Competitive Residencies

Derm is #1, hands down.

 

I think the integrated Plastic surgery spots have the highest non-match rate at present, followed by derm. Correct me if I'm wrong.

 

PM&R is getting more and more competitive every year as more people discover it. More and more money making opportunities -- pain and EMGs to name a few -- and one of the most benign lifestyles in medicine. I personally know of a few surgery residents who jumped ship to do PM&R instead of doing the traditional switch to anesthesia.

 

Great to hear about PM&R. I don't know too much about it but I read about it and was very interested, especially as it's also a way to do sports med. I know this is off topic, but how exactly do people "get into" sports med?

 

Why is Neurology unpopular? What's PM&R.

I heard someone say that you can get into sports medicine through either 4 years of orthopedics or 3 years of family practice, and then apply for a fellowship. Not too sure.

 

PM&R = Physical Medicine and Rehabillitation

Or as I've heard it Plenty of Money & Relaxation....

 

Neurology is not popular because it is not as lucrative as most procedure oriented fields. Most people also believe that neurologists can't do anything therapeutic for patients. The belief is that it is diagnose and adios.

I'm happy that most people think that way and that no one is going into neurology. That means more marketshare for me.

 

How much does class rank factor into residency selection? Are boards looked at more than your class rank or you grades?

 

Neurology is a pretty lucrative field in private practice, especially if EMGs are your thing.

 

I believe one can go into sports medicine from a few different specialties. I know FP, PM&R, and EM have fellowships leading to sports medicine. I wonder if you're looked at differently depending upon what type of residency you did in order to get to sports medicine. In other words, are all sports medicine docs created equal?

 

Without a doubt, psychiatry has the best combination of lifestyle + compensation. There is currently a shortage of Psych docs, even in the big cities. Add to this the manner in which Psych's are compensated (they get a cut of the capitation fees if a Primary Care doc refers a patient for psychiatric problems), and you've got a pretty good career. Psych's on average pull $130,000+ with mostly office-type hours.

 

What about Radiology? Dude! 45-50 hours a week and no office hours/ overhead. Not to mention the $350k a year. Sounds like the best bang for your buck. What do you guys think?

 

Interestingly, the Radiologists that I work with have a different view of the future of Radiology. The hospital I was working at is considering sending the images to Radiology Centers in a different state to be read. I think the name of this Radiology Center was Night Hawks, or something like that and they are creating centers all over the country. Anyway, according to them, this would eliminate the need for many of the full-time radiologists in the hospital. They would still need some for interventional procedures, emergencies, etc. and their lives would basically suck. It was their opinion that in 5-7 years, after hospitals and doctors got used to this idea, that it would be widely accepted. His opinion was these centers would hire the top Radiologists, be much more efficient and thus cutting down on the number of Radiologists needed, save the hospital tons of money, and make the call suck for the hospital-based Radiologists. I'm not sure if this will actually happen, but one of the interns (who is going into Rads) and I got into a discussion with him about it when we asked him to review a CT Scan with us on one of our patients.

The widespread utilization of teleradiology in this manner hasn't happened yet (and I wonder if it ever will), and as it stands now, Radiology is an extremely competitive match with a great lifestyle. I thought it was an interesting discussion, anyway.

 

Wow that's amazing. We talked about that EXACT thing in our MBA classes over the summer. "The incorporation of Radiologists" That is no joke. In the future the rads guys will have to get into more invasive procedures to keep their salaries (and numbers) up. When we discussed it, it seemed 15-20 years away, but I can see it happening faster than that.

 

crawling through this site among others, I 've heard people say that "Derm" and "orthopedic surgery" are two of the most competitive residencies. now is "Derm" - dermatology? and if so, why is it so popular...
and what are the other competitive residencies? I'm sure cardiology is up there, but its funny that things I would have thought to be very competitive really arent all that (e.g. neurology)

 

Dermatology is popular because its the closest to a regular 9 to 5 job any doctor will ever get.

 

neurology isn't the most competitve, but it's fairly competitive. the reason it's not terribly competitive is that it's the lowest paying specialty (even then the ave is still like $200,000)

the various competitiveness statitstics affirmed my belief that whenever a pre-med says that he's going into medicine not for the money, it's 80-90% bull****. (MSTP exempt)

BTW, derm is competitive 'cause you make the most money with the least amount of time

 

I think pathology can be a 9 to 5 job too...

