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As a doctor and full stack engineer, I would never go into radiology or seek further training in it. (obviously) AI is going to augment radiologists first, and

by maz1b 1y ago

As a doctor and full stack engineer, I would never go into radiology or seek further training in it. (obviously) AI is going to augment radiologists first, and eventually, it will start to replace them. And existing radiologists will transition into stuff like interventional radiology or whatever new areas will come into the picture in the future.

kstrauser 1y ago
What’s your take on pharmacists? To my naive eyes, that seems like a certainty for replacement. What extra value does human judgement bring to their work?
- skadamou 1y ago
  I'm not a doc or a pharmacist (though I am in med school) and I'm sure there are areas that AI could do some of a pharmacists job but on the outpatient side they do things like answering questions for patients and helping them interpret instructions that I don't think we want AI to do... or at least I really doubt an AIs ability to gauge how well someone is understanding instructions and augment how it explains something based on that assessment... on the inpatient side, I have seen pharmacists help physicians grapple with the pros and cons of certain treatments and make judgement calls about dosing that I think it would be hard to trust an AI to do because there is no "right" answer really. It's about balancing trade offs. IDK, these are just limitations - people that really believe in AI will tell you there is basically nothing it can't do... eventually. I guess it's just a matter of how long you want to wait for eventually to come.
- cko 1y ago
  I am a pharmacist who dabbles in web dev. We should easily be replaced because all of our work on checking pill images and drug interactions are actually already automated, or the software already tells us everything. If every doctor agreed to electronically prescribe (instead of calling it in, or writing it down) using one single standard / platform / vendor, and all pharmacy software also used the same platform / standard, then our jobs are definitely redundant. I worked at a hospital where basically doctors and pharmacists and nurses all use the same software and most of the time we click approve approve approve without data entry. Of course we also make IVs and compounds by hand, but that's a small part of our job.
- ralusek 1y ago
  I work on a kiosk (MedifriendRx) which, to some degree "replaces" pharmacists and pharmacy staff. The kiosk is placed inside of a clinic/hospital setting, and rather than driving to the pharmacy, you pick up your medications at the kiosk. Pharmacists are currently still very involved in the process, but it's not necessarily for any technical reason. For example, new prescriptions are (by most states' boards of pharmacies) required to have a consultation between a pharmacist and a patient. So the kiosk has to facilitate a video call with a pharmacist using our portal. Mind you, this means the pharmacist could work from home, or could queue up tons of consultations back to back in a way that would allow one pharmacist to do the work of 5-10 working at a pharmacy, but they're still required in the mix. Another thing we need to do for regulatory purposes is when we're indexing the medication in the kiosk, the kiosk has to capture images of the bottles as they're stocked. After the kiosk applies a patient label, we then have to take another round of images. Once this happens, this will populate in the pharmacist portal, and a pharmacist is required to take a look at both sets of images and approve or reject the container. Again, they're able to do this all very quickly and remotely, but they're still required by law to do this. TL;DR I make an automated dispensing kiosk that could "replace" pharmacists, but for the time being, they're legally required to be involved at multiple steps in the process. To what degree this is a transitory period while technology establishes a reputation for itself as reliable, and to what degree this is simply a persistent fixture of "cover your ass" that will continue indefinitely, I cannot say.
  - tartoran 1y ago
    Pharmacists are not going to be replaced, their jobs like most other jobs touched by AI will evolve, possibly shrink in demand but won't completely dissapear. AI is a tool that some professional has to use after all.
- mandevil 1y ago
