Lothric

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Hey,

What IM subspecialities have decent work hours and are not in GI/EM-level-of-difficulty-to-match-as-IMG? We can exclude cardiology right off the bat due to the crazy work hours. Decent weekly work hours are 45-55.

I'm thinking more specifically about oncology, pulmonary medicine and critical care. It seems like the latter, critical care, is possible to get into even after an anesthesia residency. That makes it special, doesn't it?
 

bashwell

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Hey,

What IM subspecialities have decent work hours and are not in GI/EM-level-of-difficulty-to-match-as-IMG? We can exclude cardiology right off the bat due to the crazy work hours. Decent weekly work hours are 45-55.

I'm thinking more specifically about oncology, pulmonary medicine and critical care. It seems like the latter, critical care, is possible to get into even after an anesthesia residency. That makes it special, doesn't it?
As an IMG, you can match into any IM subspecialty, but it depends on your IM residency and how you perform in it and if you can find a fellowship that will sponsor your visa if you need that to happen. Every year there are even IMGs matching into GI and cards. Yes it is difficult for them, but not impossible.

It depends what you mean by good hours. Don't just think quantity of hours, but also consider the quality of those hours. And consider the call burden. Are you solo, is call shared equally or unequally, etc? Do you have emergencies in your subspecialty that you have to go into the hospital at 2am for, then be back the next morning? Is your call from home but you are paged every 15 mins and may even have to go in several times while covering multiple hospitals in the area? Or is it in-house but you can sleep through the night? In-house but you're busy?

Also most subspecialties can have a relatively good lifestyle if you sacrifice money or location or something else big. For example I know a cardiologist who is rarely on call anymore, so he can sleep in his own bed and be with his family almost every night. He just doesn't make as much, but still makes enough for him. So just depends what kind of lifestyle you are looking for. But in general you can build your own practice to fit your own needs, more or less, especially as you get more senior.

Also, yes, you can do critical care through IM, anesthesiology, surgery, EM, I think neurology now too. Critical care can be good or bad in terms of lifestyle depending on what you want. It's mostly moving toward shift work now, I believe, hospitals want to fill the unit, so that's good in that you are off when you're off, more or less, however you have to work your share of nights and weekends which many people don't like, especially people with families. Also you have different CC emphases depending on which route you take. For example, IM CC tends to cover the MICU, anesthesia CC the SICU and CCU, surgery the SICU. This is simplifying and lots of exceptions, but true in general. Also consider closed vs open ICU and who is the attending of record vs consulting which can affect how much you like or dislike your work and work environment.

Oncologists can have anywhere from a great lifestyle to a horrible lifestyle. Again, simplifying, but in general an oncology group will take call q# depending on the number of oncologists in the group. But also depending on how many patients they want to see/money they want to make. You can tailor your practice how you want, but that's true of other specialties too.

But if you want to know in general, the IM subspecialties with the best lifestyle are endo, rheum, allergy/immuno. Actually, if you want lifestyle, you don't necessarily need to subspecialize. You could just do general outpatient IM (e.g., direct primary care).
 
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Lothric

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As an IMG, you can match into any IM subspecialty, but it depends on your IM residency and how you perform in it and if you can find a fellowship that will sponsor your visa if you need that to happen. Every year there are even IMGs matching into GI and cards. Yes it is difficult for them, but not impossible.

It depends what you mean by good hours. Don't just think quantity of hours, but also consider the quality of those hours. And consider the call burden. Are you solo, is call shared equally or unequally, etc? Do you have emergencies in your subspecialty that you have to go into the hospital at 2am for, then be back the next morning? Is your call from home but you are paged every 15 mins and may even have to go in several times while covering multiple hospitals in the area? Or is it in-house but you can sleep through the night? In-house but you're busy?

Also most subspecialties can have a relatively good lifestyle if you sacrifice money or location or something else big. For example I know a cardiologist who is rarely on call anymore, so he can sleep in his own bed and be with his family almost every night. He just doesn't make as much, but still makes enough for him. So just depends what kind of lifestyle you are looking for. But in general you can build your own practice to fit your own needs, more or less, especially as you get more senior.

