"Growing into" ROAD specialties

[DermViser]

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I believe another factor, and I am far too lazy to look this up, is that PDs are choosing more FMGs and red-flagged AMGs with super high step scores. Normally these people wouldn't have matched, but there are enough 240+ in the applicant pool to keep the averages up for now. Oh the horror that a PD might actually have to rank a bright, young, motivated, and rads-dedicated US senior with a 215 step 1 one day.

I believe this more occurs at the lower tier programs, esp. those which are not university based and have no fellowship programs directly on site: http://rad.msufame.msu.edu/?page_id=20

 

[DermViser]

I believe another factor, and I am far too lazy to look this up, is that PDs are choosing more FMGs and red-flagged AMGs with super high step scores. Normally these people wouldn't have matched, but there are enough 240+ in the applicant pool to keep the averages up for now. Oh the horror that a PD might actually have to rank a bright, young, motivated, and rads-dedicated US senior with a 215 step 1 one day.

Quite a difference from the: "Only the academically extremely strong should even think about this [Radiology]. USMLE scores must soar well above 230s/mid 90s, transcripts groan under the weight of A's, Honors and applause; accepted publications bend your mailbox from sheer volume; whole communities praise you as their savior; and your letters must make you appear likely to qualify for instant sainthood. On top of that, you must present a sparkling and error-free ERAS, a compelling Pulitzer-level Personal Statement, and project the vivid and charismatic presence of a talk-show host. A successful, articulate one."

 

[atomi]

Like I said, this has no reflection on the residents that match there. It's a reflection on the Radiology PD at that program herself who RUNS that program, who tried to portray her specialty as only for the "chosen ones". Any PD with half a brain would at least keep that distasteful nonsense to themselves. She posted her hubris on her program's website. @atomi had mentioned about specialty selection based on perceived salary calculations by med students. She tried to capitalize on it, as if somehow Radiology is entitled to top notch applicants and high salaries, and one needs to walk on water to match into Radiology and she didn't have the sense to not broadcast it. I find your justifying her behavior sickening.

Bingo. The issue was not whether it was a good program. The issue was that putting those words on the official website showed a profound lack of judgement.

 

[Desk_Jockey]

What's your obsession with bringing this guide up at every possible point? You rambled into a line of reasoning that allowed you to post it.

I only read the intro section, but I definitely found it to be interesting: it's always entertaining to see large organizations (academic or not) publicly post ridiculous viewpoints.

Here was my favorite: As Donna Magid, MD, MEd, my counterpart at the Johns Hopkins School of Medicine, says "Only the academically extremely strong should even think about this [Radiology]. USMLE scores must soar well above 230s/mid 90s, transcripts groan under the weight of A's, Honors and applause; accepted publications bend your mailbox from sheer volume; whole communities praise you as their savior; and your letters must make you appear likely to qualify for instant sainthood. On top of that, you must present a sparkling and error-free ERAS, a compelling Pulitzer-level Personal Statement, and project the vivid and charismatic presence of a talk-show host. A successful, articulate one."

That whole section was largely redundant and could have been summed up with " We don't offer interviews if you have a STEP 1 score below X; if you want to be competitive you should have as many of the following on your applications: X, Y, Z."

 

[Desk_Jockey]

"If your grades are poor and your Step I score is low, I will be asking you whether there is anything else you would like to do in medicine other than Radiology. That sounds very tough, but it is tough love."

Why would a PD take time to interview someone who's scores were too low for the field?

 

[DermViser]

"If your grades are poor and your Step I score is low, I will be asking you whether there is anything else you would like to do in medicine other than Radiology. That sounds very tough, but it is tough love."

Why would a PD take time to interview someone who's scores were too low for the field?

I think there she's more referring to students at her medical school who come to her for guidance in applying for Radiology (so in her case, low USMLE Step 1 score is < 235)

 

[Desk_Jockey]

That makes more sense. I see now that this is written as advice for med students at her school, but she used the word "your", which made it unclear, and I felt the need to throw out one more snarky comment.

 

[circulus vitios]

Common med student misunderstanding. It's a shame how many med students make career choices based on salary surveys posted online. So many other factors go into play. Unless you're in a surgical or IM subspecialty, you are probably going to start off around $200k/year and increase your income by 50-100% over the next 10 years, and here's the part that med students don't really get, NO MATTER WHAT FIELD YOU CHOOSE. It's stupid to make specialty choices primarily based on money when the pay is so uniformly good in this profession. Yet the competitiveness of certain specialties based on step scores shows that's exactly what is happening.

