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Radiology Vs. Ophthalmology - Life Style / Salary / Job Outlook


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Hi all,

 

I am a first-year med student who, unfortunately, still hasn't decided what he wants to do. I have ruled out most of the specialties and I'm now down to Radiology Vs. Ophthalmology. Both have pros and cons but I'm leaning more towards Ophtho at this point as I really prefer to have my own private clinic in the long run as opposed to working in a hospital for the rest of my life. 

 

For me, life style and $ are very important factors and after reading bunch of threads about how Ophtho is becoming a pretty bad specialty (Salary going significantly down, no OR time, etc.) I am really concerned if I'm making the right decision to put all my focus on ophtho. I have heard that the salary in the first few years post-grad is 150-200k, and the only ones earning 400K+ are older high-volume surgeons (and no clinic time). I don't think I want to work so hard during medical school, spend 5 years of my life in residency, earn a relatively low in come for the first 5 years or so, etc. where nowadays family physicians are averaging 350k. 

 

I would appreciate if you guys have any insight about $ and life style of ophtho (nowadays) vs. radiology/internal medicine, etc. I'm not one of those people who wanted to become a surgeon since I was 5 so if lifestyle, $$$, job availability is bad for ophthalmologist, I prefer to find out sooner than later.

 

Thanks!

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https://www.cma.ca/Assets/assets-library/document/en/advocacy/Ophthalmology-e.pdf

 

I'm sure Rmorelan and others can comment about radiology, but there are advantages and disadvantages to Rads as well.  With advances in technology you can be scrolling through 50 fine abdominal CT cuts at 3 AM while being paged by 6 different services...that didn't seem too fun for me.  Though rad people are totally rad, smartest guys and gals I know. 

 

Don't worry about the money - I know that is very hard to swallow, but you must must must MUST love what you do.  Here's an example of what might drive my colleagues crazy - seeing a posterior subcapsular cataract in an otherwise healthy 65 year old on slit lamp exam, and explaining for the 10000000th time in the week what a cataract is, why you need surgery, no there are no miracle drops that can take cataracts away, and no you are not going to go blind.  For some people that really is not fun, and it's 10 minutes of explaining something that's not billable. But for me and many others that's a lot of fun, and I'm sure later pre-operative planning and how to take the cataract out safely is going to be even more interesting during the latter residency years. The science behind intravitreal injections for many retinal diseases are advancing, and it's a field of huge technological boom (particularly in glaucoma, with a lot of surgical treatment options nowadays).  The patient population in general are really grateful for you to be able to save their sight, or monitor it with adequate reassurance.  It's a field with a clinical component, a surgical component, and imaging as well (OCT, FA, anterior segment U/S).  

 

If you want to earn more money I'm sure there are ways to do it in radiology or ophthalmology.  But if you go in worrying about that picture, it's going to cloud your judgement on what you see yourself enjoying at the worst of days.  For me, there's nothing better than enjoying the view behind a 20 D lens and an indirect headset, no matter how busy clinic and you're stressed. For guys like Rmorelan, there might be nothing better than enjoying an interesting anatomical variation and reporting on it with clinical correlation required (lol, sorry). So just focus on getting some clinical exposure first and immersing yourself more.

 

So please please please don't worry about the money. See what you enjoy more and the money will come.  

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If you want to earn more money I'm sure there are ways to do it in radiology or ophthalmology.  But if you go in worrying about that picture, it's going to cloud your judgement on what you see yourself enjoying at the worst of days.  For me, there's nothing better than enjoying the view behind a 20 D lens and an indirect headset, no matter how busy clinic and you're stressed. For guys like Rmorelan, there might be nothing better than enjoying an interesting anatomical variation and reporting on it with clinical correlation required (lol, sorry). So just focus on getting some clinical exposure first and immersing yourself more.

 

So please please please don't worry about the money. See what you enjoy more and the money will come.  

 

Hey - I go get that correlation thank you very much (clinical correlation ACQUIRED is the line I use ha). I love nothing more than freaking out ordering docs by showing the imaging findings and then describing why they match the patients clinical picture :)

 

(rad with a stethoscope - freaking out people since 2013)

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first it is hard to miss that you picked two very high paying specialties - that is fine but be aware that the government is targeting both for reductions over time. There hasn't been that much justification for why either of those fields earn so much, and people are taking notice of that and the fees are dropping. You can argue (and we do) that now radiology is actually much harder than before to push back against some of the reductions (for one thing a CT now has multi plane reconstructions, thin slices with bone and soft tissue windows and over 4 times the images in each plane. Originally a CT head had 16 images and well that was it, now it is hundreds upon hundreds and we have to look at all of them with the same fee - the tech is better but the reading time is longer). Don't expect the fields to permanently remain top of the pay scale - I am not. 