Also, yes, you can do critical care through IM, anesthesiology, surgery, EM, I think neurology now too. Critical care can be good or bad in terms of lifestyle depending on what you want. It's mostly moving toward shift work now, I believe, hospitals want to fill the unit, so that's good in that you are off when you're off, more or less, however you have to work your share of nights and weekends which many people don't like, especially people with families. Also you have different CC emphases depending on which route you take. For example, IM CC tends to cover the MICU, anesthesia CC the SICU and CCU, surgery the SICU. This is simplifying and lots of exceptions, but true in general. Also consider closed vs open ICU and who is the attending of record vs consulting which can affect how much you like or dislike your work and work environment.

Oncologists can have anywhere from a great lifestyle to a horrible lifestyle. Again, simplifying, but in general an oncology group will take call q# depending on the number of oncologists in the group. But also depending on how many patients they want to see/money they want to make. You can tailor your practice how you want, but that's true of other specialties too.

But if you want to know in general, the IM subspecialties with the best lifestyle are endo, rheum, allergy/immuno. Actually, if you want lifestyle, you don't necessarily need to subspecialize. You could just do general outpatient IM (e.g., direct primary care).
Thank you for the answer man.

I just find the fact that going critical care after anesthesia/IM/surgery is interesting as (we previously have seen) many seem to warn about the future of anesthesiologists, even with fellowships. So at this point I'm a bit confused - how are CRNAs and a lower salary in the future a threat for an anesthesiologist if he/she did a fellowship within critical care and covers the SICU? Apparently even surgery with a fellowship can end covering SICU, and I never hear CRNAs threat surgery. The thing here is that going anesthesiology was the plan, and if things go bad, a critical care fellowship would be the rescue (as I end with people who did IM/surgery etc. and thus it is as if the anesthesia residency and its ominous future with CRNAs/lower salary etc. never happened).

Also, regarding critical care, is it considered "bad" in terms of lifestyle just because of the shift work? That's how EM docs have it, isn't that so? And EM docs do have a nice lifestyle, even with the shift work being a part of the job.

How are the pulmonologists having it? Seems like they recently have gotten a big rise in salary compared to the other specialities (+11 %). Looks like a promising one, but I have no idea how the work hours are.

The reason I mentioned pulmo- and oncology and critical care is because of their income which seems to be in the 300k+/year category. And based off your text, critical care seems less workload-heavy than oncology. Unless pulmonology is even less workload-heavy than critical care, I might go anesthesia combined with critical care fellowship.
 
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PlutoBoy

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Thank you for the answer man.

I just find the fact that going critical care after anesthesia/IM/surgery is interesting as (we previously have seen) many seem to warn about the future of anesthesiologists, even with fellowships. So at this point I'm a bit confused - how are CRNAs and a lower salary in the future a threat for an anesthesiologist if he/she did a fellowship within critical care and covers the SICU? Apparently even surgery with a fellowship can end covering SICU, and I never hear CRNAs threat surgery. The thing here is that going anesthesiology was the plan, and if things go bad, a critical care fellowship would be the rescue (as I end with people who did IM/surgery etc. and thus it is as if the anesthesia residency and its ominous future with CRNAs/lower salary etc. never happened).

Also, regarding critical care, is it considered "bad" in terms of lifestyle just because of the shift work? That's how EM docs have it, isn't that so? And EM docs do have a nice lifestyle, even with the shift work being a part of the job.

How are the pulmonologists having it? Seems like they recently have gotten a big rise in salary compared to the other specialities (+11 %). Looks like a promising one, but I have no idea how the work hours are.

The reason I mentioned pulmo- and oncology and critical care is because of their income which seems to be in the 300k+/year category. And based off your text, critical care seems less workload-heavy than oncology. Unless pulmonology is even less workload-heavy than critical care, I might go anesthesia combined with critical care fellowship.
Anesthesiology is not going anywhere. We need them and they provide a valuable service. People have been predicting the demise of anesthesiology for decades and yet here they are.

