Specialties in danger of becoming obsolete

[brooksbane]

123123123123

[Lactic Folly]

There will always be less desirable aspects of a field that others are not interested in taking.

[Larrivee]

Many are saying that cardiac surgery will become obsolete, but I have talked to the big-wig interventional cardiologist in vancouver about this, in addition to two staff cardiac surgeons, and all parties believed that there would always be a need for cardiac surgeons. I know "always" is too strong a term for them to use with certainty, but I thought it was interesting to hear this perspective from one of the big names in interventional cardiology, a guy who is really progressing the field.

 

Just thought I would throw this 2 cents in here because I am pretty sure it will be brought up.

[rmorelan]

Many are saying that cardiac surgery will become obsolete, but I have talked to the big-wig interventional cardiologist in vancouver about this, in addition to two staff cardiac surgeons, and all parties believed that there would always be a need for cardiac surgeons. I know "always" is too strong a term for them to use with certainty, but I thought it was interesting to hear this perspective from one of the big names in interventional cardiology, a guy who is really progressing the field.

 

Just thought I would throw this 2 cents in here because I am pretty sure it will be brought up.

 

yeah fields don't tend to die just go through an adjustment. Who other than a cardiac surgeon is going to fix all the heart trauma, congenital defects, and some (although admitted not all potentially) the valves. Who else is going to do all that?

[aaronjw]

disruptive innovation is a good thing

[Fresh fry]

Gen Surge will eventually be broken down into a series of surgical specialties. More of a morph with a name change. Thinking something like "abdominal surgery", "thyroid surgery", and the rest of the pieces will go to "surgical oncology" with various sub specialties.

Rationale:

Neuro -> separate track

Vascular -> separate track

Cardio -> separate track

Thoracic -> separate track

Ortho -> seperate track

Obs/gyn -> separate track

Urology -> separate track

Plastics -> separate track

Optho -> separate track

And then gen surge is just the last few bits and most of them specialize anyway

[rmorelan]

disruptive innovation is a good thing

 

overall sure - not so much to our rigid specialty system. I think in large part that is why we don't have more disruptive changes.

[NewfieMike]

I was given a lecture by a guy who pioneered the use of iPads and iPhones to read radiological scans, sent digitally and privately to radiologists wherever on the planet they happen to be.

 

He advises all the radiology residents to do some sort of interventional training, out of fear of the discipline becoming outsourced. Interesting thought.

[rmorelan]

I was given a lecture by a guy who pioneered the use of iPads and iPhones to read radiological scans, sent digitally and privately to radiologists wherever on the planet they happen to be.

 

He advises all the radiology residents to do some sort of interventional training, out of fear of the discipline becoming outsourced. Interesting thought.

 

Our IR people here say the same thing - "if you know how to stick a needle into someone, you cannot be replaced".

 

Right now the licensing rule act a barrier to that kind of out sourcing, but I can certainly see how it will eventually come into play.

[proton]

Gen Surge will eventually be broken down into a series of surgical specialties.

 

Gastroenterology is already taking some of gen surg's procedures. I see that happening more and more.

[future_doc]

Our IR people here say the same thing - "if you know how to stick a needle into someone, you cannot be replaced".

 

Right now the licensing rule act a barrier to that kind of out sourcing, but I can certainly see how it will eventually come into play.

 

Isn't outsourcing of radiologists (teleradiology) here? I would think that the local radiologist who takes full responsibility signs off on everything, even if the real work was done in India.

 

http://www.canada.com/topics/news/national/story.html?id=ce4292c2-11e1-4639-9063-0068d95a9d00&k=81822

http://content.healthaffairs.org/content/25/5/1378.full

[ACase]

Possibly Plastics. All other region-based surgical specialties are doing more and more plastics procedures of their region. Eg breast surgeons doing breast recon, head and neck surgeons doing h&n recon, etc.

[Anne]

I would be so surprised if gen surg. became obsolete. In most communities that NOSM serves gen surg. is the only type of surgery there is. Maybe some places it makes sense for more specialized specialties but I think there is still lots of room for good generalists that are not committed to specialization so they can provide a wide range of commonly needed skills in their communities.

[thebouque]

Gastroenterology is already taking some of gen surg's procedures. I see that happening more and more.

