Easy to match into and good money?

[deleted1166564]

I am a below average, 3rd year DO student who is confused on what to pursue. I am applying COMLEX only. What speciality can I realistically match into and make good money as well?

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[DO2015CA]

What’s your standard of good money

 

[DrStephenStrange]

I’m not supposed to tell you this because this is a hidden gem 😉. But If you can endure one of the most challenging of specialties to do residency in, and if you’re a nerd like me who enjoys learning about the intricacies of the nervous system, neurology is pretty great. Very good job security with demand being very high translating into decent salary (350K+ even straight out of residency). Lots of different fellowship options meaning that you can take your career in whatever direction you want to. Most fellowships are 1 or 2 years extra of training and not that competitive to land outside of Neuro IR or maybe neuro critical care.

 

[Postictal Raiden]

not sure how competitive things nowadays, but 6 years ago, the answer was anesthesiology, PMR, and neurology

Anesthesiology and PMR may have gotten more competitive but neurology is still easy to match. Money is good but definitely less than anesthesia, by a lot

 

[BoneWizard]

Another vote for neurology. Our senior just took a $400k 7 on 7 off back in Houston with a monthly stipend for the rest of her PGY4 year. Also not very competitive to match into.

 

[voxveritatisetlucis]

Used to be rads and anesthesia but it seems like these are becoming harder to match. Probably IM —> GI, cards but you need to match a place with an in house fellowship most likely. Also these will not be easy to match but they are possible with comlex only if in house

The only thing is that you need to be okay with the possibility of not matching and doing hospitalist or PC

 

[Dantes]

I'd say anything outside of peds can make good money, although I suppose that's relative. FM, IM (with routes to allergy or rheum), neuro, psych (yes it's more competitive but still largely attainable), and I'll throw path in there as the job market is improving. PM&R also more competitive but still very attainable if you show interest.

 

[deleted1166564]

What’s your standard of good money

350-500K pretax income

 

[deleted1166564]

I’m not supposed to tell you this because this is a hidden gem 😉. But If you can endure one of the most challenging of specialties to do residency in, and if you’re a nerd like me who enjoys learning about the intricacies of the nervous system, neurology is pretty great. Very good job security with demand being very high translating into decent salary (350K+ even straight out of residency). Lots of different fellowship options meaning that you can take your career in whatever direction you want to. Most fellowships are 1 or 2 years extra of training and not that competitive to land outside of Neuro IR or maybe neuro critical care.

how many hours are you doing weekly on average?

 

[Obnoxious Dad]

I am a below average, 3rd year DO student who is confused on what to pursue. I am applying COMLEX only. What speciality can I realistically match into and make good money as well?

Here's the most recent Charting Outcomes In The Match for DO grads:

https://www.nrmp.org/wp-content/uploads/2022/07/Charting-Outcomes-DO-Seniors-2022_Final.pdf

See Chart 3 for the match rates for various specialties. It's 92% in Neurology. If you drill down to pages 139-149 it seems that it's difficult to NOT match if you apply to 15 or more programs. Good luck

 

[DO2015CA]

350-500K pretax income

Even hospitalist can get you in the ballpark of 350k if you aren’t requiring a major city. So pretty much everything minus primary care and peds (outside nicu or picu)

 

[DarkHorizon]

350-500K pretax income

Right now, emergency medicine.

 

[DrStephenStrange]

Right now, emergency medicine.

From what I’ve heard, it’s been decreasing due to oversaturation and midlevel providers taking over the specialty. It’s also been hard to find jobs in desirable locations. As you may already know that’s also the reason behind a lot EM programs going unfulfilled lately.

how many hours are you doing weekly on average?

Depends. Hours may vary depending on if you’re doing inpatient, outpatient, or a mix of both. Total hours worked probably also depends on how efficient you are. But I’ve seen many regular neurohospitalist jobs 7 on 7 off without calls with starting salary over 400K.

 

[voxveritatisetlucis]

From what I’ve heard, it’s been decreasing due to oversaturation and midlevel providers taking over the specialty. It’s also been hard to find jobs in desirable locations. As you may already know that’s also the reason behind a lot EM programs going unfulfilled lately.

