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Allergy & Immunology..

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pretzel

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A/I salaries must vary widely. An allergist I know is making 700K in San Fran, and he's been out for 10 years. Works 10 hr days with weekends off, no call, no nights, no pager. You can charge for procedures, even though the nurses do all of the procedures, so you make the money without the work or time normally associated with procedures.

Does anyone have allergy interviews? Curious how it's working this year.
 

My PooNoni

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Applying for Allergy/Immunology for 2008, so far, have only heard back from Rush, Penn so far. Is it still pretty early or are others hearing back from many programs?
 

Allergen

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Hey has anyone heard about New York Programs in A/I. I heard that Mt. Sinai has already started interviewing. Anyone heard from UMDNJ, Downstate, LICH, LIJ, or Montefiore....:luck:
 

thedman

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Hey has anyone heard about New York Programs in A/I. I heard that Mt. Sinai has already started interviewing. Anyone heard from UMDNJ, Downstate, LICH, LIJ, or Montefiore....:luck:


i am not sure about this but i know that Downstate only accepts new fellows every other year, and i heard that this is an off year.
please confirm if you know either way. are they accepting applications for the 2007 match?
 

Allergen

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i am not sure about this but i know that Downstate only accepts new fellows every other year, and i heard that this is an off year.
please confirm if you know either way. are they accepting applications for the 2007 match?
I heard that LIJ has already granted all interviews...Congrats to those who are fortunate enough to interview there. Also, no one at Downstate will pick up the phone or return emails...
 

dharmabum7

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i'm not sure but last year when i applied for AI, i think downstate said the same thing...that it was an off year...

oh well, good luck...
 

MastCell

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I've been a practicing allergist for a number of years. The practice of allergy has changed dramatically over the past 15 years and is continuing to change. When people think of allergy treatment, what comes to mind most often are allergy shots. This is one aspect of treatment but from a financial one, a large one. As has been pointed out, we are not a field that does procedures that warrant large reimbursements. Rhinoscopy is about it, and not all allergists do it. For the most part, rhinoscopy does not generate the revenue that makes it worth the time spent, you and your staff need to be very efficient. I would also point out the aforementioned allergist that is making 700K is a rarity in the field and most certainly is running a "shot factory". This type of practicioner in the field of allergy will be hit the hardest in the future.



So what has happened and what is happening in the field of allergy? The first was the development of safe and highly effective topical steroids for treating asthma and allergic rhinitis. Prior to the development of these topical CS any patient with moderate or worse AR or ROAD ended up at the allergist's office. Now, most of these patients can be fairly well controlled with these medications as long as they are prescribed. Initially, the PCP's were a bit shy of prescribing them and our referral numbers stayed the same. But now that the PCP's are prescribing them, our referral numbers have fallen about 20% over the past 2 years.




The 2nd development to affect the practice of allergy and the one with greatest potential to negatively affect the financial aspect of the field is the ongoing development of safer and more effective forms of immunotherapy. Currently, allergists buy concentrated extract and then dilute it to make up a patient's "allergy shot". We make a very good percentage of our income via this purchase of concentrated extract which is then diluted. We also make income from the shot itself. Additionally, even if your patient has seasonal allergies, the injections are given year round. So what effect will the newer therapies have? The newer therapies are not extracts of what a patient is allergic to but immunologically active peptides, monoclonal antibodies, etc that will be made by a pharmaceutical company eliminating the dilution-markup that currently exists. So the revenue from preparing extract will be lost. This is SUBSTANTIAL income. Also, some of these newer forms of immunotherapy/desensitization only need to be given seasonally thereby cutting down the number of injections given in a year ie more revenue lost. Most ominously, a PCP would be able to order this newer form of immunotherapy much like ordering a drug for hypercholesterolemia as you would only need to determine that the patient is allergic not what they are allergic to as the therapy is not antigen specific.


We are also seeing the PCP's starting to order the Immunocap test after a large marketing campaign by Quest Laboratories to the PCP's. This bypasses the allergist in determing the allergic state of the patient. The immunocap is a newer RAST test (detects IgE in the blood) with sensitivity and specificity approaching/equalling allergy skin tests. This has also cut down on referrals. When you add in newer allergy shot therapy that a PCP could order and their ability to determine on their own a patient's allergic status, you have to question the future of allergy. Certainly the future in regards to income is that it will be lower, substantially lower.


