How come rheumatology and endocrinology are not more popular?

[theepodiatrist]

Interesting diseases, pretty good pay, pretty good working hours...

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[blue.jay]

They are more popular than nephrology and ID.

 

[VA Hopeful Dr]

They pay isn't that much more than general IM despite more training.

The hours are no different than outpatient IM.

Both get some of the most frustrating patients from us PCP types (uncontrolled diabetics and fibro).

 

[blue.jay]

They pay isn't that much more than general IM despite more training.

The hours are no different than outpatient IM.

Both get some of the most frustrating patients from us PCP types (uncontrolled diabetics and fibro).

Saying I'm a rheumatologist or endocrinologist will sound cooler than PCP

 

[bronx43]

Because people don’t want to train more and I can’t blame them...
Would I rather be a rheumatologist than a pcp? Yes.
Would I go back and do rheumatology fellowship again? Heck no.

 

[theepodiatrist]

Because people don’t want to train more and I can’t blame them...
Would I rather be a rheumatologist than a pcp? Yes.
Would I go back and do rheumatology fellowship again? Heck no.

That doesn't explain their relative unpopularity compared to other IM specialties and surgical specialties.

 

[sloh]

They pay isn't that much more than general IM despite more training.

The hours are no different than outpatient IM.

Both get some of the most frustrating patients from us PCP types (uncontrolled diabetics and fibro).

Add on lots of obese/overweight patients seeking a hypothyroid diagnosis for their persistent "fatigue."

 

[Prehealth1011]

$

 

[VA Hopeful Dr]

That doesn't explain their relative unpopularity compared to other IM specialties and surgical specialties.

Yes it does. The popular IM subspecialties pay significantly more.

Same with lots of the surgical ones.

 

[Splenda88]

Rheumatology is getting more popular now because of lifestyle and salary (? 300k/yr)...

 

[VA Hopeful Dr]

Rheumatology is getting more popular now because of lifestyle and salary (? 300k/yr)...

And I will readily admit that the therapies we have now for true autoimmune diseases are pretty cool.

 

[rokshana]

That doesn't explain their relative unpopularity compared to other IM specialties and surgical specialties.

Why do you think they are unpopular?

Rheum has become harder to match into...mostly because they are making more money.

Endocrine doesn’t really make more money that being a hospitalists or pcp...in fact they probably make more ...but those of us that go into endo like the specialty and I for one couldn’t do hospitalists work full time and can’t even imagine doing outpt IM ...absolutely hated continuity clinic in residency.

 

[rokshana]

Add on lots of obese/overweight patients seeking a hypothyroid diagnosis for their persistent "fatigue."

That’s easy...test TSH reflex ft4 and if normal...discharge back to pcp...

 

[blue.jay]

That doesn't explain their relative unpopularity compared to other IM specialties and surgical specialties.

Competitiveness ranking
GI>Cardiology>PCCM=HemOnc>Rheum>Endo=Palliative care>ID=Nephrology>Geriatrics

 

[Splenda88]

Competitiveness ranking
GI>Cardiology>PCCM=HemOnc>Rheum>Endo=Palliative care>ID=Nephrology>Geriatrics

I would add A&I, which is probably as competitive as Rheum

 

[blue.jay]

I would add A&I, which is probably as competitive as Rheum

AI is more competitive than Rheum. Totally 70 spots among IM, MP and Peds residents. Amazing lifestyle, best speciality after psych for private practice potential.

 

[bronx43]

AI is more competitive than Rheum. Totally 70 spots among IM, MP and Peds residents. Amazing lifestyle, best speciality after psych for private practice potential.

sure, if you wanna be unemployed

 

[wjs010]

sure, if you wanna be unemployed

Elaborate please.

 

[wjs010]

They pay isn't that much more than general IM despite more training.

The hours are no different than outpatient IM.

Both get some of the most frustrating patients from us PCP types (uncontrolled diabetics and fibro).

Don’t Hospitalist and PCP make significantly more than endo? Rheum is increasing for sure

 

[VA Hopeful Dr]

Don’t Hospitalist and PCP make significantly more than endo? Rheum is increasing for sure

My understanding is that they are roughly the same over time. Hospitalists often start higher but outpatient (primary care and endocrine) can usually catch up once you're busy.

 

[rokshana]

Don’t Hospitalist and PCP make significantly more than endo? Rheum is increasing for sure

It depends...initially hospitalists will start out making more...not hard to find a spot paying 250-300k from the get.

Endo, probably 200-230k for pp, 180-200k is generous for academic. But as you build your pt panel, become partner, endo can make in the 250-350k range...and the hours will be better.
The difference in money won’t make up for anything if you dont like what you do...and I’m not sure if hospitalists is sustainable for the long run...20-30 years into it, most hospitalists are not going to continue to work the hours ...

