Which medical specialties will be obsolete in 30 years?

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BoredRlyin

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In considering our formal medical training after medical school, and factoring in technological breakthroughs on the horizon, which fields of study are under the greatest threat for minimalization?

In other words, I'm looking for strong opinions predicting specialty fields that are likely to fizzle out by the height of our careers in addition to possible fields that are presently in their infancy, which are likely to become super-hot specialties by 2037.

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In considering our formal medical training after medical school, and factoring in technological breakthroughs on the horizon, which fields of study are under the greatest threat for minimalization?

In other words, I'm looking for strong opinions predicting specialty fields that are likely to fizzle out by the height of our careers in addition to possible fields that are presently in their infancy, which are likely to become super-hot specialties by 2037.
Ideally oncology but thats not likely to happen
 
OB/GYN [har har har] seriously though, urology could be in trouble. there are better and better meds you can take to bust kidney stones, what used to be a sizeable chunk of their income
 
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in 30 years we will all have hand-held scanners a la star trek (the next generation of course) that we can just wave over the body and it will tell us what's wrong. get out while you can!!! we're all gonna be obsolete!
 
OB/GYN [har har har] seriously though, urology could be in trouble. there are better and better meds you can take to bust kidney stones, what used to be a sizeable chunk of their income

Prostate cancer is the new kidney stone!
 
With the noted exception of cervical cancers which we hope to decrease in the long term via new HPV vaccines, most cancers will increase in overall prevalence simply because we hope to be keeping people alive longer. Orthopedic surgeons might see more business from baby boomers.

If we keep getting fatter and fatter, endocrinologists and cardiologists will have very safe jobs, but some in CT surgery believe that the rise of invasive cardiology and interventional radiology will hurt their business. Staying with internal med, we are all going to be screwed when VRSA becomes a real threat, so I'd say that ID has staying power. We haven't invented a drug yet that pathogens can't mutate around.

I don't know about pathology. Increases in technology have certainly destroyed medical technology as far as labor is concerned, but I think that pathologists will always be needed (again, somebody has to read the biopsies).

Rads is heavy into new technology as we continue to pursue non-surgical diagnostic methods, but insurance companies and Medicare do not like to reimburse. Passing gas? No idea. Pain is a big deal, and anesthesiology is on the rise.

Derm--consider the ozone? Dunno. Plastics--anything where a person charges your services to a credit card is going to be lucrative in a society where looks are important. Optho--no idea.

Family and peds? Often already difficult to fill the PGY positions. Increases in med school tuition and malpractice plans coupled with an unwillingness of health care plans to reimburse does not shed much positive light.

OB/Gyn--eek! Twist my new kid's arm the wrong way, and I'll sue you. Doesn't matter that I had no intention of paying your bill anyway. What good is a healthcare system if I can't sue you if something doesn't go as planned. That does it. You have a sniffle today, ma'am? We're going to have to do a C-section.

Actually if anybody knew the answer to this, more people would be flocking to it.
 
rhuematology-
minnesota has had one resident since 1998.
 
Actually, that's a valid question and a normal concern. The problem is that things can change SO fast that it's impossible to predict. Even with some of the trends we see now, such as obesity, and an increasingly aged population etc., it's impossible to really predict this stuff over the long term.

I really believe that medicine (and history supports this) can be very cyclical. There seem to be so many factors that influence any particular field.
You're correct in that technology is the major force of change these days. But, who knows? Like others have said, if we all had crystal balls...... lol

For younger med students (traditional aged), I'd suggest choosing a field that you really enjoy. That way, over the course of a 25-35 year career, you'd be likely to experience a few "cycles" that may effect your job/income etc. both positively and negatively.
(not that I'm suggesting otherwise for older students such as myself, but we'll be more effected by the near term trends etc.).

One thing to keep in mind is that we're NOT powerless. We can always adapt our skills and practices to accomodate these changes. The challenge to us all (and not just docs, but in business as well) will be to stay on our toes such that we learn to embrace these inevitable changes, and to take proactive measures when we see them.

