Allergy/Immunology

[numbersloth]

Anyone have any insight on Allergy&Immunology job market, lifestyle, and salary? Have heard that field is struggling in PP due to primary care docs taking over procedures but I wonder how true this is especially in urban centers like SF/LA/NYC/Chicago/Miami?

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[wamcp]

Anyone have any insight on Allergy&Immunology job market, lifestyle, and salary? Have heard that field is struggling in PP due to primary care docs taking over procedures but I wonder how true this is especially in urban centers like SF/LA/NYC/Chicago/Miami?

have friends in allergy:
Job market has collapsed, offers rescinded, revenue sharply contracted in existing practices due to COVID
Not sure if things will really bounce back to how they were before COVID, if millions are now unemployed without insurance or willingness to pay for allergy visits

 

[bronx43]

Anyone have any insight on Allergy&Immunology job market, lifestyle, and salary? Have heard that field is struggling in PP due to primary care docs taking over procedures but I wonder how true this is especially in urban centers like SF/LA/NYC/Chicago/Miami?

Allergy already had a bad job market before covid, not to mention severe encroachment on their testing and treatment by non-allergists like PCPs and ENTs. I would avoid.

 

[deleted1022594]

have friends in allergy:
Job market has collapsed, offers rescinded, revenue sharply contracted in existing practices due to COVID
Not sure if things will really bounce back to how they were before COVID, if millions are now unemployed without insurance or willingness to pay for allergy visits

That is true for every single subspecialty, hell even primary care. What you are describing is not at all unique to AI in the current environment.

 

[deleted1022594]

Allergy already had a bad job market before covid, not to mention severe encroachment on their testing and treatment by non-allergists like PCPs and ENTs. I would avoid.

The issue with PCPs and ENTs taking over Allergy is that it actually doesn't happen that often. There are still plenty of Allergy Immunology patients with needs for testing for seasonal allergies, food allergies, immunotherapy etc. There is still a shortage of AI physicians which is why you see ENT and some PCP doing testing.

 

[bronx43]

The issue with PCPs and ENTs taking over Allergy is that it actually doesn't happen that often. There are still plenty of Allergy Immunology patients with needs for testing for seasonal allergies, food allergies, immunotherapy etc. There is still a shortage of AI physicians which is why you see ENT and some PCP doing testing.

There's a shortage of every field if you ask the specialty societies, even though the math is fuzzy. I think my own field (rheum) is more or less at equilibrium despite the fact that there's a huge push in the field to train more fellows. The problem with specialties is that it can saturate QUICKLY due to the inelasticity of the demand.

 

[deleted1022594]

There's a shortage of every field if you ask the specialty societies, even though the math is fuzzy. I think my own field (rheum) is more or less at equilibrium despite the fact that there's a huge push in the field to train more fellows. The problem with specialties is that it can saturate QUICKLY due to the inelasticity of the demand.

Yeah but if we are talking individual anecdotes on commenting whether fields are saturated, it can get muddy. In my mid-sized city, a new Rheumatologist has not been hired since about 3-4 years while an Allergist only had one applicant for a private practice position which couldn't be filled. So Rheumatology is a pretty saturated field in my area.

 

[bronx43]

Yeah but if we are talking individual anecdotes on commenting whether fields are saturated, it can get muddy. In my mid-sized city, a new Rheumatologist has not been hired since about 3-4 years while an Allergist only had one applicant for a private practice position which couldn't be filled. So Rheumatology is a pretty saturated field in my area.

That’s what I’m trying to say. There really isn’t a shortage of any of these fields. There isn’t a national shortage of rheumatology and there certainly isn’t a shortage of allergy in most regions.

 

[UncommonVariable]

Allergy is still a great field. I am an allergist-immunologist in a "saturated" market (the Northeast). I entered job market about 2 years ago and everyother practice was looking to hire at the time. While there may be shortages in all fields, I have found the demand for allergy is....well let's just say the sky is the limit. I do not regularly prescribe allergy shots, which can significantly increase revenue and are in demand as a "natural" way to manage allergies. I work 3 days a week from 9am to 5pm with an hour lunch break and all of my notes are done by end of the day so I can be with my family. The compensation isn't bad either I make about twice as much as primary care doctors, while working 3 days a week. Primary care hasn't touched procedures in my neck of the woods. ENTs like to pretend to be allergists, which leads to a steady stream of misdiagnosed/managed patients for me to help. I highly recommend considering the field.