Depends. Hours may vary depending on if you’re doing inpatient, outpatient, or a mix of both. Total hours worked probably also depends on how efficient you are. But I’ve seen many regular neurohospitalist jobs 7 on 7 off without calls with starting salary over 400K.

How many hours on average as a resident?

 

[DarkHorizon]

From what I’ve heard, it’s been decreasing due to oversaturation and midlevel providers taking over the specialty. It’s also been hard to find jobs in desirable locations. As you may already know that’s also the reason behind a lot EM programs going unfulfilled lately.

Depends. Hours may vary depending on if you’re doing inpatient, outpatient, or a mix of both. Total hours worked probably also depends on how efficient you are. But I’ve seen many regular neurohospitalist jobs 7 on 7 off without calls with starting salary over 400K.

Don’t entirely disagree with you but still a lot of EM opportunities. You’d easily make 400k working in a suburban, rather desirable area. Now EM is a dumpster fire, that’s a whole another debate. But all you need is a pulse right now and a passing score to get a spot.

 

[DrStephenStrange]

How many hours on average as a resident?

Intern year is pretty chill at my program. I don’t think I’ve ever worked more than 60 hours in a week this past year with average being closer to 50 hours a week. Also there were no overnight calls even when on our neuro service (4 blocks). Although, we do work 2 weeks of night shifts when on IM (x 3 blocks). Now in PGY-2 it has picked up a bit with overnight and weekend calls with half the year spent in inpatient neuro and the stroke service, so now I’m averaging more or less 70 hours a week. Hours may vary greatly between programs though.

 

[Kardio]

Here's the most recent Charting Outcomes In The Match for DO grads:

https://www.nrmp.org/wp-content/uploads/2022/07/Charting-Outcomes-DO-Seniors-2022_Final.pdf

See Chart 3 for the match rates for various specialties. It's 92% in Neurology. If you drill down to pages 139-149 it seems that it's difficult to NOT match if you apply to 15 or more programs. Good luck

The graph I assume you’re referring to is referencing the number of programs applicants submit on their rank order list, which is at most the number programs they’ve interviewed at (not the number of programs applied to).

 

[Drrrrrr. Celty]

Intern year is pretty chill at my program. I don’t think I’ve ever worked more than 60 hours in a week this past year with average being closer to 50 hours a week. Also there were no overnight calls even when on our neuro service (4 blocks). Although, we do work 2 weeks of night shifts when on IM (x 3 blocks). Now in PGY-2 it has picked up a bit with overnight and weekend calls with half the year spent in inpatient neuro and the stroke service, so now I’m averaging more or less 70 hours a week. Hours may vary greatly between programs though.

That's pretty impressive for Neurology tbh. I've seen neuro residents pushing Gen surgery hours 80-100 repeatedly while not on easier rotations like EEG/Epilepsy.

I think Neuro can be pretty cool with a solid amount of procedural and nonprocedural skills. That being said it's more akin to Endocrinology in that most people don't like it and don't understand it very well than most other fields.

 

[Drrrrrr. Celty]

350-500K pretax income

There's a difference between starting at, medium, and able to obtain with hustling.

350k pretax is doable with a lot of fields if you maximize your hustle. Even a decent amount of Endocrinologists make that by adjusting their practice to really hit higher patient volumes.

Likewise it's also what you can do to side hustle.

 

[deleted1166564]

Intern year is pretty chill at my program. I don’t think I’ve ever worked more than 60 hours in a week this past year with average being closer to 50 hours a week. Also there were no overnight calls even when on our neuro service (4 blocks). Although, we do work 2 weeks of night shifts when on IM (x 3 blocks). Now in PGY-2 it has picked up a bit with overnight and weekend calls with half the year spent in inpatient neuro and the stroke service, so now I’m averaging more or less 70 hours a week. Hours may vary greatly between programs though.

Can i apply to neurology without any Neurology letters of recommendations?

 

[DrStephenStrange]

Can i apply to neurology without any Neurology letters of recommendations?

Most programs require at least one Neurology letter. I would look at each program's website for specific requirements.