 

the best job i have witnessed is being a spine surgeon.

The guy I shadowed went from 7-3 on Tuesday, and a little Saturday morning for the clinic

the rest is all surgeries

what a great life

 

Some of the most competitive residencies are dermatology, orthopedics, neurosurgery, opthomalogy, otolaryn/ENT, and urology.

Dermatology, for example, is strictly 9-5 with no on-call duties. They also get paid a great deal, upwards of 225k/year. Over half your patients would come in for acne. You dish out prescriptions all day and maybe do some minimally invasive surgery.

There are very few derm internship positions nationwide so it ups the competition for residency even more.

 

sorry - there seem to be a few stereotypes being perpetuated in this thread ...just want to clear them up a bit. The stereotypes serve as a good basic idea of the profession, but there are some other important things to consider.

I'll start with Mr H's statement:
"the best job i have witnessed is being a spine surgeon.
The guy I shadowed went from 7-3 on Tuesday, and a little Saturday morning for the clinic
the rest is all surgeries
what a great life"

Neurosurgery is a very demanding and taxing field, although the earnings potential is quite high. You need to be on-call often, although you are paid well for it.

Ronny's statement: "I think pathology can be a 9 to 5 job too..."

Most pathology professionals are on-call often, because their expertise is often needed during surgeries, to analyze tissue specimens stat.

LizardKing: "Dermatology, for example, is strictly 9-5 with no on-call duties. They also get paid a great deal, upwards of 225k/year. Over half your patients would come in for acne. You dish out prescriptions all day and maybe do some minimally invasive surgery. "

Derm may be cushy superficially, but it's certainly not always 9-5, pill pushing.

It's good you're aware of these pgy stereotypes, but a few may be outdated, and maybe not 100% correct.

btw, my understanding is that neurology is not especially competitive, except at top schools. The same is true for internal medicine, peds, fam pract, general surgery & ER.

Some"lifestyle" fields becoming more competitive are anesiology, radiology, and pm&r.

 

Not if you get a medical examiner or coroner job. Your patients won't complain if you're not on call.

 

Isn't spine surgery performed by an Orthopedic surgeon with a spine fellowship?

 

It's so ridiculous that so many pre-meds and med students still deny it, and then apply to dermatology. Seriously, is ANYBODY so interested in people's skin that they want to dedicate their career to looking at acne and hair loss?

Perhaps I'm still in the "Patch Adams" phase, because I still want to help people by doing what I *enjoy* (psychiatry), not what brings in the dough. I think I'd go crazy if I forced myself into a field like derm, pathology, or radiology. Sure, psych doesn't make the most $, but for what it's worth, it's why I want to go into medicine.

The hours are nice, too, for the most part.

 

WaitingImpatiently, Perhaps people enjoy working decent hours and having plenty of money better than putting in 10-12 hour days every day and being on call the rest of the time. I'm the kind of person that I don't think I could stand a surgeon job, you work the lousiest hours around and then stand on your feet for most of those hours and then you're on call the rest of the time. I can't imagine studying for 10 years just so I'de get to work every weekend and holiday, LMAO... A trained monkey could do surgeries, but it's still hard to get because it pays a lot of money. It's crazy the way it works. If I'de ever become a physician there are only a few jobs that woud really appeal to me, derm and path (med examiner), and thats only because of the fairly decent hours they work, not the money. But the derm job would still have patients bothering you at odd times. The psych job you want has a lot of off hours work too. When your patients run out of meds and go to a psych hospital at 1 am they'll still wake you up... In my pharmacy I see patients call doctors at odd hours for stupid little things, these patients are crazy. Paging a doctor at 12 AM for a refill of a skin cream... And you have no choice but to deal with it. Ha. I pity them.

