
  29. braluk

    braluk SDN Surgerynator Moderator Emeritus 5+ Year Member

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    But thats what Ms. Cleo on the Psychic hotline told me :(

    But I agree, who knows what the future holds.
     
  30. megadon

    megadon 5+ Year Member

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    I'll give you anesthesiology and maybe radiology, but family medicine? If you haven't noticed, this country is now primarily based on some spin off of HMO, where a primary care provider is the gatekeeper. Guess who the PCP, either an internist or family medicine. I don't think you are going to see a decline in family med, either it stays constant or is on the rise. Basically you have two tracts, the people that want to see their PCP and be referred to a specialist, or the person who likes dealing with their family doc, the jack of all trades, but has developed trust in the doctor-patient dynamic. If you're knocking family medicine, knock it off, it's a legitimate practice and deserves respect. And that's coming from someone who wants to go IM.

    Radiology, the argument I have with it being obsolote is currently, the laws dictate that the scans have to be read by a US certified physician. So no outsourcing to India, unless a US certified radiologist moves over there.

    Anesthesiology, don't know, CRNA's are pretty good. However, everyone makes their turf, and they aren't going down without a fight. They have the money to battle too.

    Bottom line, pick the speciality you want. Odds are pretty good you will still be relevant, you just may have to morph into it. But you won't be the only one, your whole community will be doing it.
     
  31. Critical Mass

    Critical Mass Guest

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    Just keep in mind that somebody has to bear the responsibility of using the technology. The day that they remove the doc from the equation is the day that they shift the liability to the company that makes the machine. This has happened to some extent in clinical pathology, but the cost of blowing a BMP is nothing compared to missing a mass on a head scan.
     
  32. Law2Doc

    Law2Doc 5K+ Member Physician Moderator Emeritus 10+ Year Member

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    I think her notion was that family medicine encompasses many functions that can be done by non-physician healthcare providers and so it's conceivable that in an effort to lower healthcare costs or provide care to indigents, the government will loosen restrictions on what credentials one needs to do a lot of these functions without supervision.

    Not without precedent. In law, there were a variety of attempts by independent paralegals, real estate agents and accountants to handle certain legal functions without supervision which were considered the practice of law by the state bar (real estate closings, simple wills, etc). Took a lot of lobbying and lawsuits to quell this. The same could easily happen in medicine, particularly since family docs are not that well organized as an interest group compared to PAs etc.

    Clearly physicians provide better all around medical care because of their additional schooling and training, but we are coming into an era where "best medicine" may give way to "best medicine the country can afford". I don't think it will happen, but have often suggested that physicians need to circle the wagons and do a better job of defending their interests against other quasi-physician encroachments.
     
  33. Dakota

    Dakota Senior Member Physician 10+ Year Member

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    Actually a lot of people enrolled in managed care are actually in PPOs. In fact, more people are enrolled in PPOs than in HMOs and this is an increasing, not decreasing trend. PPOs allow people to see whatever sort of specialist they want without going through a gatekeeper. We'll see how far this trend continues. I am not making a value judgement on which system is better, just an observation.

    Source on PPO enrollment: http://www.mcareol.com/factshts/factnati.htm
     
  34. cfdavid

    cfdavid Banned Banned 7+ Year Member

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    This is a hugely important statement. And right on. Everyone keeps talking about how the demand for physicians is going to be so high (and likely it really will) due to the coming large number of people 65 or older within the demographic. However, who the hell is going to pay for it all?? Just watch how this large constituency handles the ever increasing costs they'll be facing in order to access healthcare. They're a very powerful voting block, and they have the ability to push prices down through legislation they support.

    On the flip side, they're going to want the gold standard. I'm afraid we'll see a continued increase in mid-level encroachment, and a continued decline in most physicians' remuneration. We'll see, but advocacy is going to be very important. Because, once you give an inch, it's been proven that people will take a mile (i.e. mid-levels pushing for prescription rights and potentially, with a "Doctorate in NP" legal equivalency to MD/DOs). So, just don't give that inch.
     
  35. Shredder

    Shredder User 5+ Year Member

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    This is a good q. I am going to eliminate much of primary care by creating a robodoc. At the end of first year I'm seeing how mindless and algorithmic much of medicine really is. I will put many docs out on the street, it will be superb
     
  36. Tired

    Tired Fading away 7+ Year Member

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    You invented Nurse Practitioners?

    <braces for onslaught>

    ;)
     
  37. MR1

    MR1 10+ Year Member

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    The problem as I have seen it with CT surgery is the number of MD's it is putting out. Back when cards starting doing stents and stuff, CT fellowships were still pumping out MDs, they have now slowed down and pretty soon I would imagine CT surg will do fine. Will they be millionaries like they once were, I seriously doubt it. CT surgeons did very well doing CABGs, now there aren't so many happening and that was the issue, there still is a lot a CT surgeon is needed for.

