Best specialty for the future?

[DOdoc22]

With all the changes coming to healthcare in this country, can anyone tell me what is the best medical specialty for the future? Given you could start from now, would you consider switching or staying with the specialty that you are in? With the greater emphasis on primary care, will we see more fp and IM docs? Just curious..

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[Sneezing]

Psychiatry

 

[earmuff]

loan shark

 

[smq123]

Moving to Topics in Healthcare.

 

[tennischamp822]

.

 

[KluverB]

Repo man.

 

[deleted50478]

Pain.

 

[neutro]

why pain medicine?

 

[MOHS_01]

why pain medicine?

Because people will pay cash to find relief, and they will pay right now.

 

[chessknt]

Pain relief isnt immediate though and often doesnt work on a long term, so idk about paying for the immediate effect/relief. But it is a very lucrative/popular field to be sure, especially with all the old messed up people we are going to get in the next 20 years....

 

[countingdays]

It isn't a question of immediacy of results or of long-term efficacy. It is a question of what people are willing to pay cash for, what they will actually pay the billed amount for, and preferably what they will pay for while they are in your office.

Anything people will pay cash for will be good= plastic surgery, cosmetic dentistry, cosmetic dermatology, lasik, botox, pain management, etc.

Anthing the government can dictate the rates for will be realtively bad= everything else.

 

[countthestars]

Lets face it, you could go into a field that everyone says will be great in the future but you absolutely hate. If you choose to go into that field hating it then you wake up every day dreading to go to work. You hate what you are doing while at work. Because of that, you care less about the work you do and subsequently do a poor job at that so called "best field for the future". You will be more prone to make mistakes. You might get sued. And now your even more in the hole.

Lets turn this scenario around. Suppose you went into a field that you loved. It might not be the most glamorous field. It might not make the best money but the thing is you love it. You like to wake up every morning to go to job. You love doing what you are doing. Because of that, you care more about the work and get more fullfillment out of it. Subsequently, you work your way up and find a way to make a killing even if there are those that dont make that much in that field.

To sum up: Go to a field you want to do. Cause who knows, in 10 years, another heathcare reform bill can come up if this one screws up badly. Then the field that you thought would be great in the future based on trends in heathcare reform at the time now pays you nothing in the future. If, however you went into something you loved, at least your still doing what you love.

With that being said, Plastics, and anything that takes out of pocket cash will probably be good bets of fields that will still be around and making loads of $$.

 

[chessknt]

Idk about that. If you <3 your job, but work your ass off and get paid the same as a lazy unionized postal worker, than I am going to bet that you start to become pretty bitter. Pay matters because every second of work is not going to be orgasmic, no matter how much you like it.

 

[MOHS_01]

Idk about that. If you <3 your job, but work your ass off and get paid the same as a lazy unionized postal worker, than I am going to bet that you start to become pretty bitter. Pay matters because every second of work is not going to be orgasmic, no matter how much you like it.

I'll see that and raise you one........ everything, even if you like it, becomes a job. Everything. Don't believe me? Try trying to get pregnant. Sure it's fun the first several nights or weeks, but f' me even that'll get old after a while.

In all seriousness, your wage is nothing more than a proxy for your labors. You will all have significant time, expense, and efforts invested in the attainment of the skill set that will be required, and you have earned the right to expect a fair wage for your efforts. Liberal and laissez-faire BS aside -- that is the truth. The problem is that you will not set the value of your services -- CMS does (and will continue to do so). If you can find a way to free yourself from this restraint, you will be better off. Here's another hint -- simple cosmetics will not be it. Every dufus with a truncated alphabet behind their name have jumped in on the game, and this will only speed up and worsen as the overall medical reimbursement climate further erodes.

 

[NYPMR]

will pain continue to be lucrative despite the drop in reimbursements and lack of evidence based medicine?

 

[RGMSU]

Sounds like to me no specialty will be good for the future, except those where you treat rich people who have cash.

 

[chessknt]

Idk abt existing evidence, but after shadowing around in a pain clinic for a few months it is pretty clear that these people return because it works. For a lot of them it really is their only hope and they become dangerously depressed when their pain gets out of control.

Ultimately its like playing the stock market. There are safe bets and there are wild cards, the only difference is that instead of chance dictating whether or not you win, its a bunch of ignorant clowns (same effect really).

