Comment by Al-Khwarizmi | Hacker News Reader

Comment by Al-Khwarizmi | Hacker News Reader

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If (as acknowledged in the article) AI automates at least part of the work of radiologists (e.g. tool that "saves her 15 to 30 minutes each time she examines a kidney image"), don't you fear that the demand of radiologists will decline? Even if some are still needed, surely if a hospital needs X reports per day and now Y radiologists are sufficient to provide them rather than the current Z (Y<Z), that should be something for people considering your career to take into account?

On the other hand, how much of your confidence in not being replaced stems from AI not being able to do the work, and how much from legal/societal issues (a human needing to be legally responsible for the diagnoses)? Honestly the description in the article of what a radiologist does "Radiologists do far more than study images. They advise other doctors and surgeons, talk to patients, write reports and analyze medical records. After identifying a suspect cluster of tissue in an organ, they interpret what it might mean for an individual patient with a particular medical history, tapping years of experience" doesn't strike me as anything impossible for AI within a few years, now that models are multimodal and they can work with increasing amounts of text (e.g. medical histories).

No. There is no area of medicine where a boost in productivity will cause doctors to have idle time. The wait times may decrease, throughput may increase, diagnosis accuracy may improve, even costs may decrease (press x to doubt) but no, there will never be a case where we will need less radiologists.

Which may take us to a sort of “Jevens Paradox” kind of place except for medical care.

Like there are times already where I’ve put off or not sought medical care because of the hassle involved.

If I could just waltz into the office and get an appointment and have an issue seen to same day I would probably do it more often.

To be clear, we also need more medical professionals in general -- they're not keeping up with the population and it's making us all less healthy. Three to six months, or more, in the SF bay area for some critical appointments is really unacceptable, but there's not really an option given supply and demand.

I'm sure this will all get better with captain brainworms at the helm.

Wonderful insight that I'd never considered. Talk to almost anyone in America and they'll tell you about a health issue that they or their family are deferring due to lack of access. Waiting months or years to simply talk to a specialist, let alone find one that can help, is sadly the norm. Patients rightly feel it's a waste of their time so won't even seek treatment.

Remove that barrier to access and we won't see a shiny new streamlined medical system but rather a flood of new patients requiring even more bureaucracy to manage.

100% why I bothered to stick w/ OneMedical after the Amazon acquisition. I tried to get a "New Dr/New Patient" appointment with any local doctor I could find that took my insurance, and the closest I could get was 3 weeks away.

I'm not worried about medical folks having "time to clean" any time soon.

>> No. There is no area of medicine where a boost in productivity will cause doctors to have idle time. The wait times may decrease, throughput may increase, diagnosis accuracy may improve, even costs may decrease (press x to doubt) but no, there will never be a case where we will need less radiologists.

I dont think this is how market participants may think about it. If costs decrease, some group of radiologists will drop out of the market. We may not "need" less radiologists, but we're signaling we need less of them by not paying them as much as before.

Much like I still "need" a photographer, but short of weddings, I'm not willing to pay as much as before. I may well acquire a photogrpher for a portrait, but it would have to be priced competitively to a selfie.

Faster CPUs, better screens, helpful IDEs, heck even Gen-AI itself did not reduce the need for software engineers let alone decrease the costs. As mentioned in another comment, The Jevons Paradox implies that in certain industries, increased productivity may actually lead to more consumption (therefore propping up the demand / cost) despite not being intuitive so.

The only industries that has observed the opposite effect I can think of so far are translators and stock photographers. Maybe also proof readers - but is that gen Ai or did spellcheckers already kill that branch?

Software engineers could spread out into new areas and find new things to do. Unless I am mistaken, the work of radiologists is more defined.

> Software engineers could spread

This is key. Radiologists that can program (or software engineers that do medicine) make a massive difference.

When someone explains what they want and it’s built for them, you get a very different product to that built by the user.

I want more radiologists that can write software please.

I'm a radiologist that can program!

I've authored and contributed to several open source projects over the years, and I'm currently doing a deep dive in CAD/CAM after buying a CNC machine.