 

[Obnoxious Dad]

The graph I assume you’re referring to is referencing the number of programs applicants submit on their rank order list, which is at most the number programs they’ve interviewed at (not the number of programs applied to).

You are correct. The OP could have a hard time getting interviews with low stats. Then he wouldn't be able to rank 15 programs. Frankly, he or she needs to go through Freida and find those programs that have low stat thresholds and apply to them.

 

[Sidus1011]

As much as I do think Neuro is an amazing field and one I am seriously looking into, I feel like you really need to enjoy the subject matter and patient population. If you don't, you'll likely reach burnout at a much faster rate than in another field.

 

[cptsam]

surprised psych hasn't been mentioned yet, though it is getting more competitive

 

[BlueBleck]

As much as I do think Neuro is an amazing field and one I am seriously looking into, I feel like you really need to enjoy the subject matter and patient population. If you don't, you'll likely reach burnout at a much faster rate than in another field.

I feel like anyone who likes medicine would also enjoy neuro. Being a hyponatremia detective is a bit like being a localization detective. MI/CAD management is similar to stroke. Undifferentiated AMS/gait is very similar to undifferentiated fatigue.

From what I gather, I think preclinical neuro gets most people. To be honest, I didn't do so well in preclinical neuro purely due to laziness. It's a lot of bulk for no reward. When you see a patient though and put anatomy to pathology, it just clicks.

Also, our patients aren't any worse in terms of debility these days than medicine patients. I remember re-admitting the same 90 year old demented to the point of aphasia like 3 times for recurrent infections in PGY1 (other teams admitted her multiple times too). Not to mention all the cancer admits or liver bombs. Heck, general neuro doesn't even really deal with neuro-onc because they've become their own thing. To name some advances, MS drugs are so exceptional that most patients do super well after an attack on long term injectables. Migrainers now have bespoke and very effective treatments.

If neuro were like the other IM subspecialties with mandated exposure and a fellowship training track, I think it would be at least a middle tier specialty for salary and lifestyle alone. Stroke after residency is benign hours hitting 400k. General neuro outpt is probably 280k starting. Also, the specialty is old with the average neurology in his 50s or something so it's easy to get jobs even in big metros.

 

[deleted1166564]

I feel like anyone who likes medicine would also enjoy neuro. Being a hyponatremia detective is a bit like being a localization detective. MI/CAD management is similar to stroke. Undifferentiated AMS/gait is very similar to undifferentiated fatigue.

From what I gather, I think preclinical neuro gets most people. To be honest, I didn't do so well in preclinical neuro purely due to laziness. It's a lot of bulk for no reward. When you see a patient though and put anatomy to pathology, it just clicks.

Also, our patients aren't any worse in terms of debility these days than medicine patients. I remember re-admitting the same 90 year old demented to the point of aphasia like 3 times for recurrent infections in PGY1 (other teams admitted her multiple times too). Not to mention all the cancer admits or liver bombs. Heck, general neuro doesn't even really deal with neuro-onc because they've become their own thing. To name some advances, MS drugs are so exceptional that most patients do super well after an attack on long term injectables. Migrainers now have bespoke and very effective treatments.

If neuro were like the other IM subspecialties with mandated exposure and a fellowship training track, I think it would be at least a middle tier specialty for salary and lifestyle alone. Stroke after residency is benign hours hitting 400k. General neuro outpt is probably 280k starting. Also, the specialty is old with the average neurology in his 50s or something so it's easy to get jobs even in big metros.

Is it possible to earn over 400k in general neurology? Considering how tough I hear the residency is for you guys, i would assume a decent payout at the end

 

[DarkHorizon]

Is it possible to earn over 400k in general neurology? Considering how tough I hear the residency is for you guys, i would assume a decent payout at the end

You can make 400k doing anything, even peds or FM

 

[BlueBleck]

Is it possible to earn over 400k in general neurology? Considering how tough I hear the residency is for you guys, i would assume a decent payout at the end

My understanding is that you can, but you'll be closer to 50-60hr/wk as outpt gen neuro. Ibn alnafis above would be better to answer, he recently got a new job.

