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  • Should doctors be afraid?

    A good business plan will always involve an analysis of the external environment first.  PEST (political, economic, social, technological) provides one of these frameworks for such an analysis.  We have often discussed, both in the media and on this thread, the first three elements and their potential effects.  Should we be talking more about the fourth?

    All medical fields have undergone significant subspecialization over the last 30 years.  Fellowships have boomed.  Technological advancements along with this fellowship training have undoubtedly allowed us to deliver better care than previously possible.  But nothing lasts forever.  Where are we on this arc where technological advancement begins to displace physicians, even those with such a narrowed training focus?  We can all see the external threats to those generalists who follow a basic algorithmic approach to diagnosis and treatment.  NPs and PAs as well as robots and apps have started their displacement.  But subspecialization is supposed to be free of this worry, right?  I'm not so sure.

    Take a head and neck cancer surgeon for example.  90% of their work is focused on squamous cell carcinoma.  Research on HPV (vaccines and optimal therapeutic regimens that are non-surgical) and non-HPV squamous cancer threatens their livelihood.  Make no mistake.  These things should be celebrated from a societal standpoint.  But that's not to say things that are largely positive don't have side effects (see free trade and the 2016 election).  My concern here is about those side effects, particularly in fields where physicians have narrowed their focus considerably.  What capacity do we have for retraining if they are displaced?  Are we as physicians set set up well for this eventuality?  Paradoxically, the narrowed focus and research of subspecialists, while bringing societal good, will be part of their undoing.  How we help them for having helped us will be, I believe, one of our greatest professional challenges over the lifetimes of our young physicians.  What is currently anticipated as a physician shortage may prove to be anything but.

    When will this occur?  Each field will be different, and some will be unaffected for some time.  But whether in 30 years or 15 we will all have to face this reality.  Does this fourth external threat concern anyone?  What insurance does a physician have for non-disability job loss?  Are young physicians thinking about this or planning with any risk-control strategies (entrepreneurial endeavors, admin/MBA, etc.)?  Curious to hear your all's thoughts.

  • #2
    I agree with your thesis.  A specialty based upon a narrow therapeutic skill set is at risk of obsolescence, esp.  the surgical specialties.  Treatments will be eclipsed.  Eg: the demand for CABG  heart surgery has dwindled since 2000.

     

    Contrast this with my field, emergency medicine.  I diagnose problems generated by impulsivity, panic, aging, alcohol, and a desire by other professionals to avoid risk.  It will never end.

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    • #3
      As a medical student, the "technology threat" is very high on my radar and is a significant factor in my decision making about how I would like to practice.  To a certain extent I feel that technological progress is inevitable in all fields, and is much more likely to be incorporated by physicians as opposed to displace them.  However, certain fields do seem more susceptible and others less.  Radiology, in my opinion, is a non-starter, because I don't see why deep learning can't read CT scans tomorrow let alone in 10 years.  (However, I guess the robots can't even read EKGs, which boggles my mind, so perhaps there is hope).  In general, I think that surgeons are the most well protected, because of the physical skill set required, by the time we make robots that can operate, they'll have robots that can do anything.  It is a good point though that the more specialized a physician, the more at risk, whether it be tech or medical progress (similar to having a portfolio all in one stock).

      Overall, I feel that physicians have a tremendous knowledge base and skill set and are in a far better position that 99% of the work force to adapt to the changes and threats of technology and maintain both our employment as well as our ability to meaningfully contribute to society.

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      • #4
        People will always need doctors. The skill set may change and you are not guaranteed fair compensation...but as long as folks get sick or hurt, physicians and surgeons will need to be in the loop.

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        • #5
          This is something I think about as well.  I can see how hyper-specialization can leave someone at risk for becoming obsolete, in which case someone who has broader training and/or maintains their broad training (ex. EP cardiologist that keeps up with general cards as well as IM) could be more adaptable and maintain a variety of income "sources."  Similarly, I think docs should be adaptable with work environment changes as well.  It seems there are docs out there who take on an entrenched attitude of being above doing a certain task or not-my-job mentality, which I think can have potential risks as well.

          Nevertheless, I'm also somewhat reassured by the fact that I look back 10-15 years and see what has happened and it's not all that bad.  I also look at other industries and see how technology still hasn't made a lot of things obsolete, despite some assuming it would (ex. checkout lines, tax preparaton, etc.).

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          • #6
            Not afraid.  I haven't met a starving doc to date.  We can debate want constitutes as 'adequately' compensated, but being afraid?  Perhaps first world issues of travelling first class or luxury estates or cruises, may be at risk for the higher echelons of our profession.  As an internist, those were never in our reach nor do we dread the doom of our specialty despite large changes in compensation methods and practice styles due to insurance and patient demands.

            Change is for certain, but the sky isn't falling and we all will be just fine.

