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Allergy & Immunology..

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olio

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Any info. anybody ..Here are 3 things i know abt it :

1.It has a direct program now in the States not as a fellowship.

2.Somehow boring .:S

3.Lots of money ..:p

So as you can see quite limited information i have here abt the subject ,Plz help me out .
 

HolyMoly

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Yeah I'd be more interested to know about it too...or any of the IM subspecialties, since my knowledge is lacking. Thanks!
 

Atlas

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olio said:
Any info. anybody ..Here are 3 things i know abt it :

1.It has a direct program now in the States not as a fellowship.

2.Somehow boring .:S

3.Lots of money ..:p

So as you can see quite limited information i have here abt the subject ,Plz help me out .

I'm sorry maybe I'm misunderstanding, but where is A&I a separate residency? It's miscorrectly listed in FREIDA if that's your source. They have it listed under "residencies" and not under fellowships, but it is (to my knowledge) still a fellowship. It says on FREIDA that it requires 3 years (IM/Peds) of previous GME credit...which makes it a fellowship. I'm not aware of any A&I "Residencies".
 

dharmabum7

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After having applied this year to AI, I can say for a fact that its definately a fellowship that can be done after IM, Peds, or Med Peds.

Boring, well that depends on what you're into...if you work in a more academic setting you can get a lot of interesting immunodeficiency cases.

So it depends on your liking. It has a high satisfaction rate among the people who enter the field. You get to see kids and adults. Patients are usually appreciative because they feel substantially better with treatment.
You see a fair amount of asthma. The research possibilities in Immunology are endless. Hours are great. Call is not too demanding. Money is good.

Hope this helps, any specific questions?
 
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eleileen

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Hi,
thanks for your input. I've been trying to find out specific stats on AI -- many programs do not appear to take fellows every year, also...any idea on where I could get a list of programs accepting fellows for the year? (I looked in FRIEDA previously).
I've also heard it's one of the more competitive fellowships. Any additional ideas on what may have helped your application?
Thank you in advance!Q

dharmabum7 said:
After having applied this year to AI, I can say for a fact that its definately a fellowship that can be done after IM, Peds, or Med Peds.

Boring, well that depends on what you're into...if you work in a more academic setting you can get a lot of interesting immunodeficiency cases.

So it depends on your liking. It has a high satisfaction rate among the people who enter the field. You get to see kids and adults. Patients are usually appreciative because they feel substantially better with treatment.
You see a fair amount of asthma. The research possibilities in Immunology are endless. Hours are great. Call is not too demanding. Money is good.

Hope this helps, any specific questions?
 

olio

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Thank u for the info.

About being a direct residency program well this is what i've heard from a Prof here in my Uni ,he said they're gona be starting it as a residency prog with one year general medicine or pedo. like the MRCpath program..I don't know how accurate this statment is.


I have another question do i have a chance haveing my private clinic or is it more hospital and center orinted .I'm planning to live in a country where i don't think i have a chance to work in a hospital and would prefer a private clinic, for this was a drawback for me when i was considering hemo/onc.

And as eleileen mentioned what could add to the applications..?.
 

AnnaMags

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dharmabum7,

I'd love to have the chance to ask more questions of you. What programs did you apply to? Do you have a spot? Most importantly, did you do research and if so when did you do it and what kind of a project?

I'm getting ready to start pediatrics residency and want to do allergy/immunology. I have known this is what I want to do now for a year or two. I have not done research yet and wonder how hard it will be to do some sort of project in residency. I've talked to several people who just did case studies.

What did the programs really seem to be looking for?

Thanks so much for taking the time to answer these questions!
 

dharmabum7

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hey,

so i'll go in order...

yes, allergy/imm tends to be mostly outpatient (the only times you would be consulted in house is for immunodeficiency and for desensitization)

unfortunately its hard to find out which programs are accepting this year and which are not...last year i sent out an email in july to all the programs (yes this took forever!) and asked if i could get an application and to find out if they were taking applicants for this cycle...most programs wrote back over the ensuing weeks...i got the addresses through FREIDA and there is another website http://www.aaaai.org/professionals/careers/trainingprograms/default.stm

i'm not sure if it will be easier this year since they are making the switch to ERAS (finally! they are); i assume they will only list programs that are accepting this year...also I assume all the program are taking part in ERAS but i'm not a 100% sure? you guys will have to call around and make sure.

as to suggestions at to what helped...who knows? its such a strange process...

what helped : continued interest in the field (i did chrysalis as a med student), i was open to going everywhere (mind you this was probably one of the bigger factors, since i'm going to the midwest and i was from the north east), research (i had done a lot of basic science research in undergrad) which touched on immunology, i was involved in clinical research as a resident- i had interesting ideas but nothing accomplished ;) ... but my take is that as long as you have some cool ideas and you can verbalize them well, people like that...they understand that we all don't have time to write tons of articles by this point...

what hurt : my residency did not have an allergy program (not only does it give you a chance to get an inhouse spot but you also tend to have bigger names write letters for you), i have no publications, the strength of your residency helps (bigger names impress people)

i applied to all 55 program that were taking (except like 2), got interviews at 5, got 2 acceptances....

my advice in the very least, get a case report done, and try to get started on an ongoing research project as early as possible (its hard, residency takes so much out of you, thats its really tough to get research time)...as all competitive residencies, a chief year helps (i didn't do one, but some of the other applicants i met in the field did)....really know the field (see it not just allergy shots, asthma, a lot of the programs emphasize immunology, basic science research, so become comfortable with it, even if you haven't done it), they obviously like more academic minded people (but realistically most do private practice), keep an eye on the latest literature (like the big studies that come out and anything new england journal)

oh most programs accept im/peds, some accept only peds...for a particular year, some only have an im spot...i was im, and at a lot of programs they like having one of each...so we can learn from each other...

i hope i answered all the questions...anything else, just ask...
good luck.
 

novacek88

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I'm going to offer a con POV since the pro's of A/I have been discussed. I'm currently a medicine resident at a competitive program. My father in-law is an Allergist and I was very much convinced I was going into A/I. Like many of you, I heard superficial comments based on the field. And based on those comments, I was sure that I was going into A/I. I had done a lot of research in the field with one paper published. After working with prominent A/I physicians in my electives, I decided against the field for a variety of reasons.