You can make 400k doing anything, even peds or FM

2019 MGMA dataset:
Median - peds 230k, FM 250k, gen neuro 320k, stroke 400k, ortho 600k.
90th percentile - peds 380k, FM 380k, gen neuro 520k, stroke 630k, ortho 1mil.

Technically, yes. But odds are that you'll practice ethically with sane hours, constraining your income to roughly the median physician's salary based on typical reimbursement rates. Outliers are often somewhat unethical or workaholics.

In med school, I worked with neuros who owned their MRI/infusion center and you bet your behind that every patient got an MRI/infusions for every possible indication. Consults took 15 minutes and followups 5 minutes. Guys were 90+% for sure. They probably would have had a similarly questionable scheme as FM or peds, so yeah, I guess anyone can make 400k.

On the other hand, worked with an efficient pediatrician seeing 4-6 patients an hour and was still a damn good doc. He would talk to me about AAP and choosing wisely guidelines and practiced what he preached. He was an non-partner employee in a group. He shared with me his salary and per MGMA, he was roughly 60-70th. He will probably never see 400k.

 

[DO2015CA]

My understanding is that you can, but you'll be closer to 50-60hr/wk as outpt gen neuro. Ibn alnafis above would be better to answer, he recently got a new job.


2019 MGMA dataset:
Median - peds 230k, FM 250k, gen neuro 320k, stroke 400k, ortho 600k.
90th percentile - peds 380k, FM 380k, gen neuro 520k, stroke 630k, ortho 1mil.

Technically, yes. But odds are that you'll practice ethically with sane hours, constraining your income to roughly the median physician's salary based on typical reimbursement rates. Outliers are often somewhat unethical or workaholics.

In med school, I worked with neuros who owned their MRI/infusion center and you bet your behind that every patient got an MRI/infusions for every possible indication. Consults took 15 minutes and followups 5 minutes. Guys were 90+% for sure. They probably would have had a similarly questionable scheme as FM or peds, so yeah, I guess anyone can make 400k.

On the other hand, worked with an efficient pediatrician seeing 4-6 patients an hour and was still a damn good doc. He would talk to me about AAP and choosing wisely guidelines and practiced what he preached. He was a non-partner employee in a group. He shared with me his salary and per MGMA, he was roughly 60-70th. He will probably never see 400k.

With peds, if you are seeing 4-6 per hour like clockwork then you shouldn’t be an employee. That’s enough volume where you’ll benefit from being self employed and be in the 80-90 range. 48 patients per day (6/h) is a reach for doing gen peds well though imo.

 

[BlueBleck]

With peds, if you are seeing 4-6 per hour like clockwork then you shouldn’t be an employee. That’s enough volume where you’ll benefit from being self employed and be in the 80-90 range. 48 patients per day (6/h) is a reach for doing gen peds well though imo.

I think that's a big thing for lots of new docs. Nobody wants to open their own practice anymore. So you probably shouldn't bank on hanging a shingle.

Also, single shingle shops don't necessarily make more. AAN has their own salary survery and per their data: median solo practice is 250k, group 280k, multispecialty 330k. and hospital 350k. Probably just economies of scale for the solo/group/multispecialty difference. Not to mention all the unpaid labor of being a business owner on top of being the sole provider.

But anecdotally, i know a decent number of solo guys who do very well. But they are pretty old, like late 40s at least. So they hung that shingle at a much different time. One of them still uses paper charts, and I wonder if they got grandfathered into that or something.

 

[DO2015CA]

I think that's a big thing for lots of new docs. Nobody wants to open their own practice anymore. So you probably shouldn't bank on hanging a shingle.

Also, single shingle shops don't necessarily make more. AAN has their own salary survery and per their data: median solo practice is 250k, group 280k, multispecialty 330k. and hospital 350k. Probably just economies of scale for the solo/group/multispecialty difference. Not to mention all the unpaid labor of being a business owner on top of being the sole provider.

But anecdotally, i know a decent number of solo guys who do very well. But they are pretty old, like late 40s at least. So they hung that shingle at a much different time. One of them still uses paper charts, and I wonder if they got grandfathered into that or something.