So, perhaps this means an extra certification in a new, emerging field, or learning a new procedure that may differ significantly from how you may be comfortable doing things etc. But, that's been going on for years in medicine. Just look at the guys (not even the video game generation! lol) that are doing procedures with the DiVinci robot, versus the open procedures they were trained on. That's totally different from what they would have been comfortable with. And there could be any number of other examples.

Look at the CT surgeons that have been impacted by invasive cardiology. Some have been negatively effected. But, others that have shifted their skill set over to those techniques that can't be addressed through a catheter (such as valve repair etc.) will be just fine.

In summary, it seems that the constantly evolving technologies and advancements in medicine is, in part, what has attracted many of us to the field. So, as long as we're prepared to keep on top of things and to change along with those powerful new trends, everyone will be just fine. Also, keep in mind that change can offer many new opportunities for those that are prepared.
 
a friend and i were discussing this. we thought dermatology would hit its peak in the next 15-20 years.
simple shave biopsies can probably be performed by other docs and other cosmetic procedures such as botox are already been taken advantage of by plastics docs etc.
 
If I had to pick one specialty that might be in danger I would pick diagnostic radiology. With the advent of PACS it is possible to outsource all diagnostic radiology work to India, cheap 24/7 good brains. Also with the increasing capacity of computers, photo recognition software, and higher resolution imaging it will be possible to compare a film to a database of millions for a more accurate interpretation than a human could ever give.
 
Big in the future = interventional radiology.

Less big in the future = family medicine, sad to say, but fewer and fewer US grads are selecting the field, and this whole "NP/PA on staff at Wal-mart" does not bode well for adult primary care.
 
The logic that spots not filling= no need is stupid. If spots aren't filling then there is a huge need. Nobody will say that we need a lot more orthopods just because it's competitive. Rheumatologists make big bucks because there is a huge need. Saying that it's obsolete b/c spots don't fill is just dumb.
 
Look at the CT surgeons that have been impacted by invasive cardiology. Some have been negatively effected. But, others that have shifted their skill set over to those techniques that can't be addressed through a catheter (such as valve repair etc.) will be just fine.

Look at GI specialists. They used to send tubes town your nose to look into your stomach for ulcers. Peptic ulcers have dramatically declined (kinda still a mystery why..) but they've adapted by going to the other hole of the GI tract and sending scopes up it. Now GI does more colonscopy/colon cancer screenings than stomach uclers..

It comes down to this...
NOTHING changes fast.. No matter how much media portrays it. 30 Yrs ago.. I was promised a freakin flying car.. still no flying car.. in 30 yrs.. You still wont have one.. The INTERNET.. was supposed to destroy all brick and mortar businesses.. Then people got a clue.. Now Barnes and Noble is not bankrupt by the internet but HOTTER than ever.. Blockbuster has more REVENUE than BEFORE the internet and BEFORE netflix..

Needless to say, whatever field you choose, if you stay current, you'll never be obsolete.

There are still 50th generation Swordsmiths out there... making Samourai swords while making more than an MD..
 
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Silly question but has any specialty ever gone obsolete before? I've never heard of one so I doubt there's much to worry about...of course being obsolete would accomplish the me-not-hearing-about-it.
 
well, look, developed countries are having chromic diseases problems since they beaten infectious disease (exption to pandemics, in which you probably wont be able to treat anyway :"P)

lets look to chronic diseases (that is more related with the high life expectancy and behavior of community)

if you're from US, cancer and cardiac diseases are huge problem.. I think cancer incidince + prevalence would increase much higher than heart problems


**********
You can think also of plasic surgeries,, your countriy seems gonna be more obssesed to it than M. Jackson :")
 
Ok, i'll throw out strange one. I'm not terribly sure of its accuracy, but its possible, so just for fun...

Interventional Radiology.

From what i've seen everone else keeps adopting their procedures. For example vascular and general surgeons are doing endovascular AAAs and CT guided stuff. What else do they have? Are neurosurgeons/vascular doing brain aneurysm coiling yet? Maybe a long shot, they'll probably develop stuff much faster than other specialties can steal them.


What about anesthesia? They've made anesthesia so safe that a trained monkey can do a good part of it. Will people keep paying to have the doc there for when the SHTF? (i know i would...)
 
Ok, i'll throw out strange one. I'm not terribly sure of its accuracy, but its possible, so just for fun...