 

[RGMSU]

Idk abt existing evidence, but after shadowing around in a pain clinic for a few months it is pretty clear that these people return because it works. For a lot of them it really is their only hope and they become dangerously depressed when their pain gets out of control.

Ultimately its like playing the stock market. There are safe bets and there are wild cards, the only difference is that instead of chance dictating whether or not you win, its a bunch of ignorant clowns (same effect really).

The ignorant clowns seem to be doing their best to insure that nobody wins - not patients, not docs, not insurance companies, not the future generations who have to pay the tax rates for all their financial disasters.

 

[chessknt]

That's where you're wrong--they insure that the govt/public employees win! Remember, public employees are always at least 3x more important than you guaranteed (or so their pensions say anyways).

 

[naus]

How would orthopedic surgery fare? Don't they have a lot of outpatient work?

 

[deleted50478]

How would orthopedic surgery fare? Don't they have a lot of outpatient work?

Outpatient work has nothing to do with it. If people are willing to pay cash, you can charge whatever rate the market sets. If you accept a government plan, you get below market rates determined by someone who think your money is his to give away. People will pay thousands for neon lights on their cars or for bigger breasts, but think they shouldn't have to pay to get that torn tendon repaired. Doing outpatient work doesn't help at all if people feel entitled to your service and are unwilling to actually pay for it with their own money.

 

[RGMSU]

How would orthopedic surgery fare? Don't they have a lot of outpatient work?

It depends on what happens with reimbursement rates. The specialties that are at the top (including orthopedics) stand to take the biggest hits because they're the easiest targets. They want to narrow the gap between primary care pay and specialist pay so that primary care won't seem so unattractive to medical students. Plus, they can save money by taking it from the doctor's pocket and the patient's pocket, too (decreased doc reimbursement and increased premiums/taxes). However, if the average orthopedic surgeon's annual income falls from say 375 to 250, it will be much more difficult to convince somebody that it's worth going to med school, being at the top of the class, doing a six year residency, and working 60+ hours a week for the rest of your life. So, we'll inevitably lose talent. The problem with most surgeons/proceduralists is that their work is generally quite dependent on a third party payer. Most people don't have thousands of dollars lying around to pay for a surgery/procedure out of pocket. A lot of outpatient work is not necessarily cheap either.

 

[GH253]

ortho--joint replacement

 

[digitlnoize]

It depends on what happens with reimbursement rates. The specialties that are at the top (including orthopedics) stand to take the biggest hits because they're the easiest targets. They want to narrow the gap between primary care pay and specialist pay so that primary care won't seem so unattractive to medical students. Plus, they can save money by taking it from the doctor's pocket and the patient's pocket, too (decreased doc reimbursement and increased premiums/taxes). However, if the average orthopedic surgeon's annual income falls from say 375 to 250, it will be much more difficult to convince somebody that it's worth going to med school, being at the top of the class, doing a six year residency, and working 60+ hours a week for the rest of your life. So, we'll inevitably lose talent. The problem with most surgeons/proceduralists is that their work is generally quite dependent on a third party payer. Most people don't have thousands of dollars lying around to pay for a surgery/procedure out of pocket. A lot of outpatient work is not necessarily cheap either.

True, but the one thing surgeons have going for them is that their jobs are absolutely necessary.

I'm not saying that other doctors' aren't, and I certainly don't want to go into surgery, but if you have appendicitis, I promise, you'll pay ANYTHING to get that sucker taken out. It's that or die.

Same with ortho. If your radius is half sticking out of your arm, you'll pay someone to fix it. They'll be fine. Worst case is that they transition to cash.
Of course, that model would be less expensive than the current one.

As far as answering the question...it's a crapshoot. Do what you love. You'll make plenty of money. It's not that important anyways...

 

[RGMSU]

True, but the one thing surgeons have going for them is that their jobs are absolutely necessary.

I'm not saying that other doctors' aren't, and I certainly don't want to go into surgery, but if you have appendicitis, I promise, you'll pay ANYTHING to get that sucker taken out. It's that or die.

Same with ortho. If your radius is half sticking out of your arm, you'll pay someone to fix it. They'll be fine. Worst case is that they transition to cash.
Of course, that model would be less expensive than the current one.

