30-year Timelines

The average radiology trainee will finish residency in their early 30s and hopefully enjoy a 30-plus year career if they like it (and otherwise make enough money fast enough to retire early if desired).

30 years is a long time

Do we really think that we have any idea what the world will look like in 30 years in a meaningful, actionable way? We don’t need to look at old-timey science fiction predictions of us flying cars and cities on the moon to know that we simply do not have this capacity as a species.

We can just look back 30 years to see how different the world is now compared with when I was growing up.

Thirty years ago, I was 9 years old playing Super Nintendo, which had 16-bit graphics with chiptune music and games with file sizes of a couple megabytes stored in plastic cartridges that you blew into when they didn’t work properly. The original Playstation was just coming out and featured a CD-ROM drive so slow that changing scenes often required waiting several minutes. We were yet on the cusp of the Nintendo 64 and the first time seeing Mario in 3D.

The internet existed, but many people used it by logging into AOL and getting curated content from its narrow gateway. Chat rooms and email were novel, but not the default form of communication for most people, and the broader decentralized World Wide Web hadn’t really taken off. Geocities had just launched, but most of its strangeness was just around the corner.

We had just moved from computers with text-based interfaces to the world’s first truly popular universal graphical user interface: Windows 95. We saved our work and transferred it from place to place in rigid, brittle plastic “floppy” disks that were 3.5 inches wide and had a magnetic tape with a capacity of 1.44 megabytes (an improvement[!] from 5.25″ ones that were actually floppy that I used on my first computer, which used MS-DOS and actually had a green and black screen a la the Matrix).

I logged onto the internet with a 28.8k modem, where images of any size took minutes to load, and you paid by the hour. We were still years away from Napster, high-speed internet, cell phones, or any number of other things that completely changed the landscape of what it means to be a citizen in America. Our lives may rhyme with our past but seem so comically different.

Things like CD & DVD collections and other relics of that era and the following decade now seem laughably quaint in the era of streaming media—and radiology is no exception.

Years ago, radiologists read films on viewboxes and dictated reports into dictaphones, which were then transcribed by hand by flesh-and-blood transcriptionists. Quick prelim reports jotted on paper were the rule of the day. MRIs and CTs took forever and were printed in multislice grids on film. Scrolling, that destroyer of wrists, did not exist as an interaction model. The job now is essentially unrecognizable compared to the job before. No one is hand-scanning every ultrasound or shooting invasive angiograms as a routine diagnostic test.

This is all to say: a lot can change in 30 years, and a lot will change over the next 30 years. And if enough people put their predictions on paper, some of them will undoubtedly be right, and in hindsight, those folks will look very prescient.

Actionable Predictions

So we should all get ready to look back from that future vantage point and celebrate some “thought leaders”—and then acknowledge that most of it will be bullshit survivorship bias.

The reality is that there is too much unknown to make meaningful, actionable predictions about the specifics of what things will look like in a way that should drive individual behavior. Instead of trying to know where things will land with AI, or the second- and third- and fourth-order effects of improved computer tools on radiology, medicine, or society more broadly, and the downstream consequences of all of these changes in the workforce and the world—the real question is: How inflexible is your comfort and success in a largely unknowable future?

When you change one thing, other things will change. We live in a nominally free market economy, and even though healthcare is essentially an exception due to a variety of regulatory and industry shenanigans, the reality is that things will change because things always change.

As Taleb argues in The Black Swan, you can know that a black swan (a highly improbable event) will eventually occur. That’s the easy part. Knowing exactly when and how is the impossible part.

So the goal can’t be to predict the future and land perfectly. The goal has to be to make yourself resilient to the unexpected.

The real answer for anybody in any profession, if you’re truly concerned about your skill set and its value in the future or the future of any tiny brick in the big house of medicine or the future of any specific profession if the future isn’t a magical post-capitalist techo-utopia, is twofold:

1. Live like your career is short.

Earn well, live modestly, save reasonably.

Make your life affordable. An intuitive example would be a 15-year instead of a 30-year mortgage. Don’t consign yourself to needing to strictly maintain your level of income for the next 30 years in order to pay for the decisions of today.

Modern first-world society has helped humans trade physical existential danger for ill-defined, constant low-grade anxiety. Don’t add extra to your plate.

2. Increase the surface area of your skills and the flexibility of your identity

The more narrowly you define what you do and how you do it, the more pivoting becomes unthinkable. This doesn’t mean you need to sacrifice your deep, narrow skills to be a generalist. The reality is that it’s possible those deep skills will be the ones that matter (predictions are hard, remember?). It’s largely a matter of mindset/attitude.

You and your big wrinkly brain have a variety of skills by the nature of who you are, how you’ve trained, and what you do. There’s a strong argument that amassing broad experiences is a great way to stay agile, whether that’s getting involved in practice management, teaching others, working with other humans face to face sometimes, etc.

What will likely serve you well overall is being less precious with what you do and who you think you are. You get to choose your identity and how crystallized you are.

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If your current position doesn’t pan out forever—whether because of AI, healthcare consolidation, or any number of other factors—you need to either be able to adapt or not need to care in the first place.