Interventional Radiology.

From what i've seen everone else keeps adopting their procedures. For example vascular and general surgeons are doing endovascular AAAs and CT guided stuff. What else do they have?

I think you've got it backwards -- it is radiology which is moving into these other fields turf. Things that would exclusively be done by surgeons a few years ago are now being done by rads. The kids with the better toys get to choose the game.
 
I think you've got it backwards -- it is radiology which is moving into these other fields turf. Things that would exclusively be done by surgeons a few years ago are now being done by rads. The kids with the better toys get to choose the game.

No, he's got it right. IR is moving forward as far as the number of procedures they can do...BUT surgeons are stepping in to DO the procedures. That is, they are doing the IR procedure instead of the rads folks. Why? Cause when something goes wrong and you need to vent the guys chest down in IR if its a rads doc there he dies and if its a surgeon there he lives. Not that simple but you get the idea.
 
No, he's got it right. IR is moving forward as far as the number of procedures they can do...BUT surgeons are stepping in to DO the procedures. That is, they are doing the IR procedure instead of the rads folks. Why? Cause when something goes wrong and you need to vent the guys chest down in IR if its a rads doc there he dies and if its a surgeon there he lives. Not that simple but you get the idea.

This is an ongoing turf war. It cannot be denied that intervational radiology is getting really big at certain hospitals because they are doing many more procedures. It will be curious to see who ultimately prevails.
 
This is an ongoing turf war. It cannot be denied that intervational radiology is getting really big at certain hospitals because they are doing many more procedures. It will be curious to see who ultimately prevails.

True, true. I guess I should clarify. IR jumped out to a huge lead and still hold it. However, the trend is that other specialties have taken an inch of thier mile back at some places. How it will turn out is anyones guess but I think surgeons have a distinct advantage...i could be a little biased however.
 
True, true. I guess I should clarify. IR jumped out to a huge lead and still hold it. However, the trend is that other specialties have taken an inch of thier mile back at some places. How it will turn out is anyones guess but I think surgeons have a distinct advantage...i could be a little biased however.

In the end, the person who has jurisdiction over the necessary equipment has a lot more clout than you are giving them. You can't play if the kid takes his ball and goes home.
 
In the end, the person who has jurisdiction over the necessary equipment has a lot more clout than you are giving them. You can't play if the kid takes his ball and goes home.

Not sure what you mean. At my program if a patient is refered to a surgeon trained in an IR procedure that surgeon can schedule time in one of the IR suites. Same as a Rads doc that gets refered a patient. The hospital owns the stuff so its not like an Rads doc can shut them out. The IR docs have more experience, a larger referal base and more clout in the IR area but that doesnt dictate who gets refered the case. Now, there's nothing like being first, and rads was the front runner so they have all the advantages I listed above. But I think as more surgeons gain experience they can move in on that for other reasons listed in a prev. post. The ball in this case is not the issue, its the stadium. And although it may be a common property it "belongs" to whoever puts asses in the seats...at least for the night.
 
Not sure what you mean. At my program if a patient is refered to a surgeon trained in an IR procedure that surgeon can schedule time in one of the IR suites. Same as a Rads doc that gets refered a patient. The hospital owns the stuff so its not like an Rads doc can shut them out. The IR docs have more experience, a larger referal base and more clout in the IR area but that doesnt dictate who gets refered the case. Now, there's nothing like being first, and rads was the front runner so they have all the advantages I listed above. But I think as more surgeons gain experience they can move in on that for other reasons listed in a prev. post. The ball in this case is not the issue, its the stadium. And although it may be a common property it "belongs" to whoever puts asses in the seats...at least for the night.

At many places the radiologists have exclusive control and use of the radiology equipment -- they are the departments'. And other departments are not permitted to get their own. (Somehow the cardiologists managed to get control of echo but in general nonradiologists are met with significant resistance and quashed if they try to do anything resembling imaging). Hence the turf wars. And the ownership of the ball.
 
At many places the radiologists have exclusive control and use of the radiology equipment -- they are the departments'. And other departments are not permitted to get their own. Hence the turf wars.

Well that sucks for surg. I suppose time will tell.