Peds still has a pretty decent number of physician owned groups who you can buy into compared to other specialties. I think it’s because less hospital systems aggressively bought them for referral streams compared to FM/IM. Completely solo, prob not a good idea. But when I wasn’t sold on fellowship, I interviewed at 2-3 physician owned groups in my city. All of them were quite happy and their median income that they shared with me was significantly more than the employees places I interviewed at in town.

 

[Postictal Raiden]

Is it possible to earn over 400k in general neurology? Considering how tough I hear the residency is for you guys, i would assume a decent payout at the end

Very

In fact I don’t know of any outpatient PP general neurologist who makes less.

Salary surveys don’t show you the whole picture. It’s almost always biased towards people who make less. People who make dough aren’t going to declare it.

To make 400k in outpatient neurology, you roughly need to bring in about 750k in collections.

Let’s do some back of the napkin calculations:
8 new visits and 8 follow ups plus one EMG/NCS and one eeg

[8 ($200) + 8 ($140) + $250 + $250] X 5 days a week X 46 weeks a year = about $750k

Even if you do 40 mins per new and 20 mins per follow up visit plus 30mins for each procedure, that’s 8-9 hours/day.

The private guys I know are seeing double the numbers above plus they have midlevels seeing the very easy meds refill follow ups. I wouldn’t be exaggerating if I told you they’re making 700k+

 

[Calizboosted76]

I wouldn’t be exaggerating if I told you they’re making 700k+

How business savvy do you have to be though? I would assume pretty savvy.

 

[Postictal Raiden]

How business savvy do you have to be though? I would assume pretty savvy.

That plus being a workaholic plus compromising patient care

 

[Calizboosted76]

That plus being a workaholic plus compromising patient care

Is there a way to achieve a salary close to that while not compromising patient care? I am at a stand still between a few specialties as of now and neurology is on the list. However I have been enjoying being in the hospital so I would want do neuro-hospitalist work.

 

[Postictal Raiden]

Yes, be really good at your subspecialty and get involved in clinical trials.

Last I heard, the MS experts in my town are getting 5k per patient they enroll in clinical trials. So if you have a panel of say, 100 patients, that’s an extra 500k of gross income. That in addition to your income from seeing patients in clinic.

Doing expert witness work also pays very very well. I heard the pay is on the magnitude of 750 an hour.

Doing pharma talks also pays.

Choose a field, be really good at it, have good social skills and know how to market yourself. That’s the “easy” and “clean” way to make big bucks nowadays

 

[deleted1166564]

surprised psych hasn't been mentioned yet, though it is getting more competitive

who has a higher earning potential?

 

[Splenda88]

Even hospitalist can get you in the ballpark of 350k if you aren’t requiring a major city. So pretty much everything minus primary care and peds (outside nicu or picu)

IM hospitalist here.

My contract is 350k/yr for 7 days on/off. Made 405k last year working ~17 days/month. I am in a small city of ~60k people in the southeast.

One of my friend/co-worker is on track to make > 600k this year as a nocturnist, but she works a lot (22-23 days/month)

 

[voxveritatisetlucis]

One of my friend/co-worker is on track to make > 600k this year as a nocturnist, but she works a lot (22-23 days/month

For how long would you say is this type of workload sustainable?

 

[Splenda88]

For how long would you say is this type of workload sustainable?

Some people are built differently. For myself, I probably can do it for about a year.

I have been friend with her for a few years now, and I think she can do it for a long time (5-7 yrs). She is just different.

The other day, I was talking to her about buying another a house for 500k and I told her I am waiting for the interest rate to come down. Her reply was I should not need to borrow any money to buy a house that just only cost 500k. I was astounded. Granted we both have been out of residency for only 2 years.

 

[Calizboosted76]

IM hospitalist here.

My contract is 350k/yr for 7 days on/off. Made 405k last year working ~17 days/month. I am in a small city of ~60k people in the southeast.

One of my friend/co-worker is on track to make > 600k this year as a nocturnist, but she works a lot (22-23 days/month)

You made $55,000 more a year for 3 extra days a month?