I help my practice where I can, and have written a little utility to make generating reports easier, but I would have to quit my job if I was trying to take on the absolutely enormous task of radiology computer aides diagnosis. And I need my job!

> I would have to quit my job if I was trying to take on the absolutely enormous task of radiology computer aides diagnosis

I think about this sort of thing every so often. The difference one person can make by creating a decent piece of software might be one of the best ways of getting a return on investment (in human hours, if not in money).

> Unless I am mistaken, the work of radiologists is more defined.

When I had cancer I had to go to an Interventional Radiologist. Never heard of it before. But they use X-Ray in real-time (flouroscopy?) to guide surgery. Pretty neat.

>> The only industries that has observed the opposite effect I can think of so far are translators and stock photographers. Maybe also proof readers - but is that gen Ai or did spellcheckers already kill that branch?

Voice-over performers. Sketch artists. Audiobook actors. Tutors (see: https://www.google.com/finance/quote/CHGG:NYSE?window=5Y)

You're making the common mistake of thinking that healthcare is some sort of normal market subject to simple supply-and-demand economics rules. The reality that supply is heavily constrained by CMS funding for residency slots, prices are (mostly) fixed by a few large payers, and patient demand is effectively infinite. There is a serious shortage of radiologists already and it's getting worse as the population grows older and sicker. If AI tools make radiologists more productive then more imaging studies will be ordered.

>> supply is heavily constrained by CMS funding for residency slots

I keep hearing this argument. Then I look at an Insurance Explanation of Benefits statement. A Radiologist might make $1-2k/day in billings. If you are in a balance-billing state, whatever insurance doesnt pay gets forward billed to the patient. On a standard 252 day workyear, that is $250-500k/yr in billings. The average resident salary is 70k, lets assume 100k with benefits.

Of course there is plenty of overhead, but from the math i'm seeing, the average Radiology Resident is a 150-400k net revenue center. Is the overhead really greater than 150-400k/yr/resident?

What am I missing, why would a profit center need "CMS funding"? From what my doctor friends tell me, the real bottleneck is the unwillingness of AMA and ABR to open up more radiology residency spots (artificial supply constraint) with "CMS funding" a boogeyman and red herring.

You cannot bill for a resident's work, without an attending signing off on it.

I like residents, I actually started a new radiology residency program.

They are a net drain on productivity in radiology, due to the teaching obligations

>> You cannot bill for a resident's work, without an attending signing off on it.

Isnt that the case for almost every industry? I was a management consultant and our Partner signed off on the work before billing clients. Architects bill clients, but only when the lead architect signs off on the plans. Same for civil engineers. Same for magazines where the editor signs off on most major pieces.

Contrary to what your doctor friends might have told you, the AMA has no power to restrict the number of residency slots. They are a private membership organization with no regulatory or accreditation authority. At one time they did lobby Congress to restrict graduate medical education funding but have since reversed that position.

https://savegme.org/

A minority of funding does come from sources other than CMS. Teaching hospitals are largely free to add more residency slots if they want to. The fact that most hospitals don't do this indicates that GME programs are largely unprofitable.

if the cost for preventative scans goes down, demand will rise. medical demand is incredibly constrained by price. people skip all kinds of tests they need because they can't afford it. the radiologists will have more work to do, not less.

There is a national shortage of radiologists in the US, with many hospital systems facing a backlog of unread cases measuring in the thousands. And, the baby boomers are starting to retire, it's only going to get worse. We aren't training enough new radiologists, which is a different discussion.

Askl to your question on where my confidence stems from, there are both legal reasons and 'not being able to do the work' reasons.

Legal is easy, the most powerful lobby in most states are trial attorneys. They simply won't allow a situation where liability cannot be attached to medical practice. Somebody is getting sued.

As to what I do day to day, I don't think I'm just matching patterns. I believe what I do takes general intelligence. Therefore, when AI can do my job, it can do everyone else's job as well.

A big wrinkle in AI evangelism is that proponents don’t understand the concept of human judgment as a “learned” skill - it takes practice and AI models / systems do not suffer consequences the way humans do. They have no emotions and therefore can not “understand” the implications of their decisions.