I would be very careful about considering allergy as a field especially if I had some debt to pay off. Hope this helps, I'm sure some will not like hearing it but it is reality.
 

curiouslystrong

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Having dealt with the entire spectrum of allergies, from the "gee, grass makes me sniffly" sort to the "oh god I need to stick myself with an epipen or possibly throw up in a hospital parking lot" variety, I've been considering allergy/immunology because it just seems like a natural fit, and my personal experience with allergies makes it interesting to me. I've noticed that the general consensus seems to be that "allergy is boring," but it also seems like that's because it seems to focus almost exclusively on asthma and seasonal allergy stuff. I'm really interested in food allergy, and it seems to me that if I was able to work with patients with food allergies it would make things a lot less "boring". I was wondering if this sounds like a valid assumption, and also if doing that would even be possible (since food allergies are a lot less common than seasonal allergies). Any input would be appreciated.
 

Sharn Penndroen

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Is there anyone here in academic A/I that can talk about the difference in practice compared to private practice with respect to: 1) scope of practice, 2) future of field, 3) income?
 

tum

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Having dealt with the entire spectrum of allergies, from the "gee, grass makes me sniffly" sort to the "oh god I need to stick myself with an epipen or possibly throw up in a hospital parking lot" variety, I've been considering allergy/immunology because it just seems like a natural fit, and my personal experience with allergies makes it interesting to me. I've noticed that the general consensus seems to be that "allergy is boring," but it also seems like that's because it seems to focus almost exclusively on asthma and seasonal allergy stuff. I'm really interested in food allergy, and it seems to me that if I was able to work with patients with food allergies it would make things a lot less "boring". I was wondering if this sounds like a valid assumption, and also if doing that would even be possible (since food allergies are a lot less common than seasonal allergies). Any input would be appreciated.

i have a friend who is doing just that. he's coming from an academic powerhouse though and he trained under a guy who had done a lot in the field, so maybe that has something to do with it.
 

MastCell

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Is there anyone here in academic A/I that can talk about the difference in practice compared to private practice with respect to: 1) scope of practice, 2) future of field, 3) income?


Academic allergists get their positions based on their research. They may only see patients 2 to 3 full days a week as much of their time is devoted to their research.


The future is good for research if you are in the hot topics that will get funded by pharmaceutical companies or the government.


Income will be dependent on the number of studies you can bring in, the number of talks you can get flown around the country to give, and the number of books you may get to write a chapter in. Otherwise academic allergists make nowhere near what an allergist makes in private practive, currently. Of course the numbers could get closer as the newer forms of IT are developed.


The field of allergy has limited training programs and therefore not many academic positions available. It is a very competitive market. Good luck.
 

tristanjouvin

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Is there anyone here in academic A/I that can talk about the difference in practice compared to private practice with respect to: 1) scope of practice, 2) future of field, 3) income?

Agree. currently, while academic A/I tends to be muchmore interesting than private practice, incomes are typically much lower than what they would be in classic private practice, sometimes half the amount it would be at a similar level of experience. But that might change with evolving reimbursment and managed care issues.
 

tristanjouvin

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A/I salaries must vary widely. An allergist I know is making 700K in San Fran, and he's been out for 10 years. Works 10 hr days with weekends off, no call, no nights, no pager. You can charge for procedures, even though the nurses do all of the procedures, so you make the money without the work or time normally associated with procedures.

Does anyone have allergy interviews? Curious how it's working this year.


check the AAAAI website: www.aaaai.org

somewhere in there there is a section on "practice management" and you can find data on median income. Keep in mind, this generally reflects the private practitioner who is quite busy with high volume routine conditions and a fair amount of income generated from skin testing and injections.
 

tristanjouvin

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Academic allergists get their positions based on their research. They may only see patients 2 to 3 full days a week as much of their time is devoted to their research.


The future is good for research if you are in the hot topics that will get funded by pharmaceutical companies or the government.


Income will be dependent on the number of studies you can bring in, the number of talks you can get flown around the country to give, and the number of books you may get to write a chapter in. Otherwise academic allergists make nowhere near what an allergist makes in private practive, currently. Of course the numbers could get closer as the newer forms of IT are developed.


The field of allergy has limited training programs and therefore not many academic positions available. It is a very competitive market. Good luck.

I agree with Mast Cell on most points, however, there is now an increasingly growing position of Academic Allergy Immunology Clinician/Educator, and because of the relatively lower income of these positions compared to private practice, there are a number of unfilled openings throughout the country. Recent studies have predicted that there will be an extreme shortage of allergists in general in upcoming years (whether these reports are correct, who knows). THere are advantages to such academic positions though - more stability, stable salary and benefits package, collaboration and sense of being part of a team, and the potential for a more interesting caseload rather than just runny nose and asthma all day.
 

