Which *specialties* are the safest (long-term)?

[modelslashactor]

I've spent the past couple days reading all the doom and gloom in this forum, the specialty forums, the allo forum, etc etc and what I kept noticing is that everyone is scared to death of tight job markets, declining compensation, and midlevel competition. Since every other thread is about money and lifestyle, I figured this would be a good change of pace.

So, if anyone knows, which specialties look to be the most secure from:

1) overcrowding, ie not enough patients/procedures per doc,
2) mid-level competition,
3) projected income loss / higher malpractice

Your thoughts on the matter are appreciated.

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[dnslay]

Just taking a stab at it but I'm guessing most surgery specialties?

Otherwise I think the ageless wisdom of "nothing is safe" will be the most common answer.

 

[Wallachia]

i think interventional radiology is an excellent and rapidly growing field; sure there is competition however you are boarded in diagnostics which is good backup; the noninvasive techniques are growing by leaps and bounds

 

[Sanman]

Well,
I guess the safest would be something like trauma surgery, ER, or maybe PM&R since people will always be getting hurt and meds can't stop that. I would probably throw neuro and psych in their as well since we know thw least about these problems. However, I always thought surgical specialties were less safe in the long run due to the fact that if you ended up injuring your hands or had motor coordination issues (e.g. tremors), your career would be over.

 

[p53]

I've spent the past couple days reading all the doom and gloom in this forum, the specialty forums, the allo forum, etc etc and what I kept noticing is that everyone is scared to death of tight job markets, declining compensation, and midlevel competition. Since every other thread is about money and lifestyle, I figured this would be a good change of pace.

So, if anyone knows, which specialties look to be the most secure from:

1) overcrowding, ie not enough patients/procedures per doc,
2) mid-level competition,
3) projected income loss / higher malpractice

Your thoughts on the matter are appreciated.

Easy question...

The answer is Cardiology.

Couple the #1 killer (Heart Disease) with new modalties within the realm of a cardiologist such as cardiac CTs, renal stents, carotid stents......It goes on and on....Plus, it doesn't hurt that cardiologists are at the middle of the self referral game for imaging. Can you say $$$$.
Hospital administrators reward specialties that bring in money to the hospital. Cardiologists are getting more privileges because they have the political power right now. Plus, some are also stealing patients from referring internal medicine docs to become the primary care provider.

The turf lines are being redrawn with cardiologists' influence expanding.

 

[Cowboy DO]

Plus, it doesn't hurt that cardiologists are at the middle of the self referral game for imaging. Can you say $$$$.

I thought this was illegal.

 

[OldPsychDoc]

Psychiatry.

They may stamp out heart disease and cancer, but we will ALWAYS have the crazies, druggies, and their f'd up kids among us!

Happy Friday!

 

[gagolden]

Psychiatry.

They may stamp out heart disease and cancer, but we will ALWAYS have the crazies, druggies, and their f'd up kids among us!

Happy Friday!

No s&*t, they reproduce like freakn rabbits on crack

OldPsychDoc just gave the most honest, insitefull comment Ive read in three years on this forum.

 

[lvspro]

Easy question...

The answer is Cardiology.

Couple the #1 killer (Heart Disease) with new modalties within the realm of a cardiologist such as cardiac CTs, renal stents, carotid stents......It goes on and on....Plus, it doesn't hurt that cardiologists are at the middle of the self referral game for imaging. Can you say $$$$.
Hospital administrators reward specialties that bring in money to the hospital. Cardiologists are getting more privileges because they have the political power right now. Plus, some are also stealing patients from referring internal medicine docs to become the primary care provider.

The turf lines are being redrawn with cardiologists' influence expanding.

Cancer became the #1 killer of americans in 05'.

 

[Chandler]

I thought this was illegal.

He is right. Cardiologists (& Orthopods) go around this by the Stark II loophole. Essentially the Stark II loophole allows self referral as long as there is considered a "inhouse exception" for a physician. Orthopods, Ob, and Cardiologists may essentially refer their own patients for a Knee MRI (Ortho), US (Ob), or CT (Cardiology) as long at the equipment is inhouse i.e in the same office.

Self-referral costs the American Health care system an estimated $16 billion per year for unnecessary imaging tests. There is no end in sight. Since Cardiologists, Orthopods, and Obstetricians own the equipment they get the profits of the imaging.

I have done extensive research on this topic in ACC, RSNA, ACOG, and Orthogate.