As far as answering the question...it's a crapshoot. Do what you love. You'll make plenty of money. It's not that important anyways...

There are lots of things besides surgery that are absolutely necessary. It's just as necessary to see your physician for maintenance meds if you have a chronic problem. And, it's much more difficult for a surgeon to practice cash only, considering that their fee per individual service is usually much higher. Most surgeons/proceduralists are very dependent on third party payers, unless they do boutique or cosmetic practice. My real point was that, if anybody's incomes are going down, it will be the people at the top. Everybody knows that the people at the bottom can't go any lower, or there won't be a workforce in these fields at all for the future.

 

[digitlnoize]

There are lots of things besides surgery that are absolutely necessary. It's just as necessary to see your physician for maintenance meds if you have a chronic problem.

I meant to address this, as I knew it would come up. What I meant was that seeing your PCP is usually not an acute situation.

While it's true that your hypertension will kill you just as well as your appendicitis, the fact remains that one needs fixing RIGHT NOW, and the other takes quite a while to exert its effects.

Many patients don't always grasp the importance of taking their meds, as evidenced by the lack of compliance seen by physicians. They usually won't drop dead if they aren't seeing their PCP regularly. It might shorten their lifespan.

On the flip side, if you have appendicitis, and you don't go see a surgeon, you are, most likely, going to die. Immediately. Not only that, but you will be in acute pain.

Most people I know, in 10/10 pain, will pay ANYTHING to make it stop. People aren't even willing to pay their $10 copays anymore for primary care...but if surgeons stop taking insurance due to low reimbursement, they'll have to pony up to stay alive.

Obviously, if this happened, it would be because surgeons fees dropped lower than what the market would bear in cash. We see this happening today in Primary Care. Many FP's are setting up Cash Only practices because they can make more in cash than they can from insurance. The same principle could apply to surgeons, if they keep getting pay cuts. Hell, it could apply to all of medicine...which would probably be an improvement. Pay for it, like you pay for everything else. You don't expect to get fed for free do you? Then why do you expect free health care?

 

[RGMSU]

While it's true that your hypertension will kill you just as well as your appendicitis, the fact remains that one needs fixing RIGHT NOW, and the other takes quite a while to exert its effects.

Many patients don't always grasp the importance of taking their meds, as evidenced by the lack of compliance seen by physicians. They usually won't drop dead if they aren't seeing their PCP regularly. It might shorten their lifespan.

Depends on how high your anti-hypertensive dosage is and how high your bp is without it as to how fast it becomes a problem when withdrawn. I wouldn't always dismiss refilling a maintenance med right before you head out of town for the weekend as something that doesn't need to happen right now, unless you want to get sued that is. I actually know a guy with hypertension who did just drop dead while he was in between primary care physicians. One refused to continue to see him, he was looking for another one, started having bp problems without his meds, and died of a heart attack in his sleep. One of the biggest illusions in our minds in modern American healthcare is that everything needs to be procedural/surgical. In fact, some of the most important healthcare moves one can make are neither procedural nor surgical - they're preventative/maintenance. Smart people will pay for a good primary care physician once or twice a year. They know it's the best money they'll ever spend. Plus most people with appendicitis start off at their PCP or ER. They don't just magically fall into the lap of a surgeon.

I get depressed about the state of healthcare sometimes too, but, dude, seriously - we're gonna be alright here. We're better off than 99% of America right now. Sure, we need to be on our toes and make sure we don't get taken advantage of, but I think we're capable of guarding ourselves. We have a lot of power as a guild of physicians/future physicians - society needs us.

 

[digitlnoize]

Depends on how high your anti-hypertensive dosage is and how high your bp is without it as to how fast it becomes a problem when withdrawn. I wouldn't always dismiss refilling a maintenance med right before you head out of town for the weekend as something that doesn't need to happen right now, unless you want to get sued that is. I actually know a guy with hypertension who did just drop dead while he was in between primary care physicians. One refused to continue to see him, he was looking for another one, started having bp problems without his meds, and died of a heart attack in his sleep. One of the biggest illusions in our minds in modern American healthcare is that everything needs to be procedural/surgical. In fact, some of the most important healthcare moves one can make are neither procedural nor surgical - they're preventative/maintenance. Smart people will pay for a good primary care physician once or twice a year. They know it's the best money they'll ever spend. Plus most people with appendicitis start off at their PCP or ER. They don't just magically fall into the lap of a surgeon.

