most competitive fields of medicine 30 years ago

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does anyone have any insight into which medical specialties were most competitive 30 years ago or longer? ie was it still derm, ent, ortho and rads?

I'm just wondering if these things change every few decades, or if rads always made the big bucks and derm always had the best lifestyle...

For sure not ortho. My dad just walked into an ortho residency by cold calling the PD at a program. This was three years after graduating and in the early sixties.

ahh the good old days...

Medicine was where all the "smart"people went. Ortho was for the dumb people that couldn't get into a medicine residency. That's what I've heard....

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In short term, things cycle because of shortages and oversupply. Anesthesiology was more compettive when I was starting med school cause there was a shortage and it was not unheard of making 400k (many still do).

In long term, things change due to change in medical technology and medical insurance payments. CardioThoracic surgery was king, then cardiac cath and better meds came around. In one of my interviews, a CT surgeon was complaining CT wasn't attracting the quality of applicants it used to.

How to figure out future competitiveness of a field:
1) Economic moat: How well is the field protected from other fields wanting to do the same procedures. (ex. vascular surgery, interventional cardiologist, interventional radiology are all fighting for intervascular stuff. One may win out, or all may suffer). Also how well is the field protected from midlevels: NP, CRNA, PA, etc.

2) Competition between practitioners: In every field docs compete. But in some fields its more fierce. Ex. in radiology, due to tela-radiology, almost any radiologist in US can read chest X-ray done at any hospital. Since all board certified radiologists are competent, hospitals will choose the cheapest. As a radiologist you are competing with every other radiologist in US vs a cardiologist has to compete with only local cardiologist.

3) Technological change: Change in technology can be a boon or a bust. In some fields, there's more push for innovation. Anything that has to do with heart, cancer will see faster innovation that can completely change the field. Things like infectious disease, not so much. A better antibiotic just changes what an ID prescribe. A better plaque removing drug can drastically reduce # of caths an interventional cardiologist does.

It depends what period you are interested in. Realize that in the 1960s prior to medicare we did not have specialties in the same sense as today. It was less common for an internist to subspecialize and referrals to specialists were not as common either. A general practioner (someone who only completes an intern year) was able to do quite well where today its nearly unheard of that a GP goes into practice without further training. The tools a radiologist had a generation ago were not the same as today. CT was not developed until the 1970s and MRI not until the 1980s, so the role of specialists in radiology were more confined.

General surgeons often de facto subspecialized in some area, say head and neck, so there was much greater overlap between a general surgeon then and specialities like ENT today. There was really no such thing as say, invasive cardiologists, because those techniques and procedures had not been invented yet. The major referrals that occured were medicine to surgery and vice versa.

In terms of competitiveness, top hospital residencies are just as competitive then as today. Internal medicine or general surgery was the most common and desirable field people entered 30+ years ago.

Man, it still blows my mind how all doctors used to do so well. Even in a recent past! Some of the middle-age pediatricians and geriatricians I know have amazing homes, sent their kids to expensive private schools, and supported stay-at-home wives. No way you could do that today.

My internal medicine preceptor, who's about 65, said that back in his day there wasn't a heck of a lot of competition in any direction. People did what they were interested in because everything paid pretty well. He doesn't even remember taking his boards, other than the fact that he passed. My dermatologist, who's also in his 60's, told me derm was totally uncompetitive when he was in med school.

rads used to be an absolute joke competition wise in the 70's.

Derm was definitely not a "hot" field.

Amazing how things can change. This is why you should pick a field for what you think you'll enjoy doing for your life (unless you think that is Family Practice)

Originally Posted by bomgd3

Man, it still blows my mind how all doctors used to do so well. Even in a recent past! Some of the middle-age pediatricians and geriatricians I know have amazing homes, sent their kids to expensive private schools, and supported stay-at-home wives. No way you could do that today.

My internal medicine preceptor, who's about 65, said that back in his day there wasn't a heck of a lot of competition in any direction. People did what they were interested in because everything paid pretty well. He doesn't even remember taking his boards, other than the fact that he passed. My dermatologist, who's also in his 60's, told me derm was totally uncompetitive when he was in med school.

"Even in the recent past" is the thing to focus on here. People who have never studied the history of medicine don't realize how rapidly the field has changed in the last 100 years. Medicine wasn't a very lucrative field at all until insurance companies and exploded with the advent of Medicare in 1965. There weren't that many wealthy doctors in the 1920s, 30s and 40s, it was more of a status symbol than a ticket to money.

Physicians made so much money in the recent past because medical spending went out of control with no regard to how it would affect the future. That's why the past is going to be such a bad predictor of the future in this field. Through the 60s, 70s, 80s and 90s spending went crazy and procedure based reimbursements were out of control. At the same time, medical schools still weren't particularly competitive as a whole and tuition was a joke compared to today. Combine all this together and you get a sweet combo of low pay-in with a very high pay-out.

