The future of allergy/immunology?

ninin said:

Are there any downsides to allergy/immunology at all

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Yes, it is a discipline that specializes in the common cold. Anything and everything an AI guy does is very easily done by an internist of FP. Once this is realized, this discipline will likely disappear.

Yes, it is a discipline that specializes in the common cold.

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Except for the immunology part.

C

I did 2 weeks of A/I last year. In that time, I saw approximately 2 cases that were not "you have seasonal allergies, take some Allegra/Claratin/Zyrtec +/- Singulair" The 2 cool cases were really cool, though

Overall seemed really boring, but most office-based non procedural things are to me. I may feel differently in 20 years.

You can definitely make bank in A/I. Don't go by salary surveys -- they send out mailers and only include the people who choose to reply, and who knows if they're honest. Also consider that 200k a year to work 40 hours in clinic is not necessarily worse than 400k a year to bust your butt 80 hours a week in the hospital ala ortho or cardiology.

What about Lupus, rheumatoid arthritis and all the other autoimmune diseases that are so common these days? Do Allergist/Immunologists see them or is that some other subspecialty?

Celestron2000 said:

What about Lupus, rheumatoid arthritis and all the other autoimmune diseases that are so common these days? Do Allergist/Immunologists see them or is that some other subspecialty?

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Those patients are usually seen and followed by a rheumatologist. There may be some overlap, but from what I've seen, the immunology in allergy/immunology is primarily a research focus vs working up congenital immunodeficiency disorders.

I know that allergist/immunologist make a lot of money and have good hours, but I'm not certain how they do this. They don't get paid any more for office visits, and one allergist who I talked with said that he only made ~10% of his office income from allergy testing and shots, the only real "procedure" that I think that they do. I know that there is a shortage of allergist in most areas, this is because of the way that fellowships are set up. Although the decision to create specialty spots is partially determined by specialty boards, most fellowships are set up and funded by hospitals whose chairperson's goal is to make the in-patient service flow smoothly. There isn't that much/any need for in-patient allergists, so these positions are not created despite the shortage of allergist because hospital execs would rather spend the money making more GI or cardio spots to cover their in-patients who require their services. I would have thought this would have been good for allergists, but the fact is that because there is such a shortage, many pulmonologists and ENT docs learn the allergy trade and do the same thing that allergist do. I don't think that the field is in any danger of going extinct despite the fact that if trained properly, the avg internist or FP could do the same job that an allergist does simply because the avg internist or FP isn't trained properly to deal with allergies. Maybe the increasing usage of nasal steroids will decrease the number of referrals, but the fact is that most generalists don't bother to learn/don't have the time to learn every specialty, that's why a lot of patients get referred in the community for conditions that most med students would feel comfortable managing.

Allergy/Immunology reminds of Physical Medicine and Rehabilitation in that everyone loves the lifestyle and pay associated with these fields but their job is boring as hell.

From a financial standpoint, you will always do well in Allergy/Immunology simply because the supply of allergists in this country is so low. In some cities, the starting salary for these docs is 300K.

Allergists/ Immunologists are not going out of business.There is a tremendous shortage of them and demand is high.They focus on asthma,sinus problems,immune realted issues.While it would seem that any internist can do this, in fact there is big demand for those with specialty training,and there are very few fellowships.The allergists I know get a large percentage of their patients from primary care docs who dont want to deal with these patients especially the more complex ones.The varous forms of allergy testing and immunotherapy are highly lucrative.An internist or FP who learns these procedures will make some extra money but wont be reimbursed by many insurance plans at specialist rates and wont get many consults from other physicians,which is the lifeblood of many allergy practices..

ninin said:

1. What's the average salary of allergists? Anecdotally, I ALWAYS hear $240,000 and usually well north of that figure. But on the official website, it's "only" $174,000.

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Oh no! What ever shall I do?! Where ever shall I go?! Damnit! I'm not going to do skin tests and prescribe Kleenex (or the generic brand, "tissue") for anything less than 200 large!

ninin said:

4. Are there any downsides to allergy/immunology at all?

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The fact that dermatologists now have someone to look down on. oooo. Low blow!

What is with the hostility toward A/I in general? This field is no longer one of the hidden gems in Medicine.

As someone starting GI fellowship in 2 weeks and who started IM thinking I was going to do Cardiology, I never considered A/I. A few months ago, I was on an ambulatory rotation and had a weekly A/I clinic. Let me share a little about what I learned.

A/Is are boarded to take care of both kids and adults. Peds and IM residents both apply to the same programs. So in addition to there not being very many spots nationally, your applicant pool is effectively doubled with both Peds and IM applying. Painful. Thus, extremely competitive.