Remember, income greater than $185k is taxed at 33% federally and income >$400k is taxed at 40%. With state taxes, you're looking at nearly a 50% cut on anything you're making at those levels. So you choose to go into anestheisology where you start at $275k instead of FM where you start at $200k solely based on the money? Great, that's another $30-40k in your pocket each year. Not chump change, but certainly not enough to make the decision for you IMO. Everytime I hear a med student or resident going into a competitive specialty bitching about how they wanted to do FM but couldn't "afford to pay back my loans" or "provide for my family" or some such nonsense, I get mad. Cognitive dissonance, man.

$275k after taxes for a single filing and no city/state taxes is $191k take home. $200k is $142k take home. That's a $49,000 a year difference which could be used to pay down a sizable chunk of your student loans.

Now let's look five years into the future. Per MGMA averages, the FM guy might be making $225k which is $158k take home. The gas guy might be making $350k-400k, which is $239k-$271k take home. That's a delta of $81,000 at the low end and $113,000 a year at the high end -- a massive difference. Think about how much earlier you could retire or have the option of retiring with that much money going into your savings and brokerage accounts.

 

[DermViser]

That makes more sense. I see now that this is written as advice for med students at her school, but she used the word "your", which made it unclear, and I felt the need to throw out one more snarky comment.

She has quite a few priceless gems in that "application guide".

 

[235009]

Why are you guys claiming that radiology still has high average step 1 scores? I thought the most recent data we have is from 2011.

 

[circulus vitios]

Why are you guys claiming that radiology still has high average step 1 scores? I thought the most recent data we have is from 2011.

Even the 2011 data shows people having great success with low to average board scores.

US seniors:

000-180: 0 matched, 3 unmatched (0%)
181-190: 3 matched, 3 unmatched (50%)
191-200: 10 matched, 5 unmatched (67%)
211-220: 56 matched, 5 unmatched (92%)
221-230: 115 matched, 7 unmatched (94%)
etc.

I mean it's possible they all did super kick-ass research projects and were best buds with a PD but I kind of doubt that.

 

[tco]

Even the 2011 data shows people having great success with low to average board scores.

US seniors:

000-180: 0 matched, 3 unmatched (0%)
181-190: 3 matched, 3 unmatched (50%)
191-200: 10 matched, 5 unmatched (67%)
211-220: 56 matched, 5 unmatched (92%)
221-230: 115 matched, 7 unmatched (94%)
etc.

I mean it's possible they all did super kick-ass research projects and were best buds with a PD but I kind of doubt that.

Radiology isn't nearly as competitive as people think it is. Most of this stems from the uncertainty in the job market, however, there are other minor factors such as increased demand for volume and decreased turnaround times.

 

[evilbooyaa]

Yeah radiology is not that competitive anymore. If you want to do it and are an average student, you will likely match somewhere. The issue is that it has essentially become a 6-year residency (due to the near-mandatory year of fellowship) and that the job market is kinda crap compared to 5 years ago.

 

[DermViser]

Even the 2011 data shows people having great success with low to average board scores.

US seniors:

000-180: 0 matched, 3 unmatched (0%)
181-190: 3 matched, 3 unmatched (50%)
191-200: 10 matched, 5 unmatched (67%)
211-220: 56 matched, 5 unmatched (92%)
221-230: 115 matched, 7 unmatched (94%)
etc.

I mean it's possible they all did super kick-ass research projects and were best buds with a PD but I kind of doubt that.

You also have to understand that a fellowship is now essentially a prerequisite to getting a job, which is much harder at low-tier/non-university radiology programs, thus 5+2 = 7. Before when a fellowship wasn't necessary, and people got lucrative jobs directly after residency, the match rate at the lower end of board scores was much lower.
http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=107436

 

[circulus vitios]

You also have to understand that a fellowship is now essentially a prerequisite to getting a job, which is much harder at low-tier/non-university radiology programs, thus 5+2 = 7. Before when a fellowship wasn't necessary, and people got lucrative jobs directly after residency, the match rate at the lower end of board scores was much lower.
http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=107436

I wonder how region-dependent that is. It might be different in cities outside of NYC/DC/LA/SF/SD/Chicago/Boston, and a guy in the comments section says only 10% of rads fellows do a second fellowship in a 'big' east coast program.

