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Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD


Long-term job prospects for ER doctors
Medical specialties in jeopardy

Smiling ER doctor . . . actually, a model portraying one, of course!
ER doctors have reason to smile!

Q: What are the long-term job prospects for ER doctors?

Answer by , MD: This is one of the bright spots for people who aspire to be ER doctors. The number of people treated in emergency rooms each year rises at a rate exceeding the overall population increase, thus creating an increasing demand for the services of ER doctors. Furthermore, there is currently a shortage of trained emergency physicians, and ER residency programs are not graduating enough doctors to erase this physician deficit in the near future. Therefore, any ER doctor can find work.

At one time the notion of an unemployed doctor was unthinkable, but it isn't any longer. Technology has enabled hospitals to outsource some physician jobs to other countries (notably India) for specialties such as pathology and radiology. For example, the Homepage of the Committee for Improvement in the Pathology Job Market indicates that the job prospects for new pathologists is dismal. You will not have this worry as an ER doctor. If someone needs an ER doctor, he needs a doctor physically present—not thousands of miles away on another continent.

Besides pathology and radiology, another medical specialty in jeopardy is psychiatry. According to Scientific American Mind (Volume 16, Number 1), initial tests of therapy conducted over a telephone have shown encouraging results. Conceivably, future sessions with psychiatrists, psychologists, and other therapists may be conducted over standard telephones and even Internet telephones (VOIP, or Voice Over IP). Once this occurs, it is only a matter of time until distraught housewives in Omaha are discussing their innermost secrets with psychiatrists in Bombay, India.

The impetus behind this outsourcing is not who delivers better care, but who is willing to work the cheapest. Politicians could end this medical offshore outsourcing in a heartbeat, but they won't. Their primary concern is saving money, not the jobs of American doctors. Politicians have given the green light to other practitioners who now perform tasks that were once the sole province of doctors. Thus, American physicians have seen their territory eroded by Nurse Practitioners, Physician Assistants, optometrists, psychologists, and now medical doctors in faraway lands. If there were doctors on Mars, and if they'd work for less than doctors in India, you can bet that they would get a piece of the pie, too.

Surgeon with mask
American surgeons will
increasingly lose patients
to medical outsourcing.

The Internet and other technological advances are bound to affect several specialties. Consider robotic surgery, for example. This can be performed by a surgeon who sits at a console several feet away from the patient, so it could be directed by a surgeon thousands of miles away. Before choosing a medical specialty, and even before you decide to attend medical school, you should carefully attempt to decide whether your intended specialty is one that could be performed by doctors in other countries using existing technology, or technology that is just around the corner. Those doctors will increasingly take business away from American doctors, and doctors in other First World countries who won't work for $20,000 per year, as the docs in India are happy to do. Just try repaying your student loans with that income!

Related articles

1. Doctor competition: Medical outsourcing and fringe practitioners (I had fun creating the mock magazine cover :-)
2. The pros and cons of specializing in surgery

UPDATE: Medicine just became a much more desirable profession, thanks to the economic crash that devastated our economy in 2008. The profession of medicine offers one thing—job security—that is nice in good times but as precious as gold in bad times. I needn't remind you that things are bad now, and almost certain to get much worse (if you doubt that, read this). When times change, it is important to change with the times. I've used a lot of ink warning students in the past about the drawbacks of a medical career, and all of those reasons were quite valid. The cons are still there, but the list of pros just mushroomed in importance thanks to the inherent job security in most medical careers. Good luck trying to find another career that offers comparable job security.

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