What specialties can be outsourced or mostly automated requiring less number of doctors in next 15-20-25 years?

[Piskaupf]

---

Members do not see this ad.

The only place AI will replace entire specialties is in the minds of sales reps and hospital administrators.

And AI experts

 

[Idahomie]

Off the top of my head without looking at other programs:
University of WA
University of MN
University of ND
University of SD

Can also confirm that in 3 of those states students can easily claim residency after 1 year and be eligible for in-state tuition. In talking with colleagues I believe this is the case for MA, NY, FL, and TX as well. If anything, it's more the rule than the exception.

Pretty sure California does this as well. Combine all those states together and that probably accounts for 50% of public state schools.

 

[VA Hopeful Dr]

You've got the burden of proof on this one. The only states I know that grant in state status after a being there for a year AS A STUDENT are Ohio and (thanks to you) South Carolina.

Nope. You're the one claiming there are people paying four years of out-of-state tuition and that's how their loans balloon to 600,000.

Prove it

 

[Obnoxious Dad]

Off the top of my head without looking at other programs:
University of WA
University of MN
University of ND
University of SD

Can also confirm that in 3 of those states students can easily claim residency after 1 year and be eligible for in-state tuition. In talking with colleagues I believe this is the case for MA, NY, FL, and TX as well. If anything, it's more the rule than the exception.

Edit: And just because of the ridiculous numbers you've been throwing around for med school debt alone - https://store.aamc.org/downloadable/download/sample/sample_id/374/

I love the irony of making baseless claims with no objective data to back them up, then demanding specific evidence when those claims are countered, especially when all it takes is a quick Google search.

Let's see the links to those medical school websites, other than Ohio, that give nonresidents instate status after one year.

 

[VA Hopeful Dr]

Let's see the links to those medical school websites, other than Ohio, that give nonresidents instate status after one year.

I'll do one for you, but you can Google the rest of them yourself.

Medical School Cost

How much does medical school cost? Review the detailed cost of attending UND's School of Medicine & Health Sciences.

med.und.edu

North Dakota Resident Cost of Attendance	$58,329	$55,583	$58,329	$55,583
Minnesota Resident Cost of Attendance	$61,630	$58,884	$61,630	$58,884

 

[Taddy Mason]

Let's see the links to those medical school websites, other than Ohio, that give nonresidents instate status after one year.

You can't Google - "How to establish residency in 'state x' for college?"

And again, not sure why you're moving the goal posts. Your initial claim (after quoting @VA Hopeful Dr out of context) was that med student grads are being strapped with $600K in debt, which isn't the case - https://store.aamc.org/downloadable/download/sample/sample_id/374/. And unless people have either extreme circumstances or absolutely no common sense, there is no reason that their educational debt from med school and earlier should be increasing in residency.

 

[Obnoxious Dad]

I'll do one for you, but you can Google the rest of them yourself.

Medical School Cost

How much does medical school cost? Review the detailed cost of attending UND's School of Medicine & Health Sciences.

med.und.edu

North Dakota Resident Cost of Attendance	$58,329	$55,583	$58,329	$55,583
Minnesota Resident Cost of Attendance	$61,630	$58,884	$61,630	$58,884

The State of North Dakota has a reciprocity agreement with Minnesota which allows Minnesota residents to pay reduced tuition at some North Dakota institutions. Reduced Out-of-State Tuition Options
North Dakota University System | Student Exchange and Reciprocity Programs (ndus.edu)
This is hardly the norm across the country.

Furthermore, you "overlooked" the third row in that link that addresses non-resident cost of attendance.

 

[Taddy Mason]

Furthermore, you "overlooked" the third row in that link that addresses non-resident cost of attendance.

None of my non ND/MN classmates who changed their state residency had issues qualifying for in-state tuition after 1st year. Again, regardless of what OOS tuition is at a given school ~80% of med school graduates graduate with <$300K in total educational debt.

 

[VA Hopeful Dr]

The State of North Dakota has a reciprocity agreement with Minnesota which allows Minnesota residents to pay reduced tuition at some North Dakota institutions. Reduced Out-of-State Tuition Options
North Dakota University System | Student Exchange and Reciprocity Programs (ndus.edu)
This is hardly the norm across the country.

Furthermore, you "overlooked" the third row in that link that addresses non-resident cost of attendance.

LMGTFY - Let Me Google That For You

For all those people who find it more convenient to bother you with their question rather than to Google it for themselves.

lmgtfy.app

 

[aldol16]

I actually think rads is one of the safest specialties. With more midlevels working independently the number of images ordered is only going to increase.

I always laugh when I read medical students saying that radiology will be replaced by AI during our careers. I doubt medical students who say this have ever even read a radiology report for a remotely complex patient. Maybe in 5-10 years we will have an AI that can find pneumothorax's on CXR's better than a radiologist...so what? Doing 10-15 true or false analyses on CXR's is literally multiple order of magnitudes less complex than interpreting a fairly benign CT chest w/ contrast. If we have AI's that can read and report on CT's and MR's as well as a radiologist, we need to start brushing up on our Skynet defense plan and give Arnold a call.