 

It is OphthAlmology

 

When will we all stop judging ppl for what they choose? I don't mean to single you out there, but I am actually interested in dermatology, although I will probably go into internal med or ob/gyn because I like being an active part of a patient's life. Why derm? I'm a big fan of good skincare and feel that the average person has no clue how to really take care of it. I had bad acne when I was young and went to many derms and eventually it cleared up. I'm also a sunscreen fanatic. I know looks are superficial but why wouldn't someone be interested in keeping their looks in good shape ? I'm not so into all that cosmetic derm though. If I did go into derm I think I would do half clinical and half research on skin cancer/new treatments. Basically, I'm a big proponent of preventative medicine/care and this can play a part in derm.

 

I agree that many of the opinions expressed concerning these specialties are stereotypic and a bit antiquated, yet I don't understand why people feel pathology is a cushy job. Remeber most general practioners, IM, and Ped even when they are on call usually just make a suggestion over the phone or advise to go to an emergency room (patient contact on call is usually not required). Yet with pathology, don't forget that bodies decompose rather quickly when not taken care of properly. Thus, as a forensic pathologist or coroner when you are on call you only have a small window to go to the scene or perform an autopsy. Thus, contrary to the consensus here pathology is pretty demanding as far as time is concerned.

 

The doctor I worked with did neurosurg. then a spine surg. fellowship. Bit I also believe the guy next door did ortho. spine. And Bikini I am not sure what stereotype you are talking about.
At least in this case I was able to shadow the doctor, and yes, the clinics are really that short. But I guess I forgot to mention he could be doing one surgery for 8 hours and is usually doing surgery that long every day.

Either way, ortho. is the money maker of doc's, just the way it is.
Just glorified mechanics.

 

Those same pre-meds are usually the ones who drop out when they realize how much work lies ahead of them. When you see how much money your friends are making that graduated the same year as you, it is hard to keep your focus, especially with declining physician salaries. Not to mention, people quickly find money can't drive your motivation whenever a major change in lifestyle is required to achieve that amount of money. It's all about heart and wanting the job, not so much the money...thats just the added bonus. Well, at least thats my view.

 

Both neuro and ortho do spine cases. Fellowships aren't really even required (at least, for neuro they aren't; that is what the bulk of neurosurgery cases are post residency).

 

Many of the competitive and popular specialties are that way because of lifestyle issues, but that doesn't mean the people choosing these fields are doing so for this reason.

It is up to each individual to think through what turns them on about medicine and what aspects are most interesting to them and decide. Many premeds can't believe why people would choose specialties that are so different from their perceived views of what medicine is. Some of these premeds may go on unwavering in their views. Most will have some change in how they see things once they start third year rotations and get to see the real thing. I don't care how much experience you've had volunteering or working in a clinincal setting, the real practice of medicine seen in third year will be different.

I enjoyed aspects of internal medicine and of surgery. I loved my radiology rotation. I sat down and thought through what excited me. It was the intellectual process behind the patient care that was most interesting to me. I enjoyed the patient contact as well, but this was not my favorite part (as you will see in clinical rotations this can be an often frustrating and unsatisfactory experience). Also, to me diagnosing patients was much more interesting to me than some of the horrible or ineffectual treatments doctors inflict on patients in an attempt to heal them. The fact that radiology plays a central role in the care of at least 75% of inpatients and that it is such a rapidly expanding and cutting edge field were the clinchers that made me choose this field. The somewhat better hours (although this is changing rapidly) and good income after residency were on my list of reasons, but much further down than the people who look down on these "lifestyle specialties" would expect.

 

i'll then ask the question that this post tends to be steering towards:
how much (roughly) do the different sub-specialties make?
so far we've got one person saying neurology is about $200K, and another saying derm pays about $225K. it seems to be the board consensus that derm pays pretty well and neurology doesnt - so the slight disparity between the two perceived salaries already speaks volumes about how fruitful this might be...
but what the h3ll - let's try it anyway.

 

ohhh I've got one - I've heard that cardiologists are around $300K.
btw - the whole medicine thing really isnt turning out to be that lucrative.
and now that I think about it, those folks who do end up going in to derm or orthopedic surgery for the money, are really missing out on something: should have gone to business school instead. its actually a waste to do medicine for the money because i-banking you can be pulling in some serious dough. ($700K as a 27 year old - and that is as a first year VP - 5 years before getting to an MD - managing director). Some MD's bring home at least $1.5MM.

