After going to a bunch of interviews and hearing practically everyone at the dinners/get-togethers/introductions say they want to do "Cards" or GI....it got me wondering why there was a disproportionate amount of people wanting to do these two things.

Seriously, are this many people genuinely interested in cardiology and GI? And if so, why those two fields? Why not Rheum and ID? What is the lure to cards and GI aside from money?

If money were not a factor, one would think the law of averages would spread the applicant pool evenly over all the specialties given the huge number of IM trainees.

That's interesting, I actually was struck on the interview trail by how few people I heard say they were interested in one of the "big two". It seemed like everyone I talked to wanted to do Hem/Onc, and Pulm/CC was quite popular as well. Everything else was far behind. Anyway, not that this answers your question, just thought the contrast between our experiences was interesting.

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My medical school was one of those places perennially ranked in the top 5 or so in US News World Report. When I did my IM rotations as a student, I noticed that literally >80% or so of the residents wanted to do GI or cards. Maybe even 90%. This is extreme. When I went to some other places (still nice IM programs, but not quite as "big name") to interview for IM residency, there were still a lot of GI and cards wannabe folks, but WAY less. I think it's self-selecting...there will be lots of folks who want to do cards if you go somewhere like Duke, Harvard, etc. People know that going to a big name residency will help them get GI or cards. Also, if you interview anywhere with a well known cardiology division (even if overall the IM dept. isn't that famous) there will likely be a disproportionately large # of residents wanting to do cards. They either came to that residency in part due to the cardiology division, or were inspired by the teaching/learning environment there.

But the answer to your original question is money and procedures. Many residents like the idea of getting more $ and doing procedures. I also think GI and cards are more "visible" than subspecialties like rheum and endocrine. How many of us have had a ton of exposure to rheumatology, and how many of the general public could tell you what a rheumatologist does, vs. a cardiologist?

have to agree w/ souljah1 simple yet true gesture.

not sure about gi but with general cards starting salaries are similar/slightly more than other fellowships... the real deal comes w/ EP or Interventional where you have amazing potential for earning power down the line but remember its a dynamic field and with health insurance companies trying to find ways to pinch every penny with time these figures will change.

but back to your question the reason why GI and Cards are so much more popular is because of the money... as with every other popular field (ie derm, plastics, radiology, ortho... blah blah)

OP

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Actually it's

GI and Cards = Procedures
Procedures = $

:D

Actually it's

GI and Cards = Procedures
Procedures = $

:D

Money's good but its not the reason I chose GI.

The balance of inpt/outpt/procedures can't be beat. We take care of a wide range of patients. We have some of the sickest patients in our clinics but when that gets to be a little much, I spend an afternoon doing fun procedures and get recharged. Its a great field.

To be honest, it's a scary thought that so many IM residents are wanting to do fellowships. We need primary care physicians far more at this point.

But, whatever, if they all want to do GI and Cards, then they shouldn't be surprised when medicine is flooded with subspecialists in those fields, jobs are hard to find, and supply outweighs demand.

Then, we'll see who has the $$$.

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To be honest, it's a scary thought that so many IM residents are wanting to do fellowships. We need primary care physicians far more at this point.

But, whatever, if they all want to do GI and Cards, then they shouldn't be surprised when medicine is flooded with subspecialists in those fields, jobs are hard to find, and supply outweighs demand.

Then, we'll see who has the $$$.

Doubt it. There are still shortages of CV/GI docs. Heck, there are shortages of over kind of doctorb out there. And given that everybody by the time they hit 70, should have a colonscopy or 2 or 3 and has had a stress test, it's easy to see where there is so much demand. On the other hand, it's much more likely you'll die at the age of 75 and never need the services of a rheumatologist or ID doc.

To be honest, it's a scary thought that so many IM residents are wanting to do fellowships. We need primary care physicians far more at this point.

But, whatever, if they all want to do GI and Cards, then they shouldn't be surprised when medicine is flooded with subspecialists in those fields, jobs are hard to find, and supply outweighs demand.

Then, we'll see who has the $$$.

:laugh: You think supply and demand will play any role in healthcare in the years to come :laugh:

With socialism pending the doctors in highest demand are likely to be considered the ones to whose skill everyone has the greatest "natural right," meaning they'll be paid whatever change Obama can dig out from under the couch...

But, whatever, if they all want to do GI and Cards, then they shouldn't be surprised when medicine is flooded with subspecialists in those fields, jobs are hard to find, and supply outweighs demand.

Then, we'll see who has the $$$.