On a broader note...if anyone can see 30 years into the future of medicine they will be a rich, rich, rich, man or woman. Changes come too fast, think about what medicine was like 30 years ago, so i think "time will tell" is about the best answer you're gonna get on most things.
 
Well that sucks for surg. I suppose time will tell.

On a broader note...if anyone can see 30 years into the future of medicine they will be a rich, rich, rich, man or woman. Changes come too fast, think about what medicine was like 30 years ago, so i think "time will tell" is about the best answer you're gonna get on most things.

It's all going to be cyborgs and clones then anyhow.
 
Look at GI specialists. They used to send tubes town your nose to look into your stomach for ulcers. Peptic ulcers have dramatically declined (kinda still a mystery why..) but they've adapted by going to the other hole of the GI tract and sending scopes up it. Now GI does more colonscopy/colon cancer screenings than stomach uclers..

It comes down to this...
NOTHING changes fast.. No matter how much media portrays it. 30 Yrs ago.. I was promised a freakin flying car.. still no flying car.. in 30 yrs.. You still wont have one.. The INTERNET.. was supposed to destroy all brick and mortar businesses.. Then people got a clue.. Now Barnes and Noble is not bankrupt by the internet but HOTTER than ever.. Blockbuster has more REVENUE than BEFORE the internet and BEFORE netflix..

Needless to say, whatever field you choose, if you stay current, you'll never be obsolete.

There are still 50th generation Swordsmiths out there... making Samourai swords while making more than an MD..

I like the sky is NOT falling attitude. I'd generally agree. But, "fast" is relative. The key is, like you said, to stay current and do what needs to be done in order not to become obsolete.
 
PPIs and H2 blockers . . . not too mysterious

Even before medicating, the rates have gone dramatically down.. Read the literature.

I would laugh my head off if the professor said they've dramatically went down and you raise your hand and answered, "Could it be due to PPIs and H2 blockers??" LoL.. Another med student solving the worlds problems from his seat.. Why have anymore research facilities..
 
Family and peds? Often already difficult to fill the PGY positions. Increases in med school tuition and malpractice plans coupled with an unwillingness of health care plans to reimburse does not shed much positive light.
Primary care reimbursements are rising while specialities are staggant and lowering in some cases. The industry is always cyclical.. Shortage of Primary care docs?? Congress decides to increase reimbursements.. Too many Primary Care docs?? Congress will cut reimbursements...
Medicine is not immune to the laws of economics..


OB/Gyn--eek! Twist my new kid's arm the wrong way, and I'll sue you. Doesn't matter that I had no intention of paying your bill anyway. What good is a healthcare system if I can't sue you if something doesn't go as planned. That does it. You have a sniffle today, ma'am? We're going to have to do a C-section.

This is a story from Yahoo in Berlin, Germany but foreign law has a way of eventually trickling down to us.. Judges sometimes even use it as precedent..

Doctor ordered to pay for unwanted baby Wed Nov 15, 9:05 AM ET

BERLIN (Reuters) - A court ruling which ordered a gynecologist to pay child support for up to 18 years as compensation for botching a contraceptive implant was condemned by the German media as scandalous on Wednesday.

The Karlsruhe-based federal appeals court ruled on Tuesday that the doctor must pay his former patient, now a mother of a three-year-old boy, 600 euros ($769) a month because she became pregnant after he implanted her with a contraceptive device. "A child as a case for damages -- this perverse idea has now been confirmed by one of Germany's highest courts," conservative Die Welt daily newspaper wrote in an editorial on Wednesday.

The device is meant to protect against pregnancy for up to three years, but half a year after the operation, the implant could no longer be found in the woman's body, the court said.

While it should be welcomed that a doctor can now be held to account in the same way as a shoddy plumber, the newspaper said, how could a child whose parents had sought damages for its birth ever come to terms with the situation?

"In addition to the highly private inkling that he was not wanted by his parents, he now has official confirmation that he was born by mistake," Die Welt also said.

The award covers the first years of the child's life and also subsequent costs to the age of 18.

The parents, who had known each other six months at the time of the conception, were no longer together, the court said, ruling that the father should also be compensated for the maintenance he was paying toward the child.

