im2003

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Hello, I'm a fourth year D.O. student applying to internal medicine programs right now (acgme accredited and some dual accredited). I was wondering if someone could detail the competitiveness of the fellowships besides cardiology and gastroenterology. I know they are #1 and #2. How competitive is heme/onc, nephro, pulm/cc, and id? I've heard that endocrinology is pretty easy to get? Any others? I'm curious. I have not decided what to pursue, just keeping my options open right now.
 

Cards Guy

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Everyone knows that cards and gi are the most competitive (arguments about which one is the most). I have heard that critical care and heme onc and second tier. Allergy is probably third tier. Rheum, endocrine, ID are probably on the bottom. Please correct me if there are other opinions out there.
 
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task

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I would argue that GI has become the most competitive subspecialty out of Medicine because of:

1)reimbursement (two years ago a Cardiologist could bill $2-3k for a two vessel PCI, whereas now they can bill $700-800 for the same procedure. Routine GI procedures like EGDs and colons still pay about the same as two to three years ago, and because these are comparatively shorter duration procedures, don't require one to be scrubbed in, etc., you can volume more of these in a given day

2)Comparatively better lifestyle out in practice for GI compared to Cards

and perhaps most importantly

3)Much fewer spots in GI compared to Cards -- some 200-250 in GI to 750-800 in Cards. The GI folks have played the game right not caving to market pressures begging for more GI docs. Many in the field I've talked to don't even predict an equilibrium in the field in terms of job market for another 10-11 years.
 

Pinky

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Allergy would be high second tier or low first tier.

The money's pretty good and the lifestyle is pretty cush. It's the poor man's derm.

What makes it competitve is the relatively limited number of spots. Many programs don't even have Allergy departments.
 

Jani

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I am happy to know it is not so competitive.. because I probably like to get in..

But, isn't it an area with plenty of supply- every other person I know has either DM or Thyroid problems. And life style is not that bad either I believe, yes if there is DKA it is emergency, but they all get the same Mx anyway. Any views ??
 
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im2003

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Yes, many many people are diabetic and hypothryoid. That is why general internists and family docs are trained to handle it so well. Many family docs don't like to play with new meds or multiple diabetes meds so they have the person go to an endocrinologist but I know very few internists who use endocrinologists for managing diabetes or thyroid problems. It is also made not competitive by the fact that pay does not increase that much and you can slant your practise to DM management without a fellowship if you are just following your interests.

Are rheumatology and id really bottow tier (for competitiveness)? I had no idea.
 

task

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I agree with Pinky, and would even argue that Allergy should be put up there as high as Cards or GI in terms of tier and level of competition.

As far as being the "poor man's derm" -- I'm not so sure about that. Busy allergists make $350-400k in the Southeast U.S., which is where docs still do the best in terms of earnings. From what I understand, this is as good if not better than many Dermatologists. Why is reimbursement so high? First of all, an Allergist has at least three billable things going on at one time -- seeing patients, skin tests, and allergy shots. Second, skin tests are still reimbursed very well, like a procedure for the most part. Plus you can do a bunch at one time. Hence, volume.

There are only 60 Allergy spots in the U.S. SIXTY! I train at a top ten IM program and there are at least one or two applying to Allergy this year out of the R2s and R3s applying to fellowship this year. Multiply this out to the top 25 IM programs, and you have a good 30-50 presumably very competitive applicants. That doesn't count the likely scores of others from other IM programs who are just as good.

Bottom line -- Allergy is becoming VERY attractive to IM grads who want a good lifestyle and don't care about procedures.
 
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