says, right?

說，對嗎？

“There will always be more patients that need doctors than there are doctors,” they

"需要醫生的病人永遠多於醫生，"他們說。

say.

說。

Well, this might not be the case anymore for some specialties.

那麼，對於某些專業來說，情況可能不再是這樣了。

Dr. Jubbal, MedSchoolInsiders.com.

Jubbal博士，MedSchoolInsiders.com。

The AAMC estimates that by the year 2034, we will experience a shortage of between 38,000

美國醫學會估計，到2034年，我們將經歷38,000人的短缺。

and 124,000 physicians; however, these shortages are not uniform across all specialties.

和12.4萬名醫生；然而，這些短缺在所有專業中並不一致。

Although fields such as primary care will likely continue to be in high demand for the

儘管像初級保健這樣的領域可能會繼續有很高的需求。

foreseeable future, the future is not so certain for others.

在可預見的未來，其他人的未來就不那麼確定了。

With issues like oversaturation, mid-level encroachment, and advancements in artificial

隨著過度飽和、中層侵佔和人工智能的進步等問題的出現，我們的工作變得越來越重要。

intelligence, the livelihoods of some specialties are not as secure as you might think.

情報，一些專業的生計並不像你想象的那樣安全。

Here are the doctor specialties that are most at risk.

以下是風險最大的醫生專業。

The first issue is oversaturation.

第一個問題是飽和度過高。

Due to concerns regarding future physician shortages, there have been large expansions

由於對未來醫生短缺的擔憂，出現了大規模的擴張。

in the number of first-year medical school positions over the last couple of decades.

在過去的幾十年裡，醫學院第一年的職位數量增加。

Since 2002, there has been an increase in allopathic medical school first-year enrollment

自2002年以來，全科醫學院第一年的招生人數一直在增加

from approximately 16,000 positions to over 22,000 positions - an increase of nearly 30%.

從大約16,000個職位到22,000多個職位--增加了近30%。

New osteopathic colleges and expansion of existing schools have also increased the number

新的骨科學院和現有學校的擴建也增加了數量。

of first-year DO students from approximately 5,000 in 2002 to now over 8,000.

第一年的DO學生從2002年的大約5000人增加到現在的8000多人。

These increases in medical school capacity have been accompanied by expansions in many

伴隨著醫學院容量的增加，許多學校也在不斷擴大。

residency programs as well, albeit to a much lesser extent.

駐地計劃也是如此，儘管程度要小得多。

Although this is good news for addressing physician shortages in some fields, it is

儘管這對解決某些領域的醫生短缺問題是個好消息，但它是

also creating issues in others.

也在其他方面造成了問題。

There are now some specialties that are training too many physicians and, as a result, it’s

現在有一些專業培養了太多的醫生，是以，它是

becoming increasingly difficult for physicians in these specialties to find a job.

這些專業的醫生越來越難找到工作。

In radiation oncology, for instance, the number of positions offered annually in the match

例如，在放射腫瘤學方面，每年提供的匹配職位的數量

increased by 227% between 2001 and 2019.

2001年至2019年期間增加了227%。

Additionally, advancements in technology and our understanding of cancer biology have allowed

此外，技術的進步和我們對癌症生物學的理解，使我們能夠

radiation oncologists to offer more effective therapies in fewer treatments than before.

放射性腫瘤學家可以在比以前更少的治療中提供更有效的療法。

As a result, the number of radiation oncologists entering the field is now higher than the

是以，現在進入該領域的放射腫瘤學家的數量高於其他國家。

demand and many new grads are reporting difficulties finding jobs after residency.

需求，而且許多新畢業的學生報告說，在住院治療後很難找到工作。

One radiation oncologist reported applying to over 50 jobs across the country and was

一位放射腫瘤學家報告說，他在全國範圍內申請了50多份工作，並被

only able to get interviews at three - all in undesirable locations.

只在三個地方得到了面試機會--都在不理想的地方。

It will only get harder for new grads to find desirable jobs out of residency too as they

新畢業的學生也會越來越難找到理想的工作，因為他們

will not only have to compete against their peers but also more experienced radiation

他們不僅要與同齡人競爭，還要與更有經驗的輻射者競爭。

oncologists.

腫瘤科醫生。

If the discrepancy between supply and demand continues, radiation oncologists will experience

如果供應和需求之間的差異繼續存在，放射腫瘤學家將經歷

further tightening of jobs and downward pressure on pay.

工作崗位進一步收緊，薪酬面臨下調壓力。

Plastic surgery is another specialty that is at risk of oversaturation - specifically

整形外科是另一個面臨過度飽和風險的專業--特別是

in aesthetics.