 

Here is the deal pre-meds...............
1) neurology does not make 200k..............the average around 90-120 depending upon where they intend to set up pracitce and how saturated the market is where they will be entering.,,,
2) Spine surgery.....depends upon what aspect of the surgery is being performed...........if the spinal cord is severd than a neuro surgeon will operate.............if the vertbrae are injured than its orthos realm....if both than there will be 2 teams operating in 2 pahses...........(and neuro is a 7 year residency.........the longest of all residencies........and the average work week is 100 hrs +.........call q3.........consider the fact than when the average individual graduates from medical school they will be 27.........add 7 years on and you are looking at 34 b4 you are done training)
3) Pathologist have an extremely wonderful lifestyle..........don't know what the "on call stat" person was talkign abuot....watching too much er
4) The competitive specialties vary depending upoin where you are applying and when you are applyng,....right now general surgery (which used to be extremely competitve) is undersaturated, so it is not nearly as difficult to get a gen surgery residency as it once was...........derm has always been competitive b/c of the very easy residency lifestyle (as with optho)....go ahead and find yourself a derm or optho consult in a hospital at 9 pm on a Friday..........

So look into these things b4 you start posting..the salaries that you gave are greatly inflated.............

 

Everytime I hear people complaining about medicine and money, I want to scream!

The difference between medical schools and other post graduate degrees is that Medical School is a virtual guarantee of making $150,000+ if your are flexible about where you take a job. This is not even close to true for business school or law school. Yes, some law school graduates go to big New York law firms and make $150,000/year to start (although they work 90 hours weeks), but others stuggle to find any job and work for $30-40,000/year. This doesn't even bring up the fact that the best jobs in law in terms of satisfaction pay nothing. Starting prosecuters and public defenders make less that most legal secretaries!. Business school is just as misleading. The top business schools take mostly experienced people out of corporate jobs, so comparing them to docs fresh out of medical school doesn't compute. On the other hand, many MBA degrees aren't worth the paper they are printed on!

In my opinion, once they're done with residency, Docs have it great, even under managed care. You have amazing job security! You get to work with people and make a difference in their lives, you have a great deal of automony, and on average you will earn FIVE times the income of the average worker.

Ed

 

I think physicians make more money in medium sized cities than in large cities and small cities. In large cities the competition is usually pretty stiff. In small cities there aren't enough patients. In medium sized cities (cities with only 1 or 2 medical groups per specialty) there isn't as much competition and there are plenty of patients. So if you're basing salaries just on large city docs it is probably off. Also most attendings make less than their partnered counterparts at the private hospital.

Also, if you make 200,000 per year (and obviously some make 2-3 times more) you can then invest in other businesses, real estate, or the stock market pretty heavily. Money makes money. Many doctors do this and that's why so many of them live as lavishly as they do.

 

yes, it can be performed by neurosurgeons

 

Maybe you're right, orthoguy, that pathologists aren't on call that much.. although neurosurgeons & gen surgeons use them a lot, i think pathologists have to be on call for that.

 

Don't forget that a lot of people, including doctors, live well beyond their means. Also...what does it matter if you have a million dollars in the bank if you are working 80 hours a week. Sometimes I try to consider just what an enormous quantity of time that is. Imagine working 12 hours a day, 7 days a week. That is 84 hours. If you factor in commuting then thats close to accurate. Now consider eating will take up at least an hour a day, sleeping 5-6...you are down to 5 hours a day. Perhaps it will be nice to have a ton of money when you are 50, or to be paying alimony and child support and still be able to make a decent living. But consider the possibility that when you are 50, or even 40, or even 35, that your priorities will have changed. Then you might even consider the money less important than your lost youth. I don't mean to bring anyone too down. I just know that there are a lot of doctors barely finished with their residency that would like out but are stuck paying loans. I hope everyone is ready for this.

~AS1~

 

I worked for a group of pathologists affiliated with a hospital and they did have to be on call on evenings, weekends, & holidays for stat calls during surgeries. From what I have seen in other groups, this is standard.

Even with that, though, their lifestyles were good.