 

[ftcm68]

Any advice on how to think about academic vs private allergist jobs - with respect to the job market, lifestyle, and salary?

 

[bronx43]

Good ol Bronx43 still running around telling people not to do AI lol. Seems like you're not content with Rheum or maybe dint get AI many years ago. The jobs are still out there for AI and always will be. I think Rheum is having quite many difficulties with oversaturation in the city.

Lol ok bruh, my home program got mad when I told them no thanks years ago. Nice try though. It’s AI... not GI.

 

[hotsaws]

A/I fellow here. All anecdotes, of course. I have two friends that finished fellowship last year. One was in a competitive market, nice city with an unusually high number of A/I fellows produced per year. That person got their initial contract rescinded but was given a job in a neighboring city, about an hour away. The other fellow got a job in a large city. The two fellows who graduated from my program last year got jobs -- one in PP in the same city, the other hired as faculty.

No clue about the details of these jobs and pay structure though.

 

[holaho]

Haven't heard of a single fellow being jobless in my 10+ years of experience.

 

[wamcp]

A/I fellow here. All anecdotes, of course. I have two friends that finished fellowship last year. One was in a competitive market, nice city with an unusually high number of A/I fellows produced per year. That person got their initial contract rescinded but was given a job in a neighboring city, about an hour away. The other fellow got a job in a large city. The two fellows who graduated from my program last year got jobs -- one in PP in the same city, the other hired as faculty.

No clue about the details of these jobs and pay structure though.

depends on your location.

In my mates’ from residency who did allergy they are in midwest and there is absolutely NOTHING in a livable city. They had a signed offer until pandemic in March got rescinded. They are jobless since finishing fellowship. Even job postings in podunk nowhere have ignored their applications in their state.

They have given up and decided to look out of state which will uproot them from their extended family/disrupt their own spouse’s career - yes they got offers quickly, but it’s in saturated high tax east coast state at 220k for 4 days a week clinic plus every other saturday and lots of call. Garbage. Keep in mind they will be without employment income until next year as as have to wait for out of state licensing/credentialing.

 

[hotsaws]

That would be scary. Have they thought about opening a practice? Probably what I'd do, especially if my wife had an established career in the area. Easier said than done, of course, but certainly not impossible. We staff with some private attendings in our training and a few solo practice people are doing surprisingly well right now. I've been considering it anyway but it's quite the upfront time investment -- facing joblessness would probably push me firmly in that direction.

Are they gonna try and pull hospitalist or PCP work to make ends meet while waiting?

 

[wamcp]

That would be scary. Have they thought about opening a practice? Probably what I'd do, especially if my wife had an established career in the area. Easier said than done, of course, but certainly not impossible. We staff with some private attendings in our training and a few solo practice people are doing surprisingly well right now. I've been considering it anyway but it's quite the upfront time investment -- facing joblessness would probably push me firmly in that direction.

Are they gonna try and pull hospitalist or PCP work to make ends meet while waiting?

One has a spouse with income to get by, another has been hospitalist moonlighting but not quite enough shifts available- forced to take on some credit card debt (not a lot of shifts since the pandemic has saturated the market).

It’s important to find work within two years of graduating though. I have a nephro buddy who did hospitalist work after fellowship for a few years and when he tried to return to renal practice the hospitals refused to credential him due to over 24 months of no renal+ over 24 months out of fellowship


You could open an allergy practice but if it is saturated market already, How will you ever get a good patient base? Would need to take on debt to rent office space, hire staff, and take time to get things worked out with major insurers, a big risk.
Opening your own practice only makes sense in area of demand- i.e. being a solo PCP probably will work for many desirable cities because there is always a ‘shortage’ as evidenced by the barrage of job offers in the location

 

[hotsaws]

Just an update on this pseudo "jobs" thread. Now in second year of fellowship. Job hunt was great for both my cofellow and myself. Landed jobs we wanted in the suburbs of the cities we wanted (large metro areas). Job market seems good. Happy to answer any questions.