IVIG

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$700,000 ? I doubt he is practicing ethically if he's making that much.
I think you all need to realize that a lot of docs who are making these kind of numbers (i.e. way out of range for an avg doc in that specialty) are probably doing tests when not indicated or running some sort of pyramid scheme (i.e keeping younger docs as "slaves" and taking a cut of their profits). How much can your conscience handle?
You wanna be known as the "unethical doc" in your community?
 

texas612

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I just finished my A/I fellowship 3 years ago. I love my field. Yes, somebody may say that it is all shiffling noses and food allergies. I don't save peoples lives like cardiology or pulmonology but I help with quality of life. I orginally did internal medicine and loved it because it is field where I take care of sick people on their death bed. But quickly, I got tired of the long hours and tough patients. I had to be there for them and less for my family and kids. TO be an good internist you have to be smart and have alot of patience. I got burnt out so went into allergy.

My patients now are younger and I make a difference in how they feel. I work from 8-5 with rare calls on weekends. Income is good. 700k is tough to believe. It depends where in the US you live, but average partnered allergist make anywhere from 200-300k. That is pretty good for the life style.

There is shortage of allergist projected. There are new A/I programs opening to meet the demands.

Again, if you are interested just do a rotation. You will find out why allergist are so happy with what they do.
 

Ava2007

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I recently applied to dermatology (this last application cycle) and, unfortunately, did not match. I'm at the point where I'm considering other options (though I love derm and have devoted so much time and effort over the past year to the field). I will be starting my internship in IM this July (just a one yr prelim position) and I'm thinking about doing the entire IM residency rather than putting myself and my family through the stress of applying to derm yet again, especially since I would likely need to do a fellowship to improve my application.

Thing is, I can't see myself as a primary care doc and would definitely like to do a fellowship after my residency. I like the idea of AI, find it quite interesting and have scheduled an elective early this yr to see whether it is a good fit for me. I know that AI is competitive and I'm wondering what are the most important application criteria (board scores, LORs, research, etc.)? How much to programs look at Step 3?

Thanks for any and all advice!
 

Sharn Penndroen

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I don't know how much this would help you, but I went to speak with the program director at my institution about what it would take to get into A/I. Among other advice he gave me this sheet of paper that he and the other A/I faculty fill out on every applicant that interviews. It has several criteria ranked for 0-5. These are the criteria listed:

Interest in Academic Allergy:
Professionalism:
Communication Skills:
Intellect/Class Rank:
Medical/Scholarly Acheivements:
Fit for Med/Peds A/I program:
Personality/Humanistic Traits:
Leadership/Teaching:
Non-Medical Acheivements:
Overall Recommendation:
 

novacek88

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IVIG or Immunotherapy comprise the majority of the income of those allergists who are famous for earning high income. The physician who is making 700K is most likely doing so because he has a significant number of patients on IVIG not because he has a "shot factory". IVIG patients are unique thus only allergists who have been in practice for several years will have the experience necessary to acquire enough IVIG patients to earn 700K especially in a saturated market like San Francisco. Nearly every Allergist has a "shot factory" and has nurses giving shots while the allergist sees to the other patients. This is not unusual by any means. Reactions rarely occur so a physician merely has to be in the vicinity if a reaction should occur. Many practices offer shots on the weekends and an allergist will basically arrive in the morning and read or check their e-mail for 4 hours while patients receive shots.

In regards to IVIG, it's costs now exceeds the amount Medicaid is reimbursing for it. This is why many allergist haved stopped treating patients on medicaid who require IVIG because it actually costs them money to treat these patients. These patients are still treated of course but they are treated at home. However, private insurance has followed suit and has lowered the amount they are reimbursing for IVIG by a significant amount and it's declining each year. Thus, when you heard of Joe Smith allergist making 500K to 1 million, that's essentially no longer going to happen. I know an established allergist who made well over a million 5 years ago and made 350K last year due to the IVIG reimbursement. This trend is going to continue.

Allergists will always be compensated well especially for the amount of work they do. They will probably earn between 175-300K which is comparable to most IM subspecialties, but it's no longer a money making field as it once was. I personally think you are going to see a major drop in demand for the field because in the past it was the combination of income and lifestyle that drove people to it much like dermatology. And while the lifestyle of A/I is certainly a strength, there are many other subspecialties of IM and Peds that offer a comparable lifestyle and similar pay like endocrinology, rheumatology, pulmonologyw/out critical care, etc. so I don't the level of competition for allergy will ever be what it once was.

The one thing A/I has in it's corner is the extremely low number of fellowship programs. Trust me, there has not been an increase in programs to meet the demand. That rumor has persisted for the last 7 years and it's failed to become a reality.It's difficult to lure a trained allergists into academics due to the difference in income and lifestyle. Many private practicer allergists can work 3-4 days a week and earn 200K while a program director or a faculty member will be required to do research as well as teach and see patients for a 110-120K. This is the major deterrant in regards to establishing fellowship programs. Also most programs require that it have two faculty members, one from an IM background and another from a Peds background, which futher makes it difficult to establish a program. In addition, there are politics involved. As the financial limitations begin to increase, the academy will likely not rush to create several fellowships because that would increase the supply of allergists thus lowering the demand. Dermatology has artificially kept it's demand high by deliberately keeping the number of derm programs low.
 