 

With the average entering GPA for 120ish med schools being 3.5, half of each year's entering med class across the US could have gotten into a top 50 (and many into top 20) law schools and could have been guaranteed to make 80+k when they graduate after 3 years of law schools. Instead they choose to go to med schools where they pay 4 years of tuition (and during those 4 years spending more hours at schools/hospitals than law students in general) and make 30-45k for 3-9 years afterwards while working 90+ hours during that period of time. Most law schools in the US have no admissions standard. So average lawyer's pay cannot be compared to average doctor's pay. Med students are giving up top law school graduates' income by going into medicine, and NOT the potential income of low-tier law school graduates (who will make 30k and pull down the average salary for lawyers).

 

I think it's very telling to compare the mean salaries of the various medical specialties on a PER HOUR basis... e.g. a Neurosurgeon making 300K/year is obviously being paid less PER HOUR than a Dermatologist making the same, right? So, without looking at any #s, off the top of my head, I'll list some of the main specialties, and what I'd rank them from highest to lowest PER HOUR income...

1 Derm
2 Path
3 Optho
4 Rads
5 EM & PM&R & Psych
6 Plastics
7 Ortho & ENT
8 Cardiology & GI & Gen Surg
9 CT & Neurosurg
10 straight IM & Peds, maybe FP

If I thought about this some more I'd probably make multiple changes but this is the rough idea I have in my head right now. Any comments?

 

I have to say I enjoy the conversations about physician income and specialty. It seems that we as students/residents try to guess how much certain specialties make without really knowing.

Also, breaking income down to a PER HOUR basis is not a bad idea but I have to totally disagree with the list. Neurosurgeons buy far make more per hour than any other specialty. Yes, these guys continue to work >80 hrs/week as an attending (although not all of this time is in house) and can easily pull in greater than 1 million/year. Most of this is from performing numerous spine surgeries which pay enormously. As a matter of fact, the highest paid GENERAL surgery case is actually a spine surgery in which the general surgeon performs the anterior exposure to the spine. Many neurosurgeons are paid $1500 a night just to take call from home and come in if they're needed. That's amazing to me.

On the flipside, one of my general surgery attendings says he has to work twice as much and do twice as many cases now than he did 8 years ago to make the same amount of money. That's sad. This guy easily works 100 hours/week as an attending! He makes around 350k but this counts the money he makes to add on Trauma call to his schedule. I don't think that's a very good PER HOUR income compared to neurosurgery. He's a very easy guy to talk to and answered many of my questions about income and how physicians are paid. It amazes me in surgery how a physician gets paid for a surgery but does not receive any added compensation for post-operative care (none). Or the physician can get paid for a patient's ICU stay but does not receive compensation for the surgery performed. Compensation in surgery is extremely messed up. Some cases that take 30 minutes are compensated extremely well, while some that take 4 hours are not.

Oh well, surgery rocks. The hours suck but you won't be poor. Plus, you get to do surgery!

Just throwing it out there.

 

Hi.
I have some questions.
May I ask some premeds and meds to keep the generalizations, the feigned possession of a vast knowledge about the specialities of medicine, and criticisms of other people to a minimum on this thread? I hope to hear some non-heated conversation from the more experienced residents and fellows about the specialties.

I will be entering medical school this month, and I dont know a lot and hope to learn more from this thread. I was wondering, how come internal medicine is not so competitive? I am interested in hematology. Is residency for that specialty competitive? How are the hours and pay for hematologist?

Also, what is the salary for residents currently? Thank you very much.

 

Hopefully you won't mind some objective info from an "experienced resident or fellow":

The median compensation for a hematologist/oncologist, according to the 2002 AMGA report (considered by many to be the most comprehensive survey), is $210,000. Salaries varied from $379,000 (90th percentile on the East Coast) to $155,000 (20th percentile on the East Coast).

Internal medicine is a non-competitive specialty because basically anyone who wants a residency in this field can have one. There are more positions than there are applicants. One of the reasons, in addition to all those Kimberli Cox mentioned, is that there so many available slots. No other specialty matches that kind of volume. However, keep in mind, though, that competition for the "best" programs in IM is very fierce.

As the author of a book-in-progress on choosing between medical specialties, I would be happy to answer any questions to the best of my ability.