2018 Fellowship Match Statistics

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rheum18

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2018 Fellowship Acceptance Rates (# of Positions Filled / Total # of Applicants)
Nephrology 94%
Infectious Disease 92%
Allergy/Immunology 87%
Endocrinology 84%
Pulm Critical Care 72%
Heme/Onc 69.5%
Cardiology 68.6%
Rheumatology 67.7%
Gastroenterology 64%

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Seems to fit general trends for past several years. GI and rheum getting more competitive as lifestyle fields and cards remaining as competitive as ever.
 
Maybe in Canada ...

Anyway for any one who reads the ASN forums , in the burnout thread one of the senior nephrologists openly admitted that the nephrology salary was the highest of all IM subspecialties back in the 70s-80s . No wonder why it was so popular back then . Let’s Make nephrology great again rah rah rah with NephMadness and ignore the dwindling reimbursements
 
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Reimbursements are cyclical. Do what you love and you'll live comfortably no matter what you do.
 
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Reimbursements are cyclical. Do what you love and you'll live comfortably no matter what you do.

Spoken like a non-nephrologist. If the government is involved , it is not cyclical . Only one way to go and that’s down.

(Not an attack post on you. Rather “it’s cyclical” is not based upon any real economic data when it comes to medicine or the overall economy.)

But agreed do what you like is a key feature of it all.
 
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Spoken like a non-nephrologist. If the government is involved , it is not cyclical . Only one way to go and that’s down.

(Not an attack post on you. Rather “it’s cyclical” is not based upon any real economic data when it comes to medicine or the overall economy.)

But agreed do what you like is a key feature of it all.

This may sound weird but I love how much you hate nephrology. Haha!
 
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This may sound weird but I love how much you hate nephrology. Haha!

No I like nephrology as a discipline . Honestly . It’s just the trends in renal are to do more with less.

There’s a pervasive schizophrenic mood amongst many nephrologists . It’s part of the burn out factor .
 
I think it's interesting to note the specialty match trend -- for example, heme/onc and cards were brutal matches this year.

Summarized from the NRMP 2018 Match statistics (percent of applicants matched) for the top 5 this year over the last 5 years:
PCCM: 65-66-73-71-72
Heme/onc: 73-70-74-75-70
Cards: 72-72-76-75-70
Rheum: 86-78-69-63-68
GI: 64-64-64-66-64

It's interesting how the GI supply/demand has remained so constant in the last 5 years lol (compare to rheum!)
 
I think it's interesting to note the specialty match trend -- for example, heme/onc and cards were brutal matches this year.

Summarized from the NRMP 2018 Match statistics (percent of applicants matched) for the top 5 this year over the last 5 years:
PCCM: 65-66-73-71-72
Heme/onc: 73-70-74-75-70
Cards: 72-72-76-75-70
Rheum: 86-78-69-63-68
GI: 64-64-64-66-64

It's interesting how the GI supply/demand has remained so constant in the last 5 years lol (compare to rheum!)

Part of the demand supply is self selection... more people tend to want to go into GI for the money and lifestyle, which is increasingly the case with rheum. Cards tends to select for people who also like the specialty as it’s not a lifestyle field. Hence why GI remains so competitive with lots of applicants every year, whereas cards tends to fluctuate.
 
The lifestyle in GI is not that great... for example, as a rheumatologist I have never once been sticking a scope down a bleeding cirrhotic esophagus in the ICU at 3 in the morning :)

Rheum is hard to beat on lifestyle. The GI money is better though, I'll give them that
 
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If you want the Rheum lifestyle, gun for Derm from the get-go.
 