在美學方面。

Although the demand for cosmetic procedures has generally been increasing year over year,

雖然對整容手術的需求總體上逐年增加。

plastic surgeons are starting to face increased competition from non-plastic surgeons.

整形外科醫生開始面臨來自非整形外科醫生的更多競爭。

There are many non-plastic surgeon physicians and mid-levels who want a piece of the action

有許多非整形外科醫生和中層人士想分一杯羹。

and attend weekend workshops to learn how to do botox, filler, liposuction, and even

並參加週末研討會，學習如何做肉毒桿菌、填充劑、吸脂，甚至是

some surgical procedures.

一些外科手術。

This is what leads to dangerous and life-altering complications, like when an OBGYN does a tummy

這就是導致危險和改變生命的併發症的原因，比如當婦產科醫生做腹部手術時

tuck and the patient develops necrotizing fasciitis, also known as flesh-eating bacteria,

tuck，病人出現壞死性筋膜炎，也被稱為食肉菌。

or when an ENT-trained facial plastic surgeon does a thigh lift with similarly devastating

或者當一個接受過耳鼻喉科培訓的面部整形外科醫生在做大腿提升手術時，也有類似的破壞性。

complications.

複雜情況。

Greed is driving many non-qualified practitioners to want a piece of the aesthetic pie, and

貪婪驅使許多不合格的從業者想從審美的蛋糕中分一杯羹，而

it’s a major patient safety issue.

這是一個重大的病人安全問題。

After a botched job, the patient comes to an actual board-certified plastic surgeon

在一次失敗的工作後，病人來到一個真正的委員會認證的整形外科醫生那裡。

to fix the damage, but many of these complications result in lifelong issues that are impossible

以修復損害，但許多這些併發症導致了終身的問題，是不可能的。

to entirely reverse.

到完全逆轉。

I’ve heard too many of these stories from my plastic surgeon friends and colleagues

我已經從我的整形外科醫生朋友和同事那裡聽到了太多這樣的故事

that I’ve now lost count.

我現在已經數不清了。

There’s a reason why plastic surgeons spend 6 or more years in training to perfect the

整形外科醫生花6年或更長時間進行培訓，以完善他們的工作，這是一個原因。

nuances of these surgical and non-surgical procedures.

這些手術和非手術程序的細微差別。

They are far more qualified and perform these various procedures more effectively and far

他們更有資格，更有效地執行這些不同的程序，並遠

more safely.

更加安全。

However, it comes down to a marketing issue.

然而，這歸結為一個營銷問題。

Patients should seek properly trained plastic surgeons who are certified by the American

患者應尋求經過適當培訓的整形外科醫生，這些醫生得到了美國政府的認證。

Board of Plastic Surgery, which is a member of the American Board of Medical Specialties.

整形外科委員會，該委員會是美國醫學專業委員會的成員。

There are several other similar-sounding organizations that are not recognized by the American Board

還有其他幾個聽起來很相似的組織，但不被美國委員會所承認

of Medical Specialties that are deceiving uninformed patients.

欺騙不知情的病人的醫學專業。

As it stands now, the aesthetic market is becoming oversaturated, and only through concerted

就目前情況而言，審美市場正在變得過度飽和，只有通過協調的

efforts to educate the public will plastic surgeons be able to effectively advocate for

在教育公眾的努力下，整形外科醫生將能夠有效地倡導

patient safety and reclaim volume.

病人安全和回收量。

Perhaps the most surprising specialty at risk for oversaturation is emergency medicine.

也許最令人驚訝的面臨過度飽和風險的專業是急救醫學。

Although emergency medicine physicians have been integral during the pandemic, many new

雖然急診科醫生在大流行期間是不可或缺的，但許多新的

EM doctors are reporting difficulty finding jobs.

急診科醫生報告說難以找到工作。

A lot of you have asked me to elaborate on EM’s job prospects.

你們中的很多人都要求我詳細說明EM的就業前景。

If you feel heard right now, let me know with a thumbs up.

如果你現在覺得被聽到了，請用大拇指告訴我。

And if you want more content like this, make sure you’re subscribed.

如果你想獲得更多這樣的內容，請確保你已訂閱。

The number of accredited emergency medicine programs has nearly doubled over the last

在過去的幾年裡，經認證的急診醫學項目的數量幾乎翻了一番。

15 years, going from 133 in 2005 to 265 in 2019.

15年來，從2005年的133人到2019年的265人。

As a result, the demand for EM physicians is not increasing fast enough to keep up with

是以，對EM醫生的需求增長速度不足以跟上

the amount of new doctors entering the field.

