March Madness

This year's "match day" was last Thursday, and medical students weren't the only ones following the results. Facilities concerned about physician shortages look to residency placements for indications about upcoming recruitment challenges and investment opportunities. We hear often of the projected shortage of 200,000 physicians by 2020, but that number doesn't adequately address the nuance of the problem. Some specialties are already experiencing shortages and have been for several years. Others may see significant growth for many years to come.

In the spirit of March Madness, here's a brief ranking of how each specialty will fare between now and 2020. Fill out your brackets accordingly:

(1) Dermatology. Most specialties that offer high salaries also have rigorous schedules with full call, and specialties with flexible schedules that appeal to "lifestyle" physicians often lag behind in compensation. But with median salaries around $400,000, dermatology offers both, and that's what makes this specialty a physician favorite.

(2-3) Plastic surgery/otolaryngology. As this New York Times article notes, medical students with the highest medical-board scores are gravitating toward "appearance-related" specialties, which have everything today's physicians are looking for: high patient demand (thanks to a looks-obsessed culture), high pay, and options for flexible and autonomous scheduling.

(4-5) Radiology/anesthesiology. Though these specialties have seen or will see shortages, they pay fairly well--a factor that is crucial when competing for a limited number of applicants--and are able to use nonphysicians (i.e., CRNAs) and technology (think teleradiology) to treat more patients with fewer physicians.

(6) Ophthalmology. With a median compensation of about $300,000, ophthalmology is in the middle of the pack on "offense" (i.e., salaries), but it makes up for that with a strong defense (i.e., opportunities for work-life balance).

(7) Cardiology. Invasive cardiologists are among the highest-earning specialists. Though hit recently by reimbursement cuts, the specialty is a big revenue generator for hospitals, which will continue to invest in this area. The problem: The aging population is going to send the need for cardiac services soaring, and facilities will need more cardiologists to keep up.

(8-11) Gastroenterology/orthopedic surgery/neurology/oncology. The middle of the bracket can be analyzed with two words: Baby boomers. There just may not be enough physicians to perform all of the hip replacements, colonoscopies, and other procedures that this generation is going to need as it enters its Medicare-eligible stage. These specialties don't offer the same lifestyle benefits as the top seeds and will be competing with each other for physicians. It may come down to a salary race.

(12) Hospitalists. Given the unique practice style and the documented benefits of hospitalists, these physicians earned their own bid on the bracket, separate from the rest of primary care. They may not be highly compensated--median levels fall below $200,000--but physicians are drawn to the controllable work schedule. Many internists prefer working as hospitalists, and the model is now spreading to other specialties.

(13) OB/GYN. High malpractice costs and call coverage are a major problem, but the laborist model of practice, which is similar to a hospitalist arrangement, may resolve those issues and draw physicians to the specialty.

(14) Emergency medicine. These physicians staff America's overcrowded emergency rooms, and their reward is a crummy payer mix and a shortage of specialists willing to take call. On the other hand, the number of emergency medicine positions increased in this year's match day, and federally-driven healthcare reform efforts could change everything and make this specialty a bracket buster.

(15) Primary care. These (family medicine, internal medicine, and pediatrics) are perennial fan favorites and could be your Cinderella specialties. Low compensation levels have been driving students away from primary care for years. But these doctors are the gatekeepers of healthcare, and most industry reformers realize their value. An influx of female physicians and international medical graduates may help primary care make a comeback, and as is the case with emergency medicine, healthcare reform could change everything.

(16) Geriatrics. How does a patient population made up almost entirely of Medicare beneficiaries sound to you? Probably not good, especially considering the upcoming 10% reimbursement reduction. Geriatricians are already in one of the lowest-paid specialties, and medical students aren't exactly clamoring to get in. Maybe they just aren't aware that geriatricians have among the highest career satisfaction levels of all physicians.

I should note that, if this is anything like my NCAA March Madness bracket, the final results will be very different from my initial predictions, so take them with a grain of salt. A lot can change in 12 years--an underdog or two may prevail and a favorite may fall--and everyone's predictions are different. What does your bracket look like?