 

As for rads - first I will say it is an interesting field as we really are the detectives that figure out in a very large way what is actually going on. Clinical exam skills are important but they really have diminished in importance with all the images (I can tell you if there is appendicitis with at least 98% accuracy vs all that 60-70% accuracy physical exam stuff. You cannot compete basically - we tell you what is wrong, then you fix it). That does mean though that I need to know all the pathology for every specialty - I have a good idea of what most other doctors actually are doing, need to know, and why. That is a ton of information but it is what makes things fun. I can talk shop with almost any doctor - can and actually have to. 

 

Drawbacks to that is that radiology is basically no longer a lifestyle specialty. Your basic radiology is now working their ass of all the time - no one will do anything without imaging, and they want and need it faster and faster it seems all the time. At our service almost no one will admit to their service without some imaging backing up the diagnosis. In the community - where most of us go - there is call coverage that extends to all hours etc as a result. The days are very busy - when the government cut the fees the rads responded by just doing more work as there was simply more work to do over time. Next result is we have being working harder and harder to stay where we were - new grads cannot to full time for 1-2 years usually as they would simply be crushed. Most start somewhere at around 80%. Bottom line expect to work hard as a staff - very hard - and at many places full 24/7 staff service is probably coming relatively soon in some fashion. The field also is always changing to you are always retraining (new technology I was reading for instance may soon replace all chest xrays - ha, that is mess some people up :) ) . 

 

It also means that training is very tough - and we have lost residents due to how bad that is or at least in part due to it (4 residents I know of in my program which may be a biased sample of course. That is higher losses proportionally than general surgery ha - people just don't see it coming). Next year is my fifth year and it will be pure study time to grind me to the floor :) Probably 4 hours a day after work and 12 hours each weekend day for 12 straight months. Crazy times ha! Our call is very busy (we only sleep if everyone else is asleep, because everyone gets imaging). If I vanish off the forum that will likely be why. 

 

Job market for rads is slowing opening up which is good - the average age of a rad is actually quite up there (mid 50s last time I checked) so bluntly that has to open up at some point. Still hard to get a job in a major city - it takes work all every step of the way. 

 

oh other point - family docs doing well may be billing 350K but you have to look at their overhead. Your numbers basically a bit extreme I would say - can a family doc gross 350K - yes, but things have to line up for that. Rads has high pay right now and at hospitals at least low overhead. That makes a big difference. 

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Hi all,

 

I am a first-year med student who, unfortunately, still hasn't decided what he wants to do. I have ruled out most of the specialties and I'm now down to Radiology Vs. Ophthalmology. Both have pros and cons but I'm leaning more towards Ophtho at this point as I really prefer to have my own private clinic in the long run as opposed to working in a hospital for the rest of my life. 

 

For me, life style and $ are very important factors and after reading bunch of threads about how Ophtho is becoming a pretty bad specialty (Salary going significantly down, no OR time, etc.) I am really concerned if I'm making the right decision to put all my focus on ophtho. I have heard that the salary in the first few years post-grad is 150-200k, and the only ones earning 400K+ are older high-volume surgeons (and no clinic time). I don't think I want to work so hard during medical school, spend 5 years of my life in residency, earn a relatively low in come for the first 5 years or so, etc. where nowadays family physicians are averaging 350k. 

 

I would appreciate if you guys have any insight about $ and life style of ophtho (nowadays) vs. radiology/internal medicine, etc. I'm not one of those people who wanted to become a surgeon since I was 5 so if lifestyle, $$$, job availability is bad for ophthalmologist, I prefer to find out sooner than later.

 

Thanks!

 

You'll find naysayers about everyfield, I would only go into ophtho if you love eyes and doing tiny microprocedures. That will literally be the rest of your life if you do ophtho and you have to be super comfortable with that. I feel like ophtho is a specialty you'll know if you like or don't like once you shadow it. 

 

If you like something don't forget that you could potentially also go to the states where the situation may be different and as it stands the US can often absorb a sizeable number of Canadians based on its size alone. 

 

Thing with rads is that it could be targeted for cuts and I still can't get it out of my head that a radiologists job could be taken over or supplanted by machine learning in the future. You also have to really like not seeing patients. You'll know if you like seeing patients or not once you start clerkship maybe even earlier. 

