5 RISKIEST Doctor Specialties

[@MedSchoolInsiders]

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[@jenno5555]

Can you do a video about doctors who work on public health?

[@nomaa3224]

@@jenno5555 for g I Zeffirelli hi

[@eliecernavarro6422]

On the field of the anesthesiology. Have you heard of certified anesthesiologist assistants (CAA’s) ?

[@catwesage]

I would trust an ENT-trained facial plastic surgeon for anything related to the head and neck region more than a plastic surgeon any day. Trusting a body-trained plastic surgeon to perform a rhinoplasty is ludicrous. Stay in your lane and do some more gluteal advancement flaps lmao.

[@icystorm9968]

As someone who was misdiagnosed by an independent nurse practitioner, I'm really glad you brought this up. We need to talk about this because people's lives are at risk here.

[@ehekatzin.belai-al-rumi]

Misdiagnosed by a nurse? Nurses are allowed to provide diagnosis in the US?

[@icystorm9968]

@@ehekatzin.belai-al-rumi I'm not in the us

[@avacadies9744]

@@ehekatzin.belai-al-rumi In the US Nurse Practitioners are allowed to diagnose, treat and prescribe medication. They just cant for surgeries by themselves.

[@avacadies9744]

They aren't regular RNs they have a Masters or Doctorate of Nursing

[@Sean-ll5cm]

I've been misdiagnosed by MDs twice. I guess it comes down to: who's wrong less of the time? Because no one is right 100% of the time, no matter their training

[@laurenhills239]

As a nursing student I will say that almost everyone in my program is trying to apply to NP school. Most of them are not even going to work as a RN. How is this even allowed? It’s SO dangerous for the patients. A NP needs at least 5 years of experience as a RN before I would trust them.

[@joshb2686]

And TBH I would say a lot more than five years if practicing independently

[@Moshinepro]

Although you make a good point, one can argue that NPs go through clinicals and generally have oversight right out of graduation. The fact of the matter is, with any field of medicine you have a patients life in your hands and without proper training it can be catastrophic. However, look at for example a PA, the only training they have with regard to physical patient care is clinicals, they don't go through "the nursing track" before obtaining their degree and they generally are great at what they do. So what your saying is not technically correct, because NPs have training regardless of being a nurse previously or not.

[@joshb2686]

@@Moshinepro Nursing clinicals don’t teach you how to think like a provider. Pretty much every PA program requires some sort of clinical experience.

[@thecuttinggardener361]

@@joshb2686 yes, PAs do have to have a certain number of patient contact hours, but the PAs I work with in my practice worked as CNAs or phlebotomists before PA school. These positions require even less critical thinking than a nurse. My practice uses NPs and PAs. I notice the biggest difference in the new grad period. Those of us that have been practicing for awhile function at pretty much the same level of expertise, but early on in the APP career NPs that have a history of bedside experience definitely have a huge advantage over new grad PAs.

[@thecuttinggardener361]

I have a huge problem with the push by nursing schools to tell everyone they need to go back for their NP right away. I experienced it in the early 2010’s when I was in nursing school, and have seen the disasters that come out of post-baccalaureate MSN programs. NPs should have a few years of experience at the bedside under their belt before going back to school. My bedside experience has been invaluable to my NP practice. Also, not every nurse needs to become an NP. We need great nurses to stay at the bedside in order to keep the staff skill ratio in balance; for me there’s nothing scarier than knowing my fresh post op heart is being cared by all new grads on nights.

[@daveh8139]

Im a nurse and getting ready to apply to medical school, I can definitely say when shadowing doctors their level of thinking of patient care is different than that of a nurse practitioner, or PA's. This along with clinical experience is what sets them above. As much as I can say NP's and PA's are definitely needed, we must put the patient first in our thinking not money or ego.

[@agustinbarquero8898]

Thinking your patients won't pay your bills ;)

[@sc100ott]

As a physician in one of the fields you mention, I believe it’s very important to point out that there will ALWAYS be room for someone who is good at their job, no matter what the field.

[@S-tc6nt]

Hi Dr. Jubbal. Can you consider making a video or releasing an article on the most optimistic/fastest growing medical specialties in the coming years? Thank you!

[@devanshimishra9969]

Yes pls. I need it too

[@MAYMAI1937]

same

[@drparisis]

Radiology

[@Romantica210]

Yes please

[@tgreetsy1201]

Psychiatry

[@ToofanStorm737]

Finally a physician social media person speaks truthfully about the dangers and greed of mid-level encroachment. I'm not a physician but I encourage more physicians to speak out about the dangers. I'm a patient that was hurt by an independent practing Nurse Practictioner. I was not aware of the vast difference in education.

[@rryan2855]

What did the NP do?

[@jays5926]

@@rryan2855 he’s probably an MD student who made that story up The truth is, the data consistently presents that a more collaborative and open health service market is more cost effective and this type of health system has yet to show significant dangers

[@ratyrat5]

@@jays5926 nice word vomit

[@Cosmystery]

Ultimately patients need to take their health more seriously and more into their own hands. Do your research about the people who are advising you on literal life altering decisions guys. That being said health professionals are not perfect as many people would like to falsely believe.

[@Cosmystery]

@@FernandoChaves you’re wrong. Many do and just assume the doctors always know what’s best for their health without question. I see it everyday

[@TheRealSkinImInMD]

My mentor told me to pick the field I enjoy the most because at the end of the day medicine is always changing and we can’t predict the changes. So obviously I agree with your advice lol! Great vid as always

[@smellypatel5272]

bad advice tbh. Yes the field changes, but certain specialties that are better compensated now are unlikely to go through radical shifts in pay in the coming decades.

[@bpdub21]

As a RN who is starting an advanced practice degree. I am troubled by the lack of training for many nurse practitioners. They have fewer hours of direct nurse practitioner training but the idea is that they should have years of experience as an RN that makes up for that lack of training. The issue is that many NP schools aren't selective in who they accept. If the NP student doesn't have excellent nursing experience they will be woefully unprepared to practice as an NP.

[@savannahwappler8231]

100% agree! I know so many nurses that get 1 year of nursing experience and then go back to school. It cheapens the profession. I am a nurse and I eventually want to become an advanced practice, but I want to get at least 3 years of experience before going back.

[@cm2973]

It was a nice idea, years of experience to make up for a lack of education, but that doesn't really pan out. Also, as you said, NP schools will take anyone with a pulse.

[@vivek27789]

True... Very True 🤦

[@vivek27789]

@@mooshikala Triggered much?🤦😂

[@dakz9296]

@@vivek27789 You're missing the point here. This is all about putting patient's lives into danger. You don't understand how serious this is.

[@JSalamonTutoring]

There was just a published study that showed mid level providers ended up costing hospitals and insurance companies MORE money due to increased testing, increased admission rates and return visits compared to physicians. Mid level providers are only attractive to hospitals if they benefit the bottom line so discussions about effectiveness asside I don't think encrochment will actually be that big of an issue moving forward.

[@littlerockdoc3183]

Ive heard about this; not to mention the over referral problem with NPs. Any chance you could post the link to this study?

[@EvitaGlez]

Thank you for this. I needed a reason to continue forward in medicine lol

[@Inqtive]

Commenting to see the link

[@hayaalany9796]

@@EvitaGlez same 😅 I’m feeling very discouraged

[@yonpark6245]

Speaking from 13 years as a radiologist, I can 100% attest to the overordering of tests by midlevel practitioners. I used to call and try to educate, but you can't educate past poor confidence in their own diagnostic skills, so they use me as their exam. No joke, esp with video visits, the problem is bad.

[@joshb2686]

Independent practice for EM mid levels is absolutely horrifying.

[@SirEnzo371]

It's going to happen and it has to happen because that's the only way admins are going to regret this decision when all their patient's drop like flies.

