IM subspecialties, why go into one?

[happyabe]

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So I have a question for people who are in, or are considering going into, an IM subspecialty.

In terms of the different subspecialties, when did you find out you were interested in going into the field...before residency, or during the elective months? I am planning on switching into IM as a PGY2 and would like to know how and when I should start considering a subspec as a career. Furthermore, it seems like with the adequate financial compensation for hospitalists these days, it may not seem wise to go into a subspec -- so long as one likes being a hospitalist and finds no interest in a subspec.

Finally, what are the pros and cons of the following fields: Rheum, Endo, Nephro, Allergy, ID, and Pulm. I am interested in lifestyle (i.e., hours), enjoyment, compensation (least important, HONESTLY). You'll notice I left out GI and cards intentionally. Let us hear what you have to say.

 

[josephf1]

Reasons NOT to go into a specialty
TO do outpatient/hospitalist IM, less years training, quicker money
Outpt IM - you have to like it, risk of being taken over by nurses, refer everyone for real care, insurance terrible to work with, could go VIP and make big bucks
Hospitalist - 2 weeks of vaca a month, good money, interesting variety of cases, have to consult everyone to fix the real problems
Specialty - will not make that much more than hospitalist down the road, especially the ones you mentioned that are not Cards, GI, HO. THey might make LESS than a hospitalist.
Rheum - no $$$ at all unless own MRI, infusions, may get interetsing cases, occasional joint aspiration, lots of boring chronicly ill depressed pts, lots of boring OA.
Endo - DM2, fat women and men with boobs, Can do repro endo and make some $$$ though, not sure why anyone would do this excpet a girl wanting a coosh office lifestyle
Nephro - Smart overall, can combine with CC, less $$$ now that HD clinics are going corporate, have to like ESRD which I think is boring
Allergy - Mostly sinusitis, rhinits, allergy shots that the nurses do ,get rid of the cat and get a pillow cover for dust mites', occasioanl cool skin cases referred from derm who just do botox now, some IVIG infusions can pad the bottom line
ID - no $$$ in general hospital based, piss off all the hospitalists by controlling their vanco and zyvox, lots of AIDS which is depressing, not that many cool parasties and worms, lots ofMRSA feet and lungs
Pulm - outpt pulm is not much different thaan allergy, heres the allegra, heres the spiriva, lets follow up the nodule in 3 months with a CT scan, bronch reimbursements are way down, the real money is probably in ICU shiftwork.

 

[jdh71]

So I have a question for people who are in, or are considering going into, an IM subspecialty.

In terms of the different subspecialties, when did you find out you were interested in going into the field...before residency, or during the elective months? I am planning on switching into IM as a PGY2 and would like to know how and when I should start considering a subspec as a career. Furthermore, it seems like with the adequate financial compensation for hospitalists these days, it may not seem wise to go into a subspec -- so long as one likes being a hospitalist and finds no interest in a subspec.

Finally, what are the pros and cons of the following fields: Rheum, Endo, Nephro, Allergy, ID, and Pulm. I am interested in lifestyle (i.e., hours), enjoyment, compensation (least important, HONESTLY). You'll notice I left out GI and cards intentionally. Let us hear what you have to say.

I can't speak about everything but I actually like Pulm. I think like most people who go into the field I fell in love with critical care in med school, and found myself liking pulm as a resident on the consult service. I also like Pulm because there's a lot of academic work to do. In the private sector how busy you'll be depends on the group set-up, and Pulm, as long as you take your turn in the unit, easily makes more money than the hospitalist.

As far as why not Gen Med? I hate outpatient medicine clinic, and out patient medicine pay is seriously so low its insulting. The biggest group of people I see going into out patient gen med these day are women with kids usually married to a physician who works longer hours doing a much better compensating field of medicine - not saying that is bad or anything, merely giving you an idea of the situation where that seems to work well. Hospitalist, like communism, sounds very good on paper, but I'd say 7 out 10 people I talk to who are doing it or have done it really don't like it, but continue doing it because the compensation is reasonable, although I think we've begun to see the salary cap out and saturation in the desireable to live in cities.

 

[dragonfly99]

Pretty good summaries above...
I actually don't like pulmonary/critical care. I find chronic lung disease boring and I'm really not that interested in managing sepsis either. You can make good money as an ICU doc but you have to be on your toes as those types of patient can crap out quickly. You have to like ventilator and sepsis management. You have to be able to deal with ICU nurses, which may be easier if you are male.

I think that allergy/immuno, endocrine and rheum have the best hours and lifestyle of the specialties you mentioned. Hospitalist hours look good on paper, but many hospitalist jobs can be kind of a grind...some of them take too many admits and get worked too hard. The money is pretty good right now, but that could change if the field approaches saturation.

Some people like endocrine b/c of all the cool feedback loops, and if you don't like diabetes you could become a thyroid or pituitary specialties and do academics.

ID doesn't seem to have a very good job market right now...can do fellowship and still get stuck doing general IM or hospitalist work.

 

[docscience]

I can't speak about everything but I actually like Pulm. I think like most people who go into the field I fell in love with critical care in med school, and found myself liking pulm as a resident on the consult service. I also like Pulm because there's a lot of academic work to do. In the private sector how busy you'll be depends on the group set-up, and Pulm, as long as you take your turn in the unit, easily makes more money than the hospitalist.

As far as why not Gen Med? I hate outpatient medicine clinic, and out patient medicine pay is seriously so low its insulting. The biggest group of people I see going into out patient gen med these day are women with kids usually married to a physician who works longer hours doing a much better compensating field of medicine - not saying that is bad or anything, merely giving you an idea of the situation where that seems to work well. Hospitalist, like communism, sounds very good on paper, but I'd say 7 out 10 people I talk to who are doing it or have done it really don't like it, but continue doing it because the compensation is reasonable, although I think we've begun to see the salary cap out and saturation in the desireable to live in cities.

Gen med doesn't seem too horrible. Outpatient docs I know make about $150K and then do something on the side, whether it be consults at a hospital/hospitalist group, one is the medical director of planned parenthood and she works there once a week. She pulls in another 40-50K from that job. Not saying it is easy, but decent pay.

Why do you say that there is saturation in the cities for hospitalists? Growing population...growing demand right?

So what are the best IM subspecialties to go into for the future?

I really like CCM like another one of the posters.

Thanks for the comments/ideas.

 

[ResidentMD]

So what are the best IM subspecialties to go into for the future?

Medical genetics.

😛

No seriously, the best one is the one YOU like,. I can never for my life understand why people choose Endocrine but they do, and thats their passion. So you will eventually find a rotation you like, either as a med student or as a resident, and decide to do that, taking into consideration many other factors. Often mentors shape your thought process, because they show you certain avenues in that subspecialty and help you to think in a way that possibly no one else in any other subspecialty did; and you unconsciously are drawn to their subspecialty.

As someone has said before, as physicians, we still make a very decent living - even a rheumatologist or an endocrinologist. So there are many other things that should float your boat, and help you to make YOUR decision, what you think is best for YOU, not what others think is the best.