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You'll find naysayers about everyfield, I would only go into ophtho if you love eyes and doing tiny microprocedures. That will literally be the rest of your life if you do ophtho and you have to be super comfortable with that. I feel like ophtho is a specialty you'll know if you like or don't like once you shadow it.

 

If you like something don't forget that you could potentially also go to the states where the situation may be different and as it stands the US can often absorb a sizeable number of Canadians based on its size alone.

 

Thing with rads is that it could be targeted for cuts and I still can't get it out of my head that a radiologists job could be taken over or supplanted by machine learning in the future. You also have to really like not seeing patients. You'll know if you like seeing patients or not once you start clerkship maybe even earlier.

Rads is also easily exportable/offshore-able.

 

The two fields are very different. One is surgical so focuses on fixing problems and doing procedures. The other is diagnostic so focuses on DDx and figuring out the problem. It should be easy to decide what you like after a couple times shadowing.

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Thank you to all of you, I really mean it. Your insights have been very helpful to me.

 

I agree that I have to pick what I enjoy the most but knowing myself, in the future, I really would like to have the time to spend with my family/children so life style is as important (if not more) as how much I enjoy my work when it comes to picking between the different specialties. 

 

I do not want to be doing something I would hate just to have a good life style (otherwise, I absolutely wouldn't be in medicine now) but sometimes between 2 specialties, there isn't a huge difference in terms of likability. For example, I really didn't like dermatology (based on my exposure) - which is why it is not on my list, although they are known to have a good life-style. I cannot see myself doing major/open surgeries (like ortho, plastics, etc.) either but I think I can do minimally invasive surgeries (like microsurgeries in ophtho or in IR) and I did enjoy when I shadowed a few radiology residents in Toronto. IM (cardiology, endocrine, gastro) are all something I would consider. So it might be the difference between a 7/10 or an 8/10 when it comes to how much I enjoy each.

 

However, if the life style (#hours on call, etc.) or job outlook (radiology being at risk in 10 years or so) of one is significantly worst than the other - this would totally change my decision. I would pick a specialty I enjoy 7/10 with a 8/10 lifestyle, then one I like 8/10 with a 2/10 lifestyle.

 

When it comes to ophthalmology: I am concerned about the ridiculously low income of new graduates (150-200k for the first few years AFTER residency is brutal) as well as job market and lack of OR time. However, I love the fact that I can become a "business owner" and run a private clinic - not just because of the flexibility but also because I don't want to be practicing 24/7/365, I like a little bit of non-medicine stuff mixed in there too (this, and teaching, research, etc.) I do enjoy having "some" patient interaction and building rapport and long-term relationships with them.

 

When it comes to radiology: I am concerned about the off-shore radiologists, role of machine learning and AI, and how radiologists are now forced to read so many studies, in so little time, and which is only getting worst. However, I like that I will be sitting at my desk and challenging myself mentally as opposed to hands on and physically taxing and "too-much" patient contact. 

 

You guys are the experts which is why I am reaching out to you to ask you about your thoughts when it comes to life style and employment opportunities for both ophtho and rad. Which residency is harder (when it comes to hours, # on call, etc.), which one has better salary and employment opportunities, which one will less likely to "die" in 15-20 years, etc.

 

Thank you guys so much for your time, you guys are amazing. 

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Thank you to all of you, I really mean it. Your insights have been very helpful to me.

 

I agree that I have to pick what I enjoy the most but knowing myself, in the future, I really would like to have the time to spend with my family/children so life style is as important (if not more) as how much I enjoy my work when it comes to picking between the different specialties. 

 

I do not want to be doing something I would hate just to have a good life style (otherwise, I absolutely wouldn't be in medicine now) but sometimes between 2 specialties, there isn't a huge difference in terms of likability. For example, I really didn't like dermatology (based on my exposure) - which is why it is not on my list, although they are known to have a good life-style. I cannot see myself doing major/open surgeries (like ortho, plastics, etc.) either but I think I can do minimally invasive surgeries (like microsurgeries in ophtho or in IR) and I did enjoy when I shadowed a few radiology residents in Toronto. IM (cardiology, endocrine, gastro) are all something I would consider. So it might be the difference between a 7/10 or an 8/10 when it comes to how much I enjoy each.

 

However, if the life style (#hours on call, etc.) or job outlook (radiology being at risk in 10 years or so) of one is significantly worst than the other - this would totally change my decision. I would pick a specialty I enjoy 7/10 with a 8/10 lifestyle, then one I like 8/10 with a 2/10 lifestyle.