  My wife is a clinical pharmacist at a hospital. I am a SWE working on AI/ML related stuff. We've talked about this a lot. She thinks that the current generation of software is not a replacement for what she does now, and finds the alerts they provide mostly annoying. The last time this came up, she gave me two examples: A) The night before, a woman in her 40's came in to the ER suffering a major psychological breakdown of some kind (she was vague to protect patient privacy). The Dr prescribed a major sedative, and the software alerted that they didn't have a negative pregnancy test because this drug is not approved for pregnant women and so should not be given. However, in my wife's clinical judgement- honed by years of training, reading papers, going to conferences, actual work experience and just talking to colleagues- the risk to a (potential) fetus from the drug was less than the risk to a (potential) fetus from mom going through an untreated mental health episode and so she approved the drug and overrode the alert. B) A prescriber had earlier in that week written a script for Tylenol to be administered "PR" (per-rectum) rather than PRN (per requisite need). PR Tylenol is a perfectly valid thing that is sometimes the correct choice, and was stocked by the hospital for that reason. But my wife recognized that this wasn't one of the cases where that was necessary, and called the nurse to call the prescriber to get that changed so the nurse wouldn't have to give them a Tylenol suppository. This time there were no alerts, no flags from the software, it was just her looking at it and saying "in my clinical judgement, this isn't the right administration for this situation, and will make things worse". So someone- with expensively trained (and probably licensed) judgement- will still need to look over the results of this AI pharmacist and have the power to override its decisions. And that means that they will need to have enough time per case to build a mental model of the situation in their brain, figure out what is happening, and override if necessary. And it needs to be someone different from the person filling out the Rx, for Swiss cheese model of safety reasons. Congratulations, we've just described a pharmacist.
  - philwelch 1y ago
    > And it needs to be someone different from the person filling out the Rx, for Swiss cheese model of safety reasons. This is something I question. If you go to a specialist, and the specialist judges that you need surgery, he can just schedule and perform the surgery himself. There’s no other medical professional whose sole job is to second-guess his clinical judgment. If you want that, you can always get a second opinion. I have a hard time buying the argument that prescription drugs always need that second level of gatekeeping when surgery doesn’t.
donnfelker 1y ago
There's a number of you (engineer + doctor), though quite rare. I have a few friends who are engineers as well as doctors. You're like unicorns in your field. The Neo and Morpheus of the medical industry - you can see things and understand things that most people cant in your typical field (medicine). Kudos to you!
- deleted 1y ago
  [deleted]
- thevillagechief 1y ago
  This was actually my dream career path when I was younger. Unfortunately there's just no way I would have afforded the time and resources to pursue both, and I'd never heard of Biomedical Engineering where I grew up.
catoc 1y ago
As a doctor and full stack engineer you’d have a perfect future ahead of you in radiology - the profession will not go away, but will need doctors who can bridge the full medical-tech range
cfu28 1y ago
I feel like I keep running into your comments on HN. There are dozens of us!
jmhmd 1y ago
As a radiologist and full stack engineer, I’m not particularly worried about the profession going away. Changing, yes, but not more so than other medical or non-medical careers.
ProllyInfamous 1y ago
>AI is going to augment radiologists first, and eventually, it will start to replace them. I am a medical school drop-out — in my limited capacity, I concur, Doctor. My dentist's AI has already designed a new mouth for me, implants &all ("I'm only doing 1% of the finish-work: whatever the patient says doesn't feel just quite right, yet"—myDMD). He then CNCs in-house on his $xxx,xxx 4-axis. IMHO: Many classes of physicians are going to be reduced to nothing more than malpractice-insurance-paying business owners, MD/DO. The liability-holders, good doctor. In alignment with last week's (H)(1)(b) discussion, it's interesting to note that ~30% of US physician resident "slots" (<$60kUSD salary) are filled by these foreigner visa-holders (so: +$100k cost per applicant, amortized over a few years of training, each).
Seattle3503 1y ago
I could see that as more radiology AI tools become available to non-radiologist medical providers, they might choose to leverage the quick feedback those provide and not wait for a radiologist to weight in, even if they could gain something from the radiologist. They could make a decision while the patient is still in the room with them.
seesthruya 1y ago
If you believe this is true, why stop at radiology? Couldn't the same be said for every other non-surgical specialty?
- chromatin 1y ago
  Partially true, and the answer to that is runway -- it will be a very long time before all the other specialties are fully augmented. With respect to "non-surgical" you may be underestimating the number and variety of procedures performed by non-surgeons (e.g. Internal Medicine physicians) -- thyroid biopsy, bronchoscopy, endoscopic retrograde cholangiopancreatography, liquid nitrogen ablation of skin lesion, bone marrow aspiration, etc. The other answer is that AI will not hold your hand in the ICU, or share with you how their mother felt when on the same chemo regimen that you are prescribing.