進入該領域的新醫生的數量。

Surprisingly, the coronavirus pandemic has only added to this issue.

令人驚訝的是，冠狀病毒的大流行只是增加了這個問題。

In many areas of the country, emergency departments experienced significant decreases in patient

在該國的許多地區，急診科的病人明顯減少。

volumes during the pandemic.

大流行期間的數量。

Many people were avoiding hospitals for fear of contracting COVID-19.

許多人因為害怕感染COVID-19而躲避醫院。

The transition to remote learning and work from home also meant that fewer people were

向遠程學習和在家工作的過渡也意味著更少的人在

leaving the house, leading to fewer accidents.

離開房子，導致更少的事故。

Many emergency departments were even forced to close their doors due to a lack of inpatient

由於缺乏住院病人，許多急診科甚至被迫關門。

beds on overrun hospital floors.

在醫院超負荷運轉的樓層中的床位。

Some emergency departments reported as much as a 40% decrease in patient volume early

一些急診科報告說，早期病人數量減少了40%之多。

in the pandemic and some continue to be down as much as 20% compared to pre-pandemic patient

在這一流行病中，一些人繼續與流行病前的病人相比下降多達20%。

volumes.

量。

This is a big issue as patient volume matters a lot more in emergency medicine than it does

這是一個大問題，因為病人數量在急診醫學中比它重要得多。

in other specialties.

在其他專業領域。

There aren’t as many high-cost procedures in emergency medicine, so EM physicians rely

急診科沒有那麼多高成本的手術，所以急診科醫生依靠的是

on seeing a high volume of patients as opposed to seeing just a few complicated ones.

與只看少數複雜的病人相比，他們要看大量的病人。

It’s also very expensive to keep an emergency department open all day, every day, and have

保持急診科全天開放也是非常昂貴的，而且要有

the necessary staffing and resources.

必要的人員配置和資源。

Since physicians are the highest-paid members of the medical team, hospitals are incentivized

由於醫生是醫療團隊中收入最高的成員，醫院被激勵著

to stretch each physician as far as they can.

儘可能地擴大每個醫生的範圍。

This brings me to the next risk category.

這讓我想到下一個風險類別。

The growth of mid-level providers such as nurse practitioners, physician assistants,

中級提供者的增長，如執業護士、醫生助理。

and CRNAs has exploded compared to physicians and many specialties are now at risk of mid-level

與醫生相比，CRNA的人數已經爆炸性增長，許多專業現在都面臨著中級職稱的風險。

encroachment.

侵佔。

Between 2016 and 2019 alone, there was a 34% increase in the number of employed nurse practitioners.

僅在2016年至2019年期間，受僱的執業護士人數就增加了34%。

At that rate, students starting medical school this year can expect over a quarter of a million

按照這個速度，今年開始上醫學院的學生可以期待超過25萬個

more nurse practitioners to be employed by the time that they graduate.

更多的執業護士在畢業時將被僱用。

In addition, many mid-levels are lobbying for independent practice so that they can

此外，許多中層人士正在為獨立執業進行遊說，以便他們能夠

practice without a supervising physician.

在沒有指導醫生的情況下進行實踐。

As of August 2021, 24 states have granted independent practice to nurse practitioners

截至2021年8月，已有24個州授予執業護士獨立執業權

and this number is likely to continue to increase over the coming years.

而且這個數字在未來幾年可能會繼續增加。

Many physicians are strongly opposed to this due to the difference in training and experience

由於培訓和經驗的不同，許多醫生強烈反對。

between mid-levels and physicians.

在中層人員和醫生之間。

For instance, a doctor that is fresh out of residency has more than 15,000 to 20,000 hours

例如，一個剛從住院醫生那裡出來的醫生有超過15,000至20,000小時的時間

of clinical training.

的臨床培訓。

At the point of certification, a new nurse practitioner only has less than one-tenth

在獲得認證時，新的護士執業者只有不到十分之一的時間。

of that at between 500 and 1,500 hours of clinical training.

其中在500至1500小時的臨床培訓。

Although that level of training may be sufficient to handle much of the bread and butter straightforward

儘管這種水準的培訓可能足以處理許多直接的麵包和黃油問題。

cases, things can quickly become dangerous without the greater expertise of a supervising

的情況下，如果沒有監督者的更多專業知識，事情會很快變得危險。

physician.

醫生。

While mid-levels are great physician extenders working alongside them, they are certainly

雖然中層是偉大的醫生擴展者與他們一起工作，但他們肯定是

not a replacement for physicians, and treating them as such is an issue of patient safety.