Ava2007

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I don't know how much this would help you, but I went to speak with the program director at my institution about what it would take to get into A/I. Among other advice he gave me this sheet of paper that he and the other A/I faculty fill out on every applicant that interviews. It has several criteria ranked for 0-5. These are the criteria listed:

Interest in Academic Allergy:
Professionalism:
Communication Skills:
Intellect/Class Rank:
Medical/Scholarly Acheivements:
Fit for Med/Peds A/I program:
Personality/Humanistic Traits:
Leadership/Teaching:
Non-Medical Acheivements:
Overall Recommendation:

Thanks for the response... I guess I'm curious about the factors deemed most important as far as obtaining interviews. Likely many of the same things important for residency application - grades, scores, honors, research, etc. With no AI fellowship at my home institution, the possibilities for research are probably a little slim. Any recommendations as far as that is concerned?
 

novacek88

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Academic allergists get their positions based on their research. They may only see patients 2 to 3 full days a week as much of their time is devoted to their research. The future is good for research if you are in the hot topics that will get funded by pharmaceutical companies or the government. Income will be dependent on the number of studies you can bring in, the number of talks you can get flown around the country to give, and the number of books you may get to write a chapter in. Otherwise academic allergists make nowhere near what an allergist makes in private practive, currently. Of course the numbers could get closer as the newer forms of IT are developed. The field of allergy has limited training programs and therefore not many academic positions available. It is a very competitive market. Good luck.

I would like to add that to be able to

1. get funded by pharmaceutical companies
2. bring in a lot of studies
3. be flown all over the country to give talks

You can't be some guy who just finished fellowship 2 years ago! The allergists that have this type of clout have been practicing for at least 15 years. Many of these people are former program directors, academy presidents and/or well published researchers. They have immediate name recognition otherwise a pharmaceutical company is not going to pay to fly you around to speak at some dinner or conference. I have attended many of these dinners and conferences and most of the speakers are extremely well established people who have been in the field for over 20 years. Writing chapters in books is fairly easy to do and they usually don't require extensive experience. However, it's not lucrative contrary to what you might believe and it can be time consuming. The people who write for journals and books do so out of interest as opposed to income potential.

It's comical to read some of these posts about people who think they can just accept an academic positions and suddently reap all these benefits. That's very typical of an SDN writer who is still in medical school.
 

novacek88

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Thanks for the response... I guess I'm curious about the factors deemed most important as far as obtaining interviews. Likely many of the same things important for residency application - grades, scores, honors, research, etc. With no AI fellowship at my home institution, the possibilities for research are probably a little slim. Any recommendations as far as that is concerned?

A/I is much more "mom and pop" in regards to the applicaton process. You are approaching it as if its cards or GI. That approach will not help you. There are not strict numbers per say. Remember that A/I wasn't even a match a few years ago; you had to apply directly to programs. What I learned is that you have to do residency at a program that is affiliated with an A/I fellowship and you basically have to know those people intimately and use your electives to do research for them. A/I directors are much less numbers oriented. They will gladly accepts someone who has far worse numbers in exchange for a person they know that has proved he or she is good in the lab and will be an asset in regards to research. If you are seriously interested, it's almost a requirement to do your residency at a program that is affiliated with an A/I fellowship. Most AI fellowships take people from within and are less likely to take outside candidates. It's not uncommon to find that a particular A/I fellowship took all their fellows from the home institution. Of course this is rare and they usually take one person from outside but it seems like your best chance would be to do residency at a program that has an A/I fellowship
 

novacek88

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THere are advantages to such academic positions though - more stability, stable salary and benefits package, collaboration and sense of being part of a team, and the potential for a more interesting caseload rather than just runny nose and asthma all day.

I too initially thought academic medicine might be better for me because it incorporates variety of clinical medicine, research and teaching. Yes, I love all of those aspects and I thought, "Gee, what a great job for me and I don't mind taking less pay if it can afford me these opportunities." But the reality was a lot different. There is a lot more peace of mind and job security in private practice than academics. You don't have to deal with the politics and research demands of an academic institution. Just the politics alone have driven talented people away from academic medicine. Academic medicine prioritizes research over teaching and clinical medicine. There is constant pressure placed on the faculty to acquire grants and finish their research. The pay is considerably less and can be a 1/3 of what a private practice allergist earns. Those who are best suited toward academics are those who are naturally inclined toward research and are genuinely passionate about it. If you go into academics for the purpose of earning money or enjoying a presumed lifestyle, you will be disppointed. I learned the only people who can truly stand all the negatives associated with academics are those who are researchers first and physicians second. If you are someone like me that sees himself as a physician first and researcher second, then academics is not for you. Even these physicians who give talks are not doing it for the money. They are genuinely passionate about research. If you ever get to know these people, you will quickly realize they are not "normal." My idea of relaxing is getting together with friends and enjoying a few drinks by the pool. There idea of relaxing is going home and reading research articles and preparing presentations for fellows.
 