I always laugh when people don't read the posts and say idiotic things.

Sure, rads orders will increase. That doesn't preclude the additional volume from being outsourced. If I can outsource diagnostic reads across state lines and have specialized centers employing radiologists to do these reads, then I can create economies of scale to the point where people can specialize (even more so) in neuro, MSK, etc. I didn't mention automation.

 

[aldol16]

While diagnostic radiology can be and typically is done virtually, it's never going to be outsourced. The docs in other countries reading nighthawk films are US-trained physicians with a state license. Perhaps they went to med school in the country they lived in, but they're trained and licensed in the US.

Critical decisions are made by physicians based on the radiologist's report. Granted, many surgeons ignore the report, but for mere mortals like myself that don't operate, the radiologist's read can be critical. They will never be outsourced to a non-US trained doc, or a computer. No doc will. At most I think we'll see AI used to "increase productivity" (ie., make us more "efficient/miserable").

I'm not talking about AI. I'm talking about outsourcing so I've ignored the second half of your post. Here's the response to the first half.

Take a more narrow view of outsourced. Currently, licensing requirements generally require physicians to hold state licenses in the state they are currently practicing in and the state that their practice is in. So based on current legislation, the scale of outsourcing can't transcend the state level. But that doesn't mean that as more and more systems consolidate, they won't figure out that they can create economies of scale by centralizing their diagnostic reads. They can employ radiologists at specific centers that are responsible for the reads at all their affiliate sites (or even have contracts where they read for other facilities as well).

Notice that I emphasized based on current legislation. I would argue that although US physicians have to be licensed in the state where they practice, there's no reason why national licensing won't eventually become popular. The standards would be pretty much the same because quality control for US trained doctors isn't at the state licensing stage - it happens before that. So if practicing across state lines becomes okay, then you're talking about huge economies of scale. Imagine if HCA commissioned a radiology center where all imaging gets sent to radiologists there. Neuro goes to neuro, MSK goes to MSK, chest goes to chest, etc.

The final barrier would be international. I don't think this will ever become a thing, at least in my lifetime. That's because the US is the strictest with respect to ensuring training quality (that's why it's really hard for foreign trained physicians to be licensed here). The US wouldn't want its radiology reads being sent to foreign docs whose quality cannot be ascertained.

Finally, with respect to decision-making. Obviously the provider ordering the imaging may want to make decisions based on the read. That goes on in their big brains, not in a computer. Whether that read was done by a radiologist in the basement or three states over doesn't matter to the provider, as long as the read is accurate and as long as they can pick up the phone and call the reading physician if there is ambiguity. None of this precludes outsourcing to any state in the Union.

 

[RangerBob]

I'm not talking about AI. I'm talking about outsourcing so I've ignored the second half of your post. Here's the response to the first half.

Take a more narrow view of outsourced. Currently, licensing requirements generally require physicians to hold state licenses in the state they are currently practicing in and the state that their practice is in. So based on current legislation, the scale of outsourcing can't transcend the state level. But that doesn't mean that as more and more systems consolidate, they won't figure out that they can create economies of scale by centralizing their diagnostic reads. They can employ radiologists at specific centers that are responsible for the reads at all their affiliate sites (or even have contracts where they read for other facilities as well).

Notice that I emphasized based on current legislation. I would argue that although US physicians have to be licensed in the state where they practice, there's no reason why national licensing won't eventually become popular. The standards would be pretty much the same because quality control for US trained doctors isn't at the state licensing stage - it happens before that. So if practicing across state lines becomes okay, then you're talking about huge economies of scale. Imagine if HCA commissioned a radiology center where all imaging gets sent to radiologists there. Neuro goes to neuro, MSK goes to MSK, chest goes to chest, etc.

The final barrier would be international. I don't think this will ever become a thing, at least in my lifetime. That's because the US is the strictest with respect to ensuring training quality (that's why it's really hard for foreign trained physicians to be licensed here). The US wouldn't want its radiology reads being sent to foreign docs whose quality cannot be ascertained.

Finally, with respect to decision-making. Obviously the provider ordering the imaging may want to make decisions based on the read. That goes on in their big brains, not in a computer. Whether that read was done by a radiologist in the basement or three states over doesn't matter to the provider, as long as the read is accurate and as long as they can pick up the phone and call the reading physician if there is ambiguity. None of this precludes outsourcing to any state in the Union.

I think what you’re referring to is already happening with radiology. The night read could be by someone in SF or NY or London-as long as they are licensed to practice in the state the image was ordered in. I think radiology is particularly susceptible to consolidation, but I don’t think it’ll make it harder to find a job. Most diagnostic radiologists have backlogs of reads to go through, so I think there’s plenty of work. Maybe we see more radiologists signing on as independent contractors for a national organization but live wherever they want.