 

[xDNA]

Just an update on this pseudo "jobs" thread. Now in second year of fellowship. Job hunt was great for both my cofellow and myself. Landed jobs we wanted in the suburbs of the cities we wanted (large metro areas). Job market seems good. Happy to answer any questions.

What attracted you to A/I ?

 

[allergy_imms]

Does anyone have ideas on general rankings for allergy/immunology fellowships? Which programs are looked at as strong training programs where graduating fellows have a higher chance of being heavily recruited?

 

[hotsaws]

What attracted you to A/I ?

The ultimate factor in me deciding on a specialty was that I wanted to be happy. That's complicated because one's perception of the actual practice of medicine changes from pre-med to med student to resident and then beyond as you progress through training and practice. That is probably the reason why I had a last minute change of heart from a surgical specialty to internal medicine with plans to subspecialize.

Here's the factors I thought would make me happy:

-lifestyle: Have to have somewhat of a normal, routine schedule so I can live a normal life. Know thyself. I am not a grind it out for a week and blow off steam the next week type of person. That's long term burn out for sure. I also would get regularly frustrated if I had days that went super long occasionally or was getting called into a hospital at 2am on a Sunday. I like being around friends and family. I like a little bit of "me time." I knew I would be a husband and father and dog owner. Working regular hours and essentially having nights, weekends, and holidays off facilitates this the best for me.

-money: "Money ain't everything, but not having it is." Grew up in the lower middle class. Worried about finances a lot. I wanted to be in a field where I could thrive financially. No shame.

-fulfillment: The meaning of this changed a lot overtime. I came into medical school thinking this meant I needed to do something "big" and cutting edge. Pretty much interventional/surgical stuff with a fair amount of risk. By the time I was finished with residency, I realized that I just wanted to make a patient feel better, increase the quality of life, and leave the exam room with both myself and the patient happy with how things went. If not...I wanted to get out of the room with minimal collateral damage and not have to keep seeing that patient again and again, in futility. You can do this in allergy while still maintaining the above criteria. Most of our patients are normal to high functioning, not responsible for their disease, and we can help them genuinely feel better. I pretty much never have to manage or workup pain-related complaints. I didn't find this to be as common in other non-surgical fields.

-Passion for the field itself: There's a lot of cool fields in medicine. I really like A/I. I also like the applied physiology and pharmacology of critical care, the tangibility and acuity of cardiology, and the structure and function involved with orthopedics. I also really enjoy the pathophysiology behind rheumatology, endocrinology, and other fields. So on and so on. A lot of people ahead of me told me "At the end of the day...it's a job" and I see that quite clearly now.

I've certainly got my share of burnout, bias, and jaded perceptions. This is just one dude's opinion.

 

[holaho]

The ultimate factor in me deciding on a specialty was that I wanted to be happy. That's complicated because one's perception of the actual practice of medicine changes from pre-med to med student to resident and then beyond as you progress through training and practice. That is probably the reason why I had a last minute change of heart from a surgical specialty to internal medicine with plans to subspecialize.

Here's the factors I thought would make me happy:

-lifestyle: Have to have somewhat of a normal, routine schedule so I can live a normal life. Know thyself. I am not a grind it out for a week and blow off steam the next week type of person. That's long term burn out for sure. I also would get regularly frustrated if I had days that went super long occasionally or was getting called into a hospital at 2am on a Sunday. I like being around friends and family. I like a little bit of "me time." I knew I would be a husband and father and dog owner. Working regular hours and essentially having nights, weekends, and holidays off facilitates this the best for me.

-money: "Money ain't everything, but not having it is." Grew up in the lower middle class. Worried about finances a lot. I wanted to be in a field where I could thrive financially. No shame.

-fulfillment: The meaning of this changed a lot overtime. I came into medical school thinking this meant I needed to do something "big" and cutting edge. Pretty much interventional/surgical stuff with a fair amount of risk. By the time I was finished with residency, I realized that I just wanted to make a patient feel better, increase the quality of life, and leave the exam room with both myself and the patient happy with how things went. If not...I wanted to get out of the room with minimal collateral damage and not have to keep seeing that patient again and again, in futility. You can do this in allergy while still maintaining the above criteria. Most of our patients are normal to high functioning, not responsible for their disease, and we can help them genuinely feel better. I pretty much never have to manage or workup pain-related complaints. I didn't find this to be as common in other non-surgical fields.