[@nickmcdonald3083]

@@SirEnzo371 this assumes that admins care that patiens die.

[@aries5685]

@@nickmcdonald3083 They'll have no choice but to care as the number of dead patients increases and word spreads.

[@HamsterPod]

@@aries5685 The NP social media brigade will make sure that anybody talking about it would be hounded off the internet, unfortunately

[@rotisseriechicken959]

from my personal experience the mid levels i've seen in the ER are very much knowledgeable in their area of practice, anything of concerns are usually brought up to physician, which honestly seem to decrease the stress of the MD themselves. Besides, independent practice doesn't eliminate referral

[@ldvclashers3532]

I don’t comment often, but the ideas surrounding mid-level encroachment could be a potential interesting topic to discuss. I don’t recall a video on this in the past, but I could be wrong.

[@redd1417]

I agree with this post. It would be worth an extensive discussion, especially while citing past events and laws that is leading to further encroachment.

[@CriminallyTired]

I have a more relaxed take with mid-level practitioners, I currently work in a clinic where there are both mid-level and surgeons. Largely they are utilized for follow-ups, post-ops, or surgery consults. It allows for the surgeons to focus on pre-ops and case reviews.

[@wannabedal-adx458]

While I have liked the PA's and NP's that have treated me over the years, I agree that letting them loose without supervision is a recipe for disaster. I think PA's and NP's are important in expanding the medical team's reach, decreasing workload on the MD's, and lower medical costs, Dr. Jubbal's is correct in that it could impact patient safety if it gets out of control.

[@yucol5661]

Would it impact patients health MORE than a shortage of any care though? We aren’t choosing between mid level providers and physicians. We are not choosing between great health care providers VS subpar healthcare providers. We are choosing between a shortage of health providers VS keeping the current path. Quantity over quality saves lives.

[@carlosalexander6448]

Agreed, this is one contention I have with some of my PA colleagues. As PAs I think it's far better when we are working alongside an MD/DO (or at least can quickly communicate with one remotely if not physically present), especially in certain circumstances that require their clinical experience/expertise in complex patient cases. I know I for one am glad I can be in constant communication with one especially prior to minor procedures where the patient has an extensive past medical history and/or a laundry list of medications they're currently taking. Funny that often times I will get a "just refer them to (insert specialist)" if it's too complicated.

[@ChunyenLIU]

As a EM physician myself, this video is very accurate. I have colleagues lost jobs due to decrease volume of patients and over saturation of provider as well as increase numbers of mid-levels. Our salary/hourly rate is also on the decrease. Best luck to new graduates.

[@Ai-Future]

Do you think they also threatens internal and pediatric medicine?

[@justinjj8767]

I believe once this older generation retires, we will be in a world of hurt for every job field in the US. I know looking at cardiology, more than 25% of them are over the age of 61. Meaning within 10 years most if not all will be retired. That is a huge loss of experience and a sudden loss in filled positions. In large cities where these carrers are so sought after, but I know where I am in rural Wisconsin, they can not hire enough physicians fast enough. The pay to cost of living is very comparable to larger city doctors. Nobody wants to practice in rural areas, except a select few.

[@YashPatel-nz9wj]

Psychiatry is likely to increase in the future, as mental health is now a rising topic

[@nishantgogna270]

Being a psych NP is the hottest topic in mid-level school right now, so that's at risk too

[@SirEnzo371]

@@nishantgogna270 And they throw a cocktail of drugs at patients that end up making their conditions worse. They have no idea what they're doing 90% of the time.

[@Bonbon-lk9gv]

@@SirEnzo371 That's a myth and rumour created by people who stigmatise mental illnesses. A lot of them do help people and are passionate about it. Only a very very small minority are as you described. Most of them do research and study mental illnesses non-stop to find solutions/improvements in treatments.

[@jays5926]

@@Bonbon-lk9gv it’s really funny seeing these insecure MD students attacking midlevels. I could snap my finger and have the most recent treatment guidelines for any psychiatric diagnosis, to date . That, alongside easy to read treatment algorithms that a high school kid studying biology could interpret. That’s the power of technology . We have to accept that health care is changing and offering a cost effective care service involves working as a interdisciplinary team. MDs used to be the gatekeepers of knowledge , in many ways. But with the how medicine has changed with the digital age - there are many more providers who can triage and diagnose for minor ailments

[@ernestopanza4194]

@@nishantgogna270 So what. Higher earning, cash pay patients are smart and know the difference between an NP and a psychiatrist. They will seek out the better trained, more educated provider (physician).

[@jamesyamamoto5155]

As an EM resident I'll say that difficulty finding jobs is both true and untrue. There are places all over the country BEGGING for doctors of any kind, but young physicians don't want to live in those areas and their families REALLY don't want to live in those areas.

[@joshb2686]

Thank goodness I want to go back to rural Arkansas / missouri

[@justinjj8767]

​@@joshb2686 that's my plan as well. The rural communities where I am are hurting for doctors to the point they are paying for malpractice insurance and helping to pay back student loans for physicians that want to work there. The medical college has ~20 opening for specialized rural medicine. It will be interesting.

[@knosis]

Rural living is where it's at. People are missing out lol. I just started my EM residency and if going rural is my only option after it's all said and done, I wouldn't mind.

[@vtn05001]

I agree, I do plan to move out west to indian reservations to help out, which also helps pay back my 400k in loans lol

[@abster237]

In my humble opinion, primary care will be the next target of mid-level provider encroachment, if this is not the case already. The last 4 times I've been to the doctor's office, I saw a PA or an NP 3/4 times. And it wasn't a pleasant experience in all 3 cases. I could spot the mistakes made by the mid-level providers because I am in the medical field.

[@timsohn7057]

Do you feel this is due to the shortage or physicians in the field? So resorting to outsourcing almost.

[@ForsakenForWhat]

I have also been treated by NP's several times in Primary Care when visiting the doctor's office, and all 3-4 experiences were as good as being treated by my regular physician, and sometimes even better.

[@abster237]

@@timsohn7057 I personally think that's part of the reason why. Also, healthcare systems that hire healthcare workers will have incentive to hire more PAs and NPs and less doctors because it will cost these companies less allowing them to maximize their profits. This is already what's happening with EM and Anesthesia as mentioned above. More independent PAs and NPs in primary care, I believe, will create competition between these and doctors. But, let's see what the future holds.

[@abster237]

@@ForsakenForWhat Okay 🙂

[@curtisfoy6735]

They’ve been the target for a while now, but the suits didn’t realize the extenders don’t wanna do primary care anymore than medical students do. It’s very difficult to be mediocre and excel in primary care given the breadth of knowledge required.

[@tbluemel4986]

As a radiation oncologist that just graduated in 2021, this video is misleading regarding our specialty. The ARRO survey (given to all graduating residents yearly) in 2020 showed 98% of graduating residents received offers for full time employment. Only one person wasn’t offered a job or did not go to a fellowship (out of 179 respondents, 190 surveys sent out). 1% went on to fellowship. 64% of respondents were very satisfied with their job offer. I and five co-residents had zero difficulty finding jobs exactly where we wanted to be. This data is in opposition to your arguments in the video. You focus on that one person who had difficulty finding a job and that is not the experience of 98% of graduating residents. It’s unfortunate because our specialty is phenomenal with top tier pay, unbelievable schedule during and after residency, and at home call where we rarely have to go in.

[@MedSchoolInsiders]

Thank you for pointing this out and we will learn from this

[@vans4lyf2013]

What do you make of the Radiation Oncology threads in SDN? They certainly seem to think the sky is falling in the field. The field has dropped significantly in popularity and there are several horror stories with regards to the job market. Where is this discrepancy coming from between your experience and the several experiences on SDN? Also you can't deny the fact that residency places have increased by over 200% with decreasing indications for radiation. You may have got lucky, or worse you're a pawn by ASTRO to mislead medical students into thinking the situation isn't as dire as it is.