1. There are no procedures - I don't count shots as procedures. There are Allergy tests but most nurses perform both procedures. As an allergist, you will not have any procedures. I was never a surgery type of person so I don't need to do a lot of procedures to be happy but some procedures would be nice. And in A/I, there were absolutely no procedures.

2. Lack of Immunology - unless you practice in an academic setting, you will not be dealing with much if any immunology. 90% of your patients have allergic rhinitis. I felt like a glorified pharmacist handing out free samples of Zyrtec. The actual clinical practice of Allergy is very bread and butter and not complicated in the least bit. I respect the expertise and knowledge of the A/I docs but I felt they really didn't get to apply what they learned in fellowship to any great extent. Most Allergists prefer not to see any Immunology since those patients require more attention and thus take up precious office time. It's much easier seeing someone with rhinitis and sending them off with a prescription 5 minutes later. Thus, most A/I physicians refer their difficult cases to Infectious Disease physicians or A/I docs in a well known academic centers who devote their lives to complicated Immunology patients. But then these academic A/I docs are not the ones earning a lot of money so you do take a hit in compensation when accepting more immuno-related cases

3. Ambiguity in regards to Compensation - Unlike Cardiology, GI, Pulmonology, Nephrology and Heme/Onc, the pay in A/I varies considerably. I know a few recently graduated fellows who started at 100K. If these individuals make partner, they will earn between 180-300K. That's a nice salary but considering you did two extra years of fellowship to earn not much more than a general IM or Peds even in regards to partner pay is daunting. A major reason for this is the lack of procedures in the field since procedures is what offers higher compensation. Both the starting and partner pay in other fields of medicine is more straightforward and higher in general. I'm sure there are some A/I docs raking it in but many of them don't whereas you know that cardiology and GI is going to be well compensated regardless of extenuating circumstances.

4. Reputation - A/I has a very soft reputation. This is might be a petty reason to judge a field but a person wants to be recognized for their achievements and Allergy is not respected among other fields of medicine. Their lifestyle is well known among their colleagues and thus they are mocked in a way. Other physicians are well aware of the fact that A/I docs handle mostly patients who are not that ill and refer their difficult immunology cases to ID or immunology specialists.

And with the way reimbursment has fallen, those fields that lack procedures will take the hardest hits in regards to compensation in the near future. It's something to think about. To those who are truly passionate about the field, then the points I have raised should not matter nor should they offend since you chose to enter the field knowing the drawbacks I have mentioned. There are a lot of positives associated with the field like lifestyle, low stress, little call, ability to see both adults and children, slightly higher pay than gen IM/Peds etc.
 

dharmabum7

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Again, I'm not the poster boy for this specialty but nonetheless, I wish to address the last post.

I agree allergy is not procedural but thats what attracts people to it (most people in this field hate procedures) so if you want procedures (GI, Cards, Pulm) are the way to go.

Next, lack of immunology. Again immunology is involved in all aspects of medicine. If you want a ton (hell, do stem cell and do oncology, thats what I almost did). Or consider rheumatology. Immunology is becoming involved in all aspects of medicine. That being said, as I said there is a changing of the
guard in academia (for allergy imm), meaning if you want a ton of immmunodeficiency and make immuno research your life, its out there. Yes your salary may take a hit in some academic jobs but at least you love what you do.

Next compensation. Okay allergy is not cards,gi,heme onc. All are higher paying. With money often comes more responsibility, hours etc. This field is known for its bang for the buck ie, good hours and descent pay. Another point, if compensation is your interest, you'll notice with time that there are business savy people in all fields. Hell I know an ID guy who makes a killing (in a field not known for its high income).

Finally, "allergy has a soft reputation". Now to be clear, this is not directed at you Novacek but all of us in the medical counterculture. The funny thing we all have this tendancy to dog everyone else. The surgeons hate medicine. Medicine hates ER. Yadda yadda yadda...Its this culture of inadequacy...Everyone has this need to feel better about themselves, while critiquing everyone else.

One of things in medicine you all need to decide is who are you doing this for. Happiness is a very personal thing...There are some people that need to do surgery to feel a sense of worth. Other need to do caths. Other need to give chemo. Some need to do it, while others sincerely love it.

Thank god there are people like this because the world needs them because who would take care of us when we have surgical needs, MIs, Cancer etc etc..or GI bleeds etc...

Allergy is a different type of field. The only life threating condition you deal with is anaphylaxis, severe asthma and perhaps immunodeficiency. Most of your practice is healthy people. For the most part, allergy is a happy practice. People like coming to you. You serve a purpose by offerring immunotherapy, desensitization, training in avoidance. Its all the thing Novacek reiterated, low stress, a nice mix of adult/peds, great call...Its true some people hate this. I have friends who rotated in Allergy and thought it was so boring. It really is not right for everyone.

But my point, you can't live and die but what others think of you. This applies not only to AI, but every field. I think Novacek and I agree, choose something that gives you happiness and hopefully be passionate about. But I would like to add, don't write off a field because of what other in the medical community will think of you.

Peace and good luck.
 

chemamr

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hey guys, i've been reading some posts and i don't know the answer to:

Which is more competitive Cardio, gastro or allergy/immuno???

how would you rank them??