Critical care is tough work. Intensivists work hard.

If your main concern is QoL and not money, you should know that the specialties with the highest burnout are EM, critical care, cardiology, IM, FM, PEDS, OBGYN, general surgery.

Pretty much the more you have to be actively involved in the day to day care of patients (being "primary") the higher the burnout.

I would not do critical care expecting an easy job. It is not.

If you have to do IM look into rheumatology, endocrinology, allergy and immunology.

I may be in the minority here but 100% outpatient primary care could afford you a good quality of life. You won't make as much money as the cardiologist or the intenvisit but let's be honest here: you will also work much less and face less stressful situations on a day to day basis. They deserve the money because they work harder

PS: Hospitalist work sucks, IMO.
 
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bashwell

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Thank you for the answer man.

I just find the fact that going critical care after anesthesia/IM/surgery is interesting as (we previously have seen) many seem to warn about the future of anesthesiologists, even with fellowships. So at this point I'm a bit confused - how are CRNAs and a lower salary in the future a threat for an anesthesiologist if he/she did a fellowship within critical care and covers the SICU? Apparently even surgery with a fellowship can end covering SICU, and I never hear CRNAs threat surgery. The thing here is that going anesthesiology was the plan, and if things go bad, a critical care fellowship would be the rescue (as I end with people who did IM/surgery etc. and thus it is as if the anesthesia residency and its ominous future with CRNAs/lower salary etc. never happened).

Also, regarding critical care, is it considered "bad" in terms of lifestyle just because of the shift work? That's how EM docs have it, isn't that so? And EM docs do have a nice lifestyle, even with the shift work being a part of the job.

How are the pulmonologists having it? Seems like they recently have gotten a big rise in salary compared to the other specialities (+11 %). Looks like a promising one, but I have no idea how the work hours are.

The reason I mentioned pulmo- and oncology and critical care is because of their income which seems to be in the 300k+/year category. And based off your text, critical care seems less workload-heavy than oncology. Unless pulmonology is even less workload-heavy than critical care, I might go anesthesia combined with critical care fellowship.
1) I agree with what PlutoBoy said.

2) From what the attending anesthesiologists on the anesthesia forum say, anesthesiology with a critical care fellowship is mixed. It could be good or bad. It depends who you ask. Personally, I think anesthesia with critical care is a good choice, but I'm not 100% focused on having a good lifestyle.

3) If you want lifestyle more than anything else, then critical care after anesthesia is not necessarily a good choice. That's because critical care tends to be a worse lifestyle than anesthesia -- or at best equal. I'm sure there are exceptions like if you are working at a lower acuity unit, but I'm speaking in general. All I'm saying is lifestyle isn't what usually comes to mind when people think of critical care.

4) Also, I keep hearing from anesthesiology attendings that it's very difficult to find a private practice job that allows you to do both anesthesiology and critical care at the same time (e.g., one week of critical care, the rest of the month anesthesia). There are some exceptions here and there (e.g., Seinfeld has such a job), but they seem few and far between.

5) However, one big exception is academics. You could work both anesthesia and CCM at an academic/university. But academics in general tends to pay a lot less than private practice. And academic lifestyle isn't necessarily any better than private practice either, but it depends on your specific institution. A lot of places do have a better lifestyle in terms of call burden for example than a lot of private practice groups, but again it depends. A lot of private practices have a good lifestyle too. But again just speaking in general, if you don't mind significantly less pay than private practice, +/- good lifestyle, then academics is an option. There are also some perks to working in academics, but again it depends on the specific institution we're talking about.

6) In addition, if you ask the attendings on the anesthesia forum, critical care through anesthesia in general covers the SICU or CCU, and usually not the MICU. Again, there are always exceptions, but I'm speaking in general. If you are covering the SICU, then you won't likely be the attending of record. Instead, that will be the surgeon. So you'll be a consultant to the surgeon. Some people don't mind this, but other people don't like having to "take orders from surgeons" as I heard someone once say. If you always want to be "the boss" and in charge of your patients in the ICU in a closed unit, then critical care via anesthesia might not be the best route for you. You should probably go the IM to pulm/cc route. You're more likely to have to work in the MICU though. But keep in mind that's a different patient population than the SICU.