[@vans4lyf2013]

Also if you're genuine can you please disclose the starting salary you were offered? Again this is apparently way lower for new grads and far from the average figure in the mgma survey.

[@tbluemel4986]

@@vans4lyf2013 I have not truly dug into the threads on SDN for radiation oncology. I’ve heard they are not positive. I did look at a thread on the ARRO survey that gives some interesting interpretation, but it at least shows the data. The number of positions may have grown for a decade or two but many programs have recently cut back on slots that were previously open, which would argue in favor of a job market scare. The ARRO survey is a decently accurate representation of what is happening to current graduating residents. A few horror stories in SDN is a small sample size to rely on and apply to the market as a whole. I feel bad for anyone that struggles finding a job, but when 95+% secure full time employment and 64% are very satisfied with the job acquired I have a hard time seeing the doom and gloom in that. As far as starting salary goes for me and my co-residents, it is as follows $350,000, $375,000, $385,000, $540,000, $540,000, and $540,000.

[@tbluemel4986]

@@vans4lyf2013 Radiation is one of the pillars of oncologic care and at least 50% of cancer patients require it at some point in their disease course. If it is eliminated as a treatment option then surgery and chemo would be on the chopping block as well. The only thing that would eliminate radiation and the specialty of radiation oncology is a cure for cancer that does not include the usage of radiation therapy.

[@khalilahd.]

I’m currently really interested in internal medicine but I was initially thinking about plastic surgery however I heard about this risk fracture early one and tried to branch out. Thanks for bringing awareness to this! 🙏🏽

[@icystorm9968]

Same, i was thinking about into plastics but now I'm also considering cardiology.

[@farazalam538]

It's too late for me I already took Radiology

[@jamiyahdillard6898]

@@farazalam538 do you like radiology? That’s the field I want to go into

[@agustinbarquero8898]

​@@jamiyahdillard6898"It's too late for me" yeah pretty sure they love it

[@ibrahim.hameed]

Thanks for being one of the only mainstream influencers who says it as it is when it comes to midlevels, excellent video

[@Maddawg31415]

I want to also comment on the “undesirable location” take. Rural America has the greatest doctor shortage right now. Perhaps some oversaturation might facilitate getting some more doctors to those regions in need

[@UrsusHorribilis]

I have had 2 family members misdiagnosed by nurses because the nearest doctor was 2 hours away (eastern Oregon). One of the family members ended up having a tumor the size of a baseball. A commentator on this video mentioned it already but alot of these hospitals will straight up help pay some of your medical school loans. New grads are missing a huge opportunity, chasing big city life.

[@jamie91995]

Mid-levels should stay in their damn lane and stop trying to practice on their own. If you wanna practice on your own, get an MD or DO

[@joshb2686]

Most of them do, sadly it’s exactly the one’s who are dangerous who fight for IP.

[@NN-ko8fu]

You sound salty or hurt.. cheer up

[@jamie91995]

@@NN-ko8fu I'm concerned about the fact these doctor wannabes are getting people killed

[@RideBound]

@@NN-ko8fu If you don't think a standard of care is important you don't belong in medicine.

[@OrganicDolphin]

@@RideBound he’s part of the reason why it got this bad. They just gaslight doctors endlessly

[@Amandaaa2244]

As a PA, I am really concerned with the level of autonomy that poorly educated nurse practitioners get. PA schooling is significantly more rigorous and much much more similar to medical school and I still don’t think that PAs should be able to practice fully autonomously.

[@mihneapopa8856]

I like how dr jabal is smart and considerate to talk more about TRAINING instead of diplomas from fancy universities, pre-med subjects or social media and other very subjective and biased ways in which healthcare professionals are often misjudged

[@camiloiribarren1450]

This is very important to learn and I'm glad Dr. Jabal is telling us about it, technology always improves quickly which makes knowledge a lot more complicated. Greed is something that I don't agree to become a physician because that can lead to patient endangerment. Also, hope to see a So You Want To Be A: Infectious Disease Specialist soon

[@nathalyalima7213]

I want to be a infectious disease doctor too! It's like the detectives of medicine 😍

[@sheilahernandez5318]

ID for the win! I love being an internal medicine resident, but I can’t wait to be an ID fellow! 🥰😻

[@Jnglfvr]

Yes Emergency Medicine is in decline. A large part of this has to do with contract management groups starting ER residencies across the country in order to saturate the labor pool and drive down wages. These CMGs basically skim 30% of an ER docs salary. NPs and PAs can generally do the work of emergency physicians because the majority of patients seen in an ED are not true "emergencies" but rather are mundane primary care issues that the patient chose to go to the ER for based upon perceived convenience (no appointment, prompt service). In my experience (4 decades as an ER doc) most mid-levels know their limitations and know when to ask for help when a patient presents an unusual challenge.

[@fredastaire6156]

Wow! Thank you for this. Really! ❤️ I purposely chose to stay out of ED because I didn’t want to deal with the contentious providers crying “they’re stealing our jobs” Im comfortable in my nice little niche of urgent care; if they’re too sick got to the ED. If it’s a minor level 5, “follow up with your PCP” Even though I’d love to be a part of a ED team taking care of pts together AEM and ACEP don’t want us there; and frankly I’m don’t want to be where I’m not wanted; even though I feel that I have quite a bit to offer 😉

[@Jnglfvr]

@@fredastaire6156 There was never any "competition" between the docs and the PAs, NPs I worked with. Maybe our situation was atypical but the mid-levels were allowed to do all procedures including intubation, joint reduction etc.

[@littlesparrow303]

Really?! Just when I was looking into Emergency Medicine & it really catches my attention. Right now I am going to study for the MCAT in the summer

[@amichalak10]

I feel like we should separate PAs from NPs when we talk about mid-levels. After all, PAs aren’t the ones lobbying for independent practice…

[@Maddawg31415]

EM has definitely been one of those specialties under the microscope these past few years. Idk about the rest of the country, but here in the northeast, EDs appear to be back to pre-COVID volumes; most are exceeding them. Having midlevels is another concern for aspiring EM docs (I’m going to med school this fall with an open mind, but would be lying if I told you EM wasn’t the #1 seed at this point), but consider that you get a diverse patient population in the ED. Most low acuity pts could be handled by any physician, PA, NP; heck, I’ll argue that an RN or paramedic could treat them with a little extra training. On the other side of things, I don’t see NPs and PAs running trauma activations by themselves anytime soon, nor managing ECMO or EVDs independently. If you think the PA or NP will be leading the pedi code coming in, think again (unless it’s an MCI). It’s a team effort- everyone has their place in the ED, even in acute cases, but you can’t care for the most high-risk pts without attendings somewhere in that continuum.

[@sandrau.3510]

I am currently in PA school. I completely agree with the fact that it's a TEAM effort, lead by the physician. I know my place as a physician assistant and that there is no shame in asking for help. You are doing the patient a great disservice if you are not confident in your assessment/plan! I do not want to practice independently (if I wanted to, I would have applied to med school). Honestly, when I started PA school I wish I had, because it is SO MUCH to learn in 2.5 years. I kept thinking, well there is a reason it takes a decade to become a doctor. I think a PA working in a specialty for years under the guidance of a good physician may be capable of practicing independently-but that’s a case by case scenario considering PAs can switch specialties whenever. Wouldn’t make sense for ALL of them to be able to practice independently WHEREVER. I can understand where frustration arises as a physician, because you worked X amount of years to have nearly an identical scope of practice as a PA/NP. I understand how it must feel when a PA/NP fails to recognize or respect the hierarchy. Which often results in a doctor feeling as if they need to constantly reinforce this hierarchy and assert dominance. This is SO common with nurses too. It’s really invigorating being dismissed, or treated as if you don’t know anything when some of us are INDEED very capable. And might I add, if a doctor make a mistake or misdiagnoses a patient- its that own individual doctor’s fault. If a PA makes a mistake, it public outrage that the PA profession as a whole is incapable. Anyways, a good PA + a good doctor working as a team and respecting each other- that’s the dream. I wish all provider could put these hostile feelings to rest and work as an actual team!