 

[evilbooyaa]

You also have to understand that a fellowship is now essentially a prerequisite to getting a job, which is much harder at low-tier/non-university radiology programs, thus 5+2 = 7. Before when a fellowship wasn't necessary, and people got lucrative jobs directly after residency, the match rate at the lower end of board scores was much lower.
http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=107436

Good lord, DOUBLE fellowships for radiologists? I see how that can happen, but I can't imagine why in the world any radiologists are OK with even more training, when 10 years ago a fellowship in and of itself was not necessary for employment.

 

[DermViser]

Good lord, DOUBLE fellowships for radiologists? I see how that can happen, but I can't imagine why in the world any radiologists are OK with even more training, when 10 years ago a fellowship in and of itself was not necessary for employment.

Seems like the fellowship is more being done to bide time while trying to get a real attending job. That's sad if what Saurabh Jha is saying is true and people are doing 2 fellowships after Rads residency. Good grief.

 

[evilbooyaa]

Seems like the fellowship is more being done to bide time while trying to get a real attending job. That's sad if what Saurabh Jha is saying is true and people are doing 2 fellowships after Rads residency. Good grief.

But that's the thing, when enough people do 1 fellowship prior to job hunting, then everyone else has to do a fellowship to keep up. If people start doing 2 fellowships, it's a matter of time before everyone has to do it.

Also sounds like he's saying that the transition to general radiologists --> subspecialty radiologists was not a good one because now radiologists focus on only one area of the body. He wants people to become closer to general radiologists by making them do more fellowships, so they can be 'fellowship-trained' in multiple areas of the body.

All of this is likely because he is a superspecialized radiologist at a huge academic center. I believe that those in private practice should not have to be fellowship trained. However, because there are so many fellowship trained radiologists out there, any fresh-faced R5 radiology resident is not going to get a job over those people.

 

[DermViser]

But that's the thing, when enough people do 1 fellowship prior to job hunting, then everyone else has to do a fellowship to keep up. If people start doing 2 fellowships, it's a matter of time before everyone has to do it.

Also sounds like he's saying that the transition to general radiologists --> subspecialty radiologists was not a good one because now radiologists focus on only one area of the body. He wants people to become closer to general radiologists by making them do more fellowships, so they can be 'fellowship-trained' in multiple areas of the body.

All of this is likely because he is a superspecialized radiologist at a huge academic center. I believe that those in private practice should not have to be fellowship trained. However, because there are so many fellowship trained radiologists out there, any fresh-faced R5 radiology resident is not going to get a job over those people.

He's also quite a pompous ***. If you see him in the Benjamin Rush video debates on MOC, he believes that if you're against MOC regulations, then you should also be ok with IMG radiologists from India getting to practice here in the U.S. automatically without doing residency.

 

[anbuitachi]

$275k after taxes for a single filing and no city/state taxes is $191k take home. $200k is $142k take home. That's a $49,000 a year difference which could be used to pay down a sizable chunk of your student loans.

Now let's look five years into the future. Per MGMA averages, the FM guy might be making $225k which is $158k take home. The gas guy might be making $350k-400k, which is $239k-$271k take home. That's a delta of $81,000 at the low end and $113,000 a year at the high end -- a massive difference. Think about how much earlier you could retire or have the option of retiring with that much money going into your savings and brokerage accounts.

This is being balanced out. FM practice salary is slightly rising or staying around the same, but gas salaries are being decreased. Soon the difference wont be much at all. Attendings are telling me they used to cap at like ~400, now its ~300. obviously there are exceptions

 

[circulus vitios]

This is being balanced out. FM practice salary is slightly rising or staying around the same, but gas salaries are being decreased. Soon the difference wont be much at all. Attendings are telling me they used to cap at like ~400, now its ~300. obviously there are exceptions

You can't really believe that. You're talking about an outpatient based specialty whose bread and butter is diabetes, hypertension, ADHD, depression, etc., versus a specialty that spends all day in the OR whose bread and butter involves putting patients in a chemically induced coma and bringing them back to life. Salaries might be trending downward but I trust a survey of a few thousand anesthesiologists over your anecdotal evidence in one particular locale.