 

When it comes to ophthalmology: I am concerned about the ridiculously low income of new graduates (150-200k for the first few years AFTER residency is brutal) as well as job market and lack of OR time. However, I love the fact that I can become a "business owner" and run a private clinic - not just because of the flexibility but also because I don't want to be practicing 24/7/365, I like a little bit of non-medicine stuff mixed in there too (this, and teaching, research, etc.) I do enjoy having "some" patient interaction and building rapport and long-term relationships with them.

 

When it comes to radiology: I am concerned about the off-shore radiologists, role of machine learning and AI, and how radiologists are now forced to read so many studies, in so little time, and which is only getting worst. However, I like that I will be sitting at my desk and challenging myself mentally as opposed to hands on and physically taxing and "too-much" patient contact. 

 

You guys are the experts which is why I am reaching out to you to ask you about your thoughts when it comes to life style and employment opportunities for both ophtho and rad. Which residency is harder (when it comes to hours, # on call, etc.), which one has better salary and employment opportunities, which one will less likely to "die" in 15-20 years, etc.

 

Thank you guys so much for your time, you guys are amazing. 

I really don't know if that number is accurate, do you have a source? 

 

There are a lot of sub-specialties in ophthal. That too will determine what you earn (if you can get a job that is). 

 

EDIT: it seems that lifestyle is really important for you - I didn't see psych in your answer.  Have you considered that? Forensic psychiatry is one of the more profitable ones, as well as that of pediatric psych. 

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I really don't know if that number is accurate, do you have a source? 

 

There are a lot of sub-specialties in ophthal. That too will determine what you earn (if you can get a job that is). 

 

EDIT: it seems that lifestyle is really important for you - I didn't see psych in your answer.  Have you considered that? Forensic psychiatry is one of the more profitable ones, as well as that of pediatric psych. 

 

I wish I had a credible source to cite here. Unfortunately, I have nothing to confirm if what I have heard from bunch of other medical students is true.

 

I have never considered Psych to be honest - I enjoy physiology/anatomy a lot more than studying mental disorders and I'm more of a technical person. Someone told me to look into Anesthesiology (a good mix of physiology/hands on + good lifestyle) but from what I can see, it seems like a pretty stressful lifestyle. Besides the life style aspect, I think I really value having a private clinic in the long run.

 

I'm assuming you are an ophthalmology resident - if so can I ask you for your thoughts on life style/$$$/job availability of ophthal? Do you think it fits a certain "personality" type person? Anything you know that you think might help me decide of ophthal is for me or not? As biased as your insight may be, it will definitely be immensely helpful.

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You'll find naysayers about everyfield, I would only go into ophtho if you love eyes and doing tiny microprocedures. That will literally be the rest of your life if you do ophtho and you have to be super comfortable with that. I feel like ophtho is a specialty you'll know if you like or don't like once you shadow it. 

 

If you like something don't forget that you could potentially also go to the states where the situation may be different and as it stands the US can often absorb a sizeable number of Canadians based on its size alone. 

 

Thing with rads is that it could be targeted for cuts and I still can't get it out of my head that a radiologists job could be taken over or supplanted by machine learning in the future. You also have to really like not seeing patients. You'll know if you like seeing patients or not once you start clerkship maybe even earlier. 

 

one point about that AI feature - ok eventually sure imaging probably in my mind very likely done that way (I am an AI research with a background in computer science). However if you think about it every time something like that has happened there has been a 20 odd year period of amazing earning for what ever field is tech upgraded. 

 

well exactly like rads and optho actually and how cataract surgery was sped up  - in theory we are actually  just one step away from the machine doing the ENTIRE operation on the eye. That wasn't a negative - it was a positive. They simply had fewer docs doing more procedures for maximum pay. If AI came out tomorrow what would happen is rads would simply be using it to generate CT reports 10x faster than they are now. They would then bill for them. If anyone else used that AI but it failed for whatever reason and they didn't figure out the issue (if the rad AI missed probably the non rad ABC doc would miss it as well almost certainly) and your career would be in serious threat - just like mine would be if I tried to do brain surgery - and that AI would fail from time to time. You have little legal defence if you go outside of standard of care) . 

 

the AI required to read imagine means we would have advanced to the point where almost every field that require logic and training would be close to AI replacement. I mean everything. Point is don't think this is going to stop with imaging because it won't. The machine would just as easily be reading EKGs/echocardiograms, lab reports, path slides, biochemistry, do surgery, do anaesthesia,  ..... humans are nothing more than biological computers in a sense. We are ultimately completely replaceable. this is just something we are all going to have deal with in the coming future. We keep advancing to that point - but we have yet to have the conversation of what happens when get there. That means that like all technology we don't talk about it is just going to show up (surprise!), and we at that point will have some issues ha :)

 

Anyway something to think about when you are getting drove around by your autodriving car past all the unemployed taxi, delivery, and truck drivers (coming soon to a road near you).

