Most and least futureproof specialties.

[anbuitachi]

For heme/onc specifically, they profit from the margin on buying/selling chemo to patients, and I don't think that's reflected in the RVUs

Yea I think there were recently cuts to this. Also it makes no sense why Heme onc gets paid by buying/selling chemo. It sounds like a huge ethical issue. Imagine if part of anesthesiologists salary comes from the drugs they use..

---

Members don't see this ad.

 

[anbuitachi]

You're a joke. It was just my point - that at the very most for a procedure that may take the surgeon ( idk, 20 minutes ), there is still turnaround time, workup, initial consultation, and follow up required of the surgeon. Surgeon's aren't making 10k every day doing appendectomies. They are handling bowel obstructions, whipple's, whatever else. And no, anesthesia won't get 50 bucks. That's not how anesthesia billing works.

Uh, sure, - here's a link:

Medicare Unmasked: Behind the Numbers

That's medicare billing from 2014. Considering medicare makes up about 20-30% ish of most of these guys income, you do the math. The highest earning IR guys are making 3-5 million. Add in their likely insurance billing ( not public ), That's probably close to 10 mil gross,
( given overhead probably eats away some of that ).

Family practice is similar. General surgery is actually lower than IR across the board.

My point is - These guys are exceptions. There's some ophtho guy that made almost 20 mil just off medicare a few years ago and has a jet. THESE ARE EXCEPTIONS.

your AVERAGE surgeon makes the SAME as your average ANESTHESIOLOGIST and RADIOLOGIST and EM DOC. I know this butt hurts you, but it's the truth, 'bro'.

Bro do you even know how anesthesiology works? An anesthesiologists logs way more cases than a surgeon, thats why salary is comparable to general surgery, but is still lower than surgery specialties. Anesthesiologists salary range is very narrow due to the billing structure. The range of surgeons go to the millions.

Anesthesiologists are in the OR ALL DAY LONG, everyday he works for his career. Anesthesiologists do way more cases, but end up with similar pay as general surgeon, the lowest paid of all surgeons. And in many instances, anesthesiologists supervise up to 4 rooms at once to get that salary.

And my point is, surgeons aren't doing appys all day. Do bowel obstructions, which can take a few hours, pay less than a 20 min appy? How much is a whipple ?

 

[Rads312]

Bro do you even know how anesthesiology works? An anesthesiologists logs way more cases than a surgeon, thats why salary is comparable to general surgery, but is still lower than surgery specialties. Anesthesiologists salary range is very narrow due to the billing structure. The range of surgeons go to the millions.

Anesthesiologists are in the OR ALL DAY LONG, everyday he works for his career. Anesthesiologists do way more cases, but end up with similar pay as general surgeon, the lowest paid of all surgeons. And in many instances, anesthesiologists supervise up to 4 rooms at once to get that salary.

And my point is, surgeons aren't doing appys all day. Do bowel obstructions, which can take a few hours, pay less than a 20 min appy? How much is a whipple ?

Yes, my dad is an anesthesiologist and a solo practice owner, so i've got a pretty good idea of how it works.

You're right, an average anesthesiologist makes about the same as a general surgeon. That's what I was talking about. There are a lot more general surgeons running around than CT or vasc. surgeons. PS - you're gravely mistaken if you think your average anesthesiologist is working surgeon hours. Just ask anyone in the GAS forum that. Maybe at a busy level 1 in a big city - but in normal suburban community hospital life? no way.

I'm sticking with my original point - don't mislead people by saying surgeons are earning in the high six figures. That is false. SOME specialists surgeons do. Even most orthopods and vasc surgeons are closer to the 500k mark.

If you're not a neurosurgeon, you're not typically hitting anywhere near 1 mil. One of my neuro IR attending makes low 7 figures. He works his tail off and dose exclusive stroke call for the hospital. So yeah, can some IR guys make that? Sure. I'm not going to try to sell that to SDN as typical, because it isn't.