I get depressed about the state of healthcare sometimes too, but, dude, seriously - we're gonna be alright here. We're better off than 99% of America right now. Sure, we need to be on our toes and make sure we don't get taken advantage of, but I think we're capable of guarding ourselves. We have a lot of power as a guild of physicians/future physicians - society needs us.

It's society I'm worried about.

I agree 100% about preventive medicine. I'm speaking from the viewpoint of a random patient. Most people are more concerned about the pain they're in RIGHT NOW than the pain they might be in tomorrow.

I'm really not trying to do a whole "procedures are more important" thing. Just trying to point out that the surgeons will be ok if they get more cuts (haha, cuts...get it?).

 

[deleted50478]

It's society I'm worried about.

I agree 100% about preventive medicine. I'm speaking from the viewpoint of a random patient. Most people are more concerned about the pain they're in RIGHT NOW than the pain they might be in tomorrow.

I'm really not trying to do a whole "procedures are more important" thing. Just trying to point out that the surgeons will be ok if they get more cuts (haha, cuts...get it?).

A lot, if not most, surgery isn't absolutely necessary and is often inappropriate for one reason or another. Sure people will always need surgery, but competition for cases would spike big time if the surgery schedule was regulated with an eye toward cost minimization. No one is safe from the government.

 

[RGMSU]

No one is safe from the government.

Very true. Read sometime about the German healthcare system if you want a good laugh.

 

[MOHS_01]

.... No one is safe from the government.

 

[deleted50478]

 

[medicinesux]

mortuary science- open up a funeral home, and kaching kaching! Don't ever have to worry about getting sued since your client is already dead. No USMLE's. No drawn out residency to suffer through. Minimal paperwork. Charge whatever you wish- mark up prices of coffins and urns to your heart's desire not worrying about Obamacare. Real estate prices are quite depressed nowadays so you could probably get a really good deal on a funeral home. And if they have another cash for clunkers incentive you could get a great bargain on a hearse. Baby boomers who screwed over the next generation will be dropping off in droves in the coming decades. You may even get some morbid satisfaction out of that. Don't laugh.......I am dead serious.

 

[RGMSU]

mortuary science- open up a funeral home, and kaching kaching! Don't ever have to worry about getting sued since your client is already dead. No USMLE's. No drawn out residency to suffer through. Minimal paperwork. Charge whatever you wish- mark up prices of coffins and urns to your heart's desire not worrying about Obamacare. Real estate prices are quite depressed nowadays so you could probably get a really good deal on a funeral home. And if they have another cash for clunkers incentive you could get a great bargain on a hearse. Baby boomers who screwed over the next generation will be dropping off in droves in the coming decades. You may even get some morbid satisfaction out of that. Don't laugh.......I am dead serious.

Every word of that was cleverly crafted. I would just add that rationing of care and reduced quality of physicians due to reduced compensation should be stimuli for the mortuary science business. A "win, win" really, except for the ones who die, of course.

 

[womp]

What about ENT? They can't be any more screwed than they already are, right?

 

[JaniceA]

mortuary science- open up a funeral home, and kaching kaching! Don't ever have to worry about getting sued since your client is already dead. No USMLE's. No drawn out residency to suffer through. Minimal paperwork. Charge whatever you wish- mark up prices of coffins and urns to your heart's desire not worrying about Obamacare. Real estate prices are quite depressed nowadays so you could probably get a really good deal on a funeral home. And if they have another cash for clunkers incentive you could get a great bargain on a hearse. Baby boomers who screwed over the next generation will be dropping off in droves in the coming decades. You may even get some morbid satisfaction out of that. Don't laugh.......I am dead serious.

LOL!!!1 you definitely have a point out there, mortuary science is the kind of business wherein in peoples death would be your way of living.

 

[aaliyahhaughton]

With all the changes coming to healthcare in this country, can anyone tell me what is the best medical specialty for the future? Given you could start from now, would you consider switching or staying with the specialty that you are in? With the greater emphasis on primary care, will we see more fp and IM docs? Just curious..