[@waycer8869]

I feel there needs to be an experience hour requirement for many of the mid-level providers. My mother was an RN for 25 years before becoming an FNP. She has found many fresh NPs aren't ready to take on the work environment with the amount of experience they have. From her experience, PA school seems to prepare you more for the real thing.

[@whitenoise5159]

I would love to see the areas of medicine that the fastest growing and most in demand!

[@saidchammas]

So basically, greed seems to be the issue here

[@sergiootero5904]

Self- interest* Everyone wants to make more money for themselves and their families. Every organization wants to maximize profits. Change the incentive structure, change behavior. Your oversimplification makes it too easy to demonize people

[@saidchammas]

@@sergiootero5904 corporations more so than people

[@Eirabear380]

Thank you for making a video on this! As an incoming MS-1, I think it’s good for us to be wary for the future because some are unavoidable. When it comes to MLP creep though, I hope people won’t let it be the MAIN factor driving them away from the field. This will only make the creep go even faster and eventually will seep even into the “safe” specialties. While there are many MLPs trying to lobby for independence, there are also many who are on our side. At the end of the day, we’re all getting screwed by admins trying to get the cheapest labor 😭

[@Charles-y4z]

As a specialist in radiology, I believe that the introduction of AI for diagnostic purposes is necessary to cope with the increasing demand for medical imaging diagnosis. Just as you wouldn't leave your legal judgment to an AI judge or determine your life partner solely through an AI matchmaking service, AI should serve as a valuable tool to assist in our work.

[@bettysmith4527]

CTs for EVERYONE... ugh, it's unreal!

[@mcdavid4606]

My father is an anesthesiologist, only time in his 28 year career he’s been sued is when one of the 5 CRNAs he was covering for killed a teenager during an elective surgery. The fact these people want to operate on their own without supervision is downright scary. They have a minute fraction of the knowledge, experience and ability- especially for cases that take a wrong turn.

[@Cosmystery]

So your dad was overseeing 5 CRNAs at once? Maybe thats why he was sued because a physician anesthesiologist is only allowed to supervise up to 4 anesthetists at once.

[@mcdavid4606]

@@Cosmystery Maybe it was 4, I could be wrong. This was also 19 years ago, maybe the laws were different then? The anesthetist and the hospital were the primary targets of the suit, but obviously as the physician on call my dad was named in the suit.

[@AestheticMD1]

There's no CRNA that I work with that think they could replace an attending for the job. Maybe some of the simplest cases but good luck geting a CRNA who is well-versed in regional blocks + cardiac anesthesia + nuances of neuroanesthesia all together

[@benpark6083]

Medical direction which most people do is up to 4, but supervision is up to 6.

[@JC-fm2rh]

@@Cosmystery We are called Anesthesiologists. That "physician anesthesiologist" or "MDA" is propaganda manufactured by the AANA. It's designed to convince patients that equivalence exists between the two groups. Different training. Different skill set. We both have a niche to fill in the perioperative setting, but CRNAs pushing for independence does not improve objective outcomes in surgery. Period.

[@pjz96]

I really want to go with Anesthesiology but I have real concerns about mid level encroachment. I feel like surgery is the only safe pathway.

[@knosis]

Dude, go do an anesthesiology rotation plus get a mentor. It's hard to see it as a med student without some experience, but CRNAs aren't taking anesthesiologists jobs. Do a surgery rotation and get in as many operations as possible to see if it's for you or not. But even some specialty surgeons (like peds cardiac) have a hard time finding a job. Talk to real people who does this for a living before listening to this KZbin video. Lots of half truths here.

[@christianf4]

Have you considered doing a video on Oncology as a whole? Despite their patient health outlook being bleak in many cases, they seem to be one of the happier specialties

[@MedSchoolInsiders]

Yes SYWTB episode is on the list

[@christianf4]

@@MedSchoolInsiders awesome!! Thank you guys for all you do.

[@mitchellfolbe8729]

Heme-Onc is a great field. New treatments coming out monthly. You will meet the bravest, most inspiring patients and families you can imagine.

[@maryannbatchelder8047]

I am a new grad NP, I have worked as an RN in multiple settings for 12 years prior to going to NP school. Do I think my training equivalent to a physician’s training? No. Do I plan to replace a physician? Definitely not! I value and respect physicians and I wouldn’t be where I am were it not for the physicians who have been my preceptors and mentors. This issue is multi-factorial, but the bottom line is mid-levels exist because there is a need. Physicians who work with and count on mid-levels as a part of their team value their contribution. Some specialties even have white papers detailing effective integration of mid-levels into clinical practice. As for me, I am looking for a position in a surgical specialty where I will be supported as a new grad with training and oversight. I want to be a physician extender and be appreciated for the work that I do.

[@jordanterry6248]

About a week and a half ago I had a chance to talk to an EM doc about this topic and he said stats during the pandemic has dramatically skewed the reality of EM job opportunity and that in placing graduates in residency programs and place residents into jobs, there has been little to no problem, and that many rural areas would employ a quality EM doc in a heartbeat. I also talked to an anesthesiologist about this at the same event, and he said they’ve been saying there will be a decreased demand for anesthesiologists for decades and it’s never made a noticeable difference for most in the field. This topic seems to be raised by people not actually practicing medicine to spread worry about students primarily and get views and attention but in the end doctors of at least a decent quality can find the job they need.

[@creolechicken2.080]

EM docs are delusional and always say this. They are wrong, I promise you.

[@kellanhills1972]

AI has essentially zero chance in the near term (20-50) years of taking over radiology. Tiny segments are improved by AI but actually issuing a report is unlikely.

[@robertmines5577]

I wouldn't even call what's happening in radiology AI. It's actually machine learning which is a bizarre subfield of statistics where you effectively over fit a large data set and hope that your model never sees anything too different from that data set. Yeah, you can train it to almost perfectly identify any one condition, but it will be years before it can be presented with an imaging study at random, check all possible conditions, and write up a report.

[@MJ-ns9om]

@@robertmines5577 You can definitely train AI to identify and diagnose a range of things, and over time (I would say sooner than later, and in my opinion much higher than zero chance in the next 20-50 years) I don't see why it couldn't completely replace a radiologist. Or at least, do to radiologists what self checkout machines have done to cashiers, replacing many professionals with a single person overseeing what is going on.

[@thesneakygamer4343]

@@MJ-ns9om ehhh I do research in machine learning in radiology, and at this point it is very far behind. I think people don’t understand all that radiologists have to do and the speed they have to interpret data AND make clinical decisions.

[@MJ-ns9om]

@@thesneakygamer4343 so do I! And i wouldn’t be surprised if in 20 years time, demand for radiologists is still high and AI has replaced 0 jobs. I would also not be surprised if it was the complete opposite. The neural network boom only started 10 or so years ago and there has already been lots of advancement, but not nearly as much as some predicted (for ex. completely self driving cars have been like “5 years away” for a long time). Still, radiology seems like the obvious first specialty that would be replaced, and i think saying anything about what things will be like in 50 years is a bit ambitious. 50 years ago we didn’t even have MRI.