 

[anbuitachi]

P.S. I'm in an integrated IR residency as of this july. I don't ever anticipate to make 7 figures. Is it doable? Sure. But i'm realistic. Chances are we will all be much closer to the average than the ceiling.

I just used the medicare website. I dont know what it is supposed to tell me since its only medicare payments. I searched for a spine surgeon who i know made 7M in 2014, and the website showed he was reimbursed for 130k from medicare in 2014.. Then i looked up a IR doc i worked with frequently, medicare reimbursed him 150k in 2014. But what am i supposed to do with that information?? We dont know the rest. In case of the spine surgeon, he had 6.8M of non medicare income. Then i searched for a section director anesthesiologist, and apparently he got 6k in medicare..

 

[anbuitachi]

Yes, my dad is an anesthesiologist and a solo practice owner, so i've got a pretty good idea of how it works.

You're right, an average anesthesiologist makes about the same as a general surgeon. That's what I was talking about. There are a lot more general surgeons running around than CT or vasc. surgeons. PS - you're gravely mistaken if you think your average anesthesiologist is working surgeon hours. Just ask anyone in the GAS forum that. Maybe at a busy level 1 in a big city - but in normal suburban community hospital life? no way.

I'm sticking with my original point - don't mislead people by saying surgeons are earning in the high six figures. That is false. SOME specialists surgeons do. Even most orthopods and vasc surgeons are closer to the 500k mark.

If you're not a neurosurgeon, you're not typically hitting anywhere near 1 mil. One of my neuro IR attending makes low 7 figures. He works his tail off and dose exclusive stroke call for the hospital. So yeah, can some IR guys make that? Sure. I'm not going to try to sell that to SDN as typical, because it isn't.

My point is surgeons can make those #s. And any interventional doc. Rest of them can't hope to touch it. A fam med, IM doc making 7 figures? Theres prob fraud involved. Same with anesthesiologist unless he owns a large group, and thats salary is from group business not from working solely as anesthesiologist.

 

[anbuitachi]

P.S. I'm in an integrated IR residency as of this july. I don't ever anticipate to make 7 figures. Is it doable? Sure. But i'm realistic. Chances are we will all be much closer to the average than the ceiling.

You are in an integraded IR residency? As far as I know there are only 17 i believe? That means ttheres a 6% chance we work at the same institution!

 

[Rads312]

I just used the medicare website. I dont know what it is supposed to tell me since its only medicare payments. I searched for a spine surgeon who i know made 7M in 2014, and the website showed he was reimbursed for 130k from medicare in 2014.. Then i looked up a IR doc i worked with frequently, medicare reimbursed him 150k in 2014. But what am i supposed to do with that information?? We dont know the rest. In case of the spine surgeon, he had 6.8M of non medicare income. Then i searched for a section director anesthesiologist, and apparently he got 6k in medicare..

Dude. That's my point. Those guys billing THAT much for medicare - I know a few of the ones in my locale, the majority of their patients ARENT medicare. They are raking it in. They are exceptions.

 

[Rads312]

You are in an integraded IR residency? As far as I know there are only 17 i believe? That means ttheres a 6% chance we work at the same institution!

Yeah, we got approval not long ago and i'm in the DR/IR section as of 2 weeks ago.

And no, there are 65 DR/IR residencies..
FYI:

Society of Interventional Radiology- Integrated IR residency

 

[anbuitachi]

Yeah, we got approval not long ago and i'm in the DR/IR section as of 2 weeks ago.

And no, there are 65 DR/IR residencies..
FYI:

Society of Interventional Radiology- Integrated IR residency

Man that's way too many.

 

[Rads312]

Man that's way too many.

What is it with you and doomsday. It's because they mostly only have 1-3 spots for the integrated IR position. We have 1. They are phasing out fellowship altogether at most of these institutions.

It won't change the average number of IR grads per year much at all.