 

[Splenda88]

You made $55,000 more a year for 3 extra days a month

Yes, but it's only 2 extra days since one works 15 days/month (contract is 182 days for a calendar year, 7 on/off). My daily rate right now is $1920. We also got paid ~23% ($445) extra of our daily rate for any day above the 15 days stipulated in the contract. For instance, if work 16 days in a month, day 16 is paid at $2365. If you take 24 x ($2365), that ~55k/yr. Hope that makes sense.

 

[Calizboosted76]

Yes, but it's only 2 extra days since one works 15 days/month (contract is 182 days for a calendar year, 7 on/off). My daily rate right now is $1920. We also got paid ~23% ($445) extra of our daily rate for any day above the 15 days stipulated in the contract. For instance, if work 16 days in a month, day 16 is paid at $2365. If you take 24 x ($2365), that ~55k/yr. Hope that makes sense.

Makes perfect sense. Thank you!

 

[Calizboosted76]

Yes, but it's only 2 extra days since one works 15 days/month (contract is 182 days for a calendar year, 7 on/off). My daily rate right now is $1920. We also got paid ~23% ($445) extra of our daily rate for any day above the 15 days stipulated in the contract. For instance, if work 16 days in a month, day 16 is paid at $2365. If you take 24 x ($2365), that ~55k/yr. Hope that makes sense.

Due they limit you to how many extra days you are allowed to work?

 

[Splenda88]

Due they limit you to how many extra days you are allowed to work?

No. As many you want to do when they have open spots.

 

[Postictal Raiden]

IM hospitalist here.

My contract is 350k/yr for 7 days on/off. Made 405k last year working ~17 days/month. I am in a small city of ~60k people in the southeast.

One of my friend/co-worker is on track to make > 600k this year as a nocturnist, but she works a lot (22-23 days/month)

22-23 days/month of hospital medicine would suck the life out of you. But I agree with what you said, people are built differently. I know this neurointensivist that does week on week off, makes 400K+ from that then takes on another 7 days of stroke call coverage and generates another 100K.

I can’t and, most importantly, don’t want that.

There’s a sweet spot where the income growth line intersects with the negative sloped lifestyle line. This spot is about mid 300Kish or 13 shifts a month for me. Any income above that comes at the cost of lifestyle.

I am also at a point in my life (despite still being a negative networth) where I’d rather sacrifice income to maintain/improve lifestyle.

Remember, every dollar you make beyond mid 200K your paying progressively more taxes, yet still taking on 100% of the responsibility

 

[Splenda88]

22-23 days/month of hospital medicine would suck the life out of you. But I agree with what you said, people are built differently. I know this neurointensivist that does week on week off, makes 400K+ from that then takes on another 7 days of stroke call coverage and generates another 100K.

I can’t and, most importantly, don’t want that.

There’s a sweet spot where the income growth line intersects with the negative sloped lifestyle line. This spot is about mid 300Kish or 13 shifts a month for me. Any income above that comes at the cost of lifestyle.

I am also at a point in my life (despite still being a negative networth) where I’d rather sacrifice income to maintain/improve lifestyle.

Remember, every dollar you make beyond mid 200K your paying progressively more taxes, yet still taking on 100% of the responsibility

Neuro definitely has better earning potential and is more prestigious than hospital medicine, but I think their job is more demanding IMO.

 

[Drrrrrr. Celty]

I would recommend not discounting doing what you actually enjoy and what you can actually do well...

I can honestly say having graduated from IM residency I wouldn't want to be a neurologist. Neurological diseases are draining and really weird. I don't want to be that guy pushing 1g of Methylpred for 5 days not knowing what the hell I am treating. And a lot of the diseases are honestly extremely debilitating to watch.

Similarly being a hospitalist has a lot of issues not only in that you're really dependent on your consultants and working with other people. And if you're not a hospital where people are generally nice, it'll eat away at you.

And I am sure someone is going to say they literally have no clue what the fk prolactin is and why it matters. And would say it's a miserable world to even consider thinking about it for 5 seconds.

So there is ofc that lol.

But I'd rather take a pay cut and go home clean and with limited trauma.


PS highly respect good neurologists. Y'all do stuff I certainly would be terrible at.