7) Yes, pulm/cc jobs are currently in huge demand. But ICU physicians in general are in demand. Especially as more ICUs become closed rather than open, there will be only increased demand for ICU physicians. So if you want to do 100% ICU and 0% anesthesia, then you could do anesthesia, then CCM (try to do your CCM at someplace that allows you to get a good mix of different ICU environments including the MICU, so that way you can have experience working in all different types of ICUs), and you should have no problem finding a 100% ICU job even in a MICU (which has traditionally been pulm/cc), at least that's my understanding.

8) Anesthesia does face its problems and challenges. So do many other specialties. But like PlutoBoy said, anesthesia will always be around. Most likely you will have to supervise CRNAs as the care team model is only expanding and as it is financially better to use the model for a lot of anesthesia groups. I think it's already ~50% of all anesthesia groups that use the anesthesia care team model, and only growing. I believe I read Richard Novak at Stanford University citing that number somewhere on his website.

For example, you may likely have to supervise anywhere from 2-4 CRNAs or maybe more in the future (who knows). So, worst case scenario, if you are okay with supervising CRNAs, then you will be fine. But keep in mind a lot of the attending anesthesiologists on the anesthesia forum say they would much rather sit their own cases and not have to supervise CRNAs.

9) CRNAs and other midlevels don't threaten surgeons, because no one else can cut the way surgeons do. There are PAs and other midlevels, but they don't do what surgeons do.

10) In terms of lifestyle, yes, I would say critical care is probably most comparable to EM. Both work tons of nights, weekends, holidays. Both can work long shifts, though from what I've seen, critical care tends to work longer single shifts than EM.

11) But personally, though I'm sure others may disagree, I would say critical care is a bit better than EM in terms of lifestyle in some ways. The pace isn't always as intense as in the ED. You still round on patients, going from one patient to the next, and don't have to juggle a bunch of patients in your head at the same time, not in the same way as in the ED anyway. You're not multitasking as much as in the ED. You're not in the "fish bowl" as in the ED where everyone else in the hospital is judging you. You don't have to call attendings or fellows and convince or sometimes fight with them to admit a patient, or see a patient or at least not as much as in the ED. You're considered a specialist rather than a generalist (though of course I believe EM physicians are specialists but a lot of people in the hospital unfortunately don't treat them that way). I'm sure there are lots of other things.

12) That being said, I would not say critical care is necessarily a good lifestyle, not compared to other specialties or subspecialties. It's still hard work. You still see a lot of deaths. You have to talk to families about why care is futile and you should pull the plug on their family member. You still see a lot of s*** that you probably won't see if you're an outpatient based specialty. Do you want to be doing chest compressions on a crashing patient in the ICU when you're 50 or 60 years old? And that's not even all that bad compared to other worse things you have to do.

13) But anyway, my point is, we all love the excitement of the ICU, especially when we're still young and single, but the problem is that a lot of older ICU physicians, once they get married and have a family, tell me that they would prefer to have a more stable life. Work during more regular hours. Work on less sick patients. Be able to see their families more and spend more time with their families when their families are awake. Obviously most people are awake during the day and asleep at night, unlike working shift work jobs where you're constantly rotating between night and day. The constant rotating or change between night and day and day and night could mess up your Circadian rhythm too. It is easy to recuperate when we're young, although it doesn't always feel that way!, but talk to older ICU physicians and some of them have told me that it gets tougher to recover as you age. I've even heard of marriages being destroyed because the ICU physician couldn't make it to many of their spouse's or children's events but had to be at work. Maybe they can switch to a lower acuity unit or work less shifts if they don't need the money. I'm not sure as I'm not an attending let alone an ICU attending. So in general, the ICU is fun, but it does seem very hard. I still like the ICU a lot though. But sometimes I do worry about working in the ICU as an older physician someday. Maybe you can reach out to older ICU physicians in the US and see what they have to say about the lifestyle of working in the ICU?