 

[razorback831]

There is a cardiologist in the hospital I'm at and he will get ~4X the reimbursement if he performs and reads echoes in his own office. Needless to say, the only patient that get sent to the hospital echo lab are the one's already admitted. If he could only find a way to have the inpatients transferred to his office for the echoes and then bill it that way.....

 

[Wallachia]

He is right. Cardiologists (& Orthopods) go around this by the Stark II loophole. Essentially the Stark II loophole allows self referral as long as there is considered a "inhouse exception" for a physician. Orthopods, Ob, and Cardiologists may essentially refer their own patients for a Knee MRI (Ortho), US (Ob), or CT (Cardiology) as long at the equipment is inhouse i.e in the same office.

Self-referral costs the American Health care system an estimated $16 billion per year for unnecessary imaging tests. There is no end in sight. Since Cardiologists, Orthopods, and Obstetricians own the equipment they get the profits of the imaging.

I have done extensive research on this topic in ACC, RSNA, ACOG, and Orthogate.

don't forget to add urology to the mix, they are currently becoming owners of radiation therapy machines

 

[Solideliquid]

He is right. Cardiologists (& Orthopods) go around this by the Stark II loophole. Essentially the Stark II loophole allows self referral as long as there is considered a "inhouse exception" for a physician. Orthopods, Ob, and Cardiologists may essentially refer their own patients for a Knee MRI (Ortho), US (Ob), or CT (Cardiology) as long at the equipment is inhouse i.e in the same office.

Self-referral costs the American Health care system an estimated $16 billion per year for unnecessary imaging tests. There is no end in sight. Since Cardiologists, Orthopods, and Obstetricians own the equipment they get the profits of the imaging.

I have done extensive research on this topic in ACC, RSNA, ACOG, and Orthogate.

..Talk about getting a "return" on your investment.

 

[emtji]

Actually, Congress just killed this via the Defecit Reduction Act of 2005. Effective 2007, the reimbursements are being slashed in outpatient imaging, hurting especially those folks and groups that own their own scanners.

obviously opposed by radiologists...
http://www.acr.org/s_acr/doc.asp?CID=2537&DID=23825

also, cards can by all means have all the money in the world. I'd rather stick a fork in my eye than do a medicine residency and all those years of a cards fellowship. I want a family. and a wife and kids. and i don't need 7 figures to do that.

 

[NinerNiner999]

Not to be biased, but EM will always have patients who make stupid mistakes and mess themselves up - no real control for that. Plus, we are required to see every patient that walks through our door (EMTALA) for at least a screening exam. There is a projected shortage of EM physicians through 2025 and congress just passed legislation to increase reimbursement by 25% next year...

 

[p53]

Actually, Congress just killed this via the Defecit Reduction Act of 2005. Effective 2007, the reimbursements are being slashed in outpatient imaging, hurting especially those folks and groups that own their own scanners.

obviously opposed by radiologists...
http://www.acr.org/s_acr/doc.asp?CID=2537&DID=23825

also, cards can by all means have all the money in the world. I'd rather stick a fork in my eye than do a medicine residency and all those years of a cards fellowship. I want a family. and a wife and kids. and i don't need 7 figures to do that.

Nice try.....DRA doesn't stop self-referrals. You are confused. The DRA just cuts image reimbursements by 40-50% that is not affiliated with HOSPITALS. The cardiologists, orthopods will continue to do images in their office. If the cardiologists and orthopods are hospital affiliated the DRA has no bearing whatsoever on their image revenue. If they are not hospital affiliated it just means that to get the same profit the number of images will have to be increased. Now tell me this, if you own a scanner and you receive profits from them, wouldn't you be subconsciously more lenient on the indications for a CT?

Also, Radiologists are against self-referrals because they don't control the patients. Why send a patient to a radiologist for a CT when a cardiologist can do one in his office and receive the profits?

If the DRA directly affects self-referral, why would the american college of radiology side with the american college of cardiology to fight against the DRA? Are you tellling me that radiologists are on the same side of the cardiologists for self referral? Yeah Right.

Cliff note version -> Cardiologists are Pro-Self Referral. Radiologists are Against Self Referral.

The only way self-referral is STOPPED is if the Stark II loophole is closed or a new bill is introduced. Consider reading more about DRA before you make an illogical argument.

Lastly, the original poster never asked about lifestyle or money. Just asked about the most secure specialty.

 

[Cowboy DO]

Nevermind, only making the problem worse.