That's not where the field is headed now. Medical schools lagged behind and once everyone saw how much money doctors were making medical school admissions started becoming hyper-competitive and tuitions went through the roof. That's also why it's not helpful to ask attendings right now about anything finance-wise...it was a whole different playing field just 20 years ago.

Originally Posted by bomgd3

Man, it still blows my mind how all doctors used to do so well. Even in a recent past! Some of the middle-age pediatricians and geriatricians I know have amazing homes, sent their kids to expensive private schools, and supported stay-at-home wives. No way you could do that today.

My internal medicine preceptor, who's about 65, said that back in his day there wasn't a heck of a lot of competition in any direction. People did what they were interested in because everything paid pretty well. He doesn't even remember taking his boards, other than the fact that he passed. My dermatologist, who's also in his 60's, told me derm was totally uncompetitive when he was in med school.

family practitioners can do pretty well in rural areas

One of the older doc I was chatting with said when he was in med school all the top students went internal med w/o looking to sub and all the students who struggled to make it through school matched into rads. Things really have changed.

In 1984:

Cost of a gallon of regular gas: $1.21
Cost of a dozen eggs: $1.01
Cost of a gallon of Milk: $2.26

Avg. public med school per year: $3,877 (avg total debt = $21,000)


Less than 30 years ago...

Originally Posted by tiedyeddog

For sure not ortho. My dad just walked into an ortho residency by cold calling the PD at a program. This was three years after graduating and in the early sixties.

Originally Posted by RafaTech

Medicine was where all the "smart"people went. Ortho was for the dumb people that couldn't get into a medicine residency. That's what I've heard....

We've got a pretty old orthopedic surgeon who said exactly the same thing. The top tier in his class all landed sweet IM residencies. The poor idiots bringing up the rear in the class (including him) were stuck with an ortho residency.

Guess that didn't turn out so bad after all.

I graduated and matched 30 years ago.

Generally, as noted, there was less competitiveness by field, but top programs in any given field were competitive.

General surgery was probably the most competitive overall as a field, as there weren't things like integrated plastics then. Pedi surg, neurosurg and plastic surg were long-term goals of many of the top folks.

High ranked academic IM was competitive, other IM not so much.

Ophtho was relatively competitive, not so the other "ROAD" fields, including derm.

Expectation was q3 for pedi and IM for the whole three years. My program where I matched only did q3 for half of residency so it was considered cush.

Originally Posted by thomprya

One of the older doc I was chatting with said when he was in med school all the top students went internal med w/o looking to sub and all the students who struggled to make it through school matched into rads. Things really have changed.

In the country I live in that's actually the way things are today. IM the one of the most uber competitive fields to match into and Rads is a mid tier field. I had more than a high enough residency exam score to match Rads and Anesthesiology but I don't find either specialty to be interesting enough. For some strange reason Pneumology is the most uber competitive field for residents but once you work the real job it's heavily underpaid.

Originally Posted by oldbearprofessor

I graduated and matched 30 years ago.

Generally, as noted, there was less competitiveness by field, but top programs in any given field were competitive.

General surgery was probably the most competitive overall as a field, as there weren't things like integrated plastics then. Pedi surg, neurosurg and plastic surg were long-term goals of many of the top folks.

High ranked academic IM was competitive, other IM not so much.

Ophtho was relatively competitive, not so the other "ROAD" fields, including derm.

Expectation was q3 for pedi and IM for the whole three years. My program where I matched only did q3 for half of residency so it was considered cush.

This^

Originally Posted by cowme

Amazing how things can change. This is why you should pick a field for what you think you'll enjoy doing for your life

and this^!

And I find it FASCINATING how specialties are not equally competitive when you compare the 1st choice/#positions ratio among different countries

Take UK for example (slides 21 and 22) http://www.slideshare.net/simon23/mm...etition-ratios (2007 data I think)
Gen surg is uber competitive there, more than neurosurg, plastics, derm, anesthesia, radio or ophto.

Or look at these data (table 1) http://surgicalcareers.rcseng.ac.uk/...cn%20Oct08.pdf
I know these are only 2005 stats, but from what I've heard it has not changed THAT much in the meantime

Do you think 1st choice specialty selection in the US is more guided by so-called prestige and income possibility than our colleagues from UK? Or is it that a general surgeon in the UK earns a good salary/has a better quality of life?

Originally Posted by calvnandhobbs68

"

That's not where the field is headed now. Medical schools lagged behind and once everyone saw how much money doctors were making medical school admissions started becoming hyper-competitive and tuitions went through the roof. That's also why it's not helpful to ask attendings right now about anything finance-wise...it was a whole different playing field just 20 years ago.