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            • #7
              Diagnosis/consultation fields can and will be replaced. You follow an algorithm, not special about it. You are drawing in your "experience"? Well pentabytes if computer cases that constantly neural networks is and will be simply better at processing symptoms. Ordering test to come to a diagnosis ? Yea ok. Computer will do that.

              How close is amazon and google are at pinpointing "what you may be interested in?" Id say pretty ************************ close.

              Procedural fields more protected but research / therapeutic paradigm shift threaten them more than processing power

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              • #8




                I agree with your thesis.  A specialty based upon a narrow therapeutic skill set is at risk of obsolescence, esp.  the surgical specialties.  Treatments will be eclipsed.  Eg: the demand for CABG  heart surgery has dwindled since 2000.

                 

                Contrast this with my field, emergency medicine.  I diagnose problems generated by impulsivity, panic, aging, alcohol, and a desire by other professionals to avoid risk.  It will never end.
                Click to expand...


                The first point is exactly what I'm saying.  The sky isn't falling or anything, but I think those specialties are at high risk.  The CABG surgeon is a perfect example.  Regarding EM protection, it may very well stand the test of time better than those more narrowly focused; however, is there a reason that advanced computer algorithms and second level providers can't perform this duty increasingly over time?  While those problems you mention might never end, what I am referencing as a concern is WHO will be doing the job.  Physicians?  Or someone else?

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                • #9
                  Not worried about this issue at all.  I have embraced technology and used it to my advantage.  I didn't even have my first computer until I was in med school.  If I can learn and adapt, anyone can.  Darwin - It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.

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                  • #10




                    Not worried about this issue at all.  I have embraced technology and used it to my advantage.  I didn’t even have my first computer until I was in med school.  If I can learn and adapt, anyone can.  Darwin – It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.
                    Click to expand...


                    But this is my point.  The sub-specialist can't adapt to change easily.  They are entrenched in their position and likely have been for years.  The surgeon with more general skills can.  Do you not think we'll have a non-surgical cure for cancer some day?  I think looking back and saying that technology won't displace us in the future because it hasn't before is a very biased way of looking at things.

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                    • #11
                      @ENTdoc,   As an ER doc, can I be replaced by a cheaper  topnotch experienced NP/PA with an algorithm?

                      YES, I could be replaced;  and shame on me if I ever let that day happen. The presence of a PA in our department compels me to manage risk, avoid fluster, behave professionally, compassionately  and lead with conviction.  If I fail to demonstrate superior value, then I deserve to be replaced by a cheaper model.

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                      • #12
                        I definitely think very narrow specialties are at greatest risk of technology and new therapies impacting income and job availability.  The more general the specialty the more insulation you get.  I think eventually, 20 years?, the machine learning will be good enough to replace us.  For now I think the issue is the difficulty of a machine relying on the input of the patient to be accurate, so maybe we'll just be glorified history and physical exam takers.  Recent example of the input example, Chief complaint - chronic pancreatitis, abd pain.  Diagnosis PE.

                        A ROS that has every single box checked may create problems for the algorithms...idk.

                         

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                        • #13
                          Not afraid one bit of the robots.. more afraid of the 22 year old mellenial that just signed up for their Steven henegars online NP degree..

                          The skill sets are what theoretically define us though that is often in the eye of the cost cutting admin beholder!

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                          • #14
                            Not worried at all. Computers are great at doing ridiculously complex math but I listened to an NPR podcast and it took years to teach a robot to fold laundry. This may sound old school, but taking a history and doing an exam (even if it is a brief one) just isn't something I see a computer doing in my lifetime. There are algorithms and guidelines for just about everything in medicine and they are used with some success depending on the field and set of guidelines, but more often than not, patients don't fit in to the guidelines because of comorbidities, complex/atypical presenting symptoms, etc. Technology may come to help or supplement the doc, but if I have learned nothing, it is that change in medicine is slow. People will also have a hard time trusting their health entirely to a computer - not an issue with some other fields such as checking out at a grocery store. Also, as someone else pointed out, computers can't even read EKGs let alone diagnose and treat people.

                            EMRs have been around for 15 years and are still pretty clunky depending on which one you're using... I have a tough time seeing computers taking over medicine in the next 50.

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                            • #15







                              Not worried about this issue at all.  I have embraced technology and used it to my advantage.  I didn’t even have my first computer until I was in med school.  If I can learn and adapt, anyone can.  Darwin – It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.
                              Click to expand…


                              But this is my point.  The sub-specialist can’t adapt to change easily.  They are entrenched in their position and likely have been for years.  The surgeon with more general skills can.  Do you not think we’ll have a non-surgical cure for cancer some day?  I think looking back and saying that technology won’t displace us in the future because it hasn’t before is a very biased way of looking at things.
                              Click to expand...


                              I didn't say it won't displace us in the future. It is unknowable if and when it will. Since I don't see it happening tomorrow, I believe there will be time to adapt to the future.

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