Ava2007

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A/I is much more "mom and pop" in regards to the applicaton process. You are approaching it as if its cards or GI. That approach will not help you. There are not strict numbers per say. Remember that A/I wasn't even a match a few years ago; you had to apply directly to programs. What I learned is that you have to do residency at a program that is affiliated with an A/I fellowship and you basically have to know those people intimately and use your electives to do research for them. A/I directors are much less numbers oriented. They will gladly accepts someone who has far worse numbers in exchange for a person they know that has proved he or she is good in the lab and will be an asset in regards to research. If you are seriously interested, it's almost a requirement to do your residency at a program that is affiliated with an A/I fellowship. Most AI fellowships take people from within and are less likely to take outside candidates. It's not uncommon to find that a particular A/I fellowship took all their fellows from the home institution. Of course this is rare and they usually take one person from outside but it seems like your best chance would be to do residency at a program that has an A/I fellowship

Thank you for this info - very enlightening. Do you have any idea about how doable it is to switch to another IM program after doing my PGY1 yr? Without an AI fellowship at my home institution, perhaps that would be wise... I'm looking at a possible move anyway due to a job change for my significant other. Do you have any recommendations for programs?
 

My PooNoni

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I would just like to put my 2 cents in about the fellowship process. I am an internal medicine resident at a program that does NOT have an Allergy fellowship. We do however, have an Allergy department, with 2 attendings that are part-time.

I think you just need to be more aggressive about research opportunities and making contacts if you are not at an institution that has a fellowship program. Make sure you get clinical exposure with well-known faculty who can make phone calls for you and make sure you have some research to talk about at interviews. Also, it is a good idea to get an abstract/poster in at either the College or Academy meeting.

I think you should be fine as long as you are aggressive about the process and I think switching residencies will not help you in the long run. Like I said, my program has no fellowship and I was able to get 90% of the interviews I wanted and matched at my first choice for A/I for 2008.
 

dharmabum7

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as a fellow starting in July 2007....I agree with the response above...i didn't goto an IM program with a fellowship...ideally its better to goto a program where there is a fellowship because it gives you more contacts and the letters will mean a lot more...

that being said its still possible to get in...i agree, try to get something done even if its great asthma research...and then get into the college or academy...

i wouldn't suggest switching programs in the middle...worst case scenario, take a year off and work with someone well known at one of the larger allergy centers if your program allows you to do this...

i was on the other extreme....applied to several programs, limited interviews, multiple acceptances...but geographically not where i wanted to stay. so its possible but you may need to be somewhat flexible.

good luck.
 

AnnaMags

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I am an almost second year peds resident. I'd love to talk with people in fellowship or recently out of fellowship (probably over email) about getting into fellowship. Let me know if you'd be willing to help. This also goes out to all the lurkers out there who just haven't posted.

Thanks!
 

AnnaMags

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Anyone planning to apply to fellowships this year? I'm getting ready to start applying. Would love to see what others have to say about different programs.
 

IVIG

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Blanche,

No you don't have to go away from immunology when in private practice. In fact, it would be nice if more private allergists practiced immunology.

The reason most private allergists don't is probably because of money and lifestyle and also because of lack of resources. If you're talking about diagnosing immunodeficiencies, you can do that in private practice. Sometimes you need to send off tests to specialized laboratories, but it's no problem.

The challenge comes in managing and treating immunodeficiencies (especially the hard core pediatric immunodeficiencies) which involve more inpatient work and requires you to have certain resources. For example you need to have a nearby facility that offers bone marrow transplantation or enough money to buy and administer IVIG to your patients or provide medications that may be considered experimental ("experimental" as there is little data on the drug because the disease is so rare). Try fighting with the insurance company to get such a drug for a rare disease! Academic centers are better able to handle such things. BUT would be very helpful if the private allergists followed immunodeficiency patients locally with 1-2 visits to the academic allergist in between to help out.
No you don't have to give up immunology totally, but would be difficult to practice the complete spectrum of immunology in private practice.
 

IVIG

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sorry-tried to reply to an earlier post on the 1st page
 

MastCell

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I would like to add that to be able to

1. get funded by pharmaceutical companies
2. bring in a lot of studies
3. be flown all over the country to give talks

You can't be some guy who just finished fellowship 2 years ago! The allergists that have this type of clout have been practicing for at least 15 years. Many of these people are former program directors, academy presidents and/or well published researchers. They have immediate name recognition otherwise a pharmaceutical company is not going to pay to fly you around to speak at some dinner or conference. I have attended many of these dinners and conferences and most of the speakers are extremely well established people who have been in the field for over 20 years. Writing chapters in books is fairly easy to do and they usually don't require extensive experience. However, it's not lucrative contrary to what you might believe and it can be time consuming. The people who write for journals and books do so out of interest as opposed to income potential.