 

[anbuitachi]

What is it with you and doomsday. It's because they mostly only have 1-3 spots for the integrated IR position. We have 1. They are phasing out fellowship altogether at most of these institutions.

It won't change the average number of IR grads per year much at all.

Nah I think IR is booming and has a great future ahead. It just means i have to spend more time getting radiated working with them

 

[Stagg737]

So what specialties are futureproof again?

As of right now, I think psych is. No way AI or technology is taking over (though I haven't read through Ox's article yet, but preventative measures aren't going to kill the field) and the mid-levels I've encountered in the field have been awful for the most part. Plus, psychiatrists work less hours than most other fields in general and there's a pretty huge demand, so still plenty of room for expansion. On top of that, there's still so much research in the field to be done that there's a lot to look forward on the academic side. Maybe it's not futureproof forever, but at this point I'm not concerned about the next 20-30 years in the least bit.

 

[Spodermin]

@Brahnold Bloodaxe
What do you want gain from this thread?

To all the rest that are "predicting" the future and arbitrarily assigning "safe" and "unsafe" fields, what are you on about?
AI replacing doctors is the modern day version of 70's sci-fi films, you know the ones that had people convinced that by 2003 there will be flying cars and and that everyone will go to Neptune for vacation.
Here we are in 2017 and, while I was a mere germ cell in my parents' genitalia during the 70s, I can safely say that world we live in isn't anywhere closer to that utopian society that generation X yearned for.
Anyone siting anything that comes out of silicon valley obviously doesn't know how the world works. Silicon valley is full of nutjobs that are so detached from reality, its actually quite scary.

Even in the off chance that I'm wrong about everything, if the time comes where doctors are out of jobs, just know that midlevels would have been unemployed for decades when that time comes.

Oh and I think aerospace medicine is the safest speciality. kthnxbye.

 

[CharlieBillings]

.

 

[oncology2020]

IR has some cool procedures but the bread and butter of IR is horrendous..doing LPs, paracentesis, drains, biopsies, etc for the services that were too lazy to do it themselves. These latter procedures will compromise most of your training on a day to day basis.

 

[anbuitachi]

@Brahnold Bloodaxe
What do you want gain from this thread?

To all the rest that are "predicting" the future and arbitrarily assigning "safe" and "unsafe" fields, what are you on about?
AI replacing doctors is the modern day version of 70's sci-fi films, you know the ones that had people convinced that by 2003 there will be flying cars and and that everyone will go to Neptune for vacation.
Here we are in 2017 and, while I was a mere germ cell in my parents' genitalia during the 70s, I can safely say that world we live in isn't anywhere closer to that utopian society that generation X yearned for.
Anyone siting anything that comes out of silicon valley obviously doesn't know how the world works. Silicon valley is full of nutjobs that are so detached from reality, its actually quite scary.

Even in the off chance that I'm wrong about everything, if the time comes where doctors are out of jobs, just know that midlevels would have been unemployed for decades when that time comes.

Oh and I think aerospace medicine is the safest speciality. kthnxbye.

You do realize our healthcare is currently being run by nutjobs who dont know how medicine actually works. Our healthcares solution to all problems is hire more administrators who are sitting somewhere making policies for the hospital thinking their policies is improving healthcare.

I think we are proceeding pretty fast. It's 2017 and we are now seriously talking about self driving cars! I totally see AI replacing certain doctors in the future, in next 15 years. I think radiology will be the first to get some replacement.

 

[DrfluffyMD]

IR has some cool procedures but the bread and butter of IR is horrendous..doing LPs, paracentesis, drains, biopsies, etc for the services that were too lazy to do it themselves. These latter procedures will compromise most of your training on a day to day basis.

I find those procedures enjoyable and bring a lot of patient satisfication. If you can't enjoy the bread and butter you cannot enjoy IR.

Also, as of now, there will be roughly half as many integrated IR being graduated that have just matched this year versus my year (yog 2019) (around 250), and even with 250 a year we got a great job market.

