For current PGY5-6 fellows - what branch?

[josephf1]

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What branch are you going into and why?
HF - EP - Interventioanl - Imaging - Noninvasive
Any thoughts on the salaries, job market, etc...

 

[josephf1]

http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3&hpt=hp_c1

 

[shark2000]

The whole medical system is going towards a socialized medicine. General population is bankrupt and they retire in a poor financial situation (most patients in most fields are elderly). The government is in huge debt. On the other hand the hospitals are taking advantage of it by forcing regulation and taking the business to the hospital.
At first they are hiring buying outpatient practices ( Ortho, Rads, Cards, Hem-onc, ... ) and offer good starting salaries to the employee physicians. 10 years down in the road they will screw all of us.
Despite what people say, I believe the gap between primary care doctors and specialists salaries will be there, but the salaries of both will drop to a much lower level.

The same model that you see in the pharmacy business in this country (CVS, Rite Aid, ... rather than private solo drugstores) or in shopping industry (big chains rule the market) will soon be implemented in medicine. Hospitals can always make money even if the benefit is very marginal, as a hospital is a wholesaler and a private office is a retailer. 10 years down the road, with the employee model that started by the hospitalist model a few years ago and is extending to specialists, barely we can make more than the typical academic salaries (160-180 K).

This is my personal opinion, so take it with a grain of salt.
Whatever happens, medicine will always be a better gig than many other fields in the foreseeable future. Other fields will also suffer at least as much as us.

 

[supp-2]

Agree with many points.. Do think the appealing shift towards hospital employment (and the buying out of all practices) is going to lead to some heartache down the road. My hospital had their highest profit year ever last year. The govt will eventually squeeze them more and more and that squeezing will trickle down to their employees.

Personally, I don't think salaries will drop <300k (if saying most are in the 400-500k range now).. We still will possess a skill set that will be very much needed in our society that only a certain percentage of people can do. This will be enhanced by more old-timers and grandfathered in docs hanging it up as the squeeze is only going to hurt more and more.

For me, that is why I think whatever skills you can get now in training will only make you more valuable (and protect you more down the road). Think if you're doing just general you should do everything you can to get advanced imaging (CT, MRI). If doing interventional to learn as much structural, peripheral, ect. If EP, be willing to do more general than they're accustomed to.

Ultimately who knows what will happen. IF nothing more if salaries drop, quality of life should improve.. hopefully.

 

[bronx43]

The whole medical system is going towards a socialized medicine. General population is bankrupt and they retire in a poor financial situation (most patients in most fields are elderly). The government is in huge debt. On the other hand the hospitals are taking advantage of it by forcing regulation and taking the business to the hospital.
At first they are hiring buying outpatient practices ( Ortho, Rads, Cards, Hem-onc, ... ) and offer good starting salaries to the employee physicians. 10 years down in the road they will screw all of us.
Despite what people say, I believe the gap between primary care doctors and specialists salaries will be there, but the salaries of both will drop to a much lower level.

The same model that you see in the pharmacy business in this country (CVS, Rite Aid, ... rather than private solo drugstores) or in shopping industry (big chains rule the market) will soon be implemented in medicine. Hospitals can always make money even if the benefit is very marginal, as a hospital is a wholesaler and a private office is a retailer. 10 years down the road, with the employee model that started by the hospitalist model a few years ago and is extending to specialists, barely we can make more than the typical academic salaries (160-180 K).

This is my personal opinion, so take it with a grain of salt.
Whatever happens, medicine will always be a better gig than many other fields in the foreseeable future. Other fields will also suffer at least as much as us.

Jesus Christ, not this again. Listen. Primary care salaries can't drop much lower, while specialist salaries can. Will the two make exactly the same amount? It'll depend on corporations and their incentive to pay higher for specialists. The only thing that matters is supply and demand, and that's what corporations will use to determine your price. The only reason that salaried positions currently are higher for specialists is because reimbursements for their services are higher, and they must throw out higher numbers to incentivize specialists to join said corporations. However, when the reimbursement rates and models change, this will no longer be the case. Specialists will be hired to fulfill a specific role in the health care machine, and primary care physicians are hired to do the same. Only supply and demand matters. And with this in mind, the only difference is in the artificial construct of "educational difference," (the proverbial argument that specialists train more which leads to higher pay) which may or may not exist depending on just how screwed finances are, and how much corporations push to leap over these legislative boundaries. I can totally see these hyper-efficient systems like Kaiser pushing to train their own providers in the future to work solely within their own system, and they likely won't see a reason to pay their specialists more as the training tracks will have relative parity.

As far as socialized medicine, I think it's a toss-up. My personal feeling is that there will not be enough political capital to get this done without a major crisis, and we essentially wasted the last one thanks to the current administration and the Fed. I mean, you'll really need apocalyptic scenarios for people to accept the fact that granny and grandpa can't stay in the ICU for an indefinite amount of time on the government (ie public)'s dime. Therefore, politicians will do all that is necessary to maintain the expenditures with a combination of bond issuance and QE. And obviously, this cannot be maintained without a concurrent exponential growth in the actual economy. And the only thing that can result from these practices is destruction of the currency. If that happens, everything we've been talking about in the past few paragraphs won't hold true. You'll have to read about Republic of Weimar, Argentina, Zimbabwe to get an idea of what happens.

Btw, the good news is that the Eurozone crisis bought us a couple years, as the scared money pours into the US. In the short term, the USD might not be a bad investment. Long term... that's a different story.

 

[josephf1]

all this is true, but i want to hear from people that despite the crapy future are still doing imaging/ep/interventional and why? just cause they like it and/or can;'t stand general cards? the latest issue of JACC had an editorial where some one was advising his buddy's son the MS2 to bail on specialty training and get an MBA. are we really there? or are we still making 350K which you can live a pretty decent life on and the old timers are just crying cause it aint 600K?

 

[shark2000]

one man's meat is another man's poison. You may love it, I may hate it.

Clearly your post is about money. You are not asking about your own interests from us.
Caring about money and job market is very reasonable. There is no problem being concerned about it. It is also VERY WISE to choose a filed with better income or income/hour. No doubt. BUT:
Believe me. The worst thing in life is to do something that you hate, no matter how much you make. As a doctor you can make enough to have a decent life. Whatever you choose, you will be on the top 5 percentile of American's income. Go for something that you like. Don't care what other people say. And as a doctor you will spend most of your time at work.

 

[bronx43]

all this is true, but i want to hear from people that despite the crapy future are still doing imaging/ep/interventional and why? just cause they like it and/or can;'t stand general cards? the latest issue of JACC had an editorial where some one was advising his buddy's son the MS2 to bail on specialty training and get an MBA. are we really there? or are we still making 350K which you can live a pretty decent life on and the old timers are just crying cause it aint 600K?

Agree with what shark said in the last post.

I don't exactly understand what you're trying to ask. Are cardiologists still making 350k? Yes, according to sources that are available to us. Is it a decent life? Yes. Are the old timers crying because it's not 600k? Yes. As far as the implications of the future, my previous post reflects my thoughts, and apparently you agree...
If you're trying to ask why people are still going into the super-specialized fields despite the bearish outlook, my answer is that few people really understand the financial and economic threat this country faces and fewer still actually choose their specialty based on it. People are currently going into interventional and EP because interventional and EP have greater financial compensation at this point in time. Do some of them do it because they hate general cards? Perhaps, but the overall trend in medicine and every other profession is that people flock to the money.