The lifestyle in GI is not that great... for example, as a rheumatologist I have never once been sticking a scope down a bleeding cirrhotic esophagus in the ICU at 3 in the morning :)

Rheum is hard to beat on lifestyle. The GI money is better though, I'll give them that
I kept on hearing people saying rheum is great on life style but makes around 250k... I just find that wage being hard to justify the additional training since you can make 250 as a hospitalist too...(ofc I'm only a 3rd year so please feel free to correct me :D)

If you want the Rheum lifestyle, gun for Derm from the get-go.
Us DO folks don't get that luxury sometimes ;)
 
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I kept on hearing people saying rheum is great on life style but makes around 250k... I just find that wage being hard to justify the additional training since you can make 250 as a hospitalist too...(ofc I'm only a 3rd year so please feel free to correct me :D)


Us DO folks don't get that luxury sometimes ;)

It's not about the number. It's about what it takes to get there and how available it is.
 
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I kept on hearing people saying rheum is great on life style but makes around 250k... I just find that wage being hard to justify the additional training since you can make 250 as a hospitalist too...(ofc I'm only a 3rd year so please feel free to correct me :D)

Hospitalists work way harder than rheumatologists and miss every other weekend and roughly half of the holidays.
 
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I kept on hearing people saying rheum is great on life style but makes around 250k... I just find that wage being hard to justify the additional training since you can make 250 as a hospitalist too...(ofc I'm only a 3rd year so please feel free to correct me :D)

I don’t want to be a resident for the rest of my life. Thus, not a hospitalist
 
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Rheum is hard to beat on lifestyle.
Just a med student so what do I know, but if it's about lifestyle, maybe endo and allergy/immuno are equal to or better than rheum? I've heard outpatient pulm only (no crit care) can have a good lifestyle (and money). I've seen hem/onc with good lifestyles (and money), but dealing with cancer patients all day seems like it could be . . . v. challenging (putting it mildly here). Derm, PM&R, psych, outpatient neurology, mommy track anesthesia, sometimes radiology and path, also, but they aren't IM fellowships.
 
I kept on hearing people saying rheum is great on life style but makes around 250k... I just find that wage being hard to justify the additional training since you can make 250 as a hospitalist too...(ofc I'm only a 3rd year so please feel free to correct me :D)


Us DO folks don't get that luxury sometimes ;)
Neither Rheum nor Endo will increase your salary much compared to being a hospitalist or even doing primary care. The opportunity cost of either fellowship (plus several others) is ~$400,000. If you're just looking at the dollar figures, only an idiot would do them.

But life isn't just about the money, and some of us find more satisfaction in our fields than we might find in general medicine.

(Probably the worst offender in my opinion is geriatrics: Opportunity cost of 1 year that really doesn't allow you to do anything that you couldn't do as a general internist. But if the fellowship gives you intellectual satisfaction? More power to you)
 
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Just a med student so what do I know, but if it's about lifestyle, maybe endo and allergy/immuno are equal to or better than rheum? I've heard outpatient pulm only (no crit care) can have a good lifestyle (and money). I've seen hem/onc with good lifestyles (and money), but dealing with cancer patients all day seems like it could be . . . v. challenging (putting it mildly here). Derm, PM&R, psych, outpatient neurology, mommy track anesthesia, sometimes radiology and path, also, but they aren't IM fellowships.

Outpatient anything has a good lifestyle. Procedures make money so any field that is highly procedural will typically make more dollars on average. But you typically have to work harder in those fields.

Ultimately you should do what you enjoy. I’ve seen miserable anesthesiologists and radiologists because they don’t like what they do, money and lifestyle be damned.
 
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Neither Rheum nor Endo will increase your salary much compared to being a hospitalist or even doing primary care. The opportunity cost of either fellowship (plus several others) is ~$400,000. If you're just looking at the dollar figures, only an idiot would do them.

But life isn't just about the money, and some of us find more satisfaction in our fields than we might find in general medicine.

(Probably the worst offender in my opinion is geriatrics: Opportunity cost of 1 year that really doesn't allow you to do anything that you couldn't do as a general internist. But if the fellowship gives you intellectual satisfaction? More power to you)
for us Canucks geriatric is good for one thing - it will give you a 4th year of training which matches the Canadian training time requirement, thus allowing us to get back to Canada.
 
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Are OP’s numbers for overall match rates? For AMG allopathics, I believe the percentages are all 15-20% higher.