14) But that's why I think if you like anesthesia, then general anesthesia might be a better choice in terms of lifestyle than working in the ICU. There are lots of anesthesia jobs out there where you can do mommy track, locums, work for an outpatient surgicenter, and so on, where you can have a good lifestyle and work predictable hours and be home with your family. There are downsides to these jobs too, but if you don't care about money, and you don't care about some possible skills deterioration (though you could pick it up again maybe), then that could be a good choice. You might have to manage CRNAs still though, but if you don't mind CRNAs, then you should be fine.

15) I agree pulm/ccm is a solid choice if you like it. They do work very hard though. But what's good about pulm/cc is that you can transition from doing less CCM and more pulm as you get older. Just focus more on outpatient pulm. You can have a good lifestyle if you do pulm only. So during your younger years, you could do lots of time in the unit since it's fun and exciting, but as you get older, see more pulm patients. You can have a great lifestyle seeing only pulm patients. It's mostly the ICU that is considered bad in terms of lifestyle. Inpatient pulm is bad in terms of lifestyle to some extent too, but not as bad as the ICU at least in my opinion.

16) I don't think oncology is necessarily worse in terms of lifestyle than pulm/cc. Actually, I think oncology is usually better, at least if we are talking about private practice. Maybe a better way to put it is to say that oncology in private practice is mostly outpatient, so it's similar-ish to doing mostly outpatient pulm. Basically, if you want lifestyle, focus more on seeing outpatients. That's true for any specialty though. Hospital-based specialties tend to have worse lifestyles than outpatient based ones, but again I'm just speaking in general, and there are exceptions. Again, as has been said, if you want lifestyle in an IM subspecialty, then allergy/immuno, endo, and rheum are your best bets. They're all mostly outpatient, few emergencies so you don't have much call, and on the rare occasion you do, you'll most likely be taking the call from home in the comfort of your own bed!

Contrast this to many anesthesia jobs where you are in-house, sleeping overnight in the hospital, not at home. Or even if you do home call, then you will often have to come into the hospital in the middle of the night for a case or place an epidural or something. But to be fair, there are anesthesia jobs where you don't have to do things like trauma or OB and so can have a better lifestyle overall.

17) If $300k is your goal, you could do that in many specialties, though again you might have to give up something like location or lifestyle. You can maybe even do that in general IM, or get pretty close, after a few years as a partner in a group. I know a couple of general IM physicians (partners) who make $300k+ in a relatively nice part of the nation. They have a good lifestyle too. So I guess they win in all the three major categories of money, lifestyle, and location. But most of their patients have good private insurance so that's probably why. Not sure if they are the exception though.

18) Actually, if you want lifestyle, and high pay, you could go for radiology (if you like the work). Do teleradiology or emergency radiology.
 
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Lothric

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Wow Bashwell, thank you for explaining things that thoroughly. I got alot from it!

At this point, anesthesia with critical care fellowship (I don't think there is any other fellowship after anesthesia with the same pay as the critical care fellowship) is my plan B. CRNAs combined with a vague future scare me alot if I go anesthesia.

So from what I'm getting here, mixing pulm with critical care is a thing. Does this mean that you have to do two fellowships - one for pulm and one for cc - after the IM residency? And if so, what additional benefits do you get compared to someone just subspecializing into one of those fields? Either way, the plan was to either do pulmonary medicine only after IM, oncology only after IM or critical care only after IM. These three subspecialities seem to be the only ones that offer a wide spectrum of location with a salary of 300k+/year, whereas for example rheum and allergy/immuno seem to be more limited in that regard. And based off your text again, it seems that pulmonary medicine has - in general - a better lifestyle than oncology. And oncology tends to have a better lifestyle than critical care.

The salary for pulmonologists seems to go up quite alot too. Looks very promising. Is this field as competitive as cardiology? How does the competitiveness compare to oncology, critical care and critical care after anesthesia for an IMG?
 