 

[Rads312]

IR has some cool procedures but the bread and butter of IR is horrendous..doing LPs, paracentesis, drains, biopsies, etc for the services that were too lazy to do it themselves. These latter procedures will compromise most of your training on a day to day basis.

Again, someone talking out of their A** yet again. We don't do any LP's, any para's, barely any drains in IR. Our body fellows handle that. We do occasional biopsies, but most of our IR work is PAD, biliary work, Neuro IR, and oncology...Maybe at your crappy hospital you subject your IR department to such things. My guess is you are an IM resident - maybe an oncology fellow? I don't know. I don't care.

Are you upset that you can't do the interventional oncology stuff? Sorry, it's not in your wheelhouse.

There is certainly a small niche of slow community practices where IR guys handle some of that BS you mentioned - but that model is fading, and fading fast.

So again, please don't say stupid stuff and make yourself look like an idiot.

P.S. I'd rather do abscess drainages all day, every day, than be an internist or an oncologist. barf.

 

[Rads312]

Why did you switch? Was the goal to be double board certified?

No,

my goal was to be an Interventionalist ( would have been double boarded regardless) - I switched because our program got accredited for an integrated position a year ahead of the match, so I jumped at it. I didn't want the headache of applying for IR fellowship in 3 years when there would be half or less the fellowships that exist now.

 

[DrfluffyMD]

Again, someone talking out of their A** yet again. We don't do any LP's, any para's, barely any drains in IR. Our body fellows handle that. We do occasional biopsies, but most of our IR work is PAD, biliary work, Neuro IR, and oncology...Maybe at your crappy hospital you subject your IR department to such things. My guess is you are an IM resident - maybe an oncology fellow? I don't know. I don't care.

Are you upset that you can't do the interventional oncology stuff? Sorry, it's not in your wheelhouse.

There is certainly a small niche of slow community practices where IR guys handle some of that BS you mentioned - but that model is fading, and fading fast.

So again, please don't say stupid stuff and make yourself look like an idiot.

P.S. I'd rather do abscess drainages all day, every day, than be an internist or an oncologist. barf.

I don't know where you are training but a lot of things like drain and biopsies make up the bread and butter of IR, especially in PP.

 

[qwerty89]

Again, someone talking out of their A** yet again. We don't do any LP's, any para's, barely any drains in IR. Our body fellows handle that. We do occasional biopsies, but most of our IR work is PAD, biliary work, Neuro IR, and oncology...Maybe at your crappy hospital you subject your IR department to such things. My guess is you are an IM resident - maybe an oncology fellow? I don't know. I don't care.

Are you upset that you can't do the interventional oncology stuff? Sorry, it's not in your wheelhouse.

There is certainly a small niche of slow community practices where IR guys handle some of that BS you mentioned - but that model is fading, and fading fast.

So again, please don't say stupid stuff and make yourself look like an idiot.

P.S. I'd rather do abscess drainages all day, every day, than be an internist or an oncologist. barf.

not exactly. What you describe can be found in academic centers and comprises a minority of PP. Most PP cases = lines, paras/thoras, drains, etc. Which is fine.

The bread and butter of any specialty is mostly boring stuff, but boring stuff pays the bills. I always wonder when I read posts like these if you are truly that hardcore about IR (and are willing to potentially sacrifice lifestyle and location to get the ideal job) or misled into believing this is how most PP runs. If you are the former then I guess it doesn't matter. You will find the right work environment. If you are the latter that will prioritize location/lifestyle, then realize you may not get the ideal IR job in the future that you seem to want.

 

[DrfluffyMD]

No,

my goal was to be an Interventionalist ( would have been double boarded regardless) - I switched because our program got accredited for an integrated position a year ahead of the match, so I jumped at it. I didn't want the headache of applying for IR fellowship in 3 years when there would be half or less the fellowships that exist now.

There will not be traditional fellowship left in 3 years.

Another thing that is good about our specialty is that we are reducing the number of spots rather than increasimg it for now.