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Just a med student so what do I know, but if it's about lifestyle, maybe endo and allergy/immuno are equal to or better than rheum? I've heard outpatient pulm only (no crit care) can have a good lifestyle (and money). I've seen hem/onc with good lifestyles (and money), but dealing with cancer patients all day seems like it could be . . . v. challenging (putting it mildly here). Derm, PM&R, psych, outpatient neurology, mommy track anesthesia, sometimes radiology and path, also, but they aren't IM fellowships.

In my view:

Lifestyle: Allergy & Immunology = Rheumatology = Endocrinology > Oncology = Pulmonary (no CCM) > GI > CCM (+/- Pulm) = Cardiology

Money: GI = Cardiology > Oncology = CCM = Pulmonary > Rheumatology = Endocrinology > ID = Nephrology
 
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Oncology is a good middle ground between competitiveness, pay, lifestyle and lack of procedures (if that’s your thing). Obviously a huge part of this field is your ability (or inability) to deal with the emotional burden which is high
 
I think it's interesting to note the specialty match trend -- for example, heme/onc and cards were brutal matches this year.

Summarized from the NRMP 2018 Match statistics (percent of applicants matched) for the top 5 this year over the last 5 years:
PCCM: 65-66-73-71-72
Heme/onc: 73-70-74-75-70
Cards: 72-72-76-75-70
Rheum: 86-78-69-63-68
GI: 64-64-64-66-64

It's interesting how the GI supply/demand has remained so constant in the last 5 years lol (compare to rheum!)

Does the fact that GI screens people now with steps <220 and DO/IMG status have anything to do with its #’s too?
 
Reimbursements are cyclical. Do what you love and you'll live comfortably no matter what you do.
Lol, please show us how reimbursements are cyclical. This whole notion of cyclicality in medical fields was solely the effect of past decades where "unpopular" fields were devoid of applicants. This then pushed down their numbers thus creating a favorable market for them. It had nothing to do with CMS arbitrarily picking specialties for which they increase the reimbursements. These days, the number of applicants outnumber the number of available training slots, so such market imbalances will not result.
 
In my view:

Lifestyle: Allergy & Immunology = Rheumatology = Endocrinology > Oncology = Pulmonary (no CCM) > GI > CCM (+/- Pulm) = Cardiology
Money: GI = Cardiology > Oncology = CCM = Pulmonary > Rheumatology = Endocrinology > ID = Nephrology
Another important factor is here job market, in which my view is:

GI > Endo = Rheum = Pulm/CC > Oncology = ID > Cardiology = Nephrology > AI
 
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Another important factor is here job market, in which my view is:

GI > Endo = Rheum = Pulm/CC > Oncology = ID > Cardiology = Nephrology > AI

Oh it’s you, hating on cardiology again.

There’s plenty of gen cards jobs in desirable markets right now. IC and EP less, but I’m not sure where you pulled this rando ranking out of
 
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Lol, please show us how reimbursements are cyclical. This whole notion of cyclicality in medical fields was solely the effect of past decades where "unpopular" fields were devoid of applicants. This then pushed down their numbers thus creating a favorable market for them. It had nothing to do with CMS arbitrarily picking specialties for which they increase the reimbursements. These days, the number of applicants outnumber the number of available training slots, so such market imbalances will not result.

"Market imbalances" have no impact whatsoever on reimbursement anyway. Especially in some larger markets, there are arguably more orthopedic surgeons and cardiologists than are really necessary. Meanwhile, the demand for rheumatology services is expected to outstrip supply by nearly 5000 FTEs by 2030. And yet we barely make half of GI/cards income
 
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"Market imbalances" have no impact whatsoever on reimbursement anyway. Especially in some larger markets, there are arguably more orthopedic surgeons and cardiologists than are really necessary. Meanwhile, the demand for rheumatology services is expected to outstrip supply by nearly 5000 FTEs by 2030. And yet we barely make half of GI/cards income
Right.
Market imbalances occurred for anesthesiology in the late 90s/early 2000s due to a severe shortage of applicants. This forced hospitals to subsidize anesthesiology for their services despite their mediocre reimbursement simply to keep their ORs open. Unfortunately, their numbers are starting to rebound (compounded by their CRNA problem), and their compensation trend is slipping the wrong direction.

