I'm thinking about working as a rural nocturnist for 3 years after residency to maximize my income and invest heavily. Is this realistic?

[Cyclogon]

Here's my situation:

I'm an IMG from Europe on a J1 visa. I started an IM residency at the age of 32 and will finish it at 35.

Although I'm a bit older, I have a low amount of student debt (~$40,000). Single, no wife, no kids (although it's something I want in the long-term).

I don't want to return to my home country for two years, so I have been thinking about getting a J1-waiver job in an underserved region for 3 years to get a green card. I have been looking at some of these jobs, and if you take a nocturnist role, the base salary can easily be in the 350-400K range. If I were to really hustle and take on extra internal moonlighting shifts (I can't moonlight externally on my current visa), I think that I could realistically get into the 450K-550K range if I was doing ~20 shifts per month, although I'd be working very hard.

The reason I want to do this is partly to get my green card, but also to take advantage of my current situation and lack of familial commitments. I could pay off the student debt very quickly (perhaps even immediately with a sign-on bonus or loan forgiveness benefits), live more-or-less like a resident for another 3 years, and invest everything else that I earn. Then, when I've got my green card and a bit of financial padding, I can decide whether I want to continue doing hospitalist work (either staying with days or nights, but working less), or think about going down the fellowship route. I'm not especially enthusiastic about any particular fellowship, but I don't know how feasible a hospitalist job will be in a few years, assuming I settle down and have a family.

I honestly wouldn't be averse to the idea of just going all-out with this and taking a job in a no-income-tax state in the middle of bum-**** nowhere to maximize my earnings. I am a natural night owl and nocturnist work appeals to me, so there's no problem there.

Does this sound like a reasonable plan, or am I being delusional here? I'd be interested to hear from any other hospitalists or IM specialists who did this.

Thanks.

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[NotAProgDirector]

It's a perfectly reasonable plan. Although getting a fellowship after a working gap like this can be difficult. GI, cards, and H/O would be quite unlikely. Pulm/CCM also difficult, although if your work included some ICU experience not impossible. Rheum challenging but possible. Endo very possible. ID, Nephrology no problem at all. Pall care also an option. Or you could switch to outpatient GIM work without a fellowship at all, or of course continue in hospital medicine.

 

[gutonc]

I think it's reasonable. Solves a bunch of problems and doesn't really introduce any new ones.

I can't really comment on whether working like a resident for another 3 years is going to be sustainable, but even working at the "standard" 1.0 FTE amount is going to get you pretty well set financially.

The fellowship issue is a little harder to address as @NotAProgDirector points out. But it will of course vary based on what specialty you're interested in and I don't think anything is completely ruled out.

 

[chessknt]

Have you ever worked pure nights for a month? Have you ever lived in a rural underserved community? What are your social needs/supports? Have you ever worked in a rural hospital with no subspecialties?

I did a modified version of what you are proposing and it was a massive mistake because my answer to all of the above was no.

 

[dozitgetchahi]

Have you ever worked pure nights for a month? Have you ever lived in a rural underserved community? What are your social needs/supports? Have you ever worked in a rural hospital with no subspecialties?

I did a modified version of what you are proposing and it was a massive mistake because my answer to all of the above was no.

Yeah exactly…to all of the points above.

I have worked in multiple rural/semi rural underserved communities. Even for a somewhat right leaning libertarian like myself, the level of conservatism in the rural south was really hard to stomach. (I found that I was less conservative than I thought I was.) I made it less than a year in rural Alabama before tapping out. I’m now in a semi rural Midwestern enclave which is pretty tolerable, and much less backwards than Alabama was - but I think even the average city dwelling blue stater might find my current digs intolerable, never mind an educated European on a visa. If you’ve never been to rural America, you may find it pretty shocking. A European with an accent is going to get a lot of grief in some of these places.

Working pure nights? Godawful, especially from a health standpoint.

Working in a rural dinky hospital with poor subspecialty support? Hoo boy. I don’t even go to the hospital as a rheumatologist, yet this has been an eye opener when it comes to the availability and quality of specialty care for outpatients. (Also keep in mind that in many rural areas, even if there is a doctor available in a given specialty, there is no guarantee that said doc knows their ass from a hole in the ground and/or isn’t a “recovering” alcoholic/drug addict in the state PHP. All of the above is shockingly common in the rural American medical scene.)

Social needs? OP is unlikely to find a lot of people like them in rural areas, so good luck.

 

[Make Or Break]

Depends on the number of admits per night but 8-10 admits x20 nights + floor call will wear anyone down fast.

 

[Osteoth]

I’m a rural Hospitalist and honestly I think you’re underselling yourself.

I work in the Midwest and know of multiple places that pay $350k+ for days, let alone nights.

 

[Splenda88]

Come to my place which is not rural and you will make 405k/yr base salary as a nocturnist.

If you work 20 nights/month, you will make 560k+ since extra night above your contracted 15 nights per month is paid at a rate of $2670/night.

 

[collegestud2013]

I’m a rural Hospitalist and honestly I think you’re underselling yourself.

I work in the Midwest and know of multiple places that pay $350k+ for days, let alone nights.