-Passion for the field itself: There's a lot of cool fields in medicine. I really like A/I. I also like the applied physiology and pharmacology of critical care, the tangibility and acuity of cardiology, and the structure and function involved with orthopedics. I also really enjoy the pathophysiology behind rheumatology, endocrinology, and other fields. So on and so on. A lot of people ahead of me told me "At the end of the day...it's a job" and I see that quite clearly now.

I've certainly got my share of burnout, bias, and jaded perceptions. This is just one dude's opinion.

Couldn't have said it any better myself! Lifestyle is unmatched and the stress is way lower than any other specialties, at the same time, a reasonable competitive pay compared to other specialties. I am yet to meet an unhappy allergist.

 

[hotsaws]

Does anyone have ideas on general rankings for allergy/immunology fellowships? Which programs are looked at as strong training programs where graduating fellows have a higher chance of being heavily recruited?

Like any residency or fellowship program, it's difficult to truly "rank" them. It depends on what you want to do after training. It depends whether you want to stay in academics or go to private practice. Even within academics, there are certain niches. If you truly want to do clinical immunology there are some particularly strong programs for this (say Duke or U Washington). Even with general academics, there's a difference between those who just have sort of a clinician educator role (underpaid and working for a big corporation, IMO) and those who are publishing machines or actually have labs. A/I is a small field and fellowship programs are primarily in academic centers. We are not like cardiology or other large subspecialties who have community hospitals, pseudo academic centers, and true academic centers abundantly. We do have a few outliers like national jewish or Scripps which are great training programs and well regarded in A/I but not necessarily as much in other fields.

I have some friends in A/I and I interviewed at 10 different programs. I can offer a rough categorization of programs but there's just so many I know nothing about.

If you really want to stay in academics, the top programs are pretty much going to be your name brand institutions that generally have abundant funding, staff, structure and overall resources to conduct research. There are certainly some state schools with a particular academic push. I never wanted to stay in academics so I know very little about this. When I interviewed at a program that came on strong with research, I put it toward the bottom of my list. There are probably others on the forum who could correct me or elaborate.

If you want to go in to private practice, there's a few things you want to consider. You will want balanced cross training. Meaning you want to see the entire age spectrum and about as close to 50/50 peds/adult as you can get. You want good clinical volume too. Otherwise, you just wanna be happy. A good state program in your hometown is probably not a bad choice and will likely help if you want to stay local for practice. If you go on multiple interviews, pay attention to the place where you get good vibes and feel a good fit. From my experience and that of my friends, private practices probably won't be overly choosey about where you trained. They will also be looking for a good fit.

It's a great field. Mostly happy people. Most programs I interviewed at would have offered good training. It's more about what's right for you...or just getting a spot at all. I wouldn't worry too much about rank -- worry more about things like focus on academics vs clinical practice, research and to what level, mix of peds/adults, call schedule, how much academic stuff they expect you to do (giving grand rounds lectures or other presentation type stuff), and how happy the current fellows and faculty seem.

 

[Pre-Medguy1995]

The ultimate factor in me deciding on a specialty was that I wanted to be happy. That's complicated because one's perception of the actual practice of medicine changes from pre-med to med student to resident and then beyond as you progress through training and practice. That is probably the reason why I had a last minute change of heart from a surgical specialty to internal medicine with plans to subspecialize.

Here's the factors I thought would make me happy:

-lifestyle: Have to have somewhat of a normal, routine schedule so I can live a normal life. Know thyself. I am not a grind it out for a week and blow off steam the next week type of person. That's long term burn out for sure. I also would get regularly frustrated if I had days that went super long occasionally or was getting called into a hospital at 2am on a Sunday. I like being around friends and family. I like a little bit of "me time." I knew I would be a husband and father and dog owner. Working regular hours and essentially having nights, weekends, and holidays off facilitates this the best for me.

-money: "Money ain't everything, but not having it is." Grew up in the lower middle class. Worried about finances a lot. I wanted to be in a field where I could thrive financially. No shame.

