A Ranking of the IM Subspecialties

[doctorfunk7]

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Can anyone give me a rough ranking of the IM specialties based on competitiveness (and, by extension, difficulty of getting in)? Specific hospital location aside, where do the different fields rank relative to each other? Everyone says Cardiology and GI are the most competitive, but what about the 20 subspecialties that come after that?

I know the sticky has a ranking, but it's from 2005. It must have changed some in the last 3 years.

 

[gutonc]

Can anyone give me a rough ranking of the IM specialties based on competitiveness (and, by extension, difficulty of getting in)? Specific hospital location aside, where do the different fields rank relative to each other? Everyone says Cardiology and GI are the most competitive, but what about the 20 subspecialties that come after that?

I know the sticky has a ranking, but it's from 2005. It must have changed some in the last 3 years.

It hasn't really changed that much. I'd say it goes something like:
Cards/GI > Onc > Allergy (very few spots) > Everything Else

There are some up and comers - Pulm/CC is more competitive than it used to be but still nowhere near the others.

 

[adam6]

This is my list for the major subspecialties (I'm including allergy even though it technically does not fall under IM):
1. (tie)Allergy, Cardiology, GI
4. Heme/Onc
5. PCC
6. Nephrology
7. (tie)Endocrinology, ID, rheum
10. others: geriatrics, palliative care

I don't think you can really even include things like medical genetics in a general discussion.

It's obviously difficult to comment without making sweeping generalizations...
It is not like comparing "apples to apples" due to confounding factors ie: number of available positions (fewest for things like allergy), applicant pool (probably most "hard-core" for cardiology), etc.

Subspecialties in general are pretty competitive, right now. For top university programs, it is very competitive regardless of the specialty.

When I was interviewing for endocrine (in this age of ERAS), it was common for programs to mention that 200-300 people applied, 10-20 were being interviewed - all for 2-4 spots...

That being said, if you look at the NRMP website, match statistics are pretty good, even for cards (probably if you are willing to apply to enough programs of varying callibers ^_^).

 

[chemamr]

rheuma is getting more competitive, similar than PCC. source: NRMP.

 

[howelljolly]

rheuma is getting more competitive, similar than PCC. source: NRMP.

how and why? (for each)

 

[bof]

Can anyone give me a rough ranking of the IM specialties based on competitiveness (and, by extension, difficulty of getting in)? Specific hospital location aside, where do the different fields rank relative to each other? Everyone says Cardiology and GI are the most competitive, but what about the 20 subspecialties that come after that?

I know the sticky has a ranking, but it's from 2005. It must have changed some in the last 3 years.

Tier 1: Cards/GI
Tier 2: Allergy (only because so few spots)
Tier 3: everything else

Ok, I am kind of generalizing on tier 3, but at the same time I think if you come from a reputable program and are geographically open you should be able to get a tier 3 fellowship without too much trouble.

 

[bof]

rheuma is getting more competitive, similar than PCC. source: NRMP.

All fellowships are becoming more competitive. How many people do you know that want to do primary care anymore?

 

[Waiting4Ganong]

It hasn't really changed that much. I'd say it goes something like:
Cards/GI > Onc > Allergy (very few spots) > Everything Else

There are some up and comers - Pulm/CC is more competitive than it used to be but still nowhere near the others.

Agreed. 👍

 

[elresidante]

Archives of Internal Med July 22, 2002 had an article called "Physician Satisfaction Across Specialties." I would hope med students/residents would at least consider physician satisfaction with their chosen specialty before picking one, as opposed to assuming the most competitive and lucrative specialties are the "best." And besides, when was the last time you saw a happy cardiologist or gastroenterologist (unless they were, like, on the golf course or something?)?

Most Satisfying:
1. Geriatrics
2. Neonatal/Perinatal Med
3. ID
4. Derm (no suprise here)
5. Peds
6. Other
7. Allergy/Immunology
8. Med Onc
9. Endocrine
1o. Cardiothoracic Surgery
11. Nephrology
12. Peds Psych

Least Satisfying (bottom of the same list):
1. GYN
2. Pulmonary
3. OB-GYN
4. ENT
5. GI
6. Optho
7. Internal Med
8. Physiatry
9. "General Practice"
10. Plastic Surgery
11. Gen Surg
12. Cards

Most Dissatisfying:
1. ENT
2. OB/GYN
3. Optho
4. Plastics
5. GI
6. Ortho
7. GYN
8. Cardiothoracic Surg
9. IM
10. Gen Surg
11. Pulm
12. Psych

Interesting, huh?