 

 

 

Also in theory you can ship rads to another country - insurance, licensing and the union effects rads have aside there are also roughly 30% of our job which is hands on with patients - we do the biopsies, drains, ports, floro imaging, angio procedures, blah, blah. that is one big reason we haven't done it yet. Rads job will be to continuously provide value - like all things in medicine be useful or ultimately be replaced. 

Edited by rmorelan
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one point about that AI feature - ok eventually sure imaging probably in my mind very likely done that way (I am an AI research with a background in computer science). However if you think about it every time something like that has happened there has been a 20 odd year period of amazing earning for what ever field is tech upgraded. 

 

well exactly like rads and optho actually and how cataract surgery was sped up  - in theory we are actually  just one step away from the machine doing the ENTIRE operation on the eye. That wasn't a negative - it was a positive. They simply had fewer docs doing more procedures for maximum pay. If AI came out tomorrow what would happen is rads would simply be using it to generate CT reports 10x faster than they are now. They would then bill for them. If anyone else used that AI but it failed for whatever reason and they didn't figure out the issue (if the rad AI missed probably the non rad ABC doc would miss it as well almost certainly) and your career would be in serious threat - just like mine would be if I tried to do brain surgery - and that AI would fail from time to time. You have little legal defence if you go outside of standard of care) . 

 

the AI required to read imagine means we would have advanced to the point where almost every field that require logic and training would be close to AI replacement. I mean everything. Point is don't think this is going to stop with imaging because it won't. The machine would just as easily be reading EKGs/echocardiograms, lab reports, path slides, biochemistry, do surgery, do anaesthesia,  ..... humans are nothing more than biological computers in a sense. We are ultimately completely replaceable. this is just something we are all going to have deal with in the coming future. We keep advancing to that point - but we have yet to have the conversation of what happens when get there. That means that like all technology we don't talk about it is just going to show up (surprise!), and we at that point will have some issues ha :)

 

Anyway something to think about when you are getting drove around by your autodriving car past all the unemployed taxi, delivery, and truck drivers (coming soon to a road near you).

 

 

 

Also in theory you can ship rads to another country - insurance, licensing and the union effects rads have aside there are also roughly 30% of our job which is hands on with patients - we do the biopsies, drains, ports, floro imaging, angio procedures, blah, blah. that is one big reason we haven't done it yet. Rads job will be to continuously provide value - like all things in medicine be useful or ultimately be replaced. 

 

Thank you for your input.

 

I agree that AI will eventually take over a lot of fields but I'm sure we can all agree that we are far, far, far from building robotic arms that can do surgeries. The evolution of software is far beyond in speed than the evolution of hardware.  The only prob with rad is the absence/minimal amount of hands on experience, otherwise it is way more intellectually challenging than a lot of other healthcare fields - which is why for example we won't be seeing robotic arms doing dental procedures any time soon because of level of complexity and cost. I do agree with you on the ECG part. 

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Thank you for your input.

 

I agree that AI will eventually take over a lot of fields but I'm sure we can all agree that we are far, far, far from building robotic arms that can do surgeries. The evolution of software is far beyond in speed than the evolution of hardware.  The only prob with rad is the absence/minimal amount of hands on experience, otherwise it is way more intellectually challenging than a lot of other healthcare fields - which is why for example we won't be seeing robotic arms doing dental procedures any time soon because of level of complexity and cost. I do agree with you on the ECG part. 

 

actually I would push back a bit on that - these sorts of AI advances always start with some form of human/machine team up and eventually leads to reduced human labour. An example is exactly opthomology - the machine actually is doing a large part of the surgery (the fact that arms aren't involved is part of the point - a machine doesn't have to work the same way a person does. A machine can be flexible in ways we cannot, use lasers or radiation in ways we cannot).  Cyperknife surgery for tumours in another example - we basically tell a computer what to destroy and it destroys it in the least damaging why to the rest. People are of course involved but a big part of it is done by a computer and before those tumours would have to be cut out.  It is faster, more accurate and better for patients.

 

Robots already are doing parts of some surgeries - people plan the operation in the sense that they tell the machine what to do and then the machine "figures out" how to do it. Google is funding AI robotic surgery right now as are many others - and businesses don't fund things they aren't hoping will turn profit at some point near.....ish term :)  I just watched a few days ago a robot sew up bowel in a way that no human could ever do, faster than we could ever do it, and do it flawlessly. Next step is having the machine close all the fascia layers automatically.   That is how it STARTS - with tools that do parts better than we can with some supervision. Then they do more and more etc. The parallel is how they replaced a huge fraction of our factory workers - almost without people really paying attention to it. 