[@thesneakygamer4343]

@@MJ-ns9om I think the technology will be there but you also have to keep in mind how difficult can it be to transition the technology into a clinical environment. MRI was supposed to replace CT and it still hasn’t because it is slow to operate. Additionally, Radiologists also have to do procedures such as fluoroscopies, ultrasound, injections and coordinate and discuss findings with other physicians. Radiologists often have a big say in making and discussing clinical decisions as a part of the patient care team.

[@richardwang2245]

Great video! M1 here and I think these issues are underdiscussed and undertaught nowadays, both in medical school and in the news. Hopefully there can be more awareness and concern in the future

[@Mohamedddd7890]

Didn’t know radiation oncology over saturation is that bad till i became a resident grads are having trouble finding jobs right now and the salaries are ridiculously low and it’s gonna keep getting worse with the 200+ grads every year it’s not even about the low salary but getting a job in the middle of nowhere that pays less than a hospitalist is really upsetting hope it gets better in the upcoming years.

[@DetectiveMcGarnacle]

“Dr. Google” takes on a literal meaning now

[@iwatchkittenvids45]

He's just reacting to a recent AI article on radiology

[@Sypossc]

Rads and Path are safe for the time being, but AI will make physicians more efficient in certain areas. In the areas where AI is already used (cytopathology, hematology, chemistry) most of the job losses are felt by MedTechs and not physicians. These technologies also will need to be validated (by pathologists) and interpreted to clinicians (again by Pathologists). Path is not a competitive specialty and there's enough demand in the market for Pathologists outside of large coastal cities to absorb some efficiency gains. In the short-term the market might be disrupted more by offsite reading made possible by digital pathology more than AI and automation, but this isn't necessarily a bad thing.

[@theoffbrandduo6756]

Would love to know more about this. Are you in pathology?

[@Bergen98]

Yeah, I remember nurses-practitioners and PA's asking questions that most first-year med students can answer - so hearing they are going independent with no supervision by a physician is actually VERY scary

[@JohnHorak]

What’s an example of one of those questions?

[@Aaron-cc7yq]

Just continuing to make my decision for ophthalmology seem better and better. Sure some encroachment from optometrists, but they will never be able to perform surgery so it's not really a big deal.

[@MultiDiceman]

Imagine spending 8 years in school, 3 to 4 years in residency getting paid just enough to survive with debt just to not be able to not find a job. Too much sacrifice for a "maybe" in job employment is messed up

[@MzUnique05]

That’s Pharmacy right now

[@davidpineda6570]

That's sad but so real

[@BadlyDrawnJack]

8:35 In the Dunning-Kruger graph, there's a grammatical error "I'm never going to understNAd this".

[@MedSchoolInsiders]

Thanks for pointing that out!

[@mo-hammadabunaser1367]

Seems like non-plastic surgeons performing "Aesthetic Medicine" is a worldwide trend, I'm surprised that legislators haven't done anything to stop it

[@KansaSCaymanS]

One trend I find disturbing and misleading is NPs who obtain a DNP degree and start referring to themselves as Dr. So and so, even though the education and training required for a DNP degree in no way corresponds to the clinical training and experience an MD/DO receives in medical school and residency. As for independent practice by NPs, even physicians must do at least 1 year of internship after med school before a state will issue a license to practice medicine. What is the requirement for these independent practice NPs?

[@miryamdev764]

Just wanted to let you know that the training and scope of NP practice varies in different countries. Where I live nurses who want to become NPs must have at least 2 years of clinical experience as a nurse to be able to get into NP school. I am planning on doing an NP program and would love for the NP program to have an NP residency and extensive clinical training. However if that were to happen then NPs would be more on par with physicians (which I don’t mind) although I am almost certain physicians would mind. Also a good NP will likely get their RN experience in a specialty related to what they want to pursue in order to better practice once they are an NP. I am getting ER experience and planning to get ICU experience and then will probably become an adult-medicine NP, although again I haven’t decided. But if an NP wants to do pediatrics they should work in peds for a few years to familiar with the specialty before they go to school. I don’t think American NP programs require nursing experience though, unlike Canadian ones.

[@KansaSCaymanS]

@@miryamdev764 I would agree that clinical experience in a specialty area you intend to practice is important. The problem is that RN training and experience is focused obviously on nursing care, not the diagnosis and management of illness and injury as is the case for physicians. I have worked with some very experienced ED NPs (and PAs) who still missed crucial life/limb threatening diagnoses. I value their help in the ER, but still believe they should work under the supervision of a physician. I wish you the best on your career plans.

[@arrekusu9709]

@@KansaSCaymanS unfortunately I do not know but that is what I have been wanting clearer answers on and hope that the healthcare system in the U.S. takes into consideration. We need to be able to provide higher education and board certification to these midlevels that want to practice independently. If that is in fact where the healthcare system goes from here. Now, there are residency/fellowships that a PA/NP can apply and attend but they are only 12 to 24 months and although they sound like proper training. Some if not all are filled with physicians that are also doing there residency. For obvious reasons there is a lack in practical application for midlevels in these programs because the MD/DO’s residents get priority. Obviously so, but for that reason they need to implement better programs and make it a requirement if mid levels want to go into independent practice. As I said before I am not for nor against independent practice. However, because it seems as if that is the path that the healthcare system in the U.S. is heading then I would implore that residency/fellowship is required and that the programs be led by MD/DO’s as such are current residency programs right now. Also, as for your comment on DNP’s, academically they can in fact refer to themselves and others can call them Doctors. They have a doctorates in such field. However they cannot in a clinical setting.

[@KansaSCaymanS]

@@arrekusu9709 Agree with both your points. If APPs want to practice independently (where allowed), they should have to complete a minimum 2 year residency first (in eg Peds, EM, Family Med, etc.). I also have no problem with DNPs (or DMSci in the case of some PAs) being called Doctor in the academic setting, only in the clinical setting where a patient may believe they are a physician.

[@sullythedoc]

Thanks for saying it how it is. A few pages will speak out about mid-level encroachment and patient safety

[@robertmandell526]

I'm a retired physicist/Electrical Engineer, and I ran my wife's Solo Neurology practice her last 15 years (couldn't find high school or Hoi polloi college types who could spell properly, or write a simple declarative sentence)! We didn't see specialty creep, but a trend more pronounced in the latter years, to have pts seek specialty neurology only after the GP's, Internist, Chiropractors, PT's, PM&R's, ad nauseum, had tried fruitless to manage underlying neurological conditions with everything going in their kit bags. In other words noblesse oblige was out the window; they were one and all out to keep hold of pts as long as possible; squeeze out the last buck from each unit, and look out for #1. This all began with the rise of insurer power and concentration, and their cut throat reimbursement rates. Our saving Golden rope in the latter years was electrodiagnostics--EMG, BAER, VNG, etc -- detailed knowledge of dermatomes, myotomes, neuroanatomy and variations; and knowing how to operate , maintain, and control complex EMG instrumentation. Since most docs and engineers run from this stuff like the plague, it provided a modest refuge. Same for doing occasional IONM's. Long past the worst of it. But MEDICINE US STYLE, is a confrontational scrum today, setting pts against docs, docs against insurers, and everybody with blood in their eyes. If you wonder why there's so much burnout, it's because the entire model is distorted, including the mindless super selectivity in the training academies,; the brutal financial weight loaded on graduates backs; and the ineluctable press for the biggest bucks (per field) that newly freed residents can get. Europe produces equal caliber docs without the torture chamber tactics.

[@theAnubis09]

Dr. Jabal, thank you for posting this video. I have seen a lot of people talk about AI and Radiology. I wonder if having more efficient radiologists would have the effect of us just taking more images to fill their time or (as is happening) having more radiologists perform image guided procedures to obtain key diagnostic information. PS: nothing is more boring in the hospital than reading overnight ICU X-rays lol

[@spartacus0987]

As a nursing student set to graduate in May, I disagree with the independent practice of NPs. While there are different providers with different levels of competency and experience, nurses just don’t receive the degree of training medical students do. End of the day healthcare is a team sport! Everyone from the environmental service workers up to the attending physicians have their place.