I actually thought clinic was quite interesting. I saw patients that PCPs had a difficult time managing. They came to see the A/I, found relief, and were very grateful for the care. That's one thing about the field I think makes it great -- you're patients are basically young and healthy and you do something for them that allows them to better enjoy being young and healthy. There is some good Medicine in there too -- combinations of inhalers and oral meds that take some specialty knowledge and experience to use properly. I liked the logic and reasoning behind therapeutic decisions.

I agree with a lot of what's been said above about the field in terms of Internists and FPs learning a lot of the field but not getting reimbursed at the same rate as a specialist. Also, with an office full of diabetes and HTN, the avg. internist doesn't have the time to spend with these patients that's needed.

Why A/I does well, in my opinion, is the following.

1. Your patient population is almost exclusively one with good private insurance that pays for shots for the kids.
2. You can see both kids and adults.
3. You can do three billable things in the same office (one overhead) -- you can see patients, you can give shots, and you can do skin testing. The MD only has to physically do one of the three, seeing patients, while the office staff does the other two, yet the MD bills for all three. Pretty damn productive, if you ask me. Also, some do some diagnostic rhinoscopy for kicks.
4. The demand is huge and constant with all the environmental exposures people suspect are the causes of all their ailments, and all the allergies that develop from living in a developed society.

Again, I for one think the field is interesting and well worth considering if you don't care for the procedural fields in Medicine and want a great lifestyle while still practicing rewarding medicine.

kinetic said:

The fact that dermatologists now have someone to look down on. oooo. Low blow!

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I was checking out the website and came across this website. I am a practicing A/I. I got into GI fellowship but decided to do A/I due to life style and pay. I rarely get paged so life style is great. In addition, I got tired of seeing old people in internal medicine. With A/I I get to see kids and adults which is really nice.

Salary. It varies from city to city. There was a poll by the American Academy of Allergy, asthma and immunology. Average salary in the west coast was about $240k, midwest is $290 and east coast was $260. Now, saying this, it varies if you are solo, multi-practice, etc. I know many who are making over $300k as well.

What I like about A/I is the life style, pay and kids. Is it boring? A/I is not for everybody. I must say that 50% is allergic rhinitis...not so exciting. But when you help their quality of life, they are really appreciative. I don't see too many hypertensive patients grateful that their HCTZ is working.

Other cool things is severe persistent asthma. I see alot of allergic asthma. I get to use allergy shots to desentitize as well as new biologics such as anti-IgE IgG, which is a monoclonal antibody to target severe persistent asthma. There is anti-Interleukin 5 on the horizon as well as other biologics that will help asthmatics. Immunodeficieny is really awesome but is rarely seen. When I make a diagnosis, it is a good feeling since I can help someone that has been passed over for so many years.

What I don't like about A/I is less respect that others give allergist. I have pulmonologist who do not respect allergist. All I can say is that I go home at 5:00 pm and rarely work on weekends. They can laugh at me all they want. I get to play with my kids on the weekends and go skiing.

If I got to do this again, would I choose this. Damn right I would. I have no doubts at all. I am happy. I make good bucks. I make my patients happy.

Happy allergist.

allergyasthma said:

I was checking out the website and came across this website. I am a practicing A/I. I got into GI fellowship but decided to do A/I due to life style and pay. I rarely get paged so life style is great. In addition, I got tired of seeing old people in internal medicine. With A/I I get to see kids and adults which is really nice.

Salary. It varies from city to city. There was a poll by the American Academy of Allergy, asthma and immunology. Average salary in the west coast was about $240k, midwest is $290 and east coast was $260. Now, saying this, it varies if you are solo, multi-practice, etc. I know many who are making over $300k as well.

What I like about A/I is the life style, pay and kids. Is it boring? A/I is not for everybody. I must say that 50% is allergic rhinitis...not so exciting. But when you help their quality of life, they are really appreciative. I don't see too many hypertensive patients grateful that their HCTZ is working.

Other cool things is severe persistent asthma. I see alot of allergic asthma. I get to use allergy shots to desentitize as well as new biologics such as anti-IgE IgG, which is a monoclonal antibody to target severe persistent asthma. There is anti-Interleukin 5 on the horizon as well as other biologics that will help asthmatics. Immunodeficieny is really awesome but is rarely seen. When I make a diagnosis, it is a good feeling since I can help someone that has been passed over for so many years.

What I don't like about A/I is less respect that others give allergist. I have pulmonologist who do not respect allergist. All I can say is that I go home at 5:00 pm and rarely work on weekends. They can laugh at me all they want. I get to play with my kids on the weekends and go skiing.

If I got to do this again, would I choose this. Damn right I would. I have no doubts at all. I am happy. I make good bucks. I make my patients happy.

Happy allergist.

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One of my close relatives is an allergist. She has a solo practice, takes home about $250,000 a year, working 35 hours a week max, non-existence call, chooses her own vacation time off. Most of her referrals come from primary care who just don't have the time to deal with A/I issues. She switched her career from a pediatrician to allergist and would do it all over again.