This (huge oversupply of GI/cards docs) is unlikely to happen, since the number of fellowship spots remains relatively fixed. What really happens is that some people who start out wanting to do GI/cards change their mind because it's hard and a PIA trying to get in, and some also will try to get in and won't, and will have to remain general IM or do some other type of fellowship. Reimbursements in medicine aren't really driven by supply and demand, since the rates are set by Medicare, and then insurance companies follow those rates to set THEIR reimbursement levels. I agree that primary care services will remain in demand, but the problem is that nobody (not patients, not insurance companies, not the gov't) wants to make their lives any easier by decreasing the paperwork/regulatory crap, or to pay them a bit more so they can see fewer patients/day and maybe work less hours. Also, they sometimes get less respect from patients and other docs than specialists do, and they have to deal with every single medical problem under the sun, as well as dealing with drug seeking and other demanding patients that specialists tend to boot from their clinics or refuse to see. Therefore, not many people want to do primary care.

:laugh: You think supply and demand will play any role in healthcare in the years to come :laugh:

With socialism pending the doctors in highest demand are likely to be considered the ones to whose skill everyone has the greatest "natural right," meaning they'll be paid whatever change Obama can dig out from under the couch...

Not only do I foresee supply and demand playing a role in healthcare in the future before a significant change takes place, but I also foresee nationalized healthcare failing miserably with the subsequent or simultaneous introduction of a two-tier system, because Doctors tend be just like Bankers; they love capitalism. However, in the future, the introductory pay into any specialty will likely be equal or close to equal across all specialties. In other words, if you work for the government, don't expect to make more than $150,000 per year regardless of what specialty or subspecialty you call home.

Of course, when such pay decreases come across and government funded national system is in place, it'll be pretty obvious who went into medicine for the people instead of the money. It's be even more obvious to patients.

Not only do I foresee supply and demand playing a role in healthcare in the future before a significant change takes place, but I also foresee nationalized healthcare failing miserably with the subsequent or simultaneous introduction of a two-tier system, because Doctors tend be just like Bankers; they love capitalism. However, in the future, the introductory pay into any specialty will likely be equal or close to equal across all specialties. In other words, if you work for the government, don't expect to make more than $150,000 per year regardless of what specialty or subspecialty you call home.

Of course, when such pay decreases come across and government funded national system is in place, it'll be pretty obvious who went into medicine for the people instead of the money. It's be even more obvious to patients.

Personally, I look at doctor's salaries differently. I'm fairly certain most of us don't enjoy living in debt and on loans, unless you are a sadist; nor, do i think we enjoy working for something close to minimum wage considering the hours we work until we are 35. Why shouldn't we be compensated for our hard work? We are setting ourselves up for failure if the health care system nationalizes considering the fact that it hasn't worked very well anywhere else in the world. Not too mention, doctor's salaries play absolutely no role in our current health care situation.

And if you think we have a problem with a physician shortage now, just wait to see what would happen when you tell a bunch of pre-meds that after an additional 7-12 years of "schooling" they will be making 120k/yr and living in debt for the rest of their lives. I know this is off the topic a bit, but just my $0.02.

And if you think we have a problem with a physician shortage now, just wait to see what would happen when you tell a bunch of pre-meds that after an additional 7-12 years of "schooling" they will be making 120k/yr and living in debt for the rest of their lives. I know this is off the topic a bit, but just my $0.02.

Agreed. Far fewer people will give up their 20's and part of their 30's in order to get paid at a level they could easily attain with a 4-yr bachelor's degree and a few productive years in the work force in a variety of other fields. I look around at many of my friends from college, and the contrast between how our mid-late 20's have shaped up is striking. While I have worked long hours and studied in my "free" time, all while continuing to go deeper into debt, they have worked 40/wk, made nice salaries, bought homes, built 401k's, etc, etc. And, while I'll start getting paid something later this year, I have many more years of low pay, high hours, and continuing debt to look forward to. Please understand that I'm not complaining; I am very happy with my career choice. My point is that not many people will be lining up to make this kind of sacrifice if what they receive in return is a compensation ceiling of not much over 100k/yr down the road. It may sound cynical, but I think it's true. While there will always be a humanistic payoff to becoming a physician (i.e. having the privilege to help others directly by preventing/treating illness), there must be a practical payoff as well or it will get much more difficult to attract bright young people into this type of career.

I'm quitting medicine if there will be a ceiling of 150k

Seriously, are this many people genuinely interested in cardiology and GI? And if so, why those two fields?

Dolla dolla billz y'all

I'm quitting medicine if there will be a ceiling of 150k

Yeah, I could've been an investment banker!... whoops... they'll be government employees too.

These posts are ridiculous

These posts are ridiculous

ridiculously awesome

We are setting ourselves up for failure if the health care system nationalizes considering the fact that it hasn't worked very well anywhere else in the world. Not too mention, doctor's salaries play absolutely no role in our current health care situation.


I have to disagree on both points. Healthcare systems in Europe do manage to provide their entire population with medical care that statistically is better than that of the US. They do so by focusing on providing proven treatments that have high benefit to cost ratios. Hence, Europe is not spending 16% of their GDP on healthcare. Yes you wont get prostate surgery with that Da Vinci robot but everyone does get there statins or ACE inhibitors or other inexpensive/non-sexy treatments that actually result in wide spread improvements in health. They also keep costs down by not paying doctors 300-500K a year and by having 2:1 ratio of PCP:specialists (as opposed to the US 1:2 ratio). If the US kept all MDs under 200k and stopped reimbursing based on utilization rates the cost of healthcare would not be as high.