不是醫生的替代品，把他們作為醫生對待是一個病人安全的問題。

Emergency medicine is one of the specialties at higher risk for mid-level encroachment.

急診醫學是中層人員侵佔風險較高的專業之一。

Mid-levels are often utilized to decrease costs by extending each physician.

通常利用中級醫生來減少成本，延長每個醫生的時間。

Now instead of needing four doctors to see one-hundred patients, they may be able to

現在，他們可能不再需要四個醫生看一百個病人，而是能夠

have 2 doctors and 2-3 mid-levels instead.

有2名醫生和2-3名中層人員代替。

We are already starting to see the effects of this with increasing numbers of mid-level

我們已經開始看到這種情況的影響，越來越多的中層人員被解僱。

providers in the ED.

在急診室的提供者。

Between 2012 and 2018, the total growth and use of nurse practitioners and physician assistants

在2012年至2018年期間，執業護士和醫生助理的總增長和使用情況

in the ED increased by 66% – and this trend is likely to continue.

在急診室的病人增加了66%--而且這一趨勢可能會繼續下去。

Mid-level encroachment into the field of anesthesiology is also a growing concern.

中層人員對麻醉學領域的侵佔也是一個日益嚴重的問題。

Many hospitals are now adopting an anesthesia care team model whereby an MD anesthesiologist

許多醫院現在都採用了麻醉護理團隊的模式，即由一名醫學博士麻醉師

simultaneously supervises multiple CRNAs - each in a different operating room.

同時監督多個CRNAs - 每個人都在不同的手術室。

This has raised concerns of decreasing employment opportunities for anesthesiologists as each

這引起了人們對麻醉師就業機會減少的擔憂，因為每一個

anesthesiologist is stretched further by overseeing multiple mid-level providers.

麻醉師通過監督多箇中級醫療服務提供者而被進一步拉伸。

Similarly, plastic surgery and dermatology are at moderate risk for mid-level encroachment

同樣地，整形外科和皮膚科也有中度侵佔的風險

- particularly in aesthetics.

- 特別是在美學方面。

With more states allowing independent practice for mid-levels, many are opening their own

隨著越來越多的州允許中層人員獨立執業，許多人正在開設自己的

medical spas and performing minor cosmetic procedures.

醫學水療中心和進行小型美容手術。

Although dermatologists and plastic surgeons are better trained and qualified to perform

雖然皮膚科醫生和整形外科醫生受過更好的培訓，有資格進行

these procedures, and discerning patients will understand this, mid-level run practices

這些程序，明察秋毫的病人會明白這一點，中層的運行實踐

are often able to charge less for their services.

往往能夠對他們的服務收取較低的費用。

Over the coming years, without a concerted effort to inform patients about safety, we

在未來的幾年裡，如果沒有一致的努力讓患者瞭解安全問題，我們將

are likely to see further mid-level encroachment.

可能會看到進一步的中層侵佔。

That being said, there are many specialties that are relatively resistant to mid-level

也就是說，有許多專業對中層人員的抵抗力相對較強。

encroachment.

侵佔。

For instance, surgical specialties tend to be on the safer side of the spectrum as mid-levels

例如，外科專業的中層人員往往比較安全。

are typically limited to first assist in the operating room.

通常只限於在手術室裡做第一助手。

While some mid-levels may experience a strong Dunning-Kruger effect with regards to anesthesia,

雖然一些中層人員在麻醉方面可能會出現強烈的鄧寧-克魯格效應。

emergency medicine, or in other clinical settings, you’ll be hard-pressed to find one that

在急診醫學或其他臨床環境中，你很難找到這樣的人

tries to convince you they’re qualified to perform surgery.

試圖讓你相信他們有資格做手術。

Specialties that require deep knowledge also tend to be safe from mid-level encroachment

需要深層知識的專業也往往不會受到中層人員的侵擾。

as the specialized knowledge acts as a sort of moat.

因為專業知識起到了某種護城河的作用。

Specialties such as pathology and radiology would fall into this category given the depth

病理學和放射學等專業將屬於這一類別，因為其深度

of knowledge and the importance of an accurate diagnosis.

的知識和準確診斷的重要性。

Although radiology and pathology may be fairly resistant to mid-level encroachment, they

儘管放射科和病理科可能對中層人員的侵佔有相當的抵抗力，但他們

may not be immune to the next point on our list: artificial intelligence.

可能無法倖免於我們清單上的下一個要點：人工智能。

Over the last decade, there have been significant advances in artificial intelligence and some

在過去的十年中，人工智能有了顯著的進步，一些

wonder if it’s going to make certain specialties obsolete - namely radiology, pathology, and

不知道它是否會使某些專業被淘汰--即放射科、病理科和其他專業。

dermatology.

