March Madness

Elyas Bakhtiari, for HealthLeaders Media , March 27, 2008

(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?

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at

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