 

[bronx43]

Elaborate please.

Job market isn’t great. You won’t be literally unemployed but if you have strict criteria for geography then allergy is probably a bad idea.

 

[PikminOC]

My Endo friend makes 315 k a year outpatient only, underserved area, lab director, supervising 2 mid-level, medical director.

 

[Drrrrrr. Celty]

My Endo friend makes 315 k a year outpatient only, underserved area, lab director, supervising 2 mid-level, medical director.

Admittedly one of my seniors who recently graduated signed a hospitalist contract within our system that was slotted to a similar amount working 14 days a month.
But honestly even aside from that Endo just has a flat out bad rep and the diseases that they treat aren't glorious. I don't think a lot of my coresidents are very good at insulin management either.

I know more than a few attendings that have told me to think about doing another field tbh.

 

[CCM-MD]

Endo, rheum, A/I, sleep med are golden. Monday to Thursday with bankers hours and essentially no call, for 250-300k a year is a freaking deal. And you don’t have to work too hard in residency to get one of those spots either. Plus they are pretty chill fellowships.

Sure hospitalists get that, while they be twerking for their corporate overlords, dealing with obstructionist consultants, and getting dumped on by everyone including family members. Primary care is a deal too ... but you have to do primary care...

 

[VA Hopeful Dr]

. Primary care is a deal too ... but you have to do primary care...

Quoted for emphasis.

I do primary care so obviously like it, but I do get jealous of all the various specialist who can say that something is not their problem.

 

[aafisahar]

Interesting diseases, pretty good pay, pretty good working hours...

Starts with M and ends with oney

 

[shouldigomd]

It is a tough pill to swallow to devote more years of study as a fellow to earn the same pay. Most people do not find rheum, allergy or endo to be glorious / prestigious. People tend to choose these specialities for the right reasons ... because they enjoy it. I am sure some others want an outpatient lifestyle however do not want to do primary care. Also you can do primary care and manage many of the things a rheum/allergist/endo would if you want.

 

[bronx43]

It is a tough pill to swallow to devote more years of study as a fellow to earn the same pay. Most people do not find rheum, allergy or endo to be glorious / prestigious. People tend to choose these specialities for the right reasons ... because they enjoy it. I am sure some others want an outpatient lifestyle however do not want to do primary care. Also you can do primary care and manage many of the things a rheum/allergist/endo would if you want.

Glorious? Brb, scoping rectum for glory. Oh, wait. No glory there... just cash.

 

[CCM-MD]

Glorious? Brb, scoping rectum for glory. Oh, wait. No glory there... just cash.

I am sure GI would be just as competitive if it didn’t pay so well...

 

[shouldigomd]

Glorious? Brb, scoping rectum for glory. Oh, wait. No glory there... just cash.

Everyone has their own bias / opinion on what "glory" in the medical field means. It is a shame $$ plays the role that it does when it comes to physicians pursuing their ideal specialty.

Sure a routine screening c-scope isn't "glorious" but saving someones life who is massively bleeding from their mouth/butt is to many people. That is not to say immunosuppression for a vasculitis is any less life saving ... but just in a very different way.

 

[CCM-MD]

Everyone has their own bias / opinion on what "glory" in the medical field means. It is a shame $$ plays the role that it does when it comes to physicians pursuing their ideal specialty.

Sure a routine screening c-scope isn't "glorious" but saving someones life who is massively bleeding from their mouth/butt is to many people. That is not to say immunosuppression for a vasculitis is any less life saving ... but just in a very different way.

No doubt, no doubt. You will find lots of people who think it’s cool to stick stuff up peoples butts even if it didn’t pay anything.

 

[disorder]

Because you can’t VAD a lymphocyte or post dilate a thyroid.

 

[bronx43]

I am sure GI would be just as competitive if it didn’t pay so well...

Maybe, maybe not. GI couldn’t fill before screening colonoscopies became commonplace. They still had their diagnostic and therapeutic scopes then.

 

[CCM-MD]

Maybe, maybe not. GI couldn’t fill before screening colonoscopies became commonplace. They still had their diagnostic and therapeutic scopes then.

That was sarcasm.

 

[theepodiatrist]

Admittedly one of my seniors who recently graduated signed a hospitalist contract within our system that was slotted to a similar amount working 14 days a month.
But honestly even aside from that Endo just has a flat out bad rep and the diseases that they treat aren't glorious. I don't think a lot of my coresidents are very good at insulin management either.

I know more than a few attendings that have told me to think about doing another field tbh.

How come it has a bad rep (don't think I've heard that before)? And the diseases they treat are rather interesting (they're pretty ugly though).

 

[Splenda88]

It depends...initially hospitalists will start out making more...not hard to find a spot paying 250-300k from the get.