For context, generative AI music is basically unlistenable. I’ve yet to come across a convincing song, let alone 30 seconds worth of viable material. The AI tools can help musicians in their workflow, but they have no concept of human emotion or expression and it shows. Interpreting a radiology problem is more like an art form than a jigsaw puzzle, otherwise it would’ve been automated long ago (like a simple blood test). Like you note, the legal system in the US prides itself on “accountability” (said tongue in cheek) and AI suffers no consequences.

Just look how well AI worked in the United Healthcare deployment involving medical care and money. Hint: stock is still falling.

>For context, generative AI music is basically unlistenable. I’ve yet to come across a convincing song, let alone 30 seconds worth of viable material.

This one pops into my head every couple months:

https://youtube.com/watch?v=4gYStWmO1jQ

It's not really my genre, so my judgment is perhaps clouded. Also, I find the dumb lyrics entertaining and they were probably written by a human (though obviously an AI could be prompted to do just as well). I am a fan of unique character in vocals and I love that it pronounces "A-R-A" as "ah-ahr-ah", but the little bridge at 1:40 does nothing for me.

You may have missed the month or so where this[1] AI-generated track (remixed by a person, but nonetheless) dominated pop culture.

[1] https://www.youtube.com/watch?v=1uW_AUwEv-0

> A big wrinkle in AI evangelism is that proponents don’t understand the concept of human judgment as a “learned” skill

Which is ironic given how much variation in output quality there is based on the judgement of the person using the LLM (work scope, domain, prompt quality, etc.)

> We aren't training enough new radiologists, which is a different discussion.

About that, I think the AMA is ultimately going to be a victim of its own success. It achieved its goal of creating a shortage of medical professionals and enriching the existing ones. I don't think any of their careers are in danger.

However, long term, I think magic (in the form of sufficiently advanced technology) is going to become cost effective at the prices that the health care market is operating at. First the medical professionals will become wholly dependent on it, then everyone will ask why we need to pay these people eye-watering sums of money to ask the computers questions when we can do that ourselves, for free.

I agree with you on all points. The only question is how long will it take?

The trial lawyer angle doesn't seem accurate. Did trial lawyers prevent pregnancy tests from rolling out? COVID tests? Or any other automatic diagnostic, as long as it was reasonably accurate?

Not as far as I know. Once an automated diagnostic is reasonably accurate, it replaces humans doing the work manually. The same would be true of anything else that can be automatically detected.

No comment on whether radiology is close to that yet, although I don't think a few-million-param neural network would tell us much one way or another.

Are you aware of any states in the US that have made it harder to sue doctors for malpractice?

My point, which I made poorly, is this: There's a reason doctors that went to medical school in India and trained as Radiologists in India can't read US cases remotely for a fraction of the cost of US trained and licensed radiologists.

It's not because the systems to read remotely don't exist.

It's not because they're poorly trained or bad doctors.

Itsty because they can't be sued.

No, it's because the AMA lobbies to protect American doctors' jobs, and refuses to license them to practice in the US. Of course you can still sue for medical malpractice regardless of citizenship. Trial lawyers have nothing to do with it, American doctors who don't want competition are entirely to blame.

You say "Legal is easy, the most powerful lobby in most states are trial attorneys."

The most powerful lobby in this case is the ABR which carefully constricts coveted residency spots in Radiology to create an artificial scarcity and keep up incomes. It is the opposite of, say, technology, where we have no gatekeeper and supply increases.

The ABR will say that Medicare doesnt fund enough residency spots, but all you need to do is look at an EoB and see that a week of residency billings covers the entire cost of the resident.

IMHO the ABR isn't quite as powerful as you're indicating, but in general I agree.

For what it's worth, I started a new residency program to train more radiologist, so I do have some skin in the game.

If a teaching hospital with an existing radiology residency program wanted to add one more spot, does the ABR have any power to stop them? If Medicare offered more funding to a teaching hospital to add more spots would the hospital turn it down?

Basically, the ABR needs to approve a residency program for the residents that graduate from the program to be eligible to sit for the boards.

I don't think they would ever do it, but technically the ABR could stop them.

There is a perpetual shortage of these types of technicians, so it is unlikely that demand for those jobs will drop.

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