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  • #46
    Just to add a quick anecdotal story about AI from a pathologist's point of view:

    We use computer algorithms to quantify ER/PR/Her2 staining in new breast cancers.  It's very simple conceptually but the computer software really struggles sometimes.  They're programmed to identify tumor cells and calculate how many nuclei are brown vs blue.  Simple, right?  Well, a case yesterday had pretty much 100% staining with ER.  I circled a small amount (1-2 mm) of the tumor that should be incredibly straightforward.  It was all positive/brown-staining with very little else in the circled area.  Any result 90%+ and I'd just accept it.  The result it gave me?  43%.  It had found every little background lymphocyte and stroma nucleus (which are about 1/10 the size of the tumor cell) and interpreted those as negative.

    If a computer program specifically designed for this ONE task can mess up so badly, I'm not worried they're going to program computers to interpret CXR, CTs, MRIs, or any number of path cases.  There are too many weird cases in my line of work to be replaced.  People watch too many sci-fi movies to think that's the future.  Just look at the book 2001: A Space Odyssey.  In 1968, they thought in 2001 we would have space travel with AI.  There's always been a fear of AI, but it just doesn't develop that fast.  The concept of computers that "learn" is more fiction than reality.  It's more fear of the unknown IMHO.  I think if I'd sit with a computer programmer and see if he can teach a computer to do my job, he'd laugh at me.

    Certainly mid-levels have their place.  I'd be hesitant to say that they'll replace physicians though.

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    • #47




      Just to add a quick anecdotal story about AI from a pathologist’s point of view:

      We use computer algorithms to quantify ER/PR/Her2 staining in new breast cancers.  It’s very simple conceptually but the computer software really struggles sometimes.  They’re programmed to identify tumor cells and calculate how many nuclei are brown vs blue.  Simple, right?  Well, a case yesterday had pretty much 100% staining with ER.  I circled a small amount (1-2 mm) of the tumor that should be incredibly straightforward.  It was all positive/brown-staining with very little else in the circled area.  Any result 90%+ and I’d just accept it.  The result it gave me?  43%.  It had found every little background lymphocyte and stroma nucleus (which are about 1/10 the size of the tumor cell) and interpreted those as negative.

      If a computer program specifically designed for this ONE task can mess up so badly, I’m not worried they’re going to program computers to interpret CXR, CTs, MRIs, or any number of path cases.  There are too many weird cases in my line of work to be replaced.  People watch too many sci-fi movies to think that’s the future.  Just look at the book 2001: A Space Odyssey.  In 1968, they thought in 2001 we would have space travel with AI.  There’s always been a fear of AI, but it just doesn’t develop that fast.  The concept of computers that “learn” is more fiction than reality.  It’s more fear of the unknown IMHO.  I think if I’d sit with a computer programmer and see if he can teach a computer to do my job, he’d laugh at me.

      Certainly mid-levels have their place.  I’d be hesitant to say that they’ll replace physicians though.
      Click to expand...


      You are kind of proving my point.

      Computer vision is just very hard. Following algorithm and figuring out what patient says and then ordering test and interpreting it is well...low hanging fruit and will be first to get hit. Not replacing doctors, but replacing doctors with NPs etc.

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      • #48
        I don't know. So often the comment bantered around is "replacing doctors with midlevels". But what I actually see, at least in my neck of the woods, is a lack of physicians and the hospitals/clinics are unable to recruit, especially in primary care, so midlevels are hired instead. I don't know of any physician, in my experience, that was fired to be replaced by a midlevel PA or NP. I be curious if any of you have experienced a practice where an MD/DO was actively replaced based on cost?

        The more I think about it, the more I can see the lower level jobs of medicine replaced first. Maybe some sort of urgent care kiosk with a camera and AI algorithm in the ED (or local drugstore) instead of an ED PA or triage nurse. Maybe a phlebotomist (or cardiac rehab or PT) robot. How about even just housekeeping tasks becoming automated?

        As a radiologist, I could see a fully automated suite taking the place of some technologists - place foot here in this holographic spot for your xray - or fully automated Head CT.  I think many of the more advanced jobs that we do as MDs, requiring active cognitive judgement in addition to knowledge, will not be replaced as easily or quickly.

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        • #49




          I don’t know. So often the comment bantered around is “replacing doctors with midlevels”. But what I actually see, at least in my neck of the woods, is a lack of physicians and the hospitals/clinics are unable to recruit, especially in primary care, so midlevels are hired instead. I don’t know of any physician, in my experience, that was fired to be replaced by a midlevel PA or NP. I be curious if any of you have experienced a practice where an MD/DO was actively replaced based on cost?

          The more I think about it, the more I can see the lower level jobs of medicine replaced first. Maybe some sort of urgent care kiosk with a camera and AI algorithm in the ED (or local drugstore) instead of an ED PA or triage nurse. Maybe a phlebotomist (or cardiac rehab or PT) robot. How about even just housekeeping tasks becoming automated?