    Alot of specialities have faced issues like this and done fine. Now of course if you specialize in one disease (like polio or syphilis) you do run the risk of being out of a job if someone cures that disease. I wouldn't worry about cancer in this aspect though because it isn't ONE disease.

    Mid levels can cause issues with ophtho, gas, and ob but you will still always need that MD and MDs will make sure of that. In a lot of ways mid levels can help the situation. IF we all worked together instead of again one another things would go so much more smoothly.

    So anyway I wouldn't go into any speciality thinking you are gonna make the same cheese as they are making now because that could change (at one point ophtho's were making millions from cataracts and then later off lasik, now not so much) but they are not hurting and will always be needed.
     
  38. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

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    Most specialties are way more mindless and algorithmic than primary care. Plus, it would be a lot easier to design a robot to deal with a single organ system. ;)
     
  39. Doctor Bagel

    Doctor Bagel so cheap and juicy Moderator Emeritus 10+ Year Member

    That's a scary thought, isn't it?

    About the specialty thing, I think the thing to realize is that physicians like all other professionals aren't immune from market changes. You just have to be adaptable and roll with it. I doubt anything so dramatic is going to happen that you're going to lose your entire livelihood immediately, so you will have time to make any adjustments that might be needed. And, no, I don't think any specialties will become obsolete, but they might not closely resemble what they look like today. Since we can't accurately predict the future, do what you like and make adjustments as necessary.
     
  40. Shredder

    Shredder User 5+ Year Member

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    Yeah maybe so, but there are still procedures involved there and it's harder to automate that. Automating "differential diagnosis" and prescriptions seems really easy and that amounts to much of primary care--family med and medicine at least. NPs yeah there is some truth to that, but why not totally roboticize it. Anyway this is something I want to pursue, lemme know if any of you guys have leads on robodoc
     
  41. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

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    Have you ever seen a modern robotic assembly line in action? Surely, somebody could come up with a "Scope-A-Tron" or a "Cath-O-Matic." ;)
     
  42. jpro

    jpro Senior Member 7+ Year Member

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    Computers will replace all doctors who do not have procedures, and the docs that have procedures will be replaced by midlevels. The only doctors who will be safe are ER(trauma), surgeons, and OB. But you guys knew that allready.

    Is it unrealistic to think that computers of the future with advanced artificial intelegence will not be able to do a focused H&P with a spot on DDX and treatment plan. Nurses can do the rest. Reading path slides and radiology films would be the first things that computers would take over.

    So, I guess were all screwed. The sky is falling and were all going to be working at starbucks. Hopefully this post helps people make informed decisions about medicine. I am a very reliable source being an MS3 and all. I got most of this information from sci-fi movies, star trek, and the voices in my head.
     
  43. Blue Dog

    Blue Dog Fides et ratio. Physician Gold Donor SDN Advisor Classifieds Approved 10+ Year Member

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    At least they have good benefits.

    I'll bet we'll all get the black aprons, too...buncha' gunners. ;)
     
  44. blackadder

    blackadder my old office view 10+ Year Member

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    fashion me a hoverboard while you're at it.
     
  45. Arsenic

    Arsenic posting from the future Physician Moderator Emeritus 10+ Year Member

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    moving to pre-allo
     
  46. pyrois

    pyrois 2+ Year Member

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    Oh, you mean like MRI/SPECT/PET/CT scans? They're all easy to read you know.

    As for image processing algorithms that allow computers to identify things, that will probably happen within the next 5 years or so. And if it doesn't, I'll make it.

    What will happen to the radiologists if this happens?

    More time with the kids.
     
  47. pyrois

    pyrois 2+ Year Member

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    It isn't the future. It's the past.

    Computers can already read EKG's and recognize faces out of a crowd. Being able to read radiology films would be child's play. Too bad it's not a lucrative field.

    Software design companies want to make billions, not tens of millions. Health care is just a crappy field to be in if it's for money.
     
  48. Doctor Bagel

    Doctor Bagel so cheap and juicy Moderator Emeritus 10+ Year Member

    So why did this get moved to pre-allo?
     
  49. Madame

    Madame SDN Mentor 5+ Year Member

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    Just as the drug treatments for TB and the polio vaccine changed career plans for pulmonologists and others who cared for those chronically ill patients, (no more sanitariums, no more iron lungs) new infectious diseases have emerged. Lyme disease was first described by a rheumatology fellow in the mid-1970s. HIV/AIDS changed the landscape for ID fellows who began fellowships in the early 80s, West Nile Virus is new in the US as of ~2002.
     
  50. Law2Doc

    Law2Doc 5K+ Member Physician Moderator Emeritus 10+ Year Member

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    Doesn't make sense to me either. But Arsenic outranks me...:laugh:
     
  51. What if you Genetics returns under a new screenname and winds up with my foot up his ass again like always happens? The same thing people will do if specialties start to become obsolete: warnings will be issued, plans will be developed and carried out and then everyone will go on with their lives. End of discussion. :laugh:
     

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