Considering Allergy and Immunology fellowship, would like more information?

[Dagrimsta1]

Hey everyone, I'm a PGY-2 in IM and I am considering doing Allergy and Immunology fellowship. I've always been interested in the immune system, specifically vaccines and such so I think it would be a good fit. Just was looking for some collateral info about the specialty, including;

1 - Lifestyle? Like hours, call shifts, patient load as outpatient/inpatient, etc
2 - Things required for fellowship, like research? chief residency (our program makes this into a PGY-4 year so I am considering it), electives etc.
3 - What is the pay like (in comparison to like GI/cardio I know its not up there, but what about hospitalist?)
4 - What are the most common dx? Procedures?

Thanks everyone in advance.

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[collegestud2013]

Networking is important since it's a very small field and nowadays pretty competitive to get in. Research will be important to have some, but if you're a USMD and don't care about going to a large academic program, probably don't need 20+ publications (it will be harder to get in if you're DO or IMG). USMLE scores don't matter as much for fellowship as for residency, but can get you screened out at programs if any of them are too low (usually <220 will close some doors). Chief residency usually only helps if you have an in-house fellowship program and want to stay in-house.

Lifestyle is probably the top reason it's competitive. Usually weekday only schedule and nearly 100% outpatient with minimal call responsibilities no weekends unless you choose to be on call (even if you don't do any hospital call, most state medical boards will require outpatient offices to be available on call for their patients after hours). Median compensation is similar to hospitalist which seems typical if you're hospital/health system employed. MGMA data from 2021 puts 50% percentile at $328k, which is similar to hospitalist median compensation of $307k for IM and 328k for FM from the same year. However, 90th percentile goes up to $555k; I suspect these are people with successful private practice partnerships, working longer hours than average, and/or have ancillary sources of income besides just E&M. Patient population tends to lean younger and not as much geriatric, so more people with higher-reimbursing commercial insurance and less with Medicare (which tends to reimburse less). However, once you consider the additional 2 year fellowship time required over just doing hospitalist or general IM, and the taxes paid once you're an attending (most physicians are in the 35-37% federal income tax bracket, and add in state and FICA taxes and you're paying 40-50% of your additional income to taxes) I don't think in most situations, you'll come out financially ahead than just doing hospitalist or general IM.

 

[Splenda88]

Just go out there start making 300-400k/yr as hospital medicine physician and live your life. Hospital medicine is underrated IMO. Only GI and heme/onc is worth doing since you will have a printing $$$ machine.

 

[Prehealth1011]

Just go out there start making 300-400k/yr as hospital medicine physician and live your life. Hospital medicine is underrated IMO. Only GI and heme/onc is worth doing since you will have a printing $$$ machine.

No Cards? That'll make 90% of my class disappointed 😆

 

[Splenda88]

No Cards? That'll make 90% of my class disappointed 😆

Cards lifestyle is crazy.

I am sure you've seen card consults for trop of 0.1, normal EKG, no chest pain in a patient with ESRD who is admitted for pneumonia. Most hospitalists like to consult cards for any BS.