by maz1b 1y ago

kstrauser 1y ago

What’s your take on pharmacists? To my naive eyes, that seems like a certainty for replacement. What extra value does human judgement bring to their work?

skadamou 1y ago
I'm not a doc or a pharmacist (though I am in med school) and I'm sure there are areas that AI could do some of a pharmacists job but on the outpatient side they do things like answering questions for patients and helping them interpret instructions that I don't think we want AI to do... or at least I really doubt an AIs ability to gauge how well someone is understanding instructions and augment how it explains something based on that assessment... on the inpatient side, I have seen pharmacists help physicians grapple with the pros and cons of certain treatments and make judgement calls about dosing that I think it would be hard to trust an AI to do because there is no "right" answer really. It's about balancing trade offs. IDK, these are just limitations - people that really believe in AI will tell you there is basically nothing it can't do... eventually. I guess it's just a matter of how long you want to wait for eventually to come.
cko 1y ago
I am a pharmacist who dabbles in web dev. We should easily be replaced because all of our work on checking pill images and drug interactions are actually already automated, or the software already tells us everything. If every doctor agreed to electronically prescribe (instead of calling it in, or writing it down) using one single standard / platform / vendor, and all pharmacy software also used the same platform / standard, then our jobs are definitely redundant. I worked at a hospital where basically doctors and pharmacists and nurses all use the same software and most of the time we click approve approve approve without data entry. Of course we also make IVs and compounds by hand, but that's a small part of our job.
ralusek 1y ago
I work on a kiosk (MedifriendRx) which, to some degree "replaces" pharmacists and pharmacy staff. The kiosk is placed inside of a clinic/hospital setting, and rather than driving to the pharmacy, you pick up your medications at the kiosk. Pharmacists are currently still very involved in the process, but it's not necessarily for any technical reason. For example, new prescriptions are (by most states' boards of pharmacies) required to have a consultation between a pharmacist and a patient. So the kiosk has to facilitate a video call with a pharmacist using our portal. Mind you, this means the pharmacist could work from home, or could queue up tons of consultations back to back in a way that would allow one pharmacist to do the work of 5-10 working at a pharmacy, but they're still required in the mix. Another thing we need to do for regulatory purposes is when we're indexing the medication in the kiosk, the kiosk has to capture images of the bottles as they're stocked. After the kiosk applies a patient label, we then have to take another round of images. Once this happens, this will populate in the pharmacist portal, and a pharmacist is required to take a look at both sets of images and approve or reject the container. Again, they're able to do this all very quickly and remotely, but they're still required by law to do this. TL;DR I make an automated dispensing kiosk that could "replace" pharmacists, but for the time being, they're legally required to be involved at multiple steps in the process. To what degree this is a transitory period while technology establishes a reputation for itself as reliable, and to what degree this is simply a persistent fixture of "cover your ass" that will continue indefinitely, I cannot say.
- tartoran 1y ago
  Pharmacists are not going to be replaced, their jobs like most other jobs touched by AI will evolve, possibly shrink in demand but won't completely dissapear. AI is a tool that some professional has to use after all.
mandevil 1y ago
My wife is a clinical pharmacist at a hospital. I am a SWE working on AI/ML related stuff. We've talked about this a lot. She thinks that the current generation of software is not a replacement for what she does now, and finds the alerts they provide mostly annoying. The last time this came up, she gave me two examples: A) The night before, a woman in her 40's came in to the ER suffering a major psychological breakdown of some kind (she was vague to protect patient privacy). The Dr prescribed a major sedative, and the software alerted that they didn't have a negative pregnancy test because this drug is not approved for pregnant women and so should not be given. However, in my wife's clinical judgement- honed by years of training, reading papers, going to conferences, actual work experience and just talking to colleagues- the risk to a (potential) fetus from the drug was less than the risk to a (potential) fetus from mom going through an untreated mental health episode and so she approved the drug and overrode the alert. B) A prescriber had earlier in that week written a script for Tylenol to be administered "PR" (per-rectum) rather than PRN (per requisite need). PR Tylenol is a perfectly valid thing that is sometimes the correct choice, and was stocked by the hospital for that reason. But my wife recognized that this wasn't one of the cases where that was necessary, and called the nurse to call the prescriber to get that changed so the nurse wouldn't have to give them a Tylenol suppository. This time there were no alerts, no flags from the software, it was just her looking at it and saying "in my clinical judgement, this isn't the right administration for this situation, and will make things worse". So someone- with expensively trained (and probably licensed) judgement- will still need to look over the results of this AI pharmacist and have the power to override its decisions. And that means that they will need to have enough time per case to build a mental model of the situation in their brain, figure out what is happening, and override if necessary. And it needs to be someone different from the person filling out the Rx, for Swiss cheese model of safety reasons. Congratulations, we've just described a pharmacist.
- philwelch 1y ago
  > And it needs to be someone different from the person filling out the Rx, for Swiss cheese model of safety reasons. This is something I question. If you go to a specialist, and the specialist judges that you need surgery, he can just schedule and perform the surgery himself. There’s no other medical professional whose sole job is to second-guess his clinical judgment. If you want that, you can always get a second opinion. I have a hard time buying the argument that prescription drugs always need that second level of gatekeeping when surgery doesn’t.

