Help finding a hidden gem specialty

[FormerNFLQB]

Hey yall!

This may be a stupid post, I was wondering if anyone had suggestions regarding specialties that I should look into. I thought I was going to go surgery however I am not sure anymore. I will be applying with only COMLEX.

Some things that I am looking for in a specialty are:

- Procedures
- high earning potential
- Saving lives

EM was a close second however I dont like the outlook of the field and dislike the lack of continuity of care. I would say that Heme/onc is up high on my list however the lack of procedures is a turn off for me.

Any suggestions?

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[diesel2202]

PCCM, cardiology, GI

 

[Dr. Anonymouss]

Hey yall!

This may be a stupid post, I was wondering if anyone had suggestions regarding specialties that I should look into. I thought I was going to go surgery however I am not sure anymore. I will be applying with only COMLEX.

Some things that I am looking for in a specialty are:

- Procedures
- high earning potential
- Saving lives

EM was a close second however I dont like the outlook of the field and dislike the lack of continuity of care. I would say that Heme/onc is up high on my list however the lack of procedures is a turn off for me.

Any suggestions?

Not taking step 2 will hinder you greatly. Realize that most specialties that have high earning potential are competitive. What you’re describing is essentially anesthesia minus the continuity of care, but without a step 2 score that’s not going to happen. EM is probably your best bet.

 

[FormerNFLQB]

Not taking step 2 will hinder you greatly. Realize that most specialties that have high earning potential are competitive. What you’re describing is essentially anesthesia minus the continuity of care, but without a step 2 score that’s not going to happen. EM is probably your best bet.

From what I’ve been reading is there are plenty of IM programs that accept students without step. As long as that residency has fellowships would I still need step 2?

 

[FormerNFLQB]

Not taking step 2 will hinder you greatly. Realize that most specialties that have high earning potential are competitive. What you’re describing is essentially anesthesia minus the continuity of care, but without a step 2 score that’s not going to happen. EM is probably your best bet.

I failed step 1 so I don’t want to apply with a fail.

 

[voxveritatisetlucis]

From what I’ve been reading is there are plenty of IM programs that accept students without step. As long as that residency has fellowships would I still need step 2?

Yes but the IM programs that don’t take step will hinder the prospects of a competitive fellowship. For example, even if you match to a community program with an in house GI fellowship, yet there are 4 other residents who want GI

 

[Dr. Anonymouss]

From what I’ve been reading is there are plenty of IM programs that accept students without step. As long as that residency has fellowships would I still need step 2?

This may be true, but if you go the route of IM with the intent of pursuing fellowship then you should be aiming to go to a top quality IM program. If you apply without a step score you will likely end up at a community IM program and your chances of IM fellowship will be reduced drastically.

 

[DrZoidbergDO]

This may be true, but if you go the route of IM with the intent of pursuing fellowship then you should be aiming to go to a top quality IM program. If you apply without a step score you will likely end up at a community IM program and your chances of IM fellowship will be reduced drastically.

Absolutely more difficult sure, but not impossible at all. I tested at a community residency IM program and the seniors there got stuff like cards and GI. It's certainly doable. Too often on here people seem to suggest that it's basically impossible when it's not.

 

[Dr. Anonymouss]

Absolutely more difficult sure, but not impossible at all. I tested at a community residency IM program and the seniors there got stuff like cards and GI. It's certainly doable. Too often on here people seem to suggest that it's basically impossible when it's not.

It’s just important to consider this if one’s intentions are to do IM only to specialize. I don’t have the interest to search for objective data online, but I would venture out and say >90% of fellows come from academic programs. I mean it’s equivalent to saying is it impossible for a DO to be a plastic surgeon, ENT, or dermatologist? No, but if someone told me those are the only specialties they wanted to do I would tell them to find a different career because statistics say they won’t match.

 

[FormerNFLQB]

It’s just important to consider this if one’s intentions are to do IM only to specialize. I don’t have the interest to search for objective data online, but I would venture out and say >90% of fellows come from academic programs. I mean it’s equivalent to saying is it impossible for a DO to be a plastic surgeon, ENT, or dermatologist? No, but if someone told me those are the only specialties they wanted to do I would tell them to find a different career because statistics say they won’t match.

Do no other factors come into play? I have a decent amount of publications Andy home program has IM and an abundance of fellowships

 

[NontradICUdoc]

This may be true, but if you go the route of IM with the intent of pursuing fellowship then you should be aiming to go to a top quality IM program. If you apply without a step score you will likely end up at a community IM program and your chances of IM fellowship will be reduced drastically.