You mentioned your DR IR has been approved for one spot. Did your ir fellowship have 2?

 

[JPSmyth]

PS, just wanted to add - I switched over from my current programs diagnostic radiology program into our new integrated radiology residency position this past year.

IR is growing in leaps and bounds - both in terms of interventional oncology, but also in terms of uterine artery embolizations, prostate embo's, neuro IR / stroke, etc. There is a lot more on the horizon. For those of you that like procedures, but don't necessarily want to do them ALL the time - consider integrated IR. I'll be double boarded in diagnostics and interventional when i finish, and there are lots of job opportunities. And again, unlikely that a midlevel or computer will replace you.

This is my number one field of interest as a med student. 3 days of procedures/clinic and 2 days reading per week sounds excellent. But I would imagine as an IR doc you can't take as much vacation as DR docs? I was told 10 weeks wasn't out of the ordinary for DR, I'm assuming IR is less? Just curious

 

[Rads312]

There will not be traditional fellowship left in 3 years.

Another thing that is good about our specialty is that we are reducing the number of spots rather than increasimg it for now.

You mentioned your DR IR has been approved for one spot. Did your ir fellowship have 2?

They have 2 but are still in flux about how to handle keeping one fellow spot open or not. For incoming matched guy and onwards we are keeping it 1 and 1 for now, may change it to 2 and delete fellowship altogether by 2020.

 

[Rads312]

This is my number one field of interest as a med student. 3 days of procedures/clinic and 2 days reading per week sounds excellent. But I would imagine as an IR doc you can't take as much vacation as DR docs? I was told 10 weeks wasn't out of the ordinary for DR, I'm assuming IR is less? Just curious

No, typically IR is more or the same. You're usually taking IR call and some DR call as well.

If you aren't gung ho IR only and want to join a diagnostics group and just do part time IR / part time DR, most groups will incentivize IR guys one of three ways:

1) expedited partnership

2) more pay ( not a ton more maybe 10-20% tops )

3) more vacation. In my locale this is typically the situation. PP IR guys get 2-3 weeks more and maybe a bonus on top of that.

All this goes flying out the window if you want to try and be a "real" IR with a clinic type practice and outpatient center. These types of IR docs are what we are trying to produce with the new model.

 

[JPSmyth]

No, typically IR is more or the same. You're usually taking IR call and some DR call as well.

If you aren't gung ho IR only and want to join a diagnostics group and just do part time IR / part time DR, most groups will incentivize IR guys one of three ways:

1) expedited partnership

2) more pay ( not a ton more maybe 10-20% tops )

3) more vacation. In my locale this is typically the situation. PP IR guys get 2-3 weeks more and maybe a bonus on top of that.

All this goes flying out the window if you want to try and be a "real" IR with a clinic type practice and outpatient center. These types of IR docs are what we are trying to produce with the new model.

Thanks for the insight

 

[iqe2010]

I lurk the physician forums often and here's one thing I learned about mid-levels: they do not like to work as much as a physician does. They rarely work over 40 hours a week neither do they work holidays or take call.

So while "mid-level encroachment" might be something to worry about, remember they are not willing to work as hard or as much as a physician.

 

[KnuxNole]

For the love of God, please no more midlevels in the ED

There are a few that work in my hospital, and all are terrible. I usually don't yell at anyone, but I've had for them.

One of them called a colleague to admit a patient because she couldn't draw blood to get labs and needed a PICC. Another one is so bad I told the ED medical director I'm not taking her calls w/o a supervising MD knowing that she wants to admit someone. Usually, they see patients and admit without any supervision...which lead to me making this dummy cry her eyes out when She kept calling for horrible ****.

 

[Mad Jack]

Very thankful for this as well, however from what I've heard the job market is pretty terrible for both of these, at least for anyone looking to do full time.

I've heard of a local dermatologist that is training two of his PAs to do Mohs, supposedly it's going pretty well. He's likely to double his income due to the need in the area.



