Endo, probably 200-230k for pp, 180-200k is generous for academic. But as you build your pt panel, become partner, endo can make in the 250-350k range...and the hours will be better.
The difference in money won’t make up for anything if you dont like what you do...and I’m not sure if hospitalists is sustainable for the long run...20-30 years into it, most hospitalists are not going to continue to work the hours ...

After 15+ yrs you should be financially independent and cut down your hours to 8 12 hrs shift/month (with a reduced salary ~150k/yr). There are good hospitalist jobs out there where people are seeing ~12 patients/day and have NP/PA and SW who do the scut work that most hospitalists don't like... Of course, these jobs are hard to find because people don't leave.

 

[Splenda88]

In my opinion, there is nothing better than working 70 hrs/wk (7am-5pm for 7 days on/off) for ~250k/yr and have a full week off. This is like having a mini vacation every 2 wks. Of course, you have to keep your phone on until 7pm to answer to dumb stuffs that nurses want, but I think that is a great deal. You also have SW support to deal with the BS that docs don't want to deal with. The only thing I did not like about that deal was the patient load (average encounter 18/day).

 

[Drrrrrr. Celty]

After 15+ yrs you should be financially independent and cut down your hours to 8 12 hrs shift/month (with a reduced salary ~150k/yr). There are good hospitalist jobs out there where people are seeing ~12 patients/day and have NP/PA and SW who do the scut work that most hospitalists don't like... Of course, these jobs are hard to find because people don't leave.

Idk, I feel like so many people get so bored they're just going to find some side gig for their weeks off. The allure of being able to make >500k a year exceeds most people's desire to have a sane and healthy living.

 

[CCM-MD]

Idk, I feel like so many people get so bored they're just going to find some side gig for their weeks off. The allure of being able to make >500k a year exceeds most people's desire to have a sane and healthy living.

Actually, most people spend their weeks off recovering from their weeks on.

 

[Splenda88]

Actually, most people spend their weeks off recovering from their weeks on.

Do you really need more than 2 days to recover?

 

[CCM-MD]

Do you really need more than 2 days to recover?

You're right. Probably not. But most I that I know don't work extra in their days off for whatever reason.

 

[rokshana]

In my opinion, there is nothing better than working 70 hrs/wk (7am-5pm for 7 days on/off) for ~250k/yr and have a full week off. This is like having a mini vacation every 2 wks. Of course, you have to keep your phone on until 7pm to answer to dumb stuffs that nurses want, but I think that is a great deal. You also have SW support to deal with the BS that docs don't want to deal with. The only thing I did not like about that deal was the patient load (average encounter 18/day).

Have you worked as a hospitalist?

 

[blue.jay]

Do you really need more than 2 days to recover?

I walk walk walk the whole day, probably 10k steps at least. I don't even get time to sit down. I'm physically exhausted to even go to the gym at the end of my day, not sure if this is a good thing.

 

[bronx43]

Do you really need more than 2 days to recover?

I think of the week off less as "recovery" and more of a temporary halt at expediting death...

 

[Splenda88]

You're right. Probably not. But most I that I know don't work extra in their days off for whatever reason.

I would not either. The beauty of having that block schedule 7 day on/off is the fact of having a mini vacation every 2 wks.. Hospital medicine has become so popular now, there is even talk about having 1-yr fellowship.

 

[Splenda88]

I think of the week off less as "recovery" and more of a temporary halt at expediting death...

Lol...

 

[Splenda88]

Have you worked as a hospitalist?

I am still a resident. Our program have us do 1 month hospital medicine as a PGY2 or PGY3 at an affiliated community hospital. In all honesty, it was not that bad. I was leaving @ 5 pm everyday and keep my pager on until 7pm (like the real hospitalists who work at that hospital). The few I was able to talk to like their job...

Again, I only did it for a month and the hospitalist there had good support as far as not dealing with social issues, and consultants were happy to see your patients. Maybe I should do it longer to have an accurate picture of what being a hospitalist entails. Well, I guess I will find out since I already decided to become one.

By the way, my cap was 10 and I was admitting an average of 2 patients/day. On the other hand, the hospitalist cap were 18 and they were also admitting an average of 2 patients/day.

 

[Drrrrrr. Celty]

I would not either. The beauty of having that block schedule 7 day on/off is the fact of having a mini vacation every 2 wks.. Hospital medicine has become so popular now, there is even talk about having 1-yr fellowship.

I mean there already exist 1 year fellowships for FM trained physicians to be better prepared for it. It's obviously becoming a significantly more popular field.

 

[Drrrrrr. Celty]

Actually, most people spend their weeks off recovering from their weeks on.

I guess. I think it's mainly just friends who recently graduated and wanting to kill their debt quick doing it. Although the internsivists at my hospital pretty much work 4 weeks in a month 2 weeks on and 2 week clinic and don't seem to hate it much. Although residents do most of their work.