I started med school 19 yrs ago, and it was hyper-competitive then and pretty expensive, except for students who paid in-state tuition to public schools (I paid out-of-state tuition). In-state public tuitions are a lot higher today than they were 20 yrs ago.

People who have never studied the history of medicine don't realize how rapidly the field has changed in the last 100 years. Medicine wasn't a very lucrative field at all until insurance companies and exploded with the advent of Medicare in 1965. There weren't that many wealthy doctors in the 1920s, 30s and 40s, it was more of a status symbol than a ticket to money.

Physicians made so much money in the recent past because medical spending went out of control with no regard to how it would affect the future. That's why the past is going to be such a bad predictor of the future in this field. Through the 60s, 70s, 80s and 90s spending went crazy and procedure based reimbursements were out of control.

Looking back at historical compensation data for professionals, it appears that physicians did pretty well in the 1930s, but physician comp really started to take off during WWII, possibly as a result of wartime demand for healthcare and as a response to wage limits that made medical benefits an attractive way to recruit workers. In 1930 and 1940, for example, lawyers earned on average a bit more than physicians, but in 1945 and 1950, physicians were earning about 50% more than lawyers. Both did better than college teachers; military officers did well, but not as well as physicians. See Table 51 and Chart 31, http://www.nber.org/chapters/c2826.pdf

According to recent DOL data, lawyers now have a mean annual wage of around $130,000, while the mean annual salaries for the eight categories of physicians ranges from $168,000 to $235,000; so physicians continued to enjoy roughly the same as the 50% premium they had back in 1945. College profs continue to make substantially less (there is no heading for military officers, though I suspect they earn less). See http://[URL="http://www.bls.gov/oes/current/oes_nat.htm"]www.bls.gov/oes/current/oes_nat.htm[/URL]

It's also interesting, in the historic data, is how quickly physicians' comp peaked and how sharply it fell relative to other professions. Physician comp peaked around age 45, declined slowly and then plunged after age 55. Comp for lawyers and college teachers peaked later and fell more gradually. See Chart 28, http://[URL="http://www.nber.org/chapters/c2826.pdf"]www.nber.org/chapters/c2826.pdf [/URL]

Originally Posted by Med0123

And I find it FASCINATING how specialties are not equally competitive when you compare the 1st choice/#positions ratio among different countries

Take UK for example (slides 21 and 22) http://www.slideshare.net/simon23/mm...etition-ratios (2007 data I think)
Gen surg is uber competitive there, more than neurosurg, plastics, derm, anesthesia, radio or ophto.

Or look at these data (table 1) http://surgicalcareers.rcseng.ac.uk/...cn%20Oct08.pdf
I know these are only 2005 stats, but from what I've heard it has not changed THAT much in the meantime

Do you think 1st choice specialty selection in the US is more guided by so-called prestige and income possibility than our colleagues from UK? Or is it that a general surgeon in the UK earns a good salary/has a better quality of life?

Exactly.

Money/lifestyle.

What is competitive is just what has the best combination of money/lifestyle. People lie to themselves about their motivations. Specialists are soon going to lose a lot of their $ and prestige via cuts in reimbursment, and maybe that is a good thing. Money clouds everything in healthcare.

Fields like ortho, derm, IM, all have drastically changed in competitiveness for one reason, money/lifestyle.

Even the cycles for things like anesthesia and *gasp* family medicine have changed dramatically in the last 20 years. Trends like managed care and the rise of mid-levels dramatically affected the perceived future in those fields.

Family medicine wasn't necessarily particularly "competitive" but its popularity was undeniable during the 90's. During that decade there was an impressive rise in both spots offered and matched US Seniors - 1998 had 3300 spots and 1997 saw 2340 US seniors match into programs (highest points in the last 20 years). By comparison, there were only 1322 US seniors who matched into Family this year, and there were only 2740 spots offered (2009 was the bottoming out of FM positions with only 2535 spots offered, and only 1071 US Seniors matching - that's about 25% fewer spots, and 50% fewer US Seniors matching than 11 or 12 years earlier). Eleven years is not that long - plenty of people matching in 2009 graduated HS in 1998.

Meanwhile Anesthesia has an opposite trend. Anesthesia was practically a wasteland during the late 90's, when spots bottomed out in 1999 with only 956 total spots between PGY1 and 2 programs(1476 offered this year). Many positions went unfilled and as best I can tell, in 1996 there were less than 200 US Seniors who matched into spots for anesthesia that year. With our current perspective, that's insane. In the 80's (where the NRMP stats are a little sketchy and more difficult to piece together), anesthesia was undoubtedly very popular, consistent with our present view of the field. So what changed in between these two peaks of interest? Probably the view that there were too many gas passers in practice and concerns over CRNA's entering the workplace. But it demonstrates just how the outlook for a field can wax and wane over time.