You really thought I was serious for a second, didn't you. That alone shows how bad things have become. But I really don't think the sky is falling, truth be told. There's just too much midlevels can't do competently, so at least for our working lifetimes, we should be fine in most fields.

 

[Mad Jack]

For the love of God, please no more midlevels in the ED

There are a few that work in my hospital, and all are terrible. I usually don't yell at anyone, but I've had for them.

One of them called a colleague to admit a patient because she couldn't draw blood to get labs and needed a PICC. Another one is so bad I told the ED medical director I'm not taking her calls w/o a supervising MD knowing that she wants to admit someone. Usually, they see patients and admit without any supervision...which lead to me making this dummy cry her eyes out when She kept calling for horrible ****.

The worst part is when you say it's a bad admit, they are perplexed as to why.

 

[Spodermin]

You do realize our healthcare is currently being run by nutjobs who dont know how medicine actually works. Our healthcares solution to all problems is hire more administrators who are sitting somewhere making policies for the hospital thinking their policies is improving healthcare.

I think we are proceeding pretty fast. It's 2017 and we are now seriously talking about self driving cars! I totally see AI replacing certain doctors in the future, in next 15 years. I think radiology will be the first to get some replacement.

if you think that a robot can do our job then i think you're gonna be the first one to go.

 

[ERDOC555]

I've heard of a local dermatologist that is training two of his PAs to do Mohs, supposedly it's going pretty well. He's likely to double his income due to the need in the area.


You really thought I was serious for a second, didn't you. That alone shows how bad things have become. But I really don't think the sky is falling, truth be told. There's just too much midlevels can't do competently, so at least for our working lifetimes, we should be fine in most fields.

You definitely got me, and I wouldn't be surprised if that was actually happening somewhere. You could train them how to cut stage 1 and then close after the final stage, all while the Mohs Surgeon reads the slides and cuts for each of the subsequent stages. Horrible idea, but as you said it could happen.

 

[Rads312]

You definitely got me, and I wouldn't be surprised if that was actually happening somewhere. You could train them how to cut stage 1 and then close after the final stage, all while the Mohs Surgeon reads the slides and cuts for each of the subsequent stages. Horrible idea, but as you said it could happen.

Never underestimate the greediness of another physician out there trying to double or triple his income.

Remember, at some point an anesthesiologist thought it would be an incredible idea to train CRNA's. In his mind, he could probably see a model where he oversees 3-4 of them in one setting and quadruple his billing. Didn't quite work out that way.

 

[Rads312]

For the love of God, please no more midlevels in the ED

There are a few that work in my hospital, and all are terrible. I usually don't yell at anyone, but I've had for them.

One of them called a colleague to admit a patient because she couldn't draw blood to get labs and needed a PICC. Another one is so bad I told the ED medical director I'm not taking her calls w/o a supervising MD knowing that she wants to admit someone. Usually, they see patients and admit without any supervision...which lead to me making this dummy cry her eyes out when She kept calling for horrible ****.

We have some in the ED - and as radiology we are front line in dealing with them. They call for every plain film. They routinely mistake sesamoid bones for fracture fragments. They don't know basic anatomy half the time. They are terrible.

 

[anbuitachi]

We have some in the ED - and as radiology we are front line in dealing with them. They call for every plain film. They routinely mistake sesamoid bones for fracture fragments. They don't know basic anatomy half the time. They are terrible.

Why are they not fired..

 

[Logic Inc]

In the future there will be automation that will fulfill the role of all specialties, just like that machine in the movie Elysium. However, this won't happen for at least another 200+ years so we have nothing to worry about.

 

[Rads312]

Why are they not fired..

$$$. They are hospital employed , billable similar to ER docs, see the 'easy' cases, where even if they mess up or can't figure something out clinically, they just order more imaging, more consults, more lab tests - eventually another doc will pick it up and diagnose something for them. In the end, the hospital makes more money, and pays them 40% less than an ER doc. It's a win-win for everyone, minus the patient.