          As a radiologist, I could see a fully automated suite taking the place of some technologists – place foot here in this holographic spot for your xray – or fully automated Head CT.  I think many of the more advanced jobs that we do as MDs, requiring active cognitive judgement in addition to knowledge, will not be replaced as easily or quickly.
          Click to expand...


          Yes, but how long until they figure the care is "good enough" and certainly the right price that it becomes an issue for the broader specialties?

          Comment


          • #50


            I be curious if any of you have experienced a practice where an MD/DO was actively replaced based on cost?
            Click to expand...


            Pretty common scenario for Mednax, and I'm sure others. Acquire private group -> increase ratio of NNP:neonatologist -> increase returns to shareholders

             

            Happy Philosopher:
            "There are much easier jobs to replace by AI than physician."

             

            +1. In another thread I said that our entire understanding of labor's role in society will likely change before then. A better question in our lifetime: should doctors be afraid... when 10% of the labor force is unemployable due to automation? 20%?  

             

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            • #51
              As a gastroenterology fellow some years ago, I debated the possibility that colon cancer screening (the main driver of our practice) would go down due to advances in prevention (i.e., CT colonography, stool tests, etc). However, we're now finding more colon cancer in younger people and it may be a matter of time before we start at an earlier age for screening. Based on the obesity epidemic curve producing more comorbidities, I do not see any threat to specialists even if medicine finds a way to reduce the need for super-specialized procedures. Nevertheless, we should always remain a general physician or surgeon, ready to go back to the basics.

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              • #52
                @zdr81, any routine repetitive procedure, like screening colonoscopy, could be done by NP/PAs.

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                • #53
                  *reports of shots fired*

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                  • #54




                    *reports of shots fired*
                    Click to expand...


                    They call him Hova

                    - jz

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                    • #55
                      .
                      Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

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                      • #56
                        I disagree with the notion that any routine procedure can/will be done by PAs/NPs.  First, someone has to both train them and get them credentialed independently.  Currently there are no states that allow this for PAs.  While we may be awash with PAs and NPs in the future (because their superiors have now discovered how lucrative the educational pipeline is), procudral specialties will be much more well insulated.  And do we really think a hospital is going to risk liability by putting a NP or PA who never went through a formal fellowship into the role of GI doctor doing scopes?  It's a bit more than sticking a tube in another tube.  It's about the recognition of disease, decision making (sometimes on the spot) and the creation of a differential diagnosis - things medical school, residency and fellowship do a much better job with.

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                        • #57
                          I personally prefer to have my screening type procedures done by someone who can handle a complication.  A PA just can't fix a colon perforation.  In the above example in my gyn practice I find patients opting for more aggressive breast surgery than they need.  It might take a lot longer for the magic pill to catch on.

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                          • #58




                            I personally prefer to have my screening type procedures done by someone who can handle a complication.  A PA just can’t fix a colon perforation.  In the above example in my gyn practice I find patients opting for more aggressive breast surgery than they need.  It might take a lot longer for the magic pill to catch on.
                            Click to expand...


                            See the point but to be honest a GI doc won't handle perforation. He'll call the surgeon. PA can do the same.

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                            • #59


                              I disagree with the notion that any routine procedure can/will be done by PAs/NPs. First, someone has to both train them and get them credentialed independently. Currently there are no states that allow this for PAs. While we may be awash with PAs and NPs in the future (because their superiors have now discovered how lucrative the educational pipeline is), procudral specialties will be much more well insulated. And do we really think a hospital is going to risk liability by putting a NP or PA who never went through a formal fellowship into the role of GI doctor doing scopes?
                              Click to expand...


                              You are a little naive if you think that only a physician can perform routine repetitive procedures. Doing a procedure does not require 4+ years of medical education. It just requires repetition, initially supervised ( just like a resident is, initially) and then the person is as good or better than the physician.

                              In one of the local hospitals two NP's do all the bone marrow exams. They are so well trained that three of the five hem/oncs don't do it any more and should they attempt it, they will have more complications than the NP's. The other two do it but not to the extent of these NP's. They are just used to credential these NP's for the procedures.

                              The local pain clinic has NP and PA's doing spinal pain block. The physicians see the consults. I don't see why cardiology and GI cannot be invaded by NP/PA doing routine procedures.

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                              • #60







                                I personally prefer to have my screening type procedures done by someone who can handle a complication.  A PA just can’t fix a colon perforation.  In the above example in my gyn practice I find patients opting for more aggressive breast surgery than they need.  It might take a lot longer for the magic pill to catch on.
                                Click to expand…


                                See the point but to be honest a GI doc won’t handle perforation. He’ll call the surgeon. PA can do the same.
                                Click to expand...


                                Newbie of course a gastroenterologist can't handle a perf.  I have a colorectal surgeon doing my colonoscopy.  I know too much.  Besides the surgeon is a friend.

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