It's comical to read some of these posts about people who think they can just accept an academic positions and suddently reap all these benefits. That's very typical of an SDN writer who is still in medical school.



Even more comical are the posts by people with poor reading comprehension. Nobody in this thread ever claimed that by becoming an academician you would be handed the benefits that only those near the top of the academic world receive.
 

AIfellow

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I recently went to a conference sponsored by the ACAAI and am puzzled by the future of AI. During the conference, the leaders spoke about concerns over a future shortage of allergist due to retirement and also an large expected increase in demand for allergist. The numbers quoted roughly were a 35% increase in demand for allergist with a 7% reduction in the number of practicing allergist out there. With this in mind, it seems that the future of allergy seems very bright as allergist seem to definitely be in need. However, when I talked to some of the practicing allergist at the conference, they all voiced their woes about diminishing reimbursement and a decrease in the number of referrals. There seems to be a discrepancy between what the leaders at the college are describing and to what is reality. Please voice your opinion as to the true state of allergy and immunology.
 

chef

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Hi guys - interesting thread. I have a friend who's considering A/I fellowship and an academic career. What programs are considered 'top tier', and which have the best research faculty? If you could list the top 5, that'd be great.

I wonder if A/I rankings usually follow general IM rankings - ie., Harvard, Hopkins, UCSF, etc..?
 

IVIG

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No they do not correlate to the IM rankings at all.
Some top programs (reputable due to research funding and faculty that are leaders in the field) would be:
National Jewish in Denver
Mount Sinai- NYC
University of Virginia
NIH
This is NOT a complete list- just the ones off the top of my head.
You really cannot rank #1, #2, #3 etc. as allergy is such a small field. The stronger programs usually are known to be leaders in a particular topic. Example: Mount Sinai for humoral immunodeficiency, food allergies. If you know who the leaders in the field are, the institution they are located at is usually considered strong.
 

IVIG

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How come it's always "a friend" whose considering? If the friend is that interested, shoudn't he/she be on here asking? --sorry grouchy mood today.
 

allergisttobe

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hey, if you are applying for the 2009 cycle for A&I: Have you heard from any programs yet? just curious. ditto here.
 

MastCell

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The reason practicing allergists don't practice alot of immunology is quite simple. Immunodeficiency is rare. Nothing more to it than that. You can't build a practice on rare diseases. Rare is rare, common is common. Guess what makes up the overwhelming majority of your practice? That's right, common. To claim we don't do it because we don't get reimbursed well for it is total BS. We don't do it a lot because immunodeficiency is rare. Add in that most allergist's have their patients get home infusions so we are not involved in the billing, the home health care agencies are. The poster who goes by the handle "IVIG" I would bet is not a practicing allergist and most likely is a drug rep, probably for one of the IVIG manufacturers. He thinks because he knows a little about our field he knows it all. He doesn't.
 

MastCell

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Let me add another death knell to the field of allergy. Sublingual immunotherapy (SLIT) has been approved in Europe and soon will be approved in the US. A physician prescribing SLIT will make as much money doing this as prescribing a medication. In other words none. SLIT is given at home and will easily be prescribed by PCP's and other specialists that have been encroaching on the field of allergy (ENT and pulmonary). Translation - less referrals for us. You are making a mistake if you are going into the field of allergy. It is a dying specialty.
 

rantes

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The jury is still out on SLIT (sublingual immunotherapy). However, key issues are still being dealt with. In no particular order, they are:

1) It is not FDA approved.
a. You can't bill Medicare/caid and most insurances.

2) Efficacy data is mixed at best.
a. Most studies show no impact on medication use - SCIT (vaccinations) can lead to a 50% reduction.
b. SCIT has a plethora of data demonstating efficacy and decreasing markers of sensitivity for pollens, dust mite, and dander. Mold (except for maybe Alternaria) is iffy.

3) Safety concerns are still significant:
a. How to administer to poly sensitized patients (the norm in US)
b. How to dose adjust for reactions or increased symptoms
c. Is anaphylaxis, asthma, esosinophilic esophagitis increased when administered in polysensitized patients? This will likely be a limiting factor for at home use. Put a few million polysensitized people on the therapy and you're bound to get a few serious reactions. SCIT is very safe, but the few few deaths attributed to it has lead to the current standards of recommending against home/remote therapy.

4) How long to prescribe?
a. SCIT - 3-5 years and stop for assesment of control.

5) Wil it be more cost effective.
a. The doses in trials tend to be MUCH higher and dosing MUCH more frequent than SCIT.