 

[DrfluffyMD]

$$$. They are hospital employed , billable similar to ER docs, see the 'easy' cases, where even if they mess up or can't figure something out clinically, they just order more imaging, more consults, more lab tests - eventually another doc will pick it up and diagnose something for them. In the end, the hospital makes more money, and pays them 40% less than an ER doc. It's a win-win for everyone, minus the patient.

This is why radiology will thrive.

There are many, many, many mid levels who have no idea how to form a differential or do a physical exam. WE the radiologists practice medicine for them.

I can teach a middle school kids to order a CT abdomen and pelvis plus US pelvis for a woman who come in with belly pain...

 

[cellsaver]

Even in the off chance that I'm wrong about everything, if the time comes where doctors are out of jobs, just know that midlevels would have been unemployed for decades when that time comes..

Without a question, ARNPs and PAs will be out of job for the simple reason they are suckers when it comes to business. They are WORSE than physicians when it comes to business practices. Actually, they can't even follow a lecture on the basic medical sciences or new journal reprints on evidenced based medicine. No, they will end up working for free or next to nothing, and then they will revolt.

Physicians will be laughing their arses off...while parking cars as valet employees and making more money

 

[zero0]

$$$. They are hospital employed , billable similar to ER docs, see the 'easy' cases, where even if they mess up or can't figure something out clinically, they just order more imaging, more consults, more lab tests - eventually another doc will pick it up and diagnose something for them. In the end, the hospital makes more money, and pays them 40% less than an ER doc. It's a win-win for everyone, minus the patient.

Yeah and the patient gets billed for all those unnecessary tests. But who cares about them anyway right?

 

[Stagg737]

This is why most fields will thrive.

There are many, many, many mid levels who have no idea how to form a differential or do a physical exam. WE the radiologists practice medicine for them.

I can teach a middle school kids to order a CT abdomen and pelvis plus US pelvis for a woman who come in with belly pain...

FTFY. I haven't done a rotation yet where I felt like most of the NPs or PAs were even on par with the decent medical students let alone an actual physician.

 

[Dr jones]

Do you guys think rheumatology is a futureproof field?

 

[bashwell]

Do you guys think rheumatology is a futureproof field?

Personally, I would say -- hell yes! Great lifestyle, solid money, you're the boss so you can work as much or as little as you like, build your practice however you like, you're not as dependent on hospital systems (among others) telling you what to do or not do, they depend more on you and not you on them (unlike hospital-based specialties), you have a knowledge base that makes it hard for midlevels to encroach on, it's got a great future in terms of what therapies are in the pipeline, and much more could be said but I'm not rheum so I'll defer to @bronx43 who has almost got me persuaded to go for it someday!

 

[bronx43]

Personally, I would say -- hell yes! Great lifestyle, solid money, you're the boss so you can work as much or as little as you like, build your practice however you like, you're not as dependent on hospital systems (among others) telling you what to do or not do, they depend more on you and not you on them (unlike hospital-based specialties), you have a knowledge base that makes it hard for midlevels to encroach on, it's got a great future in terms of what therapies are in the pipeline, and much more could be said but I'm not rheum so I'll defer to @bronx43 who has almost got me persuaded to go for it someday!

Nice to hear that bash!

Rheumatology is definitely an up and coming field. As bash said, it's not a field where there is a large midlevel presence. While they do exist in some practices, they really just deal with the most basic tasks, and they don't usually make diagnoses (due to the lack of definitive testing). Employment options are varied, and you certainly have the option of going the salaried route, or join a private practice. I actually am entertaining the idea of a concierge model for rheumatology, which can be very viable in the field due to the lack of expensive equipment (no cath lab or endo suite). As the workforce crunch really hits rheumatology (Workforce Study), you'll be in an even better position as supply and demand is completely in your favor.

All the new drugs that are coming out also makes rheumatology an interesting field, as things are constantly changing, and you will have more and more therapies to offer patients. As a side note, this also means that you can do REALLY well if you snuggle up to pharma. I know a handful of rheumatologists that make 6 figs a year just by giving drug talks.

