ROAD specialties don't have to spend 30 minutes listening while a patient lacrimates. It's probably easier and less taxing for a IM doc to make $500k by rounding on a hospital in the morning and then a second hospital in the afternoon.
these sorts of comparisons are a bit silly.... IM is still VERY taxing, there are a lot of social issues, in fact, I think a lot of people go into IM underestimating that, and it contributes to burn out. Because they find themselves dealing a lot more with lacrimation than they expected. There are a hundred other reasons I could put out there for why it's more taxing physically, mentally, and emotionally than many realize.
Anyone that makes any claim that IM is easier than anything but some surgical specialties, really doesn't understand it. It's generally regarded as one of the least desirable specialties for many, many reasons.
IM is extremely emotionally taxing. Chronic issues that tend to lead to nasty deaths, a lot of wasting deaths on vents, by the 4 Ws (wind, water, wound, walk, ie PNA/respiratory failure, urosepsis, bed sores, immobility, etc)
(and here I'll say walk usually means VTE/PE, here I use "walk" to mean how mobility issues leads to nasty deaths. Mostly this acronym is used in surgery to discuss the most common causes of fever and post-op complications, wound is taken for wound, but this is easily adapted as an IM acronym for a lot of the serious issues to consider in your chronically ill)
A lot of it is medical handholding people and families to these wasting deaths.
Derm spends a lot more time dealing with patients' emotional problems too, than people think. It was put to me this way by derms: of all the body organs, skin is the one you see the most of, and it's exquisitely sensitive, and a huge part of our identities.
You don't really feel your liver failure until it's pretty far along, and in the meantime you don't have the self esteem issues and social problems that severe acne makes people suffer. Frankly a lot of people care more about what they can see and feel, than what they can't, when it comes to health. Acne vs atherosclerosis.
A lot of what derm does is managing painful chronic conditions like eczema, psoriasis, acne. Not to mention, if it's beyond what a PCP can manage on their own, it's quite likely so severe it might even be to the point of disability. They just don't see as much acute passing rashes. They deal a lot with the elderly, because they develop all sorts of skin problems. If they're mainly doing more cosmetic stuff, guess what, not a cakewalk. I've heard over and over again that those patients can be pretty crazy. But you don't have the tools to deal with that crazy at its source, you palliate with procedures, and in the end it can make you feel pretty rotten to give in to that at times.
Rads is not at all what it used to be. Path neither. The job market is going into the shytter, and they are being pushed to read so fast, so much volume, that there creeps a big fear of what you might be missing, it actually keeps some of them up at night.
Anesthesia is having its own job market issues.
Opthalmology is still what it's cracked up to be.
ROAD is not as sweet as it once was. Although I agree, besides derm, that patient social and emotional issues are less of the stress in those fields.
The reality I think, is that whether or not you find psych or IM more stressful, has more to do with what subset of patient suckiness you'd rather deal with, what you enjoy, what you find fulfilling, what skills you possess. They're just too different for a blanket statement when I think it's a great deal of subjective.