Originally Posted by michaelrack

I started med school 19 yrs ago, and it was hyper-competitive then and pretty expensive, except for students who paid in-state tuition to public schools (I paid out-of-state tuition). In-state public tuitions are a lot higher today than they were 20 yrs ago.

I would be very surprised if it was even 1/3 of what it costs now.

I paid out-of-state tutiton first year...it was $69,000. Add living expensive and I was pushing 100K for a one year of med school (lucky I am instate now).

With a few exceptions its next to impossible to make it through med school now with less than 200K of debt.

Originally Posted by link2swim06

I would be very surprised if it was even 1/3 of what it costs now.

I paid out-of-state tutiton first year...it was $69,000. Add living expensive and I was pushing 100K for a one year of med school (lucky I am instate now).

With a few exceptions its next to impossible to make it through med school now with less than 200K of debt.

this is insane... and after that you'll have to pay crazy insurance premiums... lolz @ people who are in medicine for tha monay'!

Originally Posted by calvnandhobbs68

That's also why it's not helpful to ask attendings right now about anything finance-wise...it was a whole different playing field just 20 years ago.

You mean like this gem from the SDN Feature Article?

If you took out educational loans, is/was paying them back a financial strain?
I probably could have paid back more of my educational loans by now if I chose to, but the interest is so low on these types of loans that I have opted to devote more of my income to paying ahead on other items such as my home mortgage. The loans are not a financial strain.

Originally Posted by Med0123

this is insane... and after that you'll have to pay crazy insurance premiums... lolz @ people who are in medicine for tha monay'!

Depends on how your practice is set up. Keep in mind most salary figures are post malpractice insurance (it's a business expense. Just like your office rent).

Originally Posted by BigRedBeta

Even the cycles for things like anesthesia and *gasp* family medicine have changed dramatically in the last 20 years. Trends like managed care and the rise of mid-levels dramatically affected the perceived future in those fields.

Family medicine wasn't necessarily particularly "competitive" but its popularity was undeniable during the 90's. During that decade there was an impressive rise in both spots offered and matched US Seniors - 1998 had 3300 spots and 1997 saw 2340 US seniors match into programs (highest points in the last 20 years). By comparison, there were only 1322 US seniors who matched into Family this year, and there were only 2740 spots offered (2009 was the bottoming out of FM positions with only 2535 spots offered, and only 1071 US Seniors matching - that's about 25% fewer spots, and 50% fewer US Seniors matching than 11 or 12 years earlier). Eleven years is not that long - plenty of people matching in 2009 graduated HS in 1998.

Meanwhile Anesthesia has an opposite trend. Anesthesia was practically a wasteland during the late 90's, when spots bottomed out in 1999 with only 956 total spots between PGY1 and 2 programs(1476 offered this year). Many positions went unfilled and as best I can tell, in 1996 there were less than 200 US Seniors who matched into spots for anesthesia that year. With our current perspective, that's insane. In the 80's (where the NRMP stats are a little sketchy and more difficult to piece together), anesthesia was undoubtedly very popular, consistent with our present view of the field. So what changed in between these two peaks of interest? Probably the view that there were too many gas passers in practice and concerns over CRNA's entering the workplace. But it demonstrates just how the outlook for a field can wax and wane over time.

Does anyone have links to these or similar stats?

Originally Posted by link2swim06

I would be very surprised if it was even 1/3 of what it costs now.

I paid out-of-state tutiton first year...it was $69,000. Add living expensive and I was pushing 100K for a one year of med school (lucky I am instate now).

With a few exceptions its next to impossible to make it through med school now with less than 200K of debt.

Holy moly! I've never heard of a school that costs $69k for tuition. There are some crazy people who went to private undergrad on loans, then went to out-of-state med school... so hey, it could still be worse!

Also, I'm not sure why people like to point out "that's not including malpractice". All salaries AFAIK are AFTER malpractice has been deducted. It would be pointless to report your salary before malpractice, that's like saying "my salary is $1 million but then my boss gets a cut".

Originally Posted by Bearie

Does anyone have links to these or similar stats?

All are readily available from the NRMP

http://www.nrmp.org/data/historicalr...html#mainmatch

Originally Posted by link2swim06

I would be very surprised if it was even 1/3 of what it costs now.

I paid out-of-state tutiton first year...it was $69,000. Add living expensive and I was pushing 100K for a one year of med school (lucky I am instate now).

With a few exceptions its next to impossible to make it through med school now with less than 200K of debt.

Holy ****

Do you go to Colorado?

Originally Posted by cowme

rads used to be an absolute joke competition wise in the 70's.

Derm was definitely not a "hot" field.

Amazing how things can change. This is why you should pick a field for what you think you'll enjoy doing for your life (unless you think that is Family Practice)

+1

Choose something you like, and then do your due diligence to get into the residency.