1)Allergy/immuno
2)Gastro
3)Cards

am i right???? :rolleyes:

thank you for your comments, i just wanna give me an idea. :cool:
 

novacek88

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dharmabum7 said:
Next, lack of immunology. Again immunology is involved in all aspects of medicine. If you want a ton (hell, do stem cell and do oncology, thats what I almost did). Or consider rheumatology. Immunology is becoming involved in all aspects of medicine. That being said, as I said there is a changing of the
guard in academia (for allergy imm), meaning if you want a ton of immmunodeficiency and make immuno research your life, its out there. Yes your salary may take a hit in some academic jobs but at least you love what you do.

I think dharmabum7 gave an excellent response. And I agree with all of his points except for this one. Many people go into allergy with the expectation that they will be involved with immunology in a significant manner hence the title. What suprises nearly every A/I physician is how little immunology plays a part in A/I private practice. You won't find one A/I doc who will say they were not suprised by how little immunology was integrated into their field. It's not about wanting a ton of immunodeficiency but rather a significant portion to warrant the title. I'm sure dharmabum can tell you that it's not uncommon to find there are many A/I docs who do not participate in any immunodeficiency whatsoever.

My comment about Allergy's "soft reputation" still stands. Yes, none of us should allow other's opinions to influence how we think. Of course that is true but you can't deny that it doesn't feel good to have others say nice things about your field. The bottom line is no field is perfect. Dermatologists also have a soft reputation and it is arguably the most competitive field of medicine. I was just trying to offer every potential negative aspect. If you are someone who cares what others think of you then A/I may not be the best field for you because it does have a soft reputation much like dermatology.

And believe it or not, pride is often a factor when one weighs certain fields. Many people go into surgery and cardiology for its reputations despite the many drawbacks each field has to offer.
 

novacek88

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chemamr said:
hey guys, i've been reading some posts and i don't know the answer to:

Which is more competitive Cardio, gastro or allergy/immuno???

how would you rank them??

1)Allergy/immuno
2)Gastro
3)Cards

am i right???? :rolleyes:

thank you for your comments, i just wanna give me an idea. :cool:

In terms of sheer numbers, Allergy is the most competitive. However, this can be misleading. The types of people who apply to Allergy/Immunology are generally less competitive in regards to stats than those who apply to cards and GI. Mind you, this is a general assessment. Of course, you will have rock stars that apply to Allergy but generally Cards and GI attract students with better numbers but there are more Cards and GI spots so Allergy is the most competitive numbers-wise. Taking this into consideration, if I had to rank the top 3, I would say

1. Gastro
2. Allergy
3. Cards
 

AnnaMags

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Thanks so much for all the information. I hadn't been back to this thread in a while and was so excited to return to some responses. Usually there is very little on here about A/I.

It's great to hear about your successes in applying this past year. It sounds like a very daunting process with applying to all programs and getting so few interviews. That's what I've always heard it was like. Hopefully ERAS will change things a bit. I wonder if people will continue offering spots outside the match though to their own residents. That's what made it so hard to get interviews.

Also, I appreciate the opposing views. That is just as helpful sometimes to those of us in the process of making decisions. I'm excited for the next year to see how things go and where my interests lie as a resident.

Thanks again and keep the conversation going if you have any more thoughts.
 

osucomdustin

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I think both A/I and rheumatology are awesome. I'm thinking about doing a combined subspecialty in these areas after an IM residency. I'm planning to move to a town that doesn't have either specialty represented, so the area's wide open. Am I crazy? I'll be about 34 by the time I'll be ready to start my private practice.
 

blanche

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so I have some A/I questions also....let's revive this thread!

1. i'm planning on going into pediatrics, with the hope of doing a fellowship in A/I (or else HemeOnc, rheum) For any who have thought about the peds route, is it better to go to the more well known children's hospital which may not have a fellowship program or maybe a less prestigous peds hospital with a fellowship program? then at least i could get involved with research during residency and get my foot in the door possibly...

2. i always hear about money being good in a/i, but honestly all the surveys i've seen make it look pretty average. i'm interested in the field and not the money, but after looking at my loans it's nice to think about being able to pay them off someday also! why such discrepencies? does this have to do with low salaries for academic A/I, but much more potential for private practice? how is reimbursement changing the field?

3. are there any new fellowships opening up? it seems there are so few available....i'm interested in research and would like to go somewhere that would have more opportunities for less common stuff like transplant immunology and GVHD

thanks guys
 

IVIG

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Hi,
I completed an Internal Medicine track Allergy Fellowship a while back.


1. I would go to a program where you will get good training in general pediatrics as well as have contact with a fellowship program that you are interested in. A lot of A/I programs take their own residents, so if your program does not have an A/I program, it's a considerable disadvantage. But this can be overcome by doing a rotation in A/I at the other institution if your program will allow it. You want to get recommendations from recognizable AI faculty at the program you want to go to.
If I had to do it all over again, I would pick out the A/I program I wanted to be in, and then do a residency there (as long as the residency provided good IM or pedi training). Research also helps but doesn't have to be with an A/I person. Many fields have research opportunities that will overlap: example bench or clinical asthma research(pulmonary), studying T cells in lupus (rheumatology), eosinophilic GI disease etc.

Money
2. A/I salaries have a very wide range, depending on geography/market saturation, how far you are out from your fellowship and whether you work solo, large group, managed care or academics.
Private practice group practice starting salaries this year have been around 120K. That's less than my internal medicine and pedi friends have been getting straight out of residency. I only looked in the major cities and suburbs within 1 hour from a major city as my significant other's occupation requires him to be near a major airport.