The ruling could spark a flood of similar claims against gynecologists, Stern magazine wrote on its Web site.
 
Even before medicating, the rates have gone dramatically down.. Read the literature.

I would laugh my head off if the professor said they've dramatically went down and you raise your hand and answered, "Could it be due to PPIs and H2 blockers??" LoL.. Another med student solving the worlds problems from his seat.. Why have anymore research facilities..

Wow! I thought this was a good answer too...Im curious as to what literature you were reading? Maybe you could enlighten us? Or let me guess...you're to busy?
 
If I had to pick one specialty that might be in danger I would pick diagnostic radiology. With the advent of PACS it is possible to outsource all diagnostic radiology work to India, cheap 24/7 good brains. Also with the increasing capacity of computers, photo recognition software, and higher resolution imaging it will be possible to compare a film to a database of millions for a more accurate interpretation than a human could ever give.

Yeah, but both of those ideas might be a problem for our letigous society. :barf:
 
I imagine as more is understood about brain structure and function neurosurgeons will be able to offer much better outcomes and will see a significant increase in business.
 
Even before medicating, the rates have gone dramatically down.. Read the literature.

I would laugh my head off if the professor said they've dramatically went down and you raise your hand and answered, "Could it be due to PPIs and H2 blockers??" LoL.. Another med student solving the worlds problems from his seat.. Why have anymore research facilities..

Wow! I just had a Freshman medical student try and punk me down! "The most important risk factors for the development of peptic ulcers are infection with H. Pyolari . . . " -Cecil's Essentials of medicine 6th edition. It goes on to say that PPIs and H2 blockers are the first line treatments. Antacids were probably responsible for the initial decrease, but today it's due to these new drugs and a hieghtened awarenes of GERD.

I actually help teach an M1 course. You haven't even seen patients yet . . . or even had pathophysiology. Here's a lesson in professional etiquette. If you're going to correct someone 1) don't be wrong and 2) don't be obnoxious.
 
If I had to pick one specialty that might be in danger I would pick diagnostic radiology. With the advent of PACS it is possible to outsource all diagnostic radiology work to India, cheap 24/7 good brains. Also with the increasing capacity of computers, photo recognition software, and higher resolution imaging it will be possible to compare a film to a database of millions for a more accurate interpretation than a human could ever give.

I used to think this as well but then someone pointed out to me the fact that for an American MD to rely on an Indian MD's assesment of an imaging study to direct care is the sort of thing that makes lawyers salivate.

Are the Indians qualified? Probably, in fact they're probably better qualified than many American docs. But if they don't have US licensure, how are you going to cover your arse medciolegally?
 
I used to think this as well but then someone pointed out to me the fact that for an American MD to rely on an Indian MD's assesment of an imaging study to direct care is the sort of thing that makes lawyers salivate.

Are the Indians qualified? Probably, in fact they're probably better qualified than many American docs. But if they don't have US licensure, how are you going to cover your arse medciolegally?

Has nothing to do with qualifications, it has to do with what flies in court in front of a jury. If a mistake gets made thousands of miles away, by someone who doesn't have a US licensure seal of approval, it becomes a very bad situation for the hospital left holding the bag. The hospital didn't adequately supervise. There was no US licensing board adequately supervising. An error was made by someone far away hired because he was cheaper - ie out of greed. It becomes a very hard case to defend.
So you really need someone in the US to reread the films, and serve as a backstop. Or alternatively train and export radiologists. And once you do one of those things, the savings just aren't that significant.
 
Has nothing to do with qualifications, it has to do with what flies in court in front of a jury. If a mistake gets made thousands of miles away, by someone who doesn't have a US licensure seal of approval, it becomes a very bad situation for the hospital left holding the bag. The hospital didn't adequately supervise. There was no US licensing board adequately supervising. An error was made by someone far away hired because he was cheaper - ie out of greed. It becomes a very hard case to defend.
So you really need someone in the US to reread the films, and serve as a backstop. Or alternatively train and export radiologists. And once you do one of those things, the savings just aren't that significant.


Always glad to get clarification, thanks L2D. It seems like you agree with the bottom line though: Rads r' Us in Bangalore isn't going to fly.
 
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