SLIT may provide a role for remote allergen desensitization or even in patients with cross reacting sensitizations. I doubt it will replace SCIT for the moderate/severe allergic rhinitis/conjunctivitis/asthmatic patients. I would bank on vaccinations linked with adjucts as a more plausible future therapy. Allergic diseases and asthma are increasing in frequency and severity. Patients will be not a huge issue. Immunotherapy (though it is reimbursed well like almost any procedure), actually makes up less of a practice than you would anticipate (<10% in many paractices, and I guess 15-20% seems like a high end normal).
 

IVIG

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MastCell,
For clarification, I am a practicing board certified allergist and have no affiliation with any pharmaceutical company. Also, for clarification, I was not suggesting that one can build an entire (private) practice on immunodeficiency patients alone, (although this is possible if you are in academics). Rather, I am stating that it is very possible to incorporate immunodeficiency patients into your private practice if you wish to. In my metropolitan area, we have private allergists who choose to see immunodeficiencies as well as those who do not.

Additionally, I did not claim that private allergists don't see immunodeficiency patients because they don't get reimbursed for it. The majority of the private allergists do not see immunodeficiency patients (that is, turn them away and refer to academic allergist) do so simply because they do not have the resources to manage the condition. I will make the point that many immunodeficient kids are making it to adulthood now, and because they cannot get insurance, have no place to go other than the academic center.

One other comment, we have an infusion center and I don't see how you can make that much giving IVIG infusions (700K?), unless you are overdiagnosing CVID or treating multiple other conditions (non AI field) requiring IVIG?
I agree with novacek88 on the reimbursement part. It is close to our cost.

I don't see Allergy/Immunology as a dying field at all--more like a rapidly evolving field--and that's a good thing.
SLIT may look promising, but there are a lot of issues that still need to be addressed as rantes summarized so well. Even if SLIT comes into the picture, I agree that adjuvant immunotherapies are not far behind, and then who knows? Isn't evolution fun?:)






The reason practicing allergists don't practice alot of immunology is quite simple. Immunodeficiency is rare. Nothing more to it than that. You can't build a practice on rare diseases. Rare is rare, common is common. Guess what makes up the overwhelming majority of your practice? That's right, common. To claim we don't do it because we don't get reimbursed well for it is total BS. We don't do it a lot because immunodeficiency is rare. Add in that most allergist's have their patients get home infusions so we are not involved in the billing, the home health care agencies are. The poster who goes by the handle "IVIG" I would bet is not a practicing allergist and most likely is a drug rep, probably for one of the IVIG manufacturers. He thinks because he knows a little about our field he knows it all. He doesn't.
 

snanny

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Gi , cards , allergy , see NRMP match stats , 6 programs were unfilled in allergy immunology . See a significant number of FMG's matching in allergy and immunology based on stats than it was thought.
 

bronx43

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Are there any updates in the field of allergy/immunology since 2008? I am wondering if these trends that were talked about then have evolved significantly since then. For what it's worth, an allergist here in town reportedly made 1.5 mil last year. He's got incredible marketing and you see his billboards all over town. Anyone care to comment on whether or not this is possible in this day and age?
 

D elegans

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are there any updates in the field of allergy/immunology since 2008? I am wondering if these trends that were talked about then have evolved significantly since then. For what it's worth, an allergist here in town reportedly made 1.5 mil last year. He's got incredible marketing and you see his billboards all over town. Anyone care to comment on whether or not this is possible in this day and age?

$hot$
 

Extracts

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Are there any updates in the field of allergy/immunology since 2008? I am wondering if these trends that were talked about then have evolved significantly since then. For what it's worth, an allergist here in town reportedly made 1.5 mil last year. He's got incredible marketing and you see his billboards all over town. Anyone care to comment on whether or not this is possible in this day and age?

What area in the US is this? As far as allergy/immunology goes, SLIT is still not FDA approve (but it should/might be in the next year or so). Data is still mixed with it's efficacy in patients with polysensitization and there is still no concensus with dose and duration of therapy.

In Europe, both SLIT and SCIT are utilized. I don't think SCIT will go away in the US, even if SLIT is FDA approved. There's new data from Florida showing the cost effectiveness of SCIT in adult medicare/Medicaid patients. This maybe relevant in an era where cost effectiveness and evidence based medicine will be tied to payment.

There's an expected shortage of allergist/immunologist in this country (predicted by AAAAI). Food/aero allergies and asthma are increasing. We are now prescribing Xolair for chronic urticarial and there's other modes of immunotherapy being studied for seasonal allergies as well as food.

I think the future of allergy/immunology is bright. As far as compensation. In a presentation from the AAAAI, in 2008 the mean profit based on a survey from members were 356k +/- 272k. I think 1.5 million is a definite outlier.
 

bronx43

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What area in the US is this? As far as allergy/immunology goes, SLIT is still not FDA approve (but it should/might be in the next year or so). Data is still mixed with it's efficacy in patients with polysensitization and there is still no concensus with dose and duration of therapy.