Allergy is quite saturated in many cities. There are a lot of jobless fellows despite AAAAI hype about there being an allergist shortage. Just look at the AAAAI's Academy News publication. It's the only specialty I've seen so far where docs are posting "job wanted" ads. But if you are content with moving out to rural areas or > 1 hour from a city, you can find a job. You can make more income in rural areas because there is less competition from other allergists (200K and up to start). Academic starting salaries are 90K to 130K.
Reimbursement is always going down. That's nothing new.

A/I programs
3. Yes there are new fellowships opening up. I can think of about 2 in the last 2 years. I don't know details. Combined programs also exist (with pulmonary or rheumatology).

4. Allergy programs vary A LOT in terms of what they practice. You will have to examine all this carefully. Some programs practice bread and butter allergy only and do this very well (Allergic rhinitis, sinusitis, food allergy, asthma, skin testing and allergen immunotherapy), but they may or may not get exposure to hardcore immunodeficiency (chronic granulomatous disease, DiGeorge's, X-linked hypogamma, SCID). Some are the other way around and those fellows spend hours admitting inpatients, rounding in the unit or bone marrow transplant unit, but after fellowship don't know how to write IT orders or treat complicated asthma. Some do all HIV and not much of anything else. Some have asthma centers and see patients with pulmonary and other subspecialties as a team(a great way to approach management). At other places the culture is that pulmonary sees all the asthma and ID sees all the immunodeficiency and A/I just does allergy. Also take note of how flexible the program is in allowing you to tailor your fellowship program to get exposure to areas you need by rotating through clinics of other departments.
Transplant immunology and GVHD may be more of a Heme/onc thing at most places. But there are a few A/I programs that focus on this--they are usually strong in pediatric immunodeficiency.

For those pursuing an academic career in any specialty:
Know how much and what type of research you want to do: bench (basic science) research, clinical research (drug trials, investigator initiated, epidemiology), translational. Know what faculty are available to mentor you so you can learn the skills to perform this research on your own when you finish the program. The mentor should 1) have time to talk to you, 2) be NIH funded, 3) should want you to become independent (not just their lab slave forever), 4) get along with you, 5) should get along with others, 6) should help you navigate the world of grants.

Also, do you still want to be a clinician?? It is difficult to be a good clinician and an NIH funded researcher in basic science. The physician who is a successful laboratory researcher and an above average (note I did not say excellent) clinician is extremely rare.
This is because you lose your skills if you don't use them. There are many faculty who are very successful basic science researchers, but no one wants to check out patients to them or (God forbid) have them as their impatient ward team attending-- because as clinicians they are useless (and sometimes dangerous).
This is also because academic programs are changing the way faculty get credit for what they do. If you are a clinician, you are judged on productivity (how much money you bring in from office visits and procedures). If you are a researcher, you are judged on the amount and type of grants you bring in as well as the number and/or quality of publications. If you like teaching medical students, you're screwed because that time counts for nothing---your productivity will go down or it will take time away from writing grants. After all, it's ok if we crank out medical students who can't perform a simple history and physical or make any type of treatment decisions.

Being a clinical researcher and a clinician is very doable. Translational research--depends on what you do.

I hope this helps.
 

restam

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IVIG-- thanks for the post- very interesting

I am VERY surprised, as many of us on this site, that the job market is not so great in A/I. Reading the AAAAI website it seems really promising. I'm also surprised at the starting salaries for fellows. So do you think there is a geographic difference (ne vs. midwest/south) or is everyone struggling to find a job except if they don't mind a rural setting?

thanks, anyone else is welcome to answer if they have any insight
 

rahulazcom

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I can confirm IVIG's post and it was interesting to read that her experience was similar to that of my wife's. My wife finished her A/I fellowship last June and started her job this past summer. I can tell you that it wasn't easy to find a job out of fellowship. She didn't have a host of recruiters calling her. There were no job offers posted on the walls in her hospital like in other subspecialties such as cardiology. Even at the national meetings, there were no hiring physicians or recruiters in the cities she was interested in. And yes, we were suprised to see A/I fellows post job seeking ads in some of the journnals. She was lucky because I had previous work experience in a business related field and I knew how to acquire jobs since business professionals are always switching jobs and finding work is nothing new. I told her to be proactive regarding finding a job as opposed to relying on recruiters or waiting for offers to come to you. We applied to nearly every private practice group in the Phoenix area and got serious offers from only 2 places! One other practice was interested in hiring only a part-time associate. She ended up with a perfect firm and she is thrilled to be working there. In retrospect, we honestly think we got flat out lucky. We think divine intervention took place because of the two offers we received this firm was a perfect fit for her personality. What we noticed is that there are many A/I practices in existence , but that they aren't hiring. A lot of these practices are content with having just 2 or 3 doctors, and many of these physicians were very experienced and practicing near or past retirement.

At the same time, I do think A/I is the type of field that a person could realistically start their own practice and have some success if they were willing to take some risk and devote a lot of energy to it. For my wife, lifestyle was very important so starting a practice was not an option for her. The starting fellowship salary suprised us initially because we assumed it would be higher. As with IVIG's experience, my wife's friends in general internal medicine and pediatrics were getting multiple offers for a higher starting salary. However, we later came to appreciate why the starting fellowship salaries were lower than anticipated due to the more competitive income that could be earned as a partner. My wife has not changed her opinion of A/I but we were suprised at how difficult it was to find a job. We didn't think we would have to work so hard to find a job in A/I because it isn't a saturated field.

We do think there is a geographic difference. There were a lot of academic positions available on the east coast especially at big time programs. If you are interested in academics, you will be happy with your prospects. Private practice opportunities seemed to be the greatest in the southeast like Tennessee, Kentucky, Alabama, Mississippi, Georgia etc. The west coast was obviously tough and the opportunities there are limited. Obviously California is tough to find a job but even in places like Arizona and Oregon there were not many open positions. Again, we just felt fortunate to land a great position in Phoenix but we really had to do our homework.
 

handsports

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Sorry to hear that some people's job searches were so difficult. But, I am convinced that there is some sampling error in these posts. The 2 fellows that just finished at my allergy program had numerous job opportunities. The IM grad had 7 interviews and the peds grad had 6 interviews. Each of them had more than 4 offers, picked their favorite, and is very happy with their decision.

