SDN Members don't see this ad. (About Ads) Here is the long-overdue subspecialty FAQ. Feel free to PM me with anything you might want to add, correct, or clarify. What are the internal medicine subspecialties? There are presently 15 subspecialties that are certifiable by the American Board of Medical Specialists. Internists can begin fellowships after completing their 3 year internal medicine residency. Most residents apply for fellowship programs during the beginning of their second year of residency. Fellowships include: Specialty: Overall Length of Fellowship Training 3 years of internal medicine training +: Allergy and Immunology: 2 years Cardiology: 3 years Cardiology/Cardiac Electrophysiology: 4 years Cardiology/Interventional Cardiology: 4 years Critical Care Medicine: 2 years Endocrinology: 2 years Geriatric Medicine: 2 years Gastroenterology: 3 years Gastroenterology/Hepatology: 4 years Hematology: 2 years Hematology/Oncology: 3 years Infectious Diseases: 2 years Medical Genetics: 2-4 years Nephrology: 2 years Oncology: 2 years Pulmonary: 2 years Pulmonary/Critical Care: 3 years Rheumatology: 2 years Sports Medicine: 1 year ABIM recognized subspecialties/Length of Training As a somewhat different way to list the above info, the following are ABIM recognized subspecialties where you may be certified as a specialist: http://www.abim.org/cert/policiesssaq.shtm The first number in the parentheses is the total overall months of fellowship required, and the second number is the minimum required time doing clinical rotations during fellowship, as dictated by the American Board of Internal Medicine (ABIM). For example, a fellowship with (24/12) would be a 2 year fellowship with a minimum of 1 year of clinical rotations during the fellowship. The rest of the time is spent at the program's discretion: some fellows will do more clinical rotations as electives, while others will spend that time doing research in their subspecialty field. (minimum months/clinical months required) Cardiovascular Disease (36/24) Endocrinology, Diabetes, and Metabolism (24/12) Gastroenterology (36/18) Hematology (24/12) Infectious Disease (24/12) Medical Oncology (24/12) Nephrology (24/12) Pulmonary Disease (24/12) Rheumatology (24/12) There are three dual certification programs: Hematology & Medical Oncology (36/18) Pulmonary Disease & Critical Care Medicine (36/18) Rheumatology & Allergy and Immunology (36/12 rhem & 18 allergy/immu) There are added qualification programs: Adolescent Medicine (24/) Clinical Cardiac Electrophysiology (12/12, requires cardiovascular disease certification) Critical Care (3 pathways, see http://www.abim.org/cert/policies_aqccm.shtm) Geriatric Medicine (12/12) Interventional Cardiology (12/12, requires cardivascular disease certification) Sports Medicine (12/) Transplant Hepatology (12/12, requires gastroenterology certification) Which subspecialties are more competitive to get into then others? Right now, most people agree with the following order of competitiveness: Most Competitive: Cardiology Gastroenterology Allergy and Immunology Moderately Competitive: Pulmonary Nephrology Hematology/Oncology Mildly Competitive: Infectious Diseases Endocrinology Rheumatology Geriatric Medicine Do you think that those fields will always be competitive? Its important to realize that levels of competitiveness can rapidly change and what may be competitive now may not be in 5 years due to changes in medical technology, changes in the management of patients, reimbursement, or changes in the patient population. As you can see, with so many different variables, predicting which specialists will be needed and which specialty is in surplus is an inexact science at best. A classic example of this is gastroenterology. During the mid-1990s, it was widely believed that there was a major surplus of all internal medicine subspecialists and there was a drive to train more primary care physicians. Gastroenterology was particularly affected as many of the experts foresaw a large surplus of gastroenterologists and they believed that there were many more gastroenterology doctors then gastroenterology procedures that needed to be done. As a result, gastroenterology fellowships became very non-competitive. By the year 2000, the managed care revolution was on the back-swing, and new recommendations were being put out for things like screening colonoscopies, it was recognized that there was not an oversupply of gastroenterologists but rather a shortage of them. As a result, their reimbursement rates rose, and the field became more competitive as many more US graduates realized that their procedures were enjoyable to do, their patients were not all that sick, and they would be compensated well for their work. I point to that story because many medical students choose their specialties based on salaries, when in fact, by the time that they complete their training, the salary of their chosen specialty today may be drastically different then the salary of the specialist of the future. An example of a specialty in flux today in hematology oncology, with the decision of the government to stop reimbursing oncologists as much as they have been for chemotherapeutic agents that by some estimates have been accounting for one half to two thirds of many oncologists salaries. I am certain that this will have the effect of dissuading many people from pursuing oncology, but I would just remind those people of what happened to gastroenterology and just state that it simply is not possible to predict the future. The take home message is to find a specialty that you enjoy and go for it, irrespective of whether its very competitive, or reimbursed very well today. If you truly enjoy what you do and the patients that you interact with, none of it will matter.