In Europe, both SLIT and SCIT are utilized. I don't think SCIT will go away in the US, even if SLIT is FDA approved. There's new data from Florida showing the cost effectiveness of SCIT in adult medicare/Medicaid patients. This maybe relevant in an era where cost effectiveness and evidence based medicine will be tied to payment.

There's an expected shortage of allergist/immunologist in this country (predicted by AAAAI). Food/aero allergies and asthma are increasing. We are now prescribing Xolair for chronic urticarial and there's other modes of immunotherapy being studied for seasonal allergies as well as food.

I think the future of allergy/immunology is bright. As far as compensation. In a presentation from the AAAAI, in 2008 the mean profit based on a survey from members were 356k +/- 272k. I think 1.5 million is a definite outlier.

Wait, plus or minus 272k?? So some people are making <100k? Wow that's unbelievable.

Is SLIT good or bad for the PP allergy provider? Also, what do you think about the current job market? How about the feasibility of starting one's own practice somewhere?

The person I mentioned is located in a medium sized city in the Midwest. He just set up shop 2 years ago, and is apparently a whiz at marketing. There's a large 8 physician practice in town as well, but you wouldn't know that if you just walked around town. His logo is pretty much ubiquitous.
 
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Extracts

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Wait, plus or minus 272k?? So some people are making <100k? Wow that's unbelievable.

Is SLIT good or bad for the PP allergy provider? Also, what do you think about the current job market? How about the feasibility of starting one's own practice somewhere?

The person I mentioned is located in a medium sized city in the Midwest. He just set up shop 2 years ago, and is apparently a whiz at marketing. There's a large 8 physician practice in town as well, but you wouldn't know that if you just walked around town. His logo is pretty much ubiquitous.

Ah, the glass is half empty argument. Look at it the other way, some people are making 600k+. There's always people in academics or part timers making around 100k or so.

No one knows what SLIT will do to the private practice allergist. I think it will increase market share. Then again, maybe primary care docs will start prescribing it. No one can predict anything in medicine. Most allergist are in private practice.

I'm in the military, but I have friends in private practice who are extremely busy. For now PP appears to still be feasible.
 

Silent Cool

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What area in the US is this? As far as allergy/immunology goes, SLIT is still not FDA approve (but it should/might be in the next year or so). Data is still mixed with it's efficacy in patients with polysensitization and there is still no concensus with dose and duration of therapy.

In Europe, both SLIT and SCIT are utilized. I don't think SCIT will go away in the US, even if SLIT is FDA approved. There's new data from Florida showing the cost effectiveness of SCIT in adult medicare/Medicaid patients. This maybe relevant in an era where cost effectiveness and evidence based medicine will be tied to payment.

There's an expected shortage of allergist/immunologist in this country (predicted by AAAAI). Food/aero allergies and asthma are increasing. We are now prescribing Xolair for chronic urticarial and there's other modes of immunotherapy being studied for seasonal allergies as well as food.

I think the future of allergy/immunology is bright. As far as compensation. In a presentation from the AAAAI, in 2008 the mean profit based on a survey from members were 356k +/- 272k. I think 1.5 million is a definite outlier.

Are you sure it wasn't +/-72K? +/-272K is a HELLUVA variable. I find that hard to believe. Either that or the sampling was terrible or very biased (read: terrible). From everything I have read (and make no mistake: I am sure as hell NOT an expert), most allergists make upper 200's. But most also work dentist hours (read: <40hrs per week). So for the baller allergists our there (that sounds funny...), I could see 400+. Likewise, for the ballin'-out-of-control allergist makin' 1.5 mil, my guess is that he/she owns multiple clinics and employs other allergists. I doubt one allergist could do that just from practicing allergy medicine in and of itself.
 

Extracts

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Are you sure it wasn't +/-72K? +/-272K is a HELLUVA variable. I find that hard to believe. Either that or the sampling was terrible or very biased (read: terrible). From everything I have read (and make no mistake: I am sure as hell NOT an expert), most allergists make upper 200's. But most also work dentist hours (read: <40hrs per week). So for the baller allergists our there (that sounds funny...), I could see 400+. Likewise, for the ballin'-out-of-control allergist makin' 1.5 mil, my guess is that he/she owns multiple clinics and employs other allergists. I doubt one allergist could do that just from practicing allergy medicine in and of itself.

Yes, I can read, and this is from the AAAAI surveying private practice members. 57 practices with a total of 180 physicians. If you want to look at the data yourself, get a AAAAI user ID and pw. It's too much work for me to attach the file here.

What resource are you using/reading?
 
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