According to my calculations, 50% of grads have difficulty finding jobs and 50% of grads have no problem. Let's increase our power for this post. Any other stories to share?
 

restam

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handsports- did these fellows get job offers from big cities or rural areas and were they applying for academic or private practice? Did these fellows also find that their starting salaries were lower than excepted?
 

rahulazcom

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handsports said:
Sorry to hear that some people's job searches were so difficult. But, I am convinced that there is some sampling error in these posts. The 2 fellows that just finished at my allergy program had numerous job opportunities. The IM grad had 7 interviews and the peds grad had 6 interviews. Each of them had more than 4 offers, picked there favorite, and is very happy with their decision.

According to my calculations, 50% of grads have difficulty finding jobs and 50% of grads have no problem. Let's increase our power for this post. Any other stories to share?

My wife would have received multiple offers if she was willing to move to certain areas of the country or do academics. But we were focused on finding a private group in Phoenix and that's an entirely different ball game. So I suppose our story isn't really indicative of the A/I market since we were limited to a popular city on the west coast.
 

IVIG

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restam said:
IVIG-- thanks for the post- very interesting

I am VERY surprised, as many of us on this site, that the job market is not so great in A/I. Reading the AAAAI website it seems really promising. I'm also surprised at the starting salaries for fellows. So do you think there is a geographic difference (ne vs. midwest/south) or is everyone struggling to find a job except if they don't mind a rural setting?

thanks, anyone else is welcome to answer if they have any insight


I think it applies more to the northeast and west coasts. Down south, there were more opportunities in the suburbs.
I looked in SF Bay area, LA area, Chicago , NYC/NJ/Philly, DC, Houston, Dallas, Atlanta, Cleveland, Minneapolis, Charlotte.
Of these I found one good opportunity in a Dallas suburb.
I have to admit that I did not look at many smaller sized cities because of the lack of direct flights. But the fellows I know from other programs and the current fellows in my old program are looking at smaller cities and have been able to DIG up opportunites with some difficulty. Most of the fellows from our program went into academics or started up a solo practice. Of the ones that went solo, all are about 1-2 hours outside the city they live in and all are doing well. But most have satellite clinics so they can cover more territory and the commute is killing them.

If there are any recently graduated fellows lurking, how were your interview experiences? Of the opportunities that are out there, I felt that the allergists I ran into were kind of dishonest or practiced "wierd stuff." There were a lot of ENT groups hiring allergists, but the way they had the IT set up was also "questionable." I would feel uncomfortable joining a lot of the people out there because of how they practice. Wanted to see if anyone else had the same experiences.

So maybe I should say that there are some (not a lot of) opportunities out there, but very few decent opportunities.
 

IVIG

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Forgot to mention for the above post.. I was only talking about private practice job searching. Not academic job search.
 

blanche

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IVIG and rahul....thanks for your posts, very informative!

it's good to get info from those who have been on the job hunt.
one thing i'm wondering--it was mentioned that starting salaries are low because of high earning potential in the future. is that something that's guaranteed at hiring--making partnership or whatever?

also, does anyone here have experience with starting solo practice?
 

Kleenex

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I'm currently looking for jobs. It is different from, say, a hospitalist or general medicine position. You aren't getting innundated with fliers, calls, and email. The journals that you may typically look in during residency for jobs (e.g. NEJM), rarely have positions posted. The best site for job ads is the AAAAI site and the ACAAI. However, just sending letters out to practices in locales of interest is high yeild. The most lucrative position I heard someone signing with was via a recruiter. I have had no problems finding a position (one by word of mouth, one in the want ads, one by a email from a practice), and I hear about positions weekly this time of year.

As for my current search, things are going very well. Like the previous posters mentioned, landing a job with a competitive salary, good hours, and a practice ideology that's reasonable is tough to find in popular destinations both big (e.g. NYC, Boston, So Cal) and smaller (e.g. Asheville, Austin, etc.) areas. However, you don't have to practice in an isolated small city - unless that's what you like. I am looking at three practices with varying salaries, buy-ins, overhead, signing package, and locations (Pacific Northwest, New England, and Southeast). Things to consider:

1) Percentage of patients on IT. Anything over 15% you need to worry about joining a shot factory.
2) Can patients give themselves there own IT? An absolute no-no. Anaphylaxis is completely unpredictable and patients must receive it in a clinical setting.
3) Are Clinical Trials an aspect of the practice? This can be a means to keep plugged into the academic aspect of medicine.
4) Number of full-time allergist needed per population? The sweet spot is considered 1 per 75,000 people.
5) Satellite clincs? Many have them. Allergist are needed and this is a way to provide care to more rural settings without having to buy a farm. the travel can eat away on time.

As for the financial stuff (important, but really only a part of the whole decision process)
5) Buy-in? Ranges from 0-300k. It seems to be a random number. Just ask how they came up with the number.
6) What is the salary? When I first started looking this was the most important (I'm poor and debt-laden), now it is simply a consideration. I have heard starting salaries from 140k (seems typical) to 200k (practicing in the middle of Middle America). The signing package can make a 140k better than a 180k. On a partnership track, two-years as an employee before partnership is pretty "standard". After that, probably 200-275k (this is from talking to different folks. But a busy, well-run practice that is in a position to be primarily referrral-only, the upside can be significant). You can make a lot more, but that is probably is related to business acumen and/or IT patterns (see #1). The academic postions are much less (90k-120k), but usually offer great benefits.