PlutoBoy

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Wow Bashwell, thank you for explaining things that thoroughly. I got alot from it!

At this point, anesthesia with critical care fellowship (I don't think there is any other fellowship after anesthesia with the same pay as the critical care fellowship) is my plan B. CRNAs combined with a vague future scare me alot if I go anesthesia.

So from what I'm getting here, mixing pulm with critical care is a thing. Does this mean that you have to do two fellowships - one for pulm and one for cc - after the IM residency? And if so, what additional benefits do you get compared to someone just subspecializing into one of those fields? Either way, the plan was to either do pulmonary medicine only after IM, oncology only after IM or critical care only after IM. These three subspecialities seem to be the only ones that offer a wide spectrum of location with a salary of 300k+/year, whereas for example rheum and allergy/immuno seem to be more limited in that regard. And based off your text again, it seems that pulmonary medicine has - in general - a better lifestyle than oncology. And oncology tends to have a better lifestyle than critical care.

The salary for pulmonologists seems to go up quite alot too. Looks very promising. Is this field as competitive as cardiology? How does the competitiveness compare to oncology, critical care and critical care after anesthesia for an IMG?
Pulm/CC are often combined into a single three year long fellowship. There are a few 2 year long pulm only programs and many critical care only programs. Most commonly, they are combined. So to answer your question, it is usually one fellowship but could be two depending on how you approach it.

From a practical standpoint, being dual certified in pulm/cc will open up more job opportunities for you. Why? Most CC groups are led by Pulm/CC trained folks. They are going to want someone that can help out in the clinic and the unit. Having said that, there are plenty of job opportunities for pulm only and CC only.

In the United States Oncology is usually mixed with hematology ("heme/onc") similar to pulm/cc. However, you can still find hematology and oncology only programs.

Pulm/CCM has become very competitive in the last couple years. I believe last year Pulm/CCM was harder to match into than cardiology, IIRC. What does this mean to you? You are not going to get a spot easily. The least competitive specialties are nephrology, ID, endocrinology, rheumatology. Plan accordingly.

I think Pulm/CCM and Heme/Onc may be on equal footing as far as competitiveness goes. You can review the NRMP Match Outcomes to find more data.

I don't know much about the world of anesthesia but I think it has become more competitive. I'm not sure.
 
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At this point, anesthesia with critical care fellowship (I don't think there is any other fellowship after anesthesia with the same pay as the critical care fellowship) is my plan B. CRNAs combined with a vague future scare me alot if I go anesthesia.

The salary for pulmonologists seems to go up quite alot too. Looks very promising. Is this field as competitive as cardiology? How does the competitiveness compare to oncology, critical care and critical care after anesthesia for an IMG?
uh...pain management?!?!

you seem to be a bit hung up on competitiveness on a specialty...why? do you equate competitiveness with prestige?
 

bashwell

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Wow Bashwell, thank you for explaining things that thoroughly. I got alot from it!

At this point, anesthesia with critical care fellowship (I don't think there is any other fellowship after anesthesia with the same pay as the critical care fellowship) is my plan B. CRNAs combined with a vague future scare me alot if I go anesthesia.

So from what I'm getting here, mixing pulm with critical care is a thing. Does this mean that you have to do two fellowships - one for pulm and one for cc - after the IM residency? And if so, what additional benefits do you get compared to someone just subspecializing into one of those fields? Either way, the plan was to either do pulmonary medicine only after IM, oncology only after IM or critical care only after IM. These three subspecialities seem to be the only ones that offer a wide spectrum of location with a salary of 300k+/year, whereas for example rheum and allergy/immuno seem to be more limited in that regard. And based off your text again, it seems that pulmonary medicine has - in general - a better lifestyle than oncology. And oncology tends to have a better lifestyle than critical care.

The salary for pulmonologists seems to go up quite alot too. Looks very promising. Is this field as competitive as cardiology? How does the competitiveness compare to oncology, critical care and critical care after anesthesia for an IMG?
Cool, no worries.

1) Again I agree with everything @PlutoBoy said!