Now if you are patient making six figures you probably want to be in the US (expect you might end up getting an unnecessary elective knee or back operation). However for the average working stiff who has just lost his/her job they would probably like to know that they would have access to healthcare.

[QUOTE=Reddpoint;7685307]I have to disagree on both points. Healthcare systems in Europe do manage to provide their entire population with medical care that statistically is better than that of the US. They do so by focusing on providing proven treatments that have high benefit to cost ratios. Hence, Europe is not spending 16% of their GDP on healthcare. Yes you wont get prostate surgery with that Da Vinci robot but everyone does get there statins or ACE inhibitors or other inexpensive/non-sexy treatments that actually result in wide spread improvements in health. They also keep costs down by not paying doctors 300-500K a year and by having 2:1 ratio of PCP:specialists (as opposed to the US 1:2 ratio). If the US kept all MDs under 200k and stopped reimbursing based on utilization rates the cost of healthcare would not be as high.

There are no "perfect" health systems. If we socialize our medical care it will probably improve primary care somewhat (at least primary care for the working poor). Specialist care and medical innovation, as well as pharmaceutical research/discovery, would likely be harmed quite a bit. A lot of these "socialized medicine" countries are basically leeching off our medical innovation/discoveries. I don't blame them, but I wonder where the innovation/discovery will come from if we (the US) go the route of socialized medicine.

We do spend a large part of our GDP on health care. Of course, we do a lot more "elective" things like plastic surgery, ACL repairs (in Germany if you tear your ACL you just limp around on it forever, or get a private surgeon to fix it, or so I've been told), LASIK surgery, etc. But we in the US also have more disposable income than some folks in other countries, so some of us chose to spend it on health care.

I don't really have much of a dog in this fight. I'm an internist, soon to be cardiologist, and I'm not worried about not having a job either way. I've considered working @the VA, and have worked their as a resident/fellow. I have to say that it does some things well (i.e. pushing for blood pressure control) but other things poorly (slow to provide surgical services, etc.). I suspect any single payer health system would be similar.

Also, I don't know many docs who make 300k-500k/year. Ortho and radiology and probably anesthesia do, but most do not. I do know several who make <100k/year. I don't think physician salaries are the major thing driving the health care cost increase we've seen in recent years...docs made more (relative to the average person) in the 1980's than they do now, as salaries have been relatively flat for the past several years. The cost of prescription drugs and the costs of end of life care and care for chronic diseases has added to increased health care costs in recent years.

I agree with trying to decrease overutilization of some medical care/technology. One thing that drives overutilization is fear of lawsuits/cover-your-ass type medicine. Another one, to be quite honest, is PATIENTS. They often demand/argue for things like MRI's for their back pain, when it's really not going to change the treatment. The reason patients want these things is that if they have insurance they generally aren't the ones paying. If they had to pay some %age, say $500 or so, they'd be more willing to wait a couple of months to see if the NSAIDS would work...

I think instead of trying to fit ourselves into some other country's mold, we need to think more about how we can maximize the benefits of our current health system while minimizing the bad things (inequity, etc.).

Yes you wont get prostate surgery with that Da Vinci robot

Yes, you won't. That might not sound like a big deal to you, but when you are the 55yo guy with the prostate cancer who would rather not be incontinent and with erectile dysfunction for the rest of your life due to the radical prostatectomy you just had, not having that treatment option might not please you.

Like I said, I don't have much of a dog in this fight...I think that neither side (the radical pro-capitalism side, and the radical "single payer is best!" crowd) is completely correct in this debate. Nobody can really "fix" our health care system...we have to just pick our poison that we want to drink.

Actually it's

GI and Cards = Procedures
Procedures = $

:D

so true....

Could you elaborate on this? I'm interested in GI because I think it's the most interesting and diverse system. I like outpatient but really don't like rounding on inpatient so it's a bit of a concern. What % of time does GI doc spend on taking care of inpatient? Thanks.

Money's good but its not the reason I chose GI.

The balance of inpt/outpt/procedures can't be beat. We take care of a wide range of patients. We have some of the sickest patients in our clinics but when that gets to be a little much, I spend an afternoon doing fun procedures and get recharged. Its a great field.

Once you're in private practice you might not have to do that much inpatient, but as a fellow and resident, inpatient GI is tough. The liver disease patients are the main ones who are very sick and stay in the hospital a long time, and/or die there. They get GI bleeds (such as from esophageal varices) as well as hepatic encephalopathy.

You also have old people with diverticular bleeds, bleeding stomach or duodenal ulcers, etc.

Also there are some people with inflammatory bowel dz who get so sick they have to be hospitalized for that.