The practice I like best is in a great location, one office, a partner that really needs help because his practice is busy, and a small building with good utilization of space that allows him to keep overhead low and a conservative approach to medicine (IT around 5%). He does everything you learn in training (skin biopsies, rhinoscopy, IT, skin tets, immunotherapy, severe asthma), has medical students rotate through the office, and is involved in clinical trials. Drawback, far away from family. I hope this helps. Overall, it's a friggin' awesome field with tons of job satisfaction.
 

blanche

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4th yr med student here, interested in A/I...
i'd been planning on applying to chrysalis (program for students interested in the field) but noticed it's nowhere on the AAAAI website anymore. any other students looked into this, or know what's up?
if they're no longer doing it, too bad...looked like a great opportunity to get to learn more about the field:(
 

Pedi07

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I was also planning on applying. Last word I had from my advisor was that they may start holding the program every other year--but that is yet to be decided. They did say that there was no registration fee for students.

btw-Congrats on landing an interview at CHOP!
 

blanche

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hey thanks!
i actually emailed someone from the aaaai site about whether chrysalis will be available this year, and here's the response i got:
"I regret to inform you that this opportunity will not be available for the 2007 Annual Meeting in San Diego. Funding was reallocated to support those students who are pursuing research opportunities. I would encourage you to consider attending the meeting regardless of this fact, as the registration fee is waived for medical students. It is also an excellent opportunity for those interested in allergy/immunology to learn more about the field"

shoot! i guess maybe they were too successful in garnering interest in the field amongst medical students...too bad it has to end the year we're interested in applying! oh well....

good luck with applications!
 

koolkatmd

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3rd year med student...recently developed a new interest in allergy/immuno although i heard different things. some people say it does not make that great of money whereas others say it is the new and upcoming specialty and will make 300,000 +. i do not like procedures, and like more outpatient settings so thought this would be a good choice? also, how hard is it to get into med/peds residency..esp. in california? what does the typical day at work consist of? Thanks...
 

AnnaMags

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Do any residents plan on attending the AAAAI meeting in San Diego in February??
 

newbiedoc1977

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I am interested in allergy, but also interested in living in a smaller town.

I want to live in a smaller town that is located near some bigger cities. How do you judge whether a town can support your practice or not? The town I would like to move to has a population of 30,000 and there is one allergist working there.

Also, how do allergist build up their practices? I know of few people that see an allergist. Most people I know with allergies are managed by FPs or internists, most with asthma by pulmonologist. Many laymen may not even know that allergy is a specialty! How do you get the business and is it necessary to have a large population base (millions) in the city where you have your practice??
 

Llenroc

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My father is an allergist in private practice. What do you want to know?
 

Llenroc

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I told her to be proactive regarding finding a job as opposed to relying on recruiters or waiting for offers to come to you. We applied to nearly every private practice group in the Phoenix area and got serious offers from only 2 places!

Back before they had Allergists, the recommended treatment for people with severe allergies was to move out to California or Arizona. No joke. Wayne Newton and Frank Zappa both had parents who moved their families out west because of their severe allergies. No offense, but there's probably not much scope for Allergy out where you live. Hell, I just went out to Ontario, CA in August at the height of the ragweed season here in Ohio and my rather severe allergies cleared up almost instantaneously the moment I got there, because there's not many plants that can tolerate the searing hot desert winds.

The real promised land for Allergy is in the southeast, where they have pollen year round. Although, the Midwest and Northeast arent' bad either. Busy practice during the spring and summer, and a bit more relaxed during the winter months with molds and dust mite allergies.
 

Llenroc

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You see a fair amount of asthma. The research possibilities in Immunology are endless. Hours are great. Call is not too demanding. Money is good.

The last time my Dad took call was never.
 

Llenroc

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1. There are no procedures - I don't count shots as procedures. There are Allergy tests but most nurses perform both procedures. As an allergist, you will not have any procedures. I was never a surgery type of person so I don't need to do a lot of procedures to be happy but some procedures would be nice. And in A/I, there were absolutely no procedures.

The great thing is that you don't have to do any procedures, but you bill like you are doing procedures. The shots and the skin tests both count as procedures, even though the nurses do them. Procedures = $$$ in medicine.
 

newbiedoc1977

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My father is an allergist in private practice. What do you want to know?

How did your father go about selecting a location for his practice and how does he feel about the market for allergy now?

I want to live in a smaller town in Louisiana (allergies abound). There is one guy already in practice there, the town has about 30,000 people. However, it is near some larger cities, I am unsure how many allergist there are there.

My question is how does one decide if a location is suitable for a allergy practice, or any practice for that matter? how much does it cost to start an allergy practice and how long does it take to build up?? Do you advertise directly to the consumer or try to get most of your business through referal??

I can't imagine that most internist and FPs would not feel comfortable managing basic allergic rhinitis and asthma. At what point does the allergist come in??

Thank you for any info you can provide.
 

blanche

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My father is an allergist in private practice. What do you want to know?

does he like it

and what in particular does he like/no likee

and what's the overall feeling about the field from those who have been practicing for a while (ie love, gloom, excitement, ambivalence, boredom)

and is he happy with his compensation (ie how old were you when the loans were paid off)
 

MATV78

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A/I has traditionally been known as "no procedures" however a rapidly emerging and now necessary procedure is fibreoptic rhinolaryngoscopy. My fellowship program (as well as a couple others I know of) stress this procedure with a scope clinic once a week. In order to complete this program you have to log a certain amount of scopes, irrespective if you wish to incorporate scopes in your practice.