 

The point isn't that the machine will show up and do the surgery without a person - at least not right away. The real short to mid term question is what if the machine can augment a person dramatically (like they did for opthomology by turning a 2 hour surgery into a 15 minute one, and other tech related fields. Can a computer help a surgeons do something twice as fast? If so would we need 1/2 as many surgeons? 

 

this skips the technical details but gives a taste:

 

http://www.cnn.com/2016/05/12/health/robot-surgeon-bowel-operation/

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 Cyperknife surgery for tumours in another example - we basically tell a computer what to destroy and it destroys it in the least damaging why to the rest.

 

It sounds counter-intuitive but all the advances in radiotherapy have actually made rad oncs work more not less. Before we were able to just draw our shielding but with the new Stereotactic techniques, we have to contour ALOT more than we used to. We are able to give much higher doses and because of this, we have seen significant improvement in survival and toxicity. The computers do play a role in the planning but our current AIs are terrible at contouring.

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It sounds counter-intuitive but all the advances in radiotherapy have actually made rad oncs work more not less. Before we were able to just draw our shielding but with the new Stereotactic techniques, we have to contour ALOT more than we used to. We are able to give much higher doses and because of this, we have seen significant improvement in survival and toxicity. The computers do play a role in the planning but our current AIs are terrible at contouring.

 

oh absolutely - I mean we can simply do more. But one some level technology has now replaced to at least some degree the need for other options - like directly neurosurgery. Your contouring is telling the computer what to destroy. 

 

on top of all this technology doesn't just make of course existing activities faster/better - but it opens entire new avenues. One probably reduces work, the other probably increases it. How that plays out in particular fields is really interesting. 

 

In terms of contouring - yeah they suck :) yet that problem is basically a key subset what would need to be done to replace radiology with AI (you have to be able to segment out an organ and know what it is critical to have a radiology AI system) so if rads goes then AI would be able to very likely to radiation oncology planning as well, perhaps eventually with even better contouring (again notice they are already trying to do it - once they start doing something it just get progressively better over time. Humans are advanced but static, computer are improving exponentially.). 

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Ophthalmology is not exempt from AI learning (actually one of the cooler parts I'm interested in!) 

 

Look at the collaboration with Deep Mind (from Google) and a recent gorgeous publication in JAMA in regards to machine learning for screening diabetic retinopathy: http://jamanetwork.com/journals/jama/article-abstract/2588763 .  

 

Pros: cheap screening, more accurate screening (the ophthalmoscope is essentially a nice pen light in the med school curriculum, let's be real folks). 

 

As cool as it is, and when we're done wondering about Skynet and if this reality is truly reality and not some pseudo-program that machines have constructed and that we need to further see how far the rabbit hole goes....now what? 

 

Cons: More cheap and accurate screening = more people to be treated, either currently with panretinal photocoagulation or anti-VEGF injections. Or surgery for PDR complications such as VH or tractional RD's, which can further lead to PVR and more surgery. More people to follow up with person who provides said treatment. Currently those are ophthalmologists, though maybe one day machines can do the lasers and injections (kinda freaky to me, very Dead-Space esque).  

 

I think it's amazing that computers have come this far, but we're still taking baby baby steps towards replacing MD's in total. I think it makes our jobs a lot easier, safer, but it doesn't mean it makes it more efficient.  

 

For more reading: http://ophthalmologytimes.modernmedicine.com/node/435238

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I wish I had a credible source to cite here. Unfortunately, I have nothing to confirm if what I have heard from bunch of other medical students is true.

 

I have never considered Psych to be honest - I enjoy physiology/anatomy a lot more than studying mental disorders and I'm more of a technical person. Someone told me to look into Anesthesiology (a good mix of physiology/hands on + good lifestyle) but from what I can see, it seems like a pretty stressful lifestyle. Besides the life style aspect, I think I really value having a private clinic in the long run.

 

I'm assuming you are an ophthalmology resident - if so can I ask you for your thoughts on life style/$$$/job availability of ophthal? Do you think it fits a certain "personality" type person? Anything you know that you think might help me decide of ophthal is for me or not? As biased as your insight may be, it will definitely be immensely helpful.