[@alexpeguero38]

As an NP, I agree partially. After years of experience, NPs should be able to practice independently. However, I believe collaborating with MDs or other NPs is important regardless of experience

[@torresthemonster]

@@alexpeguero38 I seen NP struggling to treat patients and often have to use google for medications. I rather seen a physician that has gone through extensive amount of education and training to get to where they are today instead of taking the nurse - NP route

[@alexpeguero38]

@@torresthemonster understandable but I have also seen that with MDs. Be open minded to NPs or PAs treating you as they are becoming more common and you may not have a choice who may treat you.

[@torresthemonster]

​@@alexpeguero38 "you may not have a choice who may treat you", that is a very bold statement considering the fact that patients have to pay the same BILL as if a MD was seen by them, but it was a PA or NP. How does that work? If I at patient is being charged as the same as a MD, then I bet they better make sure they see a MD. I volunteer at a ED, and we only have MD/PA's that see the patients. I would only be comfortable to see a PA, when a MD is present.

[@alexpeguero38]

@@torresthemonster NPs can practice independently depending on the state and most likely, you’ll be charged a lower fee if you’re ever seen by one. What I’m trying to say is the most facilities are using NPs or PAs. You can request an MD, but don’t be surprised if you schedule to see someone, that an NP or PA will be treating you as well. Keep an open mind! When they hire providers, especially at big institutions, they’re not being hired because they’re not qualified for the job. Also, facilities may require an MD to sign off on a note because the insurance will pay 100% for the visit or encounter. If an NP or PA saw the patient, the reimbursement will likely be about 85%. Most often, if you’re seen by NP or PA, they’ll write the note and their assessment, an MD may read the note, and sign off without question unless the NP or PA is not confident in their judgment. In the end, you will still get charged the MD rate.

[@funsize198]

Yea...I saw the trend with so many medstudents going into EM bc it's great job with a great lifestyle, but mid levels and the fact that everyone is wanting to do EM, made me realize that in a couple of years, it would be hard finding a job...either that or EM salaries would plummet.

[@joshb2686]

Evidently you aren’t the only one. Match went from 79% match rate for DO’s to 90 in one year (similar for MD). 700 less applicants as-well. If I wanted to live in a big city I would reconsider path’s, but there is still a need for level 2 and 3 trauma centers in rural areas (where I live).

[@joshb2686]

I do expect salaries to stagnate at the very least though

[@littlesparrow303]

Really?! I was looking into the EM field especially being in a big city

[@joshb2686]

@@littlesparrow303 you won’t get a job out of residency. Might be able to snag one eventually, but not right off the bat.

[@akadopeboi]

In Canada we have a massive crisis that is growing regardless of the amount of docs. We either need more docs or more middle ground care providers like NPs and PAs. We just cant keep up with the population expansion and really dont have enough students entering the field. Also, when they graduate its hard to retain them in Canada vs the MASSIVE profits they can make heading south to the USA. Maybe once this happens some US docs can come north and help out haha.

[@JyyTv.]

This video scared me as an upcoming EM Physician but i’m still going to pursue my dreams!!! May the odds be in their will.!

[@nyxqd1290]

Fortunately for me, the kind of pathologist I want to be has the ultimate job security: forensic pathology. Not only does the work disgust and disturb most people, but as far as I know robots are currently incapable of conducting an autopsy. Sure, AI might help to interpret my slides someday, but some human still has to do the dissecting and inspecting. Can’t wait until it’s me.

[@charlesparent8850]

Not only is the growth of MLPs hurting some physicians its devastating nursing. 80% of my nursing cohort planned on going back to school and leaving the bedside last year. Health care administration and the Ivory Towers of nursing fail to see that the cheaper and expanded scope nursing pros are making bedside nursing into a short staffed hellscape. This will only put more pressure on bedside RNs to leave the field.

[@zackarywiggins3175]

I’m in nursing school now and plan on going to NP school later on. One thing that isn’t really discussed is how together NPs and PAs can help with the horrible physician shortage in the US. Also one thing that is assumed is that NPs are going to try to do everything themselves. If you go to a Primary care doctor and they don’t have the answer or it needs a specialist, they’re going to send you to one. Same with NPs. If your case is too complex or above their scope of practice, they’re going to send you to a specialist. They’re not going to (or should know better not to) try to treat it themselves. We’re all in this together. Doctors, NPs, and PAs are all important to make sure everyone has access to healthcare. We shouldn’t be trying to tear each other down.

[@MedSchoolInsiders]

Absolutely and this is how it should be! We are proponents of physician led care and the appropriate scope of practice for each provider. The issue we see is when the groups for certain professions push hard for equal scope of practice and argue they are equally qualified (dunning kruger).

[@ZyNeEnZyNe]

@@MedSchoolInsiders Sucks to the see the US system is such a mess. Here in the UK, it's getting worse too. We have physicians assistants playing doctor and introducing themselves as medical students, nurses doing TAVIs, radiographers reporting a bunch of nonsense from scans etc. The rise of the noctor is a dangerous one indeed

[@tenhauser]

My NP program (arguably the best public program in the state) is teaching about NP independence as a necessary thing due to problems with healthcare access, which seems kind if backwards if mid levels are encroaching on even existing physician jobs.

[@caleb3781]

Yep, they claim that mid-level's will improve and increase quality care to more rual areas. But it's hilarious because that's not even what's happening, NP students want to work in big cities, and guess what, hospital administrators are letting them since they're cheaper lol.

[@vann0911-uwu]

@@caleb3781 It is that the truth is that all of you are very selfish, you treat nurses very hard in the comments. A nurse will obviously aim to live in the big cities because we get paid decently, it's not at all fair that we want to fulfill our dream of helping others in the more remote areas and earn the same as a mcdonalds cashier if we stay there. A McDonald's cashier, can you believe it? Hundreds of late nights studying and we aspire to not earn enough. It's one thing to "do things by vocation" and another to starve to death because we can't pay the thousands of debts we have. I hope you think a little more before commenting, everyone already treats nurses like shit, and we nurses don't even get paid that well ;_; we only go to the big cities to earn a salary that allows us to live at least a little more peacefully ;-;

[@mo7mdalmutairi]

Great video thank you 🙏 Please make a video of MOST IN DEMAND SPECIALTIES. And please make sure into subspecialties especially in IM as they are very different from a hospitalist job opportunities

[@Nyesafah]

I would love an updated version of this. Curious to know what the numbers are now

[@BedrockPorkchop]

Great video Doc! As an incoming OMS I’ve been doing tons of research into job safety for future specialities. Hopefully physicians can gather together and lobby against independent practice as that seems like the only avenue to protect patients and their outcomes.

[@joshb2686]

There will be blowback eventually. Anyone with any common sense understands midlevels are overreaching.

[@RideBound]

@@joshb2686 I don't think this is the case. for several reasons. First, greedy doctors have come to love midlevels because they can bill under their own name, pay the NPs less than the insurance compensation, and scalp the difference. Scale this up and you're raking it in. A reasonable limit on the number of NPS a physician can oversee is crucial. Second, patients are rarely aware of the difference. In my practice, the patients refer to the NPs as Dr. even though the NPs clearly introduce themselves as Nurses. additionally, hospital systems love them for the reasons listed in this video- cost. If they can bill under the physician for midlevel care they don't give a rats ass. lastly, the NP lobby is extremely organized and politician are stupid. AOA has been doing a good job to anti-lobby, but AMA can do more imo.