I respectfully disagree with this statement. I am at a community program, and we have plenty of fellowship placements ranging from critical care medicine to HemeOnc to cardiology to Endo and rheumatology. It is very dependent on the resident.

 

[DrZoidbergDO]

It’s just important to consider this if one’s intentions are to do IM only to specialize. I don’t have the interest to search for objective data online, but I would venture out and say >90% of fellows come from academic programs. I mean it’s equivalent to saying is it impossible for a DO to be a plastic surgeon, ENT, or dermatologist? No, but if someone told me those are the only specialties they wanted to do I would tell them to find a different career because statistics say they won’t match.

Oh I absolutely agree, if you want to specialize you should try to go to a academic place. It's just not impossible from a community program, plenty of people do it

 

[Drrrrrr. Celty]

I respectfully disagree with this statement. I am at a community program, and we have plenty of fellowship placements ranging from critical care medicine to HemeOnc to cardiology to Endo and rheumatology. It is very dependent on the resident.

Certainly going to a brand name helps. That being said Cardio & GI are honestly really tough for DOs in general.

Honestly your interests are a bit difficult to pull off.
You want continuity of care. But you want to do it in a field where you're "actively" saving lives. And you want to do procedures in large enough number.

I think you're basically looking at Surgical fields, Procedural IM like CritCare + Something extra. GI. Or subspecialty cardiology.

You don't want to do surgery so that basically means thats off the table.

Critical Care as a DO is reachable. Especially if you do Nephro or ID. And you can do ID 1 week outpt 1 week ID critical care inpatient. Pulm CC is honestly hard to reach. And Cardio is harder. GI basically is beyond a shot in the dark for most DO applicants not at university programs.

Being a hospitalist with an open icu and being certified to do procedures is your fall back. And most community programs will train you to line, tube, procedure better than academic programs who want to avoid liability or have fellows as first choice.


Long story short you're not looking for a hidden gem. You're prospecting for something you and everyone else is. Hidden Gems are things like rural primary care, cosmetic medicine, cash based OMM, etc. Things that few people want to do, but are not only easy to get into, but also make bank.

 

[DOVinciRobot]

Honestly I would consider one of the stronger former AOA IM programs that have in house fellowships.

And have a back up. Because there is a significant chance you don’t end up in a procedural heavy field that makes a lot of money (all of which are competitive).

 

[FootballAndSkiing]

Interventional Pain, through a PMR and R residency, prob easier than anesthesia. I also know a doc who did it from neuro, but harder. You won't be saving any lives though.

 

[FormerNFLQB]

I thank you all for commenting. I could do without the continuity of care I suppose. I wanted to do surgery however I was deterred from it on a separate post due to a STEP1 failure. I don't want to make excuses and determined I need to look beyond my want for surgery.

I think that things that are important to me is to be able to do procedures and earning potential. The want to do procedures makes me hesitant with going for Oncology. On a different note, the earning potential and ability to help those facing a disgusting disease like cancer is enticing.

Neurology to interventional neurology sounded cool to me for a while but I heard not many neurologists are being chosen for that specialty with IR and NS being able to do more.

 

[FormerNFLQB]

I just feel lost since having to choose a different specialty from surgery.

 

[FormerNFLQB]

Also to be clear, high earning potential to me is $350-400,000 take home. Obviously if I can make more than great, if not, fine.

I have a masters in business as well and no matter what specialty I go into I plan to open a day practice for individuals in my home town ( the pcp system sucks and patients that are low income have to wait months to see a doc.)

 

[Dantes]

Also to be clear, high earning potential to me is $350-400,000 take home. Obviously if I can make more than great, if not, fine.

I have a masters in business as well and no matter what specialty I go into I plan to open a day practice for individuals in my home town ( the pcp system sucks and patients that are low income have to wait months to see a doc.)

You can make that in pretty much any specialty except maybe peds, if you're willing to compromise on location and working more hours.

Edit: skipped over take home. Yeah that's not happening. But gross total comp sure.

 

[DOVinciRobot]

Also to be clear, high earning potential to me is $350-400,000 take home. Obviously if I can make more than great, if not, fine.

I have a masters in business as well and no matter what specialty I go into I plan to open a day practice for individuals in my home town ( the pcp system sucks and patients that are low income have to wait months to see a doc.)