Based on most assembly of data, nasal polyps following surgical polypectomy have in general a 100% of recurrence. This is a known fact. The only thing that is known to reduce their recurrence is the administration of intranasal corticosteroids. Eventually it will be the standard for most allergist to perform diagnostic scopes to detect nasal polyposis and to treat these with high dose CS. Using NCS alone shows better overall outcomes than surgery and certainly has less morbidity considering the risks associated with polypectomy. Hopefully more will be understand about the genetics and more specific therapeutic options developed.

Allergy is an extrememly diverse field where if you wish to do office based practice you can. If your interest lies in immunology and medical research you concentrate in that. If you are like me and enjoy procedures, clinical practice and immunology then you can join an academic clinical practice.

There are countless options, in particular if you find a very strong A/I fellowship program. If you like scopes, find a program that stresses this, if you like genetics find a place where they have a solid rearch program. I am doing research in detecting the genetics of nasal polyps and I enjoy my immunology research but at the same time, scopes are fun and always interesting. A major difference I encountered between A/I and ENT is that allergists are also trained in managing asthma which have a high propensity in developing in an individual with nasal polyposis and allergic rhinitis. There may be alot of underlying immunologic problems that allergists deal with - you just have to cater your practice to watch your most interested in beit general A/I with rhinitis/asthma/anaphylaxis/scopes etc., or if you wish to treat other immunologic disorders.

Another really interesting thing in A/I is the development of immunomodulators... Anti-IgE (Omalizumab) for asthma, Infliximab for Crohn's, RA and even gleevec a monoclonal antibody for Ph+ve CML. It's fascinating how much immunology continues to integrate these fields. You can even specialize in immunomodulators if thats what you like, or treat post transplant patients, or be do A/I with your clinical concentration in oncology (U. Wash I think is strong in this.. not sure though, something about post recognition by dendritic cells of tumor antigens)

Sorry for making this post long, but if you took the time to read through this, maybe you do have a genuine interest in A/I. I have read this post for a while and never responded but these are my two cents. Basically allergy is in demand, the clinical practice and responsibility of an allergist is changing, I think it is very important to understand that environmental influences are worsening, and the allergic problems in the general population is unfortunately growing. I hope that A/I programs will recruit people who genuinely are interested in advancing the field and are not "doing A/I because its easy and makes money". Good luck for those of you who are looking for a spot. It is competitive, and is not getting any better. I was surprised reading there is no chrysalis program.. As long as you do it for the right reasons, you will get in. As far as dough - A/I is tough enough to get into, you can find plenty of other specialties that may even pay much more without being so competitive. I did research as a resident and now am doing a yr as an academic hospitalist before starting in July, but I get to do my research, go do scopes, and it makes me really happy and feel it a privilege to practice A/I, it's alot of fun and you get paid for it.

Just dont go into thinking your sole intention is to make money, its just not worth it and your self satisfaction from financial rewards (I would think) would not justify going to a job that you dont really like. The most important point is that you would be doing a disservice to your patients unless you really wanted to be there... If you really enjoy something, financial compensation is just an added bonus to the satisfaction you get from helping your patients...
 

Llenroc

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I'm sure all that stuff is real interesting MATV, but I'm not sure if much or any of that stuff is done outside academic centers or even by more than a handful of people in America. The ground reality of Allergy is skin tests and allergy shots, period.

does he like it

Yeah he does like it.

and what in particular does he like/no likee

He has few complaints. In the first two years, he had to run around a bit to establish his practice, wining and dining people and so forth, setting up satellite locations, some of which didn't work out. These days it's pretty laid back though. The biggest problem is that the money falls off during the winter months, and the practice can run in "loss" if you take out a fixed amount of money each month, although you're not really losing money.

and what's the overall feeling about the field from those who have been practicing for a while (ie love, gloom, excitement, ambivalence, boredom)

Most Allergists seem to keep working until the age of 75-80 or even beyond, so they must like it quite a bit. There's concern every few years about miracle drugs coming out real soon now that will cure all allergies, but so far that's not happened.

and is he happy with his compensation (ie how old were you when the loans were paid off)]

He had no loans, he came here from overseas and had many years of prior work experience in Pediatrics. I'm not divulging his salary here. :laugh:
 

Llenroc

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How did your father go about selecting a location for his practice and how does he feel about the market for allergy now?

In the city that we were in at the time, the Allergist at a prestigious group practice ditched rather abruptly and they hired my Dad. No pay in was required, although on the other hand when my Dad retires he's not going to sell the practice because he doesn't own it. He keeps what he makes though.

I want to live in a smaller town in Louisiana (allergies abound). There is one guy already in practice there, the town has about 30,000 people. However, it is near some larger cities, I am unsure how many allergist there are there.

I don't think that's going to happen. I bet the guy with the practice there lives in a nearby city and comes in once a week to see a handful of patients. That's how it usually is in small towns.

My question is how does one decide if a location is suitable for a allergy practice, or any practice for that matter? how much does it cost to start an allergy practice and how long does it take to build up?? Do you advertise directly to the consumer or try to get most of your business through referal??

You can wait for some geezer to sell off his practice and buy into it. That's low risk, but costly. Or you can start your own practice, during which the first few years might be rough. Advertising to the consumer directly is worthless. You have to meet the family practice and internal medicine doctors, and get them to break their referral habits and send patients to you instead. Your best bet might be to join a group that has 5-10 internal medicine people obligated to support you, but positions are limited.

I can't imagine that most internist and FPs would not feel comfortable managing basic allergic rhinitis and asthma. At what point does the allergist come in??