-fulfillment: The meaning of this changed a lot overtime. I came into medical school thinking this meant I needed to do something "big" and cutting edge. Pretty much interventional/surgical stuff with a fair amount of risk. By the time I was finished with residency, I realized that I just wanted to make a patient feel better, increase the quality of life, and leave the exam room with both myself and the patient happy with how things went. If not...I wanted to get out of the room with minimal collateral damage and not have to keep seeing that patient again and again, in futility. You can do this in allergy while still maintaining the above criteria. Most of our patients are normal to high functioning, not responsible for their disease, and we can help them genuinely feel better. I pretty much never have to manage or workup pain-related complaints. I didn't find this to be as common in other non-surgical fields.

-Passion for the field itself: There's a lot of cool fields in medicine. I really like A/I. I also like the applied physiology and pharmacology of critical care, the tangibility and acuity of cardiology, and the structure and function involved with orthopedics. I also really enjoy the pathophysiology behind rheumatology, endocrinology, and other fields. So on and so on. A lot of people ahead of me told me "At the end of the day...it's a job" and I see that quite clearly now.

I've certainly got my share of burnout, bias, and jaded perceptions. This is just one dude's opinion.

This is such a great response. Especially in a field you get almost minimal exposure to as a student.

I completely agree with the lifestyle. As far as money, I grew up similarly/a little worse off. If you don't mind me asking, what's a good ballpark estimate (especially after COVID)?

I worry the most about going through a long training process and having loans to pay and not being able to find a well-paying job.

 

[mulberry]

I have a question regarding A/I fellowship. I’m a Pgy2 IM resident now interested in allergy. When I made my schedule at the end of last year, I had a different fellowship in mind and didn’t schedule any allergy elective for this year. If my program is unwilling to switch an elective, what would my options be if I want to apply to fellowship but have no letters? Would I have to apply a year late and do electives in 3rd year?

I know for some inpatient heavy specialties people say you can get experience working as an attending in that field to get letters/experience/research but it would be hard with allergy being primarily outpatient.

 

[Lucky1993]

PGY-3 applying to AI this year. I would try to get an away elective in AI if that is an option. This field is very small and they really want atleast 1-2 letters from AI faculty, so I would try your best to get some letters. Otherwise you could apply for chrysalis project (but late for spark program now) where they will match you with fellows and faculty. You could network that way and start working on research with someone at other programs.

 

[Legend of Link]

The ultimate factor in me deciding on a specialty was that I wanted to be happy. That's complicated because one's perception of the actual practice of medicine changes from pre-med to med student to resident and then beyond as you progress through training and practice. That is probably the reason why I had a last minute change of heart from a surgical specialty to internal medicine with plans to subspecialize.

Here's the factors I thought would make me happy:

-lifestyle: Have to have somewhat of a normal, routine schedule so I can live a normal life. Know thyself. I am not a grind it out for a week and blow off steam the next week type of person. That's long term burn out for sure. I also would get regularly frustrated if I had days that went super long occasionally or was getting called into a hospital at 2am on a Sunday. I like being around friends and family. I like a little bit of "me time." I knew I would be a husband and father and dog owner. Working regular hours and essentially having nights, weekends, and holidays off facilitates this the best for me.

-money: "Money ain't everything, but not having it is." Grew up in the lower middle class. Worried about finances a lot. I wanted to be in a field where I could thrive financially. No shame.

-fulfillment: The meaning of this changed a lot overtime. I came into medical school thinking this meant I needed to do something "big" and cutting edge. Pretty much interventional/surgical stuff with a fair amount of risk. By the time I was finished with residency, I realized that I just wanted to make a patient feel better, increase the quality of life, and leave the exam room with both myself and the patient happy with how things went. If not...I wanted to get out of the room with minimal collateral damage and not have to keep seeing that patient again and again, in futility. You can do this in allergy while still maintaining the above criteria. Most of our patients are normal to high functioning, not responsible for their disease, and we can help them genuinely feel better. I pretty much never have to manage or workup pain-related complaints. I didn't find this to be as common in other non-surgical fields.

-Passion for the field itself: There's a lot of cool fields in medicine. I really like A/I. I also like the applied physiology and pharmacology of critical care, the tangibility and acuity of cardiology, and the structure and function involved with orthopedics. I also really enjoy the pathophysiology behind rheumatology, endocrinology, and other fields. So on and so on. A lot of people ahead of me told me "At the end of the day...it's a job" and I see that quite clearly now.