Orthopedic or Dermatology

 

[African]

Neurosurgery is the best bet, you will always remain indispensable though you will probably work longer and harder. Btw those in medicine in the US always make a big deal out of the low pay of german doctors, but you always miss the whole picture, medicine in most of western europe is a 9-5 job, and you earn a lot more compared to other salaried workers. 80,000 euro net salary is more than enough for a 9-5 job, that is about 10,000 USD a month, net salary that is(sport cars, big house, multiple girlfriends lol). working in the summer, i do backbreaking menial jobs for a month to make about 1500 USD. I know doctors here in belgium that make about 800k, euros that is, that is well over a million USD, but to me that is just ridiculous, i will be contented with the 80,000 net salary, and go back to my country of origin to do some voluntary work in the summer.

 

[bronx43]

Neurosurgery is the best bet, you will always remain indispensable though you will probably work longer and harder. Btw those in medicine in the US always make a big deal out of the low pay of german doctors, but you always miss the whole picture, medicine in most of western europe is a 9-5 job, and you earn a lot more compared to other salaried workers. 80,000 euro net salary is more than enough for a 9-5 job, that is about 10,000 USD a month, net salary that is(sport cars, big house, multiple girlfriends lol). working in the summer, i do backbreaking menial jobs for a month to make about 1500 USD. I know doctors here in belgium that make about 800k, euros that is, that is well over a million USD, but to me that is just ridiculous, i will be contented with the 80,000 net salary, and go back to my country of origin to do some voluntary work in the summer.

Taxes my friend. 10k USD a month seems like it's a good amount, but you have to remember that Uncle Sam will take 35-40%, depending on your location. Then add in 401k payments, and that's not alot of money for a big house, nice car, and multiple girlfriends.

 

[EctopicFetus]

Yep 10k a month isnt much at all. Look for a 500k house you are looking at a mortgage and taxes of 3500 or so (depending on where u live), throw in a nice car, electricity, health insurance etc and your basically broke.

Def not a million dollar house at 10k a month.

most people tell you that you can afford 2.5 to 3 times your salary for a home, so at 10k a month or 120k per yr your looking at 360k for a house which isnt anything special.

 

[Lokhtar]

From reading the legislation, I would probably advise against Radiology. I know its hot and lucrative. But I think they should prepare for some butthurt.

 

[Dr Skeptismo]

Palliative medicine anyone? I'd think for similar reasons as pain med and mortuary science. I've definitely heard a lot of talking points on the importance of end of life care. Who knows if the pols were actually serious or not (albeit a big if), but since it's potentially a cost saver IMO increased reimbursements for what's currently a lower paying specialty don't seem too unlikely. I don't see pay ever reaching the levels of the more lucrative specialties, but with possible increased $$ emphasis in the field and with the lifestyle that it offers, it seems like it might fare pretty well.

Either that, or a cash only OMT clinic.

 

[bronx43]

From reading the legislation, I would probably advise against Radiology. I know its hot and lucrative. But I think they should prepare for some butthurt.

I've been saying this for years. But, just curious... what specific parts of the bill makes you conclude that radiologists are looking at hefty pay cuts?

 

[Lokhtar]

I've been saying this for years. But, just curious... what specific parts of the bill makes you conclude that radiologists are looking at hefty pay cuts?

SEC. 3135. MODIFICATION OF EQUIPMENT UTILIZATION
FACTOR FOR ADVANCED IMAGING SERVICES.

CBO estimates these changes will save $1.2 billion over 10 years.

 

[brickandlace]

SEC. 3135. MODIFICATION OF EQUIPMENT UTILIZATION
FACTOR FOR ADVANCED IMAGING SERVICES.

CBO estimates these changes will save $1.2 billion over 10 years.

also i think radiology is one of those fields where outsourcing is an issue. xrays can always be transmitted elsewhere to be read for a lower cost. there's no pt contact neccessary.

i agree with the above posters that cash-based specialities will flourish.

i cant sufficiently describe how enraged i am about the possibility surgeons taking pay-cuts - the hours and commitment have to count for something.... is the govt going to treat surgeons like robots? the more surgeries the merrier? without taking into account how much effort and time the physician is investing in each procedure... i'm all for providing healthcare for the uninsured... however i dont agree with the current administration's perception of physicians. seems like the AMA hasn't protested much.