 

Really? Like what?

[rmorelan]

Really? Like what?

 

Scoping I have seen and the simply stuff that follows.

 

Of course some gen surgs are doing virtual colonoscopies as well which is the rads department. Often a lot of blurring going on.

[A-Stark]

GI has been scoping for ages. They have pretty much taken over management of upper GI bleeds.

 

Do you mean CT colonography?

[Skylerate2]

I think with enough time, anes will be replaced by CRNAs. Also derm may be shifted into FM

[thebouque]

Scoping I have seen and the simply stuff that follows.

 

Of course some gen surgs are doing virtual colonoscopies as well which is the rads department. Often a lot of blurring going on.

 

I wouldn't say that scoping was stolen from gen surg. As someone already mentioned GIs have been scoping for a long long time, it's hard to say who started.

[Prince Medward]

Technology makes everything in medicine easier an cheaper. An NBC news story recently featured a cardiologist who takes EKGs (if i recall the test correctly) on his iPhone which is slipped into an adapter that looks like an iPhone case.

 

Cataract surgery and LASIK have been made simple as heck thanks to technology. These procedures can take as little as 5 minutes. I think you can get all the equipment for cataract surgery for around $6000 (this figure may be totally wrong - don't hold me to it).

 

With the proper protocols regarding risky patients and management of complications, could these and more be done by GPs?

 

It is plausible that much that is done by specialists could in the future be downloaded to GPs thanks to technology. The benefits of this will accrue to everybody:

 

1. System saves money. Pay the GPs less for these procedures because they did not have to endure the extra years of training and because equipment is cheaper.

 

2. GP satisfaction. GPs have a more satisfying career with more options.

 

3. Patients have greater access to procedures.

 

4. Patients have greater access to specialists because GPs have taken some stuff off their plate.

 

What about the work that GPs no longer have time to do because of downloading? Give it to nurse practitioners at $10 a visit.

[rmorelan]

Isn't outsourcing of radiologists (teleradiology) here? I would think that the local radiologist who takes full responsibility signs off on everything, even if the real work was done in India.

 

http://www.canada.com/topics/news/national/story.html?id=ce4292c2-11e1-4639-9063-0068d95a9d00&k=81822

http://content.healthaffairs.org/content/25/5/1378.full

 

They aren't actually doing that, just some people are pushing for it.

 

The problem is we are not training enough radiologists to meet the need and just like anything like this if we don't solve the problem them someone else will solve it for us - we won't like that solution

[medigeek]

They aren't actually doing that, just some people are pushing for it.

 

The problem is we are not training enough radiologists to meet the need and just like anything like this if we don't solve the problem them someone else will solve it for us - we won't like that solution

 

so who gets sued when a negligent mistake was made?

[rmorelan]

so who gets sued when a negligent mistake was made?

 

the problem is the scan is interpreted and acted on immediately. You cannot just have another rad sign off on it the next day - that would mean a double reading in effect and that just costs more and it wouldn't .

 

Insurance is a big problem with telerads - is it the hospital, telerad company, or the overseas doc who gets sued? Who would insure all of this? Messy.

[seeking1]

Insurance is a big problem with telerads - is it the hospital, telerad company, or the overseas doc who gets sued? Who would insure all of this? Messy.

 

If I have come to understand how telemedicine works here, I believe that technically the overseas doc is the one who is legally liable. The way telemedicine works here in Ontario is that the Ontario docs providing the medical service through telemedicine equipment are legally liable for the advice/treatments they give. Am I misunderstanding the system?

[Lunasly]

Our IR people here say the same thing - "if you know how to stick a needle into someone, you cannot be replaced".

 

Right now the licensing rule act a barrier to that kind of out sourcing, but I can certainly see how it will eventually come into play.

 

It was to my understanding that unless patients can sue for malpractice, then it won't happen. I highly doubt that most Canadians would feel safe knowing that some random doctor across the world without a Canadian medical license is reading their MRI. It also would overly difficult to regulate, unless you make it private – in which case I'm sure the company could care less about your health and more about their profits.

[cheech10]

Seeking, you are correct. The overseas/telerads doc has to be licensed in the appropriate jurisdiction (CPSO for Ontario), and assumes liability for their reading/interpretation.