 

[Gastrapathy]

And besides, when was the last time you saw a happy cardiologist or gastroenterologist (unless they were, like, on the golf course or something?)?
\
\\

When was the last time I saw a happy gastroenterologist? Umm...I don't know an unhappy gastroenterologist.

 

[Tigerz_Fan]

When was the last time I saw a happy gastroenterologist? Umm...I don't know an unhappy gastroenterologist.

I have to agree with that!

 

[Tigerz_Fan]

Can anyone give me a rough ranking of the IM specialties based on competitiveness (and, by extension, difficulty of getting in)? Specific hospital location aside, where do the different fields rank relative to each other? Everyone says Cardiology and GI are the most competitive, but what about the 20 subspecialties that come after that?

I know the sticky has a ranking, but it's from 2005. It must have changed some in the last 3 years.

I would have to say:

1. cards
2. GI
3. pulm/ccm
-getting much more competitive
4. allergy (lack of positions)
5. heme/onc
6. rheum and nephro
7. ID, geri, endocrine

 

[cdql]

it seems like the competitiveness of the im subspecialties is directly linked to income

are there uncompetitive im subspecialties that still pay very well?

 

[Tigerz_Fan]

it seems like the competitiveness of the im subspecialties is directly linked to income

are there uncompetitive im subspecialties that still pay very well?

Hmmm, good one. Salary always directly reflects procedures.

Best bet might be nephrology, then a fellowship in interventional nephrology. Although, I don't know what the salary scale is....

 

[Bluemirage]

I'm curious as to know why you had ranked Pulm/CC above Heme/Onc in competitiveness. Pulm/CC seems like a very interesting specialty but in general pays alot less and work much longer hours than Heme/Onc. From speaking to IM residents and fellows in various specialties, I think the order should be:

1) GI
2) Cards (closely following GI simply because of more spots)
3) Allergy
4) Heme/Onc
5) Pulm/CC
6) Nephro
7) Rheum, Endocrine and ID
8) Geriatrics

I would have to say:

1. cards
2. GI
3. pulm/ccm
-getting much more competitive
4. allergy (lack of positions)
5. heme/onc
6. rheum and nephro
7. ID, geri, endocrine

 

[cdql]

Hmmm, good one. Salary always directly reflects procedures.

Best bet might be nephrology, then a fellowship in interventional nephrology. Although, I don't know what the salary scale is....

hmm, that makes sense

 

[Tigerz_Fan]

I ranked according to competitiveness only. Many things factor into a specialty's competitiveness such as salary, lifestyle, and number of positions available.

If you factor procedures into salary, then I think CCM is grossly underpaid....would likely make the field more competitive. In the past couple of years pulm/CCM and CCM is getting much more competitive, likely due to the improvement in lifestyle....

I'm curious as to know why you had ranked Pulm/CC above Heme/Onc in competitiveness. Pulm/CC seems like a very interesting specialty but in general pays alot less and work much longer hours than Heme/Onc. From speaking to IM residents and fellows in various specialties, I think the order should be:

1) GI
2) Cards (closely following GI simply because of more spots)
3) Allergy
4) Heme/Onc
5) Pulm/CC
6) Nephro
7) Rheum, Endocrine and ID
8) Geriatrics

 

[Waiting4Ganong]

I ranked according to competitiveness only. Many things factor into a specialty's competitiveness such as salary, lifestyle, and number of positions available.

If you factor procedures into salary, then I think CCM is grossly underpaid....would likely make the field more competitive. In the past couple of years pulm/CCM and CCM is getting much more competitive, likely due to the improvement in lifestyle....

Tigerz_Fan - going into Pulm/CC by any chance? 🙂

Pulm/CCM is not a competitive specialty. Even some of the best programs have difficulty getting quality fellows.

While I think this is shaping up to be the stupidest thread ever I'd just like to sign off by saying there is wider variation within a specialty (much much easier to get a community GI or cardiology fellowship than an pulm or rheum fellowship at Hopkins for example) than between specialties.

General trends are generally accepted: For programs of similar quality the difficulty of matching is something like:


GI maybe very slightly harder than cards (but basically the same at top
places)

>

Oncology slightly harder than Allergy (for top programs, although few allergy programs means mid-tier applicants have a much harder time getting an allergy fellowship)

>>>>

Pulm/CCM slightly above the others (Rheum/Nephro/Endo/ID)

>>

Finally Geriatrics, GIM, Palliative Care, HIV, Public Health, Policy etc are generally non-competitive.