 

[IlDestriero]

This is being balanced out. FM practice salary is slightly rising or staying around the same, but gas salaries are being decreased. Soon the difference wont be much at all. Attendings are telling me they used to cap at like ~400, now its ~300. obviously there are exceptions

I'm not sure what a "cap" is.
The high end in anesthesia is over $600.
I don't know anyone making under $300 outside of some low paying academic jobs and mommy track, no call no weekend, jobs in desirable cities. The sky has been falling in anesthesia for 25 years, and we're still making hay while the sun shines. And my FP friend still wants to scrape together enough money to buy a fishing boat.
Even the evil Anesthesia Management Companies pay more than your supposed "cap".
If you want to work hard and are willing to move outside of the handful of most desirable cities, even as little as 30-60 min out, you can make a killing. And if income is cut 30%, you'll still clean up.

 

[Silent Cool]

Well, urgent care is very different. It's not a specialty per say. It's a practice model of doing things. I've heard it more on the EM side, but I guess theoretically any full-license physician can do it. I think it very much allows a good work-life balance, and hence physician happiness.

Yup.
The reason I ask is that owning an urgent care center can be extremely profitable. Many of the issues that present lend themselves well to evaluation by an FM/IM/ER doc, and one does not even need to be a physician to own an urgent care center. The primary care fields are so often lamented because they are (relatively) less lucrative, but I think that owning an UC can give a PC doc independence and money--moreso potentially and reasonably than becoming a medical specialist.

http://www.bizbuysell.com/Business-...able-South-Florida-Urgent-Care-Center/759876/

Because their entire perception of derm is based on a private practice cosmetic derm in NYC/LA/Beverly Hills or based on watching a Proactive commercial. They don't know about the ridiculous amounts of reading you have to do once you go home, preparation for conferences, or grand rounds. Not to mention, at a real academic medical center, you will see much more than just the mundane skin afflictions of suburbia. There are some IM attendings who realize how interesting Derm can be and can see beyond lifestyle.

Especially in the House of Medicine, if you're not stenting a vessel, sticking a scope up someone, pumping someone with IV fluids, or doing a major abdominal operation, etc. then you're not doing real medicine, as far as they're concerned. Internal Medicine (I'm assuming that's your prelim) is one of the worst when it comes to believing it's better than everyone else, bc at one time, it was the specialty that those at the top of the medical school class pursued in droves.

Not too long ago, it was well known that those at the top of the medical school class tended to go for Internal Medicine and General Surgery. Believe it or not, Ortho was for people at the bottom of the class. Same for Radiology and Rad Oncology (known as Therapeutic Radiology) - which were filled in droves by IMGs bc at that time there were only X-rays as MRI and CT hadn't been invented yet.

Bingo. It's interesting how times change.

 

[atomi]

$275k after taxes for a single filing and no city/state taxes is $191k take home. $200k is $142k take home. That's a $49,000 a year difference which could be used to pay down a sizable chunk of your student loans.

Now let's look five years into the future. Per MGMA averages, the FM guy might be making $225k which is $158k take home. The gas guy might be making $350k-400k, which is $239k-$271k take home. That's a delta of $81,000 at the low end and $113,000 a year at the high end -- a massive difference. Think about how much earlier you could retire or have the option of retiring with that much money going into your savings and brokerage accounts.

By all means tell this to the PD when you are interviewing for anesthesia residency. Make sure to highlight the fact that you expect to be earning $400k/year 5 years out of residency.

 

[DermViser]

By all means tell this to the PD when you are interviewing for anesthesia residency. Make sure to highlight the fact that you expect to be earning $400k/year 5 years out of residency.

Due to CRNAs (self-induced)?

 

[DermViser]

Yup.
The reason I ask is that owning an urgent care center can be extremely profitable. Many of the issues that present lend themselves well to evaluation by an FM/IM/ER doc, and one does not even need to be a physician to own an urgent care center. The primary care fields are so often lamented because they are (relatively) less lucrative, but I think that owning an UC can give a PC doc independence and money--moreso potentially and reasonably than becoming a medical specialist.

Also requires a lot of upfront capital, I imagine.

 

[IlDestriero]

By all means tell this to the PD when you are interviewing for anesthesia residency. Make sure to highlight the fact that you expect to be earning $400k/year 5 years out of residency.

He wouldn't have to say it. It's a reasonable expectation.

 

[circulus vitios]

By all means tell this to the PD when you are interviewing for anesthesia residency. Make sure to highlight the fact that you expect to be earning $400k/year 5 years out of residency.

I have no idea what you're trying to say or do.