Honestly, I'm not sure how much I trust our workforce study from 2015. They included fibromyalgia as a condition treated by rheumatologists. However, as less and less rheumatologists are following FM patients, it actually makes our projected "shortage" a lot less severe. In fact, I would argue that our training spots should NOT be increased, lest we fall into the cardiology trap of overtraining.
 
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Oh it’s you, hating on cardiology again.

There’s plenty of gen cards jobs in desirable markets right now. IC and EP less, but I’m not sure where you pulled this rando ranking out of
Lol, not from what I've seen. Obviously this kind of ranking is anecdotal given the lack of hard data out there, but does anyone really disagree with cardiology having a significantly more saturated market than the likes of GI, rheum, endo, onc, and pulm/CC? For these fields, you can literally drop a pin on a map and have multiple job openings.

And honestly, I still don't know why you are sensitive about this... if I were in cardiology right now, I would be trying to raise awareness in order to convince the governing bodies to back off on training slots. The more of you there are, the less you are worth. This is true for everyone, and exactly why I am all for my governing bodies to freeze training spots.
 
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Lol, please show us how reimbursements are cyclical. This whole notion of cyclicality in medical fields was solely the effect of past decades where "unpopular" fields were devoid of applicants. This then pushed down their numbers thus creating a favorable market for them. It had nothing to do with CMS arbitrarily picking specialties for which they increase the reimbursements. These days, the number of applicants outnumber the number of available training slots, so such market imbalances will not result.
The number of applicants do not outnumber Nephrology spots and there others just like that. I didnt say they make arbitrary selections of which to fields they will pay more. They do make selections on how much to reimburse for certain services. When there's a shortage of nephrologists, reimbursement for dialysis will go up. When they find cheaper alternatives that are more cost effective to screening colonoscopies then GI reimbursements will go down. When reimbursements have made it not profitable to own your own practice, hospital shift work is relatively more profitable and now people want to do shift work (ER, hospitalist, ICU), making those fields more in demand. Things will continue to keep changing. That is what I mean by cyclic.
 
Lol, not from what I've seen. Obviously this kind of ranking is anecdotal given the lack of hard data out there, but does anyone really disagree with cardiology having a significantly more saturated market than the likes of GI, rheum, endo, onc, and pulm/CC? For these fields, you can literally drop a pin on a map and have multiple job openings.

And honestly, I still don't know why you are sensitive about this... if I were in cardiology right now, I would be trying to raise awareness in order to convince the governing bodies to back off on training slots. The more of you there are, the less you are worth. This is true for everyone, and exactly why I am all for my governing bodies to freeze training spots.

Cards job market trend has not headed in the right direction over the past few years. Pumping out close to 900 fellowship grads every year isn't helping things. Anyone who doesn't believe this is probably doing so on purpose.
 
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When there's a shortage of nephrologists, reimbursement for dialysis will go up.

You're wrong about this. CMS doesn't look at "physician demand" when deciding payment for services.

Best example: there has been a giant shortage of primary care physicians in this country for God knows how long. They could easily drive up payments to incentivize hospitalists/internal medicine sub specialists/inpatient heavy family docs to practice outpatient primary care. Has not happened.

Don't hold your breath about nephrology $ going up. I don't even see the dismal job market getting better anytime soon.
 
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Rheumaholiday finally emerges out of the shadows of other specialties (thanks to biologics and emphasis on work-life balance)!
 
I kept on hearing people saying rheum is great on life style but makes around 250k... I just find that wage being hard to justify the additional training since you can make 250 as a hospitalist too...(ofc I'm only a 3rd year so please feel free to correct me :D)

Spoken like someone who hasn't worked as a hospitalist . . .
 
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You're wrong about this. CMS doesn't look at "physician demand" when deciding payment for services.

Best example: there has been a giant shortage of primary care physicians in this country for God knows how long. They could easily drive up payments to incentivize hospitalists/internal medicine sub specialists/inpatient heavy family docs to practice outpatient primary care. Has not happened.