 

1) I'm not sure even I have the correct numbers. But with the exception of one province (Quebec) where physicians are compensated as a whole a bit lower, I don't think that's the right number, it seems a bit low. I am strongly in the camp where compensation should not play a major factor in your decision to pursue a specialty, because I personally know some people who are miserable in their current specialty.  I've provided a link already in my first post in this thread in regards to public data re: compensation.  Another news article by the NP states here: http://news.nationalpost.com/news/canada/canadian-doctors-warn-fee-cuts-pay-inequalities-will-spur-exodus , with a quote by an ophthalmologist re: billings.  I can't answer that question about what new grads are making but again, it sounds a bit low to me. Why don't you inquire in your school's ophthalmology interest group in re: to speaking with some residents and your concerns? 

 

2) Private clinics are expensive to run.  Most ophthalmologists now work in a group practice, so that the equipment and tech costs are shared between group members.  Google how much an OCT costs, how much a slit lamp costs, how much a humphrey field costs...multiply that by 3 or 4.  It's very rare for individual ophthalmologists now to start their own clinic independently. 

 

3) I think that job availability is a concern, particularly OR time.  There are COS abstracts to support this - I think the 2016 COS poster stated that there were concerns that a lack of retirement (or increased productivity) from older physicians may be influencing an age-bias for billings (Greene et al, COS poster abstract 2016).  In an oral presentation for COS 2015, Manusow et al. in an employment survey stated that 1/5 ophthalmology grads in the past 5 years do not have a job placement and 1/5 do not have OR time.  A lot of people do fellowships and locuming is common. However, for that survey's results (with a fairly high respondant rate), 80% of respondants did have OR time, approximately 1 day a week.  So there's some data to suggest it's not all doom and gloom, but there is still anxiety about it.  

 

I think you really need to immerse yourself into the field and decide early if this is the right specialty for you.  Ophthalmology is very different from rads, and you need to spend as much time possible shadowing to see if the things you are seeing under the slit lamp make you excited to come back.  It is a fairly competitive specialty (but nothing compared to derm, plastics) if you look at the CaRMS stats this year, so it's important to get started early if you can.  But it's also important to get a wide diverse exposure, especially during clerkship, to see if there's something else for you. 

 

You don't want to be myopic in your medical acuity  ;)

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The only reason I mentioned rads as being susceptible to AI, and I do agree that anything technology related that is invented takes minimum 10 years to enter the healthcare field and likely 20 years before it gets widespread, unless of course it is incredibly lifesaving, but if rads jobs are on the line you can bet that there will be some delays to implementation. 

 

I think clinical medicine has some buffer against AI due to the fact that human-human contact is still important and we aren't close to developing robots that look, talk and act like human doctors yet and even once we have that built we will need a multi-year study to determine outcomes. We might develop diagnosis machines but at least in our careers i don't believe we will have fully autonomous robotic doctors and I can assure you doctors will not be the first ones taking welfare there are a whole list of jobs that will be supplanted first. 

 

I think surgery even though we do talk about AI robots is still a ways away from fully autonomous surgery. My reasoning is that surgery is still incredibly complex and I don't believe we will be able to just press a button and expect the robot to do the surgery from start to finish with all the complications that occur and surprises that we find. It is still very common for CT scans to over or underestimate the disease. 

 

Either way, the easiest job to overtake is a desk job that requires book knowledge and I don't believe that we will not have oversight from radiologists. There will be radiologists for sure, the question is how many radiologists will we need and what will happen to pay. Pilots for instance are still needed to operate planes despite autopilot but their clout and pay has definitely dropped over the years due to their increasingly routine and checklisted nature of their work. 

 

While I worry about the future of radiology, I don't believe anyone our age is going to need to worry. If anything the fastest robots could take over would be 20 years in my opinion and by that time we will all have had jobs and seniority enough that it will be the next generation who will have issues finding jobs. 

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In theory, technology can have a much greater role in health care.  In practice, there are always a lot of concerns about the exact role of tech and letting a machine or computer do the actual diagnosis or work.  In anesthesia for example, a product on the market was pulled partly because of poor sales and the opinion that replacing a human was considered too dangerous - technologyReview .    

 

It's a nice analogy of a pilot with regards to technology.  I also think that the real-time adjustments that are needed in surgery are from a computing point of view, very complicated - seems it would take a while to really have autonomous robot surgeons.  I'm not familiar with all the current technological aspects of surgery though.    

 

Rads is definitely being targeted now - IBM among other is putting a lot of money into it.  But, I think the same concerns of replacing humans will be always there, just a question of what kind of adjustment occurs.  