You mean gross? Because a take home of 400k is very difficult outside of very few specialties

 

[FormerNFLQB]

You mean gross? Because a take home of 400k is very difficult outside of very few specialties

No I meant take home however I was a little overzealous there.


I did have a question. Will this STEP 1 failure hinder me from fellowships in the future? Lets say if I chose to go IM - to a fellowship? Is this going to stop that from happening?

 

[DrZoidbergDO]

No I meant take home however I was a little overzealous there.


I did have a question. Will this STEP 1 failure hinder me from fellowships in the future? Lets say if I chose to go IM - to a fellowship? Is this going to stop that from happening?

My understanding is that it doesn't matter that much for fellowships

 

[Drrrrrr. Celty]

My understanding is that it doesn't matter that much for fellowships

It still matters. If you cannot pass ABIM and then pass ABIM subspecialty it looks based on the program. The exception being ofcourse that you can get ABOIM boarded.
But no programs still care.

 

[FormerNFLQB]

My understanding is that it doesn't matter that much for fellowships

Currently rotating on hospitalist service and it isnt the worst day. The week went by pretty quick. I just dont know if I would be happy ONLY doing IM. I want to specialize and not just deal with patients on the floor. Also the Pay of IM is below what I would like to be at.

It may be stupid however I would like to retain any prestige that can be attainable.

 

[FormerNFLQB]

It still matters. If you cannot pass ABIM and then pass ABIM subspecialty it looks based on the program. The exception being ofcourse that you can get ABOIM boarded.
But no programs still care.

Still care enough to make specialties completely unattainable? I have a decent amount of research and can easily obtain more as I have just began my 3rd year in medical school.

 

[deleted1139416]

Absolutely more difficult sure, but not impossible at all. I tested at a community residency IM program and the seniors there got stuff like cards and GI. It's certainly doable. Too often on here people seem to suggest that it's basically impossible when it's not.

The thing is that one person's easy = another person's hard = another person's impossible. Sure, it's potentially possible. But some people have kids, spouses, parents to take care of, etc. Some people just can't do more than the bare minimum during residency, so they aren't able to get a million publications to apply for fellowship. It's all relative.

 

[FormerNFLQB]

The thing is that one person's easy = another person's hard = another person's impossible. Sure, it's potentially possible. But some people have kids, spouses, parents to take care of, etc. Some people just can't do more than the bare minimum during residency, so they aren't able to get a million publications to apply for fellowship. It's all relative.

My issue isn’t research or anything like that. It’s specifically if I will be able to match a fellowship without Steps.

I have decent research and can get more.

 

[Drrrrrr. Celty]

Still care enough to make specialties completely unattainable? I have a decent amount of research and can easily obtain more as I have just began my 3rd year in medical school.

Enough to add another hurdle.

Fellowship applications for Cardio & GI are really picky. Heme/Onc and Rheum somewhat more in the middle, niche enough that they have specific things they're looking for . Endo probably more forgiving and willing to look into it. ID & Nephro really forgiving.

My issue isn’t research or anything like that. It’s specifically if I will be able to match a fellowship without Steps.

I have decent research and can get more.

Yes, you can match into fellowship without steps. Your program brand name matters more than your step score.

 

[FormerNFLQB]

Okay so here is the last question I’ll bother everyone with.

If I wanted something that paid well, was intellectual, but could also provide me the adrenaline rush of “actively saving life”? What should I look for?

I obviously am still very very early in training and want to just not let any other doors shut for me for potential specialties.

 

[voxveritatisetlucis]

f I wanted something that paid well, was intellectual, but could also provide me the adrenaline rush of “actively saving life”? What should I look for?

Honestly, this is probably going to be a tough combo to find as a DO with a step failure, especially if “well compensated” means 400k take home. Most general cardiologists probably don’t even make that. I would say try to get the best IM residency you can with fellowship in cardio and GI but know that you’ll have to perform very strongly as a resident and possibly do a chief year

 

[Drrrrrr. Celty]

Okay so here is the last question I’ll bother everyone with.

If I wanted something that paid well, was intellectual, but could also provide me the adrenaline rush of “actively saving life”? What should I look for?

I obviously am still very very early in training and want to just not let any other doors shut for me for potential specialties.

Critical care or Open ICU hospitalist.

Though how intellectual you are in those fields is on you. A lot of CC physicians can barely work up/ or care to work up basic hyponatremia and most hospitalists are slammed enough that they need to refer to a lot of subspecialists to keep their sanity.