[@joshb2686]

@@RideBound ohhh it will never go back to what it was. Patients will get hurt and there will be some regression though

[@hi2978]

@@RideBound NPs never refer to themselves as nurses lol in my hospital (I work as a CNA) every NP introduces themselves as Provider/Doctor and nothing else.

[@Ai-Future]

What is your opinion concerning family,pedriatic and internal medicine?

[@lukasloh2509]

As non-American, I just learned right now that US healthcare system is indeed so complicated with mid level professions. There’s NP and PA. And there’s DO. In our country, It is just assistant, nurse, and MD. But in the US, NP can perform certain duties as what doctors do. So as the PA.

[@08ranaiu]

In the US, DOs are not mid-level but equal to MDs

[@MrSmithphil95]

I'm a PA student and I worked with a NP student who couldn't even read an EKG and was a few months from graduating. It frustrates me that PA training is routinely considered to be equivocal to NP training when this is totally not the case. PAs learn under the medical model and NPs learn under the nursing model. Our profession was literally created BY A DOCTOR, yes that's right, look it up. No, I don't want to practice independently and the vast majority of my classmates feel that way too. For all the MD students and residents, please don't treat your fellow PAs like crap when we are here to help you in your practice.

[@rotisseriechicken959]

i'm a nurse and i've seen practicing MDs and PAs who are completely clueless about EKG. One PA was trying to give adenosine to a tachycardic patient trying to compensate for sepsis, simply to "treat tachycardia". An MD kept ordering pain meds to my friend's grandma for a hip pain, not until she went to an NP who actually listened and diagnosed her with a bone cancer! My point is, there's always outliers, and generalizing a profession based on one personal experience is completely ignorant.

[@pspdslite5991]

Your just a PA, chill out.

[@protectork9831]

Now you know how MD feel .

[@Veteran365]

Incompetence finds itself in all professions.

[@lg3689]

Bro please unless you are a PA that works in a cardiology group besides obvious abnormal rhythms you know for a fact you lack the knowledge to comprehensively read an ECG that is why you consult a cardiologist.

[@nishantgogna270]

What are your thoughts on Direct Primary Care? I'd love to see a video on that.

[@zachjones6944]

Personally, It think is a great idea. My buddy quit Emergency Medicine and know works cash-only.

[@DBasedAlex]

It’s shocking how many states allow for independent mid-level providers

[@westfield90]

Of course I don’t mean to broad brush everyone, but recently developed sudden hearing loss in one ear. At the ER, the NP took a quick look in the ear and was ready to send me home after blood work came out ok. I had to request a CT and steroids which thankfully the doctor prescribed. Then next day I went to ENT specialist and the PA had no clue what a patulous Eustachian tube was. Once again thankfully the doctor explained this to her and took care of me. But my confidence was shaken by my experience with these non MD specialties. I think moving forward you have to be your own advocate and become informed.

[@janfellow7455]

This has some useful information, but far too much opinion. Since you didn’t complete residency and aren’t a practicing physician this is largely anecdotal…furthermore, as word of mouth, from what you’ve heard from your friends - as you put it.

[@sej4633]

I love the amount of research that is put behind each of your videos, good job,!

[@eliasali9383]

I thought diagnostic radiology would be at the top of the list

[@911Ranger1]

I've seen critical care docs worrying about mid-level encroachment in the ICU, any comments on that?

[@futureDrNLB]

The reason most of these people are not finding jobs is because they don’t want to serve in certain communities “Undesirable Locations” smh and people like me just want to serve but are required to leap through so many hoops it makes you want to give up but I will not.

[@amp9672]

Can’t believe radiologist made the “safe list”. My father is one and he went from being the most active and needed doctor of the hospital, constantly consulted by his colleagues for his knowledge, from probably the least needed. He says AI basically replaced him in 30 years and tbh he scrolls on fb all day long and is pretty depressed at work.

[@lonewolf604]

This is scary to hear because EM is my number one choice currently (although maybe its a tad different in Canada, future vid perhaps?

[@prettypurplepolishes]

I feel like a lot of science PhDs entered undergrad wanting to go to med school. I’d love to hear your thoughts on a PhD as an alternative to med/PA/NP/pharmacy/dental school as well as the job outlook and pros and cons of pursuing both industry and academia

[@abby3494]

As a science BSN who planned on doing an MD/PhD combined program, but stayed to do a PhD under her undergrad research advisor with the intention of getting a PhD and then going to medical school, I can tell you from my personal experience as a PhD candidate that’s been with my department for 4 years now, most of our students take >5years to complete their degrees and most are disheartened by the job offers they can get from academia. Many have dropped out to redirect their career goals as they are realizing a PhD will not get them a job that they want. The “prestige” is not at all worth the pay or work/life balance for most and even the most qualified PhDs are struggling to find tenure track positions after their post-docs, being forced to jump from post-doc to post-doc to try to build their resume and ultimately leaving the field all together or entering industry. If you do get a STEM PhD, I would highly recommend building niche skills or getting very good at coding while you complete your PhD so you can get a nice industry job and work reasonable hours for decent pay. After working many many hours for practically no pay and realizing that mid level practitioners have more patient interaction, I have reconsidered my drive to enter the medical field as an MD/PhD and plan on entering nursing school after I defend. I would highly recommend you evaluate what you want out of your career: income, amount of schooling, career growth, flexibility, level of patient interaction, teamwork, independence, work-life balance etc. and decide which factors matter most to you. For me, I am tired of working a lot (60+ hours) for little pay (less than (30k) a year and I am no longer interested in going through residency and beyond working the same if not greater hours. I value work-life balance and patient interaction most. This is also why I’ve decided an industry position doing bioinformatics is not for me. I like people and while this job offers a great work life balance- I am an extrovert and miss interacting with people. While this is just one perspective, I hope this gives you some insight as you think about what it is that you want.

[@prettypurplepolishes]

@@abby3494 I consider myself to be a highly introverted person and am only interested in industry. I would be most interested in studying immunology or microbiology and then working in medical or regulatory affairs in the pharmaceutical industry. I realized after working as a pharmacy technician that patient care and interaction is not something I am passionate about- at least, not as much as science and pharmacy alone. Thank you for your feedback!!

[@prescilia23]

Love your channel! Can you talk more about the dental field?

[@udaynj]

I would say cardiac surgeons are being encroached on by cardiologists in the field of stents. A cardiologist with no surgical training can do the vast majority of procedures which since they need stents vs surgery before stents were invented. Cardiac surgeons can’t place stents. Guess the cardiologist lobby is bigger and stronger than thatnof cardiac surgeons.

[@rosemaryaaberg6311]

Hi! I am in the nursing field and I want to talk about midlevels. Where I live NPs are often treated as primary care providers who practice independently. I think the reason that this model is able to be successful is simply a difference in culture. I know that in the United States there is currently a culture of pushing undergraduate nursing students towards graduate school pretty much as soon as they finish their first degree, often in response to the physician shortage. This isn't the case where I am - the NP qualification is for RNs who have held their designation for many years and have the tens of thousands of clinical experience needed to actually provide primary care safely. You have to have worked as an RN, specifically in a more medically intensive field such as the ER, ICU, or OR to even qualify for entry into the programs. I wish it could be different in other places because while I know one of the issues with the NP qualification is that it takes away from the number of RNs, the NPs I've worked with have all been amazing and knowledgeable, and have truly provided amazing care to their patients. EDIT: I forgot to mention this, but nurse anesthetists do not practice where I live which I believe is also a contributing factor to the culture difference.

[@cm2973]

Regarding EM. We HAVE to stop approving EM residencies. We need to reform the ACGME process to stop HCA hospitals from creating more residency slots specifically to drive down labor costs.