 

[Dr jones]

That Sounds good. What about in regards to AI and machine learning. Do you see reumatologists in danger of being places by ai in the future?

 

[J ROD]

I think Psychiatry has a bright outlook.

 

[bronx43]

That Sounds good. What about in regards to AI and machine learning. Do you see reumatologists in danger of being places by ai in the future?

Absolutely not in the near future. One of the biggest aspects of rheumatology is the physical exam, which is as nuanced as they come in the field of medicine. In fact, I have yet to find a board certified internist know what synovitis actually is with any degree of certainty.

Furthermore, the lack of definitive testing or even clear cut definitions for many rheumatologic diseases makes it so that your clinical acumen is valued much more.

"How do you know if you have lupus? When a rheumatologist tells you that you have lupus."

 

[Brahnold Bloodaxe]

Again, someone talking out of their A** yet again. We don't do any LP's, any para's, barely any drains in IR. Our body fellows handle that. We do occasional biopsies, but most of our IR work is PAD, biliary work, Neuro IR, and oncology...Maybe at your crappy hospital you subject your IR department to such things. My guess is you are an IM resident - maybe an oncology fellow? I don't know. I don't care.

Are you upset that you can't do the interventional oncology stuff? Sorry, it's not in your wheelhouse.

There is certainly a small niche of slow community practices where IR guys handle some of that BS you mentioned - but that model is fading, and fading fast.

So again, please don't say stupid stuff and make yourself look like an idiot.

P.S. I'd rather do abscess drainages all day, every day, than be an internist or an oncologist. barf.

How "hard" ie technically demanding and knowledge intensive are IR procedures, anyway? I was watching an aneurysm embolization video yesterday and it didn't seem like a very difficult procedure. You literally thread a catheter into the aneurysm and stuff a bunch of string through it until there is a big lump of string inside the aneurysm. It seemed like something you could teach a freshly released felon how to do in a day or two, with the most challenging part being having him commit the route through the vasculature to memory.

That's the impression I got from watching the video. I'm not even remotely trying to suggest that it really is as easy as that but rather I want to ask people with first hand experience how challenging these procedures really are that you can't glean from watching a youtube video.

 

[bronx43]

How "hard" ie technically demanding and knowledge intensive are IR procedures, anyway? I was watching an aneurysm embolization video yesterday and it didn't seem like a very difficult procedure. You literally thread a catheter into the aneurysm and stuff a bunch of string through it until there is a big lump of string inside the aneurysm. It seemed like something you could teach a freshly released felon how to do in a day or two, with the most challenging part being having him commit the route through the vasculature to memory.

That's the impression I got from watching the video. I'm not even remotely trying to suggest that it really is as easy as that but rather I want to ask people with first hand experience how challenging these procedures really are that you can't glean from watching a youtube video.

I have no dog in this fight about IR vs interventional blah blah.

But, that's kind of how most procedures go. Anyone that tells you that you need 4 years of medical school and X number of years of residency to do the majority of procedures is full of BS. You can teach anyone with an opposable thumb how to do a central line, art line, LP, para, thora, US guided hip, knee, shoulder, SI injections (I use these as examples as these are some of the procedures for which I am proficient). In fact, I would bet my entire bank account that if one were to do a well-controlled study on which factors determine procedural outcomes, the only thing that matters is how often one does said procedure. In other words, it's all about muscle memory and even if you spent 5 years training to do X procedure, once you stop doing it, you would probably lose proficiency in the matter of months.

 

[Jabbed]

I doubt psych will be threatened by future tech unless future tech can read minds and diagnose mental illnesses. If anything, the mind (as distinct from the brain) will likely be medicine's last frontier.

Once they start pumping SSRIs into the public water source and aerosolizing antipsychotics at WWE events I think that psychiatry as a field will shrink.

*pun alert*