 

[DOVinciRobot]

No I meant take home however I was a little overzealous there.


I did have a question. Will this STEP 1 failure hinder me from fellowships in the future? Lets say if I chose to go IM - to a fellowship? Is this going to stop that from happening?

My understanding is that it doesn't matter that much for fellowships

It matters for IM fellowships, yes. Hence why my above suggestion was to find a strong former AOA IM program with in house fellowships.

400k take home is…. Zealous. Personally I think you need to wake up and smell the roses a bit.

 

[deleted1139416]

400k take home is…. Zealous.

Best thing about not having friends, wife, or kids is you can work your butt off and become rich!

 

[Ho0v-man]

Critical care checks a lot of boxes. It’s my understanding that just critical care isn’t nearly as competitive as PCCM.

Just so we’re clear, you want $400k after taxes? That’s possible I guess if you’re an interventional cardiologist who works a lot by interventional cardiology standards. Other than that, that’ll really only happen in medicine if you’re a business owner or go into specialties that are largely closed to you ( and work hard AF). I think this is pretty unrealistic.

You could still shoot for gen surg at a community program. I don’t think that’s totally closed to otherwise solid applicants with only comlex.

 

[FormerNFLQB]

Thank you all.

 

[FormerNFLQB]

Critical care checks a lot of boxes. It’s my understanding that just critical care isn’t nearly as competitive as PCCM.

Just so we’re clear, you want $400k after taxes? That’s possible I guess if you’re an interventional cardiologist who works a lot by interventional cardiology standards. Other than that, that’ll really only happen in medicine if you’re a business owner or go into specialties that are largely closed to you ( and work hard AF). I think this is pretty unrealistic.

You could still shoot for gen surg at a community program. I don’t think that’s totally closed to otherwise solid applicants with only comlex.

I was under the impression that a lot of community programs are even closed to me with no STEP

 

[FormerNFLQB]

Critical care checks a lot of boxes. It’s my understanding that just critical care isn’t nearly as competitive as PCCM.

Just so we’re clear, you want $400k after taxes? That’s possible I guess if you’re an interventional cardiologist who works a lot by interventional cardiology standards. Other than that, that’ll really only happen in medicine if you’re a business owner or go into specialties that are largely closed to you ( and work hard AF). I think this is pretty unrealistic.

You could still shoot for gen surg at a community program. I don’t think that’s totally closed to otherwise solid applicants with only comlex.

I also have an MBA. I was an co-owner for buisness prior to medical school that did well.

I don’t expect $400,000 take home right out the gate, I should have been more clear. I apologize.

Making alot of money isn’t a huge goal I guess. I come from very poor family and can do without. Main concern is to make enough to take care of a family member (buy them a house and pay their bills for them) while not living under a bridge myself.

Maybe I am stupid to how financials will work even bringing home $200,000.

 

[Dr. Anonymouss]

I also have an MBA. I was an co-owner for buisness prior to medical school that did well.

I don’t expect $400,000 take home right out the gate, I should have been more clear. I apologize.

Making alot of money isn’t a huge goal I guess. I come from very poor family and can do without. Main concern is to make enough to take care of a family member (buy them a house and pay their bills for them) while not living under a bridge myself.

Maybe I am stupid to how financials will work even bringing home $200,000.

You will live a good life, but it’s all dependent on how you are financially. The key phrase is you can have almost anything you want but you can’t have everything you want. Of course everyone wants to earn as much as possible, but it’s also a balance of finding a job you will be happy doing. At the end of the day I wouldn’t worry too much about the money because all physicians live a very comfortable life.

 

[Prehealth1011]

No I meant take home however I was a little overzealous there.


I did have a question. Will this STEP 1 failure hinder me from fellowships in the future? Lets say if I chose to go IM - to a fellowship? Is this going to stop that from happening?

Scores follow you until you're done training. Not perfect but if you want a glimpse of what kind of applicant you have to be to match into the most competitive IM fellowship


Yes, people match into these fellowships from community programs but there are a lot of factors. Did they do a chief year? How much research did they have? Community programs often don't have the research opportunities that academic programs have, yet you'll see IMGs from these programs matching sometimes because they've done plenty of it before residency. What region are you in? DO-friendly states are mostly in the Northeast/midwest.

Considering another competitive fellowship - Heme/Onc. If you're an AMG from a community program without many research opportunities/infrastructure, you'll have a tough time coming up with presentable material at their major conferences. None of their conferences accept case reports (GI/Cardio/PCCM conferences do). Even if they don't amount to much, everyone's doing them and it's easier to rack up numbers that way for the other 3.