My Dad said that when they made Claritin OTC, it made no difference because all of his patients had already tried that stuff. That's the great thing about allergy. These people that come into your office all get an allergy test. And invariably, they get put on allergy shots. And once they're on allergy shots, they never come off it. :laugh: I know because I have ****ty allergies myself and there's no cure for it.
 

guarana

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I'm sure all that stuff is real interesting MATV, but I'm not sure if much or any of that stuff is done outside academic centers or even by more than a handful of peole in America. The ground reality of Allergy is skin tests and allergy shots, period.

maybe so? but it's nice to know that you can get into all of that other sort of stuff also. let's face it immunology is very cool. i mean, i can remember the agony of memorizing and forgetting class switching and gene rearrangement, but still it's fascinating that a) we have such evolved such elegant defenses and b) we are developing such specific ways to target immune defenses, immunomodulators, etc. and the evolution of allergy/atopy in modern times is something else to think about (they had a bit about food allergy on 'sunday morning' this morning, speaking of..)

i've heard of at least one A/I fellowship that includes HIV work into its curriculum also, though i'm not sure how much this is the norm. (i'm guessing not very much..)
 

MATV78

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I wish to respond to what Llenroc replied about my post.
It serves my point, all that "stuff" is interesting... to Me. If it does not interest you then its okay. There are plenty of people ready to do A/I. This year my fellowship program has recvd over 350 applications.

In response to scopes, In both the university I did residency in and in this program they have billing sheets for diagnostic rhinoscopy, right along with skin tests, immunotherapy and now immunomodulators.... medicare does reimburse this procedure and it is reimbursed as a specialist technique (billing is different if it is done by a specialist, like a flex sig done by a GP vs one done by a GI person). I know 3 allergists in the city I live in that bill for scopes and get compensated from medicare and most insurers.

By the way aside from observing your father who I assume to be an older practicing allergist, what kind of current experience do you have in the practice of A/I to state skin tests and shots is all there is?
Every allergist I know administers Omalizumab when indicated or is familiar with it's use. Some allergists (at least 2 I know) give immunomodulators for autoimmune diseases. These also from what I hear have good reimbursement potential, counted as a procedure I believe since they are administered in the office and patients need to be observed following the infusion.

It is is simply not true that most allergists just give shots and skin tests. I am sure there are some that do, lucky for me I have never met any, and I have had 2 great mentors and have had the opportunity to meet 10-15 allergists, some of whom are older but are quite sharp and very up to date.

This guy illustrates what I said, if you are concerned with money and not with the practice of A/I (especially if you are not interested in immunology) Dont do it... He obviously is not interested in it (it is surprising why he posts in this forum? ) I am sure there are people who went into A/I for the wrong reasons, dont do it, unless it really does interest you.
 

blanche

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Wow, this thread really woke up

So MATV, you've obviously touched on a lot of what is new and innovative in the field. Obviously you haven't expericenced other fellowships, but to your knowledge is your program unique or do most give pretty good exposure to Immunology and not 'just skin tests and allergy shots'? Do you have to go away from immunology if you decide to do private practice instead of staying academic?
 

rahulazcom

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Back before they had Allergists, the recommended treatment for people with severe allergies was to move out to California or Arizona. No joke. Wayne Newton and Frank Zappa both had parents who moved their families out west because of their severe allergies. No offense, but there's probably not much scope for Allergy out where you live. Hell, I just went out to Ontario, CA in August at the height of the ragweed season here in Ohio and my rather severe allergies cleared up almost instantaneously the moment I got there, because there's not many plants that can tolerate the searing hot desert winds.

The real promised land for Allergy is in the southeast, where they have pollen year round. Although, the Midwest and Northeast arent' bad either. Busy practice during the spring and summer, and a bit more relaxed during the winter months with molds and dust mite allergies.

My wife hails from and trained in the southeast so we know a lot about the area. And my wife gets about 10-20 new patients per day in Phoenix as a person fresh out of fellowship so there is plenty of "scope" in regards to A/I in Phoenix. The average wait to see the senior partners is 4 months. Yes, we are both aware that people used to be sent to Arizona if they had bad allergies. We also know that phenomenon took place about 30 years ago and we laugh when people such as yourself bring that up as if its a novel concept. I can't tell you how many people asked my wife why she was moving to Phoenix to practice allergy. :)Things have changed since then. In case you haven't heard, Phoenix is the 5th largest city in the United States and recently overtook Las Vegas as the fastest growing city last year. It's no longer a little desert town on the way to Los Angelas. Frank Zappa and Wayne Newton were in their prime in the 1960's so I think it's fair to say that things have changed since then. 45,000 people moved to Phoenix alone last year and that doesn't include the rest of our suburbs like Scottsdale, Mesa, Tempe, Glendale which are really just a part of Phoenix since they bleed into one another like the Pasadena, Burbank, Anaheim and the LA suburbs. The development that has occurred here has unfortunately brought an influx of allergies as well. In fact, my allergies are worse here than in Memphis and this is a common complaint from many people that move to Phoenix since this city is mostly comprised of transplants and people that move here from places like the southeast. In lieu of the population explosion, there is a massive shortage of allergists here.
 

Chairman Natto

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IVIG and rahul....thanks for your posts, very informative!

it's good to get info from those who have been on the job hunt.
one thing i'm wondering--it was mentioned that starting salaries are low because of high earning potential in the future. is that something that's guaranteed at hiring--making partnership or whatever?

also, does anyone here have experience with starting solo practice?

Raising money involves getting.... Grants... donations...sponsors???
WHAT IS hot research? Immunology! WHY? Cloning Lymphocytes! How do I raise the money? Take a look at http://khalidnatto.tripod.com/proposal.html

WATCH THE VIDEOS!

OH yeah! Take a look at the fund raising tactics....http://khalidnatto.tripod.com/id22.html

The research will involve Stem Cell Research on a level that produces both T and B lymphocytes. If you have any questions feel free to contact Chairman Natto directly.
 

bulldog

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so i'm a 4th year interested in doing ai....mainly the allergy component. what type of research is easy to get publications from a month of work?
 
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