Hope this helps somebody somewhere. Essentially though - if you work at it - and are reasonably good - you can match *somewhere* in what you want to do (except Allergy) if you put the extra effort in.

 

[Tigerz_Fan]

How do you guess? 😉

Will be starting a CCM on July 1st.....

Tigerz_Fan - going into Pulm/CC by any chance? 🙂

Pulm/CCM is not a competitive specialty. Even some of the best programs have difficulty getting quality fellows.

While I think this is shaping up to be the stupidest thread ever I'd just like to sign off by saying there is wider variation within a specialty (much much easier to get a community GI or cardiology fellowship than an pulm or rheum fellowship at Hopkins for example) than between specialties.

General trends are generally accepted: For programs of similar quality the difficulty of matching is something like:


GI maybe very slightly harder than cards (but basically the same at top
places)

>

Oncology slightly harder than Allergy (for top programs, although few allergy programs means mid-tier applicants have a much harder time getting an allergy fellowship)

>>>>

Pulm/CCM slightly above the others (Rheum/Nephro/Endo/ID)

>>

Finally Geriatrics, GIM, Palliative Care, HIV, Public Health, Policy etc are generally non-competitive.


Hope this helps somebody somewhere. Essentially though - if you work at it - and are reasonably good - you can match *somewhere* in what you want to do (except Allergy) if you put the extra effort in.

 

[ThinkTooMuch]

is there a speciality in IM that deals with how foods effect hormonal secretion?

 

[dragonfly99]

Endocrinology is the internal medicine subspecialty that deals with hormones. They also take care of things like thyroid disease, diabetes and pituitary disorders. You would do internal med x 3 years, and then 2-3 years of endocrinology fellowship (usually the 1st year is mostly in the hospital and clinics, and the last year or two is doing medical research for the most part). It's actually a fairly easy field to get into (vs. becoming a surgeon or some other medical subspecialties like cardiologist or GI doctor).

 

[JHopRevisit]

Most Satisfying:
1. Geriatrics
2. Neonatal/Perinatal Med

I know I'm dragging up a very old topic, but I can't imagine that neonatal is the amongst the most satisfying residencies. I've got a potential interest in peds and even I think the NICU is the most depressing place on Earth. Am I mixing up specialties here? How are they happy dealing with little gremlin span all day (or maybe I'm getting a skewed vibe working at a large academic center delivering 24 weekers, when I hear 35 weeks these days I think "whats taking so long, why isn't that baby out yet?")?

 

[howelljolly]

It just so happened that I did my prenatal/high risk and then L&D blocks in my OB/Gyn rotation, immediately followed by nursery/neonatology/NICU blocks of my Peds rotation. I really just wanted to grab those perinatal OB guys by the necktie and drag them into the NICU, and ask them if they're pleased with what they've done.

While I definitely liked the pathophys and ICU management in the NICU, I nearly stroked out from hypertension on a daily basis.

 

[nomer24]

the physician satisfaction study that came out in 2002 is where a number of websites have obtained the list that was posted to this threat.

i find it difficult to interpret this list from an individual perspective. why would cardiothoracic surgeons be on both the most satisfied and dissatisfied lists simultaneously? maybe there are two populations, one who is in it for the money and the other who is in it for the glory. perhaps there are members of each population that are on the satisfied list. however, it may be that members of both populations are on the most dissatisfied list also because they did not get what they bargained for (aka the money/glory aren't worth the time they invest)?

just speculation here, but it seems the only underlying principle is that money correlates with competitiveness.

 

[radslooking]

the physician satisfaction study that came out in 2002 is where a number of websites have obtained the list that was posted to this threat.

i find it difficult to interpret this list from an individual perspective. why would cardiothoracic surgeons be on both the most satisfied and dissatisfied lists simultaneously? maybe there are two populations, one who is in it for the money and the other who is in it for the glory. perhaps there are members of each population that are on the satisfied list. however, it may be that members of both populations are on the most dissatisfied list also because they did not get what they bargained for (aka the money/glory aren't worth the time they invest)?

just speculation here, but it seems the only underlying principle is that money correlates with competitiveness.

my personal belief about that study is that it sucks. it does not gauge at all with my personal observations about who is happiest.