I've certainly got my share of burnout, bias, and jaded perceptions. This is just one dude's opinion.

You sound exactly like me..I'm interested in allergy as well due to all those factors...but all these talk about job market really scares me. Sometimes I think I should just pursue rheumatology but then I think u really can't beat the allergy lifestyle and pay in any other speciality..

 

[Legend of Link]

PGY-3 applying to AI this year. I would try to get an away elective in AI if that is an option. This field is very small and they really want atleast 1-2 letters from AI faculty, so I would try your best to get some letters. Otherwise you could apply for chrysalis project (but late for spark program now) where they will match you with fellows and faculty. You could network that way and start working on research with someone at other programs.

I'm interested in AI as well. How do you think the job market and salary will be in a few years? Specially if someone is geographically very flexible?

 

[hotsaws]

The job market for AI isn’t bad. It’s a small field and I’m sure others may have more options. I’m pretty sure I have some previous posts that went into more detail. Bottom line is that academics and private practice are both hiring. Private equity owned groups are hiring as well. Good and bad to all those options. Just look on the aaaai and Acaai website job boards and you can get a rough idea of what it would look like right now. I think you’ll find a fair number of decent sized cities and areas around the country that have job opportunities.

 

[Prehealth1011]

@hotsaws are the private practice typical salaries higher than hospitalist salaries (around 300k)?

 

[hotsaws]

You really shouldn't be using compensation as the main metric to differentiate between specialties. Comparing hospitalist work to A/I using salary as a metric is basically comparing apples to oranges using calories as a metric. If that's a main concern, probably not worth doing an A/I fellowship.

 

[Legend of Link]

The job market for AI isn’t bad. It’s a small field and I’m sure others may have more options. I’m pretty sure I have some previous posts that went into more detail. Bottom line is that academics and private practice are both hiring. Private equity owned groups are hiring as well. Good and bad to all those options. Just look on the aaaai and Acaai website job boards and you can get a rough idea of what it would look like right now. I think you’ll find a fair number of decent sized cities and areas around the country that have job opportunities.

Hey hotsaws ty for the response! Do you feel like there is enough patient volume to work as much or as little as you want? I tend to see a lot of people that def needs the help of an allergist and they just brush it off or go see their PCP for it and some of those PCPs just won't refer them out to allergists and keep mismanaging their patients.

Is it possible to find a job (private) working 5 days/ week working ~8 hour days and making north of 400k? I know allergy is known for its lifestyle but I don't mind hustling a bit in my earlier career since I got loans to pay off.

How's the demand now overall? I read somewhere else that apparently the sky is the limit. How does base salary look like starting in private practice? What's the up potential in the long run?

When you were hunting for jobs after fellowship, did u go through recruiters or cold calling places?

 

[Deecee2DO]

@hotsaws are the private practice typical salaries higher than hospitalist salaries (around 300k)?

Yes they are and they work less. Most guys i know in PP especially the partner track gigs make north of 400K easily even 2-3 years out depending on model/location. Academics absolutely not

 

[Legend of Link]

Yes they are and they work less. Most guys i know in PP especially the partner track gigs make north of 400K easily even 2-3 years out depending on model/location. Academics absolutely not

What if employed instead of partner track?

 

[hotsaws]

I would be surprised to see an employed doc making that kind of money. Although, it depends what you mean by employed. Employed by a large hospital or multispecialty system, probably not, unless they negotiated a very favorable production based reimbursement. These type of employed gigs typically come with a higher base salary but relatively low ceiling. There may be some other perks in terms of benefits in that you are an employee of a large corporation and they may have appealing benefit packages and things like parental leave, larger staffing pool, etc. There could be a scenario where you are employed by a private group in that you aren't getting equity in the business but are still essentially reimbursed in collections - overhead. In the latter scenario, your compensation could still be quite high. Equity in any practice will always come at a cost but it should open you up to ancillary services in addition to just your collections (eg PA/NP revenue, buy and bill revenue from biologics, appreciation of real estate holdings, and perhaps most importantly, compensation if the group is bought out).