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  • 3 weeks later...
  • 2 years later...
On 5/2/2017 at 9:22 PM, rmorelan said:

first it is hard to miss that you picked two very high paying specialties - that is fine but be aware that the government is targeting both for reductions over time. There hasn't been that much justification for why either of those fields earn so much, and people are taking notice of that and the fees are dropping. You can argue (and we do) that now radiology is actually much harder than before to push back against some of the reductions (for one thing a CT now has multi plane reconstructions, thin slices with bone and soft tissue windows and over 4 times the images in each plane. Originally a CT head had 16 images and well that was it, now it is hundreds upon hundreds and we have to look at all of them with the same fee - the tech is better but the reading time is longer). Don't expect the fields to permanently remain top of the pay scale - I am not. 

 

As for rads - first I will say it is an interesting field as we really are the detectives that figure out in a very large way what is actually going on. Clinical exam skills are important but they really have diminished in importance with all the images (I can tell you if there is appendicitis with at least 98% accuracy vs all that 60-70% accuracy physical exam stuff. You cannot compete basically - we tell you what is wrong, then you fix it). That does mean though that I need to know all the pathology for every specialty - I have a good idea of what most other doctors actually are doing, need to know, and why. That is a ton of information but it is what makes things fun. I can talk shop with almost any doctor - can and actually have to. 

 

Drawbacks to that is that radiology is basically no longer a lifestyle specialty. Your basic radiology is now working their ass of all the time - no one will do anything without imaging, and they want and need it faster and faster it seems all the time. At our service almost no one will admit to their service without some imaging backing up the diagnosis. In the community - where most of us go - there is call coverage that extends to all hours etc as a result. The days are very busy - when the government cut the fees the rads responded by just doing more work as there was simply more work to do over time. Next result is we have being working harder and harder to stay where we were - new grads cannot to full time for 1-2 years usually as they would simply be crushed. Most start somewhere at around 80%. Bottom line expect to work hard as a staff - very hard - and at many places full 24/7 staff service is probably coming relatively soon in some fashion. The field also is always changing to you are always retraining (new technology I was reading for instance may soon replace all chest xrays - ha, that is mess some people up :) ) . 

 

It also means that training is very tough - and we have lost residents due to how bad that is or at least in part due to it (4 residents I know of in my program which may be a biased sample of course. That is higher losses proportionally than general surgery ha - people just don't see it coming). Next year is my fifth year and it will be pure study time to grind me to the floor :) Probably 4 hours a day after work and 12 hours each weekend day for 12 straight months. Crazy times ha! Our call is very busy (we only sleep if everyone else is asleep, because everyone gets imaging). If I vanish off the forum that will likely be why. 

 

Job market for rads is slowing opening up which is good - the average age of a rad is actually quite up there (mid 50s last time I checked) so bluntly that has to open up at some point. Still hard to get a job in a major city - it takes work all every step of the way. 

 

oh other point - family docs doing well may be billing 350K but you have to look at their overhead. Your numbers basically a bit extreme I would say - can a family doc gross 350K - yes, but things have to line up for that. Rads has high pay right now and at hospitals at least low overhead. That makes a big difference. 

Hi there,

I am currently interviewing for radiology soon, I am just wondering what school was that where you saw 4 residents switch out?

Thank you!

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  • 4 weeks later...
On 12/22/2019 at 3:55 PM, medlover5885 said:

Hi there,

I am currently interviewing for radiology soon, I am just wondering what school was that where you saw 4 residents switch out?

Thank you!

Hey I missed this :)

I want to really make sure it is clear that this is NOT unique to the centre but perhaps this one had it a bit worse because it is a harder program or maybe just bad luck - it lost a resident give or take once a year for a while there. There were 5 or 6 actually ( an update due to it now being 2020) that I know of that for a variety of reasons left the program. Most switched to other programs (going either to family medicine one way, or to other highly competitive ones the other way - it was funny like that). That was my residency program - and I would not say it is an easy program. The program is tough, the 2 hours of teaching daily is tough, and man the call is tough. They have worked to find solutions to that and done a good job - no one likes to lose a resident. 

However on the flip side the residents there were trained extremely well (I am biased here of course but there is objective evidence for it) . The residents come out and match to top fellowships without issue, there is a perfect pass rate for well over a decade on the boards (so long that no one seems to remember the last failure) .....the residency program is respected is what I am getting at, and that helps with the hiring down the line. The school is hard but if you get through it you are well trained - which in the end is a good thing. 

Now on this side of things - almost done my fellowships and entering the staff phase I can be glad for the pressure applied. 4 years ago doing a lot of radiology call and getting the squeeze probably not so much. 

Point is to reinforce the idea that radiology is no longer a walk in the park - not during training, and not after. You will work and work hard but if you do there are rewards in the end.

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