 

[thedrjojo]

No one is safe from the government.

I've said it before, and I'll say it again...

Those on the extreme right think government is all about control and our only salvation is through the benevolence and power of the corporation and the invisible hand of the market... those on the far left think that government is the only salvation to the greed and manipulative forces of corporations... the actual reality is that while government is inheritly wasteful because of the regimented way it must operate it does function to safegaurd and protect the people, and while corporations have the overriding goal of creating as much wealth as possible for the services they provide and will do so in whatever means possible, they also provide the innovation, employment, and luxuries that make our world possible.

Our current healthcare system had fallen too far to the right with corporations (insurance companies) exploiting too much from the system. Physician salaries have been steadily declining for the past 20-30 years, mainly due to the private company influences (which own the companies that set the usual fees schedule, and as I also point out, in NY a few years back had to pay out billions of dollars because of artificially price fixing and lowballing doctors), partially due to the government with CMS, and highly due to the lack of business knowledge and bargining ability of physicians to protect themselves from the exploits of the above two. We have been micromanaged out of equitible fees for service by levels of HMO's and administrators above us.

This bill doesn't address or affect this above in much ways... what it does is affect people getting access to health insurance (subsidizing premiums, establishing an exchange for individuals to buy into it, prevents drops in coverage etc), how much premiums they pay, etc. The actual effect on wages of doctors is all speculation and heresay...

 

[mig2k]

Best specialization now looks like Lawyer and lying Politician.

 

[African]

Taxes my friend. 10k USD a month seems like it's a good amount, but you have to remember that Uncle Sam will take 35-40%, depending on your location. Then add in 401k payments, and that's not alot of money for a big house, nice car, and multiple girlfriends.

I am not sure if we are on the same page here, but i said net salary that is after all deductions, and that is pretty much all i need, with ten thousand a month i can live big both here in belgium and eastern africa, remember mine is a 9-5 job. A good house costs about 150k euros, a nice sport car is about 40k euros.

Seriously with 10k net salary a month, i am pretty much set for life, but then salary is subjective, as a 10 year old i used a gas lantern to study math at night, my mother sometimes used money for food to buy us gas to do our homework, looking back i guess she made the right choice, so yeah, i do much better than my classmates and i am sure i will be able to choose any specialty and to be honest good salary is a motivation for me as well as helping others, but 10k/month after all deductions is perfect NOW, who knows what the inflation will be like in a few years, anyways good luck to you all i guess you guys will take a serious pay cut with obamacare, i do genuinely sympathise with you, it is hard to give up privileges regardless of how ridiculous a million dollar/year is to others NO ENVY on my part.

 

[docscience]

Yep 10k a month isnt much at all. Look for a 500k house you are looking at a mortgage and taxes of 3500 or so (depending on where u live), throw in a nice car, electricity, health insurance etc and your basically broke.

Def not a million dollar house at 10k a month.

most people tell you that you can afford 2.5 to 3 times your salary for a home, so at 10k a month or 120k per yr your looking at 360k for a house which isnt anything special.

This is a lot in the midwest.
Even in the expensive northeast the average price of a house is around $250K.

 

[dilated]

Physician salaries have been steadily declining for the past 20-30 years, mainly due to the private company influences (which own the companies that set the usual fees schedule, and as I also point out, in NY a few years back had to pay out billions of dollars because of artificially price fixing and lowballing doctors), partially due to the government with CMS, and highly due to the lack of business knowledge and bargining ability of physicians to protect themselves from the exploits of the above two.

I disagree totally. I believe CMS is the prime mover behind decreases in salary. It has far more power than any insurer in the country and does not "negotiate", it dictates. If you take a basic surgery such as appendectomy and look at how much Medicare has cut payment for it over the past 20 years, you have your answer. Furthermore, "innovations" in billing that hurt doctors (for example, the idea that paying for surgery actually means paying for surgery and all visits for the postoperative period) invariably spring from Medicare. Private insurers just copy as much of what Medicare does as they think they can get away with.

Every extra bit of power that CMS gets (and "reform" gives it a TON) is another brick in the wall of ruining the practice of medicine.