2) I'll just add for anesthesia, the fellowship that is currently most lucrative if you want to remain in anesthesia is probably cardiac, at least from what I hear from anesthesia attendings. That's because anesthesia groups want to hire them and will be more likely to offer them a better or faster partnership track. If you're a partner in a fair and good anesthesia group, then that's how you'll be able to make the most money.

Pain can be very lucrative too, but then pain is doing a completely different specialty. You're no longer doing anesthesia. And there's a lot of issues with pain that you can read about from the anesthesia and pain forums. It looks good on paper (e.g., good hours, never or rarely ever on call, no nights or weekends unless you want, high pay, be your own boss), but if you've ever dealt with pain patients, insurance companies, government regulations, etc., then you'll know it's not exactly an easy job.

Critical care tends to pay less than anesthesia. Not always, but in general. But I hear anesthesia compensation and critical care compensation are drawing closer toward one another. Anesthesia compensation trending downward, while critical care compensation trending upward.

Pediatric also tends to pay less than anesthesia since lots of kids are on MediCal or government insurance rather than private insurance, and because a lot of pediatric anesthesiologists tend to work at children's hospitals which tend to be academic based. But there are a lot of private pediatric anesthesiologists and if you can become a partner because a group needs a peds guy, then that's great money too, but you'll probably not be able to do exclusively kids. And you'll most likely be working very hard (e.g., high call burden, peds is very stressful, the entire OR atmosphere changes).

I hear regional fellowships are on the rise, but I don't really know much about this.

All that said, if you are a general anesthesiologist, but make partner in a great group, then that can be extremely lucrative too. Plus you'll save yourself a year of lost opportunity cost. But great groups are apparently rapidly diminishing. And lots of attendings recommend doing a fellowship to keep yourself safe or at least safer from CRNAs.

3) As @PlutoBoy said, check out NRMP for data on competitiveness. Keep in mind there's a big difference between US grads (allopathic or MD) vs everyone else (DOs, IMGs, US-IMGs, etc). Here's what I see from 2017 (keep in mind "Total" includes US grads so for others especially IMGs who need a visa it's probably even lower):

Cardiology
-U.S. Grads 482/537 (89.8%)
-Total 855/1147 (74.5%)

Endocrinology
-U.S. Grads 103/108 (95.4%)
-Total 270/342 (78.9%)

Gastroenterology
-U.S. Grads 319/377 (84.6%)
-Total 493/742 (66.4%)

Hematology and Oncology
-U.S. Grads 287/332 (86.4%)
-Total 544/729 (74.6%)

Infectious Disease
-U.S. Grads 162/169 (95.9%)
-Total 312/335 (93.1%)

Nephrology
-U.S. Grads 64/68 (94.1%)
-Total 284/308 (92.2%)

Pulmonary and Critical Care
-U.S. Grads 289/323 (89.5%)
-Total 524/742 (70.6%)

Rheumatology

-U.S. Grads 94/114 (82.5%)
-Total 210/332 (63.3%)

4) Whatever specialty you choose, make sure you actually enjoy or at least can tolerate the actual bread and butter patients and pathologies of the job as well as the core parts of the job since that's where you'll be spending most of your time and energy.

It's good to think about specialty choice, but if you aren't the type of person that can handle for example breaking bad news to a woman who has breast cancer, having her cry and cry and cry in front of you, while her husband is angrily yelling at you, trying to comfort both of them, and so on, then maybe don't pick oncology.

If you're the type of person who freezes like a deer in headlights when you see a patient suddenly turn blue on the operating table, BP suddenly drops, and so on, so you have a crashing patient, and you can't "unfreeze" yourself to quickly respond, take command of the situation and direct everyone else in the OR to their designated roles, even jumping on the patient and doing chest compressions yourself, whatever it takes to save them, then perhaps don't choose anesthesiology or critical care.

In other words, you have to know yourself and ask yourself honestly what type of a person you are and whether you can handle the ins and outs of a particular specialty. That should be something you figure out before asking about lifestyle and money, even though I understand both lifestyle and money are also important. Just my opinion.
 
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