Still, a hospital-employed radiologist makes a hospital system more money than a third party, as the hospital can bill for the facility fee and take a cut of the radiologist’s fee. Not to mention big groups get reimbursed more from insurance for the exact same work as a solo doc.

While a national license is a great idea, I don’t think it’s happening anytime soon. It’s essentially there with the DOD/VA (ie., nationalized healthcare) since providers can be licensed in any state. Moving to a national license will smell like nationalizing healthcare to some and “infringe” on state rights. So I think we’ll see it when we see nationalized/socialized medicine.

Which I actually think we’ll see eventually because our system is so inefficient. Just look how much money we spend on administration compared to other countries. Obamacare was essentially the state-based free-market solution many advocated for. I’m not so sure there are any better market-based ideas aside from a national marketplace and just getting rid of employer-based coverage. After that, what is there? Personally I say do it-Obamacare for all, with national plans. Yet, I’d be willing to wager employers wouldn’t pass on their huge premium savings to their employees...

Unless Obamacare expands/gets improved or we have a national marketplace with plans that transcend state lines, I’d be willing to wager money that we’re headed towards Medicare for all.

Separate debate though.

 

[Lawpy]

I'm not talking about AI. I'm talking about outsourcing so I've ignored the second half of your post. Here's the response to the first half.

Take a more narrow view of outsourced. Currently, licensing requirements generally require physicians to hold state licenses in the state they are currently practicing in and the state that their practice is in. So based on current legislation, the scale of outsourcing can't transcend the state level. But that doesn't mean that as more and more systems consolidate, they won't figure out that they can create economies of scale by centralizing their diagnostic reads. They can employ radiologists at specific centers that are responsible for the reads at all their affiliate sites (or even have contracts where they read for other facilities as well).

Notice that I emphasized based on current legislation. I would argue that although US physicians have to be licensed in the state where they practice, there's no reason why national licensing won't eventually become popular. The standards would be pretty much the same because quality control for US trained doctors isn't at the state licensing stage - it happens before that. So if practicing across state lines becomes okay, then you're talking about huge economies of scale. Imagine if HCA commissioned a radiology center where all imaging gets sent to radiologists there. Neuro goes to neuro, MSK goes to MSK, chest goes to chest, etc.

The final barrier would be international. I don't think this will ever become a thing, at least in my lifetime. That's because the US is the strictest with respect to ensuring training quality (that's why it's really hard for foreign trained physicians to be licensed here). The US wouldn't want its radiology reads being sent to foreign docs whose quality cannot be ascertained.

Finally, with respect to decision-making. Obviously the provider ordering the imaging may want to make decisions based on the read. That goes on in their big brains, not in a computer. Whether that read was done by a radiologist in the basement or three states over doesn't matter to the provider, as long as the read is accurate and as long as they can pick up the phone and call the reading physician if there is ambiguity. None of this precludes outsourcing to any state in the Union.

Does this also apply to pathology?

 

[aldol16]

I think what you’re referring to is already happening with radiology. The night read could be by someone in SF or NY or London-as long as they are licensed to practice in the state the image was ordered in. I think radiology is particularly susceptible to consolidation, but I don’t think it’ll make it harder to find a job. Most diagnostic radiologists have backlogs of reads to go through, so I think there’s plenty of work. Maybe we see more radiologists signing on as independent contractors for a national organization but live wherever they want.

Still, a hospital-employed radiologist makes a hospital system more money than a third party, as the hospital can bill for the facility fee and take a cut of the radiologist’s fee. Not to mention big groups get reimbursed more from insurance for the exact same work as a solo doc.

It's happening but not at scale. There's no incentive to consolidate unless you get cost or revenue efficiencies. With cost, you presumably would be able to be more efficient with how many radiologists you need because they'll be able to specialize even further. So the efficiencies will vary by market. Rural places where volume is low will probably see their jobs dry up as markets that are oversaturated (coastal cities) take up that demand.

Hospital considerations don't matter when we're talking about consolidation/M&A. You might imagine a private equity firm coming in and buying up not only a hospital system but also radiology practices (they're already doing this with specialty practices). Then they centralize the diagnostic reads, getting cost efficiencies in the process. This is what makes healthcare so attractive for private equity nowadays.

 

[Georgebrown901]

Honestly I do not understand this. I’d happily take a more normal salary for highly educated, technical professions like 150k (rather than 300+) if it means the system works better as a whole and if I don’t have to work as hard. Debt sucks but PART of the high cost of healthcare and justification for high cost of med school is how much physicians are paid, so you’d expect that debt load would be lower too.

Makes me want to practice med in canada. Cut out all the bs paper work, actually deal with patients as your priority. Way less burnout, work very reasonable hours. Make less than US but quite fine to live a good life

SDN has way too much obsession with super high salaries (on top of the usual top tier addiction).

 

[Putkernerinthehall]

Compare the earnings of a primary care doctor under the AOC/far left proposals versus a UPS driver who is aggressively saving in the SP500 or AAPL over the last decade. Then you will have your answer.

UPS driver....now there is a job ripe for automation!