皮膚病學。

Several new studies have come out that demonstrate computers can outperform doctors in cancer

幾項新的研究表明，計算機在癌症方面的表現可以超過醫生。

screenings and disease diagnoses.

篩查和疾病診斷。

In one study, an algorithm designed to diagnose skin cancer at Stanford University had a success

在一項研究中，斯坦福大學設計的用於診斷皮膚癌的算法取得了成功

rate nearly identical to 21 board-certified dermatologists.

率幾乎與21名委員會認證的皮膚科醫生相同。

Another algorithm developed by Google using 42,000 patient scans from a NIH clinical trial

谷歌利用NIH臨床試驗中的42,000個病人掃描數據開發的另一種算法

was able to detect 5% more cancers than its human counterparts and reduced false positives

能夠比人類同類產品多檢測出5%的癌症，並減少了假陽性。

by 11%.

11%。

This is especially of interest as false positives are a big problem with lung cancer - made

這一點尤其值得關注，因為假陽性是肺癌的一個大問題--由

even more alarming by the fact that lung cancer is the leading cause of cancer death in the

更加令人震驚的是，肺癌是癌症死亡的主要原因。

United States.

美國。

With such positive preliminary results, some people joke that we should stop training radiologists

有了這樣積極的初步結果，有些人開玩笑說，我們應該停止培訓放射科醫生。

and pathologists now as AI will soon replace them; however, I don’t believe this to be

和病理學家，因為人工智能很快就會取代他們；然而，我認為這不是

the case.

該案。

Although these studies are promising, AI is not without its flaws.

儘管這些研究很有希望，但人工智能並非沒有缺陷。

No matter how much the technology has advanced, it is still far from where it would need to

無論技術有多大的進步，它仍然遠遠沒有達到它需要的程度。

be to be used without physician oversight.

可以在沒有醫生監督的情況下使用。

Take EKGs for instance.

以心電圖為例。

Although the computer outputs its analysis of the EKG, its interpretation is far from

雖然計算機輸出了它對心電圖的分析，但它的解釋遠非如此。

perfect and the magnitude of the risk of being wrong is very high.

完美，而且出錯的風險程度非常高。

This is why we need doctors and cardiologists to review them.

這就是為什麼我們需要醫生和心臟病專家來審查它們。

They understand nuance and take into account the patient’s presentation and other clinical

他們瞭解細微的差別，並考慮到病人的表現和其他臨床情況。

factors.

因素。

As it stands, AI is simply unable to replicate this level of attention to detail.

就目前而言，人工智能根本無法複製這種對細節的關注程度。

Even if an algorithm is 98% accurate and can do so at a fraction of the cost of a physician

即使一個算法有98%的準確度，並且能以醫生的一小部分成本做到這一點

with zero cost of replication, the effects of being wrong even 2% of the time can be

在複製成本為零的情況下，即使有2%的時間是錯誤的，也會產生影響。

devastating for patient care.

對病人護理具有破壞性。

The interpretations made by radiologists and pathologists are the foundation of a large

放射科醫生和病理科醫生所做的解釋是一個大型醫院的基礎。

part of a patient’s care plan, so accuracy is incredibly important.

是病人護理計劃的一部分，所以準確性是極其重要的。

An incorrect interpretation on a CT scan or biopsy specimen could be the difference between

對CT掃描或活檢標本的錯誤解釋可能是以下兩者之間的區別

detecting a patient’s cancer early versus missing it and allowing it to grow and metastasize.

儘早發現病人的癌症，而不是錯過它，讓它成長和轉移。

You’ll always need a human with specialized knowledge to be able to recognize the nuance.

你總是需要一個具有專業知識的人能夠識別細微差別。

What I do think is of concern is if artificial intelligence can significantly increase efficiency

我確實認為值得關注的是，如果人工智能能夠大幅提高效率

among radiologists and pathologists.

放射科醫生和病理科醫生之間。

If you can effectively decrease workload for each physician and make them more efficient,

如果你能有效地減少每個醫生的工作量，使他們更有效率。

then theoretically they should be able to interpret more images and more slides in the

那麼理論上，他們應該能夠解釋更多的影像和更多的幻燈片。

same amount of time.

同樣的時間。

In this scenario, we will likely see decreased demand for these physicians.

在這種情況下，我們可能會看到對這些醫生的需求減少。

Although these issues are important to be aware of for anyone considering pursuing one

雖然這些問題對任何考慮追求一個人來說都是很重要的，但也要注意到。

of these specialties, it is impossible to know exactly how the landscape of medicine