Specializing is very doable for DOs much more than for IMGs who have to score extremely well on the USMLE to simply get a residency. DOs also have their own training programs, so that is another opportunity. I myself am aiming for Pediatrics, so I am not really worried. Not that sure that Peds is low paying, the Pediatrician in my neighborhood, she has a Porsche and is an IMG.
I've heard a lot of different thoughts on this, and it seems like there are some crucial factors that could lead to a nice salary:
-Don't live in the most desirable places in the planet. IE living in Beverly Hills, NYC, etc are going to pay much less than practicing in the midwest. Also, if you did want to live in CA, for example, practice somewhere far enough outside the big cities. Living in big cities sucks anyway
-Learn how to properly code and bill. I read in the FP forums that a family practice doc, on average, can earn 30% more than they currently are if they coded and billed properly. If you're making 150k, an extra 45k from billing properly goes a long way.
-Private practice pays more than academics.
-Most importantly - you can't predict what's going to be hot. Look at ophthalmology. Used to be known for lifestyle + loads of money ... now if you read the forums for them, they are getting killed and starting at 150k, getting sucked into revolving door practices, etc. I also shadowed a doc who does gas, but said that when he went to school IM and FP were all the rage. He caught the wave of great Gas pay (which he said is starting to fade, but still quite good) and IM and FP are very low paid right now. This indicates that it's almost impossible to predict what's gonna be hot in 10 years ... so like what you're doing in case it flops or goes hot.
-My FP bought a beautiful 911 Turbo in the mid 90s ... his practice has really changed and I know he's not making what he did, but I also don't think he's hurting too bad. He seemed to adapt pretty well ... sees more patients, hired a NP to pick up slack, etc. I'm sure it's not ideal, but he's smart and making it work (he's a DO also).
Another thing to keep in mind is that it's probably going to take a while for this economy to swoop back up, and making 150k with nice job security 3 years down the road is a HELL of a lot better than you're buddy who got the econ degree in 2005 and now can't get a job (personal experience with two different friends of mine, fresh out of college, biz/econ degrees from top 50 schools, can't get jobs, going back for masters).