donnfelker 1y ago

There's a number of you (engineer + doctor), though quite rare. I have a few friends who are engineers as well as doctors. You're like unicorns in your field. The Neo and Morpheus of the medical industry - you can see things and understand things that most people cant in your typical field (medicine). Kudos to you!

deleted 1y ago
[deleted]
thevillagechief 1y ago
This was actually my dream career path when I was younger. Unfortunately there's just no way I would have afforded the time and resources to pursue both, and I'd never heard of Biomedical Engineering where I grew up.

catoc 1y ago

As a doctor and full stack engineer you’d have a perfect future ahead of you in radiology - the profession will not go away, but will need doctors who can bridge the full medical-tech range

cfu28 1y ago

I feel like I keep running into your comments on HN. There are dozens of us!

jmhmd 1y ago

As a radiologist and full stack engineer, I’m not particularly worried about the profession going away. Changing, yes, but not more so than other medical or non-medical careers.

ProllyInfamous 1y ago

>AI is going to augment radiologists first, and eventually, it will start to replace them. I am a medical school drop-out — in my limited capacity, I concur, Doctor. My dentist's AI has already designed a new mouth for me, implants &all ("I'm only doing 1% of the finish-work: whatever the patient says doesn't feel just quite right, yet"—myDMD). He then CNCs in-house on his $xxx,xxx 4-axis. IMHO: Many classes of physicians are going to be reduced to nothing more than malpractice-insurance-paying business owners, MD/DO. The liability-holders, good doctor. In alignment with last week's (H)(1)(b) discussion, it's interesting to note that ~30% of US physician resident "slots" (<$60kUSD salary) are filled by these foreigner visa-holders (so: +$100k cost per applicant, amortized over a few years of training, each).

Seattle3503 1y ago

I could see that as more radiology AI tools become available to non-radiologist medical providers, they might choose to leverage the quick feedback those provide and not wait for a radiologist to weight in, even if they could gain something from the radiologist. They could make a decision while the patient is still in the room with them.

seesthruya 1y ago

If you believe this is true, why stop at radiology? Couldn't the same be said for every other non-surgical specialty?

chromatin 1y ago
Partially true, and the answer to that is runway -- it will be a very long time before all the other specialties are fully augmented. With respect to "non-surgical" you may be underestimating the number and variety of procedures performed by non-surgeons (e.g. Internal Medicine physicians) -- thyroid biopsy, bronchoscopy, endoscopic retrograde cholangiopancreatography, liquid nitrogen ablation of skin lesion, bone marrow aspiration, etc. The other answer is that AI will not hold your hand in the ICU, or share with you how their mother felt when on the same chemo regimen that you are prescribing.