Don't hold your breath about nephrology $ going up. I don't even see the dismal job market getting better anytime soon.
In regions where there's a need for PCPs, outpatient makes excellent money for the hours and liability they have. God knows those recruiters won't stop emailing me about it.

What's going to happen when a large area doesn't have a nephrologist? We are arguing about speculations and predictions... only time will tell.
 
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Lol, you know you love us.

I have found rheumatologists less than helpful in the comanagement of any of the pulmonary manifestations of their diseases. And you can forget about an inpatient consult on one of their pulmonary renal syndromes. I can't even get one of you all to consider a case that is CLEARLY an auto immune phenomenon without a specific antibody. And there was the one time I did find that antisynthetase syndrome and the patient was told to go to Mayo. Good advice. Patient has no money. Thanks for nothing.

I know. I know. #notallrheumatologists

I am cranky today. Context.
 
I have found rheumatologists less than helpful in the comanagement of any of the pulmonary manifestations of their diseases. And you can forget about an inpatient consult on one of their pulmonary renal syndromes. I can't even get one of you all to consider a case that is CLEARLY an auto immune phenomenon without a specific antibody. And there was the one time I did find that antisynthetase syndrome and the patient was told to go to Mayo. Good advice. Patient has no money. Thanks for nothing.

I know. I know. #notallrheumatologists

I am cranky today. Context.
Are you in an academic center? I've found that community rheumatologists want to wash their hands of anything that isn't arthritis, whereas academicians like to over-call and over-manage everything that may or may not be autoimmune in etiology. Some of the faculty at my institution have never seen a patient that didn't need Cellcept or Azathioprine.
 
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In regions where there's a need for PCPs, outpatient makes excellent money for the hours and liability they have. God knows those recruiters won't stop emailing me about it.

What's going to happen when a large area doesn't have a nephrologist? We are arguing about speculations and predictions... only time will tell.
I can't imagine an area big enough to support a dialysis center without a nephrologist. Those are the jobs that actually allow someone to support themselves. Some poor nephro fellow will be happy to move to East Bum**** if such an opportunity existed.
 
Are you in an academic center? I've found that community rheumatologists want to wash their hands of anything that isn't arthritis, whereas academicians like to over-call and over-manage everything that may or may not be autoimmune in etiology. Some of the faculty at my institution have never seen a patient that didn't need Cellcept or Azathioprine.

It's a large nonprofit health system I work for. And I miss the discussions with the rheum folks at the U during training.
 
And there was the one time I did find that antisynthetase syndrome and the patient was told to go to Mayo. Good advice. Patient has no money. Thanks for nothing.

That's good advice though :p
 
This probably isn't the best thread to tell people about how I really feel about rheumatologists . . .

Had an inpatient consult from the house staff for grossly abnormal CT chest with pretty classic story for Wegener's. I made them page the rheumatology consult fellow.....after 5 pm. Mwahahahaha!
 
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Had an inpatient consult from the house staff for grossly abnormal CT chest with pretty classic story for Wegener's. I made them page the rheumatology consult fellow.....after 5 pm. Mwahahahaha!
"Draw these fifty labs. We will see him in the morning."
 
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"Draw these fifty labs. We will see him in the morning."
When the labs are all back. PS...19 of them are send outs to 14 different labs in 6 different countries. Turnaround time is typically 4-6 weeks. If he's still in-house at that time, we'll come make recommendations. Otherwise arrange for next new outpatient visit in our clinic. First new patient appointment time is currently 9 months out.

FTFY.
 
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In my view:

Lifestyle: Allergy & Immunology = Rheumatology = Endocrinology > Oncology = Pulmonary (no CCM) > GI > CCM (+/- Pulm) = Cardiology

Money: GI = Cardiology > Oncology = CCM = Pulmonary > Rheumatology = Endocrinology > ID = Nephrology

I think you need to put a " >>> Nephrology " (the more >s the better) in Lifestyle and Money. Don't forget Professional Satisfaction and Respect as well.
 
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