[@Quid_est_viratas]

Good thing I just matched EM…only 2/3 problems

[@Lawlesslarry69]

High turnover rate. I used to be a ER scribe, most of the docs were over the age of 60. The few younger docs switched specialties. This is in Berkshire Massachusetts.

[@ForsakenForWhat]

@@Lawlesslarry69 Did you ask them why?

[@Lawlesslarry69]

@@ForsakenForWhat yes, high burnout.

[@tarheelblue23198]

Thanks for your insight!

[@kaz128]

I'm a pharmacist working per diem at Walgreens and a hospital in my area while in medical school. Right now I am an OMSII and looking to go into EM. Initially I wanted to run from EM because of midlevel encroachment but in practice there's no substitute for a physician. The amount of mistakes I see from NP/PA's is crazy high and once hospitals see that they actually don't save money they'll stop utilizing them at the rate they are now. My wife is an ultrasound tech and gets tons of orders from NP/PA that are not indicated given symptoms and are just ordered as a shot in the dark. I'm not trying to bad mouth NP/PA's either, it's just you don't know what you don't know... I figured this out once I left pharmacy for medical school and was shocked at the volume and detail you needed to know. The other issue is all the NP's that seem to go straight to NP school while having close to no clinical experience. Everyone wants to play doctor but no one wants to go to medical school and actually become a physician.

[@daddy3484]

Just wait until you’re actually practicing. Academia is nothing like actual clinical practice.

[@swimmingviolin29]

Anesthesiologists oversee CRNAs AND AAs. (Anesthesiologist assistants) They often get forgotten about, but they are essentially the PA version of a CRNA and equal and interchangable within the context of the care-team model. Both are great physician extenders, but AAs will never try to gain independent practice, as we were brought up in medical model like PAs, and enjoy working with physicians as a backbone.

[@tezz5702]

If you think bout it doctors had done terribly as a group, as individuals they fought back many diseases once thought to be untreatable, as a group doctors are lossing practically every single battle to protect the field of medicine.

[@daelcart1947]

That's a more American problem then doctors in general. But America has amazing surgeons. It's the push to try and make other carriers as similar to doctors as possible that messes things up. As well as rge fact doctors aren't allowed to see patients for long times.

[@nosheenhussain5384]

That because doctor dont have a union, and are not in administrations and political positions and lastly medical school teaches their students to compete with each other not work together. As a result individually doctors have become weak!

[@cruzan8183]

I am an anesthesiologist and I throughly enjoy my job. At this point there’s strong demand for anesthesiologists. Select the specialty that you love and the rest will fall into place.

[@brianmack6040]

As am I. The data presented here about our specialty is just wrong. There is a dire need for anesthesia services and HUGE demand. Our salaries have risen quickly and there is no resolution of the problem in the foreseeable future

[@bluemortem6232]

A good portion of the mentioned states, still require a year or two of post graduation experience before independently operating. The clinical hours during school are about 1500 as stated, but vast majority will be required to have a bout 2 years of acute care experience before being granted the ability to open practices. I don’t believe it is on the list, but I know Florida operates this way.

[@alexandera3482]

People who don’t use AI think of it as a replacement for some doctors, while those of us who use it acknowledge that it is a tool

[@WorldwideScents]

So becoming a pathologist is safe right?

[@savannahmetzger3069]

9:07 NO A.I. should ever be “given” the lead in any medical specialty due to the fact that human beings are better at detecting + determining treatments personally tailored around complex medical nuances’ upon physical patient presentation, in MOST situations. Although, this topic could be arguable with certain specialties as they STRICTLY orbit around heavy reliance on technology for diagnostic purposes such as “diagnostic imaging,” prior to treatment. I personally believe A.I. use in the medical field should mainly be used as a first or second assist only to that of the specialist of a given field. Thoughts?? Share your thoughts on this topic with me!😊🤔💭

[@imanamatullah2378]

In my opinion, NP’s should only be allowed to practice autonomously as General Practitioners/Primary Care in underserved communities if no doctors are willing to practice there. Anything above primary care in my opinion is too risky.

[@hi2978]

they dont go to rural areas tho, they all want to go to urban cities. Check the stats, this argument isn't based in reality.

[@lukeriordan5877]

Primary care is also extremely complicated and requires a vast fund of knowledge

[@sarahb7626]

Primary care is just as important as specialties. Family medicine, internal medicine, and pediatrics have to know enough about every organ system to diagnose and treat a myriad of conditions, and also know when it's time to refer if typical treatments fail or the disease is more complicated, like getting diagnosed with cancer. Primary care physicians know when it's best to either manage a condition themselves or when to refer. But the problem with NPs is that they don't know what they don't know. They go through 1/10 of the rigor and training of a physician and are constantly told they know just as much, or even more, than physicians. So you have NPs harming patients or improperly prescribing/referring/testing all over the place and patients don't know any better. The poorest and most vulnerable should not be given lower care. In addition, for all the lobbying by NP groups stating that they will go and help the poorest communities, it almost never happens. Most stay in larger cities.

[@selinama9270]

Hey Dr. Jubbal, when you say emergency medicine, does that include trauma surgeons as well

[@MedSchoolInsiders]

I usually separate the two when I mention them and refer to EM doctors as their own entity from trauma surgeons

[@rsjunior05]

What are your thoughts about psychiatric on the next years?

[@mo.sharif1]

I'd say it's a growing field and psychiatrists are only going to become more important as time goes by. This is because mental health is becoming less taboo and more accepted nowadays.

[@rsjunior05]

@@mo.sharif1 I agree. Getting a residency spot is becoming more challenging, especially for a Non-Us IMG like me.

[@joseaguirre9389]

I’m genuinely worried.. I am an MRI Technologist, and I really wanted to get into a Radiology program with a fellowship in IR, but it would be unfortunate if the demand tanks due to increased efficiency from AI :(

[@zed3063]

They call physician assistants “physician associates” in the UK which has muddied the waters even more. Most patients and interestingly lots of other healthcare professionals have no idea that they’re not doctors.

[@boybiboy21]

NP on a rural ER here, would never wish responsibilities of an independent practitioner esp in a hospital setting… ever, 100% good with having MD/DO supervision

[@malikaalibdat7079]

I feel like he discussed every specialty I’ve pondered on. What is there left???

[@2charlin]

Maybe it’s a case of hospitals being stingey with staffing because in my large city, the ER is frequently reaching like 8 hours

[@adams303]

Wow I can’t believe anaesthetists in the US have allowed this encroachment of nurses into practice.

[@melissabalvastro7002]

They have been practicing anesthesia since the 1800’s though, so it’s not that surprising.

[@adams303]

@@melissabalvastro7002 yeah but it’s a medical specialty, at least in the UK and Australia. The exams are some of the hardest around. I don’t think I’d be comfortable with a nurse anaesthetist.

[@kandttv1454]

Nurses were the first people to practice anesthesia in the civil war. It’s nothing new. 300k for 50 hours a week and being as safe and capable is fine by me. The problem is ego comes in and a sunken cost fallacy. “How dare there demand the same social respect as me as a DOCTOR!!” Call me whatever you want but social respect comes from money. Social respect is the house and car and clothes and lifestyle. People are just angry there is an easier option to get the same result. If CRNAs were more dangerous and killing people more than doctors it would be all over the news.

[@rebeccabeniamen487]

@@kandttv1454 i’ve been looking for a comment explaining exactly this! The ASA is putting so much money into tarnishing the reputation of CRNAs with research on their patient outcomes that if there was substantial evidence of any difference it would be broadcasted like crazy.

[@adventureswithbranisha8511]

This is scary to know when all I ever wanted to be was a anesthesiologist and thinking that I would give me job security. I guess I have plenty of time to change my specialty 😕 I should have watch this because I feel like all it did was get in my head. I know what it’s like to not have job security after spending time in school and going to MED school to no have job security is beyond scary