 

[DOVinciRobot]

You could still shoot for gen surg at a community program. I don’t think that’s totally closed to otherwise solid applicants with only comlex.

Without a Step there are only a handful of former AOA programs that are available. GS is notoriously unfriendly to COMLEX only applicants, 98% of programs filter for Step scores. Even most of the former AOA programs will expect a Step score

 

[FormerNFLQB]

You will live a good life, but it’s all dependent on how you are financially. The key phrase is you can have almost anything you want but you can’t have everything you want. Of course everyone wants to earn as much as possible, but it’s also a balance of finding a job you will be happy doing. At the end of the day I wouldn’t worry too much about the money because all physicians live a very comfortable life.

Yes, I don’t have much of a want money wise for myself. Just enough to have a decent house, car. As well as afford my family members house and bills.

 

[FormerNFLQB]

Scores follow you until you're done training. Not perfect but if you want a glimpse of what kind of applicant you have to be to match into the most competitive IM fellowship


Yes, people match into these fellowships from community programs but there are a lot of factors. Did they do a chief year? How much research did they have? Community programs often don't have the research opportunities that academic programs have, yet you'll see IMGs from these programs matching sometimes because they've done plenty of it before residency. What region are you in? DO-friendly states are mostly in the Northeast/midwest.

Considering another competitive fellowship - Heme/Onc. If you're an AMG from a community program without many research opportunities/infrastructure, you'll have a tough time coming up with presentable material at their major conferences. None of their conferences accept case reports (GI/Cardio/PCCM conferences do). Even if they don't amount to much, everyone's doing them and it's easier to rack up numbers that way for the other 3.

As a 2nd year med student I had roughly 10 publications (mostly surgical or Neurological). I can easily increase those numbers.

I’m in the South and would like to say here but I know I can’t be choosy.

 

[FormerNFLQB]

Without a Step there are only a handful of former AOA programs that are available. GS is notoriously unfriendly to COMLEX only applicants, 98% of programs filter for Step scores. Even most of the former AOA programs will expect a Step score

Right but in another post I believe I was advised not to retake because it wouldn’t help me for surgery matches since I have the fail

 

[Splenda88]

Also to be clear, high earning potential to me is $350-400,000 take home. Obviously if I can make more than great, if not, fine.

I have a masters in business as well and no matter what specialty I go into I plan to open a day practice for individuals in my home town ( the pcp system sucks and patients that are low income have to wait months to see a doc.)

What do mean "take home"? you mean after deductions (taxes, SS, Medicare etc...)

Most specialties, and even primary care, can make 350-400k.

My base pay now as an IM (hospitalist) is 350k and I made 405k last year (when the base pay was 330k).

 

[FormerNFLQB]

What do mean "take home"? you mean after deductions (taxes, SS, Medicare etc...)

Most specialties, and even primary care, can make 350-400k.

My base pay now as an IM (hospitalist) is 350k and I made 405k last year (when the base pay was 330k).

Yes, I was meaning take home after all taxes etc taken out. However after looking more into it, probably unrealistic however I plan to have multiple buisness ventures that could get me there.

 

[FormerNFLQB]

What do mean "take home"? you mean after deductions (taxes, SS, Medicare etc...)

Most specialties, and even primary care, can make 350-400k.

My base pay now as an IM (hospitalist) is 350k and I made 405k last year (when the base pay was 330k).

What region are you in if you don’t mind me asking?

 

[Splenda88]

What region are you in if you don’t mind me asking?

Southeast. Small city of 60k with the closest metro or international airport 1:45 mins away.

 

[Dr. Anonymouss]

Right but in another post I believe I was advised not to retake because it wouldn’t help me for surgery matches since I have the fail

This is true. If you have a fail you’re dead in the water to any competitive specialty. As advised earlier your best chance to would be to apply to formed DO programs with only a comlex. You’re at a big disadvantage but retaking step won’t significantly help you. Programs that use step will to still screen you out with a prior fail.

 

[Splenda88]

Yes, I was meaning take home after all taxes etc taken out. However after looking more into it, probably unrealistic however I plan to have multiple buisness ventures that could get me there.

You would have to make ~600k/yr to have a take home of 350-400k.

 

[FormerNFLQB]

Southeast. Small city of 60k with the closest metro or international airport 1:45 mins away.

Sounds like a similar region to where I am at.