Problem is OP needs a J1 wavier job since he is an IMG. Those are notorious ate low-balling IMGs since they know he must complete the J1 waiver to continue to practice in the U.S., and won't have many jobs to choose from. He may just have to suck it up for the first few years out of residency until the J1 waiver period is completed, and then switch to a better job.

 

[collegestud2013]

Here's my situation:

I'm an IMG from Europe on a J1 visa. I started an IM residency at the age of 32 and will finish it at 35.

Although I'm a bit older, I have a low amount of student debt (~$40,000). Single, no wife, no kids (although it's something I want in the long-term).

I don't want to return to my home country for two years, so I have been thinking about getting a J1-waiver job in an underserved region for 3 years to get a green card. I have been looking at some of these jobs, and if you take a nocturnist role, the base salary can easily be in the 350-400K range. If I were to really hustle and take on extra internal moonlighting shifts (I can't moonlight externally on my current visa), I think that I could realistically get into the 450K-550K range if I was doing ~20 shifts per month, although I'd be working very hard.

The reason I want to do this is partly to get my green card, but also to take advantage of my current situation and lack of familial commitments. I could pay off the student debt very quickly (perhaps even immediately with a sign-on bonus or loan forgiveness benefits), live more-or-less like a resident for another 3 years, and invest everything else that I earn. Then, when I've got my green card and a bit of financial padding, I can decide whether I want to continue doing hospitalist work (either staying with days or nights, but working less), or think about going down the fellowship route. I'm not especially enthusiastic about any particular fellowship, but I don't know how feasible a hospitalist job will be in a few years, assuming I settle down and have a family.

I honestly wouldn't be averse to the idea of just going all-out with this and taking a job in a no-income-tax state in the middle of bum-**** nowhere to maximize my earnings. I am a natural night owl and nocturnist work appeals to me, so there's no problem there.

Does this sound like a reasonable plan, or am I being delusional here? I'd be interested to hear from any other hospitalists or IM specialists who did this.

Thanks.

Rural hospital at night will mean virtually not subspecialty support (and in many cases not much even during the day). And nights tend to be poorly staffed across the board in most non-teaching hospitals. At a rural hospital, it's likely that you may just be single coverage at night doing all the admissions and cross coverage without any NP/PA support. And this x 20 shifts per month sounds like a recipe for very quick burnout, and also potentially set you up for extra liability due to poor staffing. Would come down to your motivation and work ethic, as well as your health; if all those are good it may be doable for a few years.

Daytime hospitalist work is obviously a lot more sustainable in the long run, especially if you're working at a place with lower volume (which will usually come with lower pay as well).

Getting into fellowship will be harder down the line after a few years out of residency, especially as an IMG who has only worked in a rural hospital since residency graduation. The exception would be the least competitive fellowships that typically have more spots than applicants like ID or nephrology.

 

[Nocturnist]

Here's my situation:

I'm an IMG from Europe on a J1 visa. I started an IM residency at the age of 32 and will finish it at 35.

Although I'm a bit older, I have a low amount of student debt (~$40,000). Single, no wife, no kids (although it's something I want in the long-term).

I don't want to return to my home country for two years, so I have been thinking about getting a J1-waiver job in an underserved region for 3 years to get a green card. I have been looking at some of these jobs, and if you take a nocturnist role, the base salary can easily be in the 350-400K range. If I were to really hustle and take on extra internal moonlighting shifts (I can't moonlight externally on my current visa), I think that I could realistically get into the 450K-550K range if I was doing ~20 shifts per month, although I'd be working very hard.

The reason I want to do this is partly to get my green card, but also to take advantage of my current situation and lack of familial commitments. I could pay off the student debt very quickly (perhaps even immediately with a sign-on bonus or loan forgiveness benefits), live more-or-less like a resident for another 3 years, and invest everything else that I earn. Then, when I've got my green card and a bit of financial padding, I can decide whether I want to continue doing hospitalist work (either staying with days or nights, but working less), or think about going down the fellowship route. I'm not especially enthusiastic about any particular fellowship, but I don't know how feasible a hospitalist job will be in a few years, assuming I settle down and have a family.

I honestly wouldn't be averse to the idea of just going all-out with this and taking a job in a no-income-tax state in the middle of bum-**** nowhere to maximize my earnings. I am a natural night owl and nocturnist work appeals to me, so there's no problem there.

Does this sound like a reasonable plan, or am I being delusional here? I'd be interested to hear from any other hospitalists or IM specialists who did this.

Thanks.

Sounds reasonable to me.
I've been a nocturnist for 8 years, doing 18-20 shifts a month. No burnout whatsoever. You can easily make 400-500k and still have the time to travel back to your country (or anywhere else) every month.

All my colleagues have been at it for 10-20+ years. You've done multiple months of pure nights in residency by now and if you're a nightowl and didn't mind them, you'll likely thrive as a nocturnist. Nothing more sustainable about days IMO. I rounded for one day as an attending as a favor to a colleague and promised myself coming home exhausted and beat up that night I'll never do that again in my life.

Your mileage may vary but you can find rural J1 visa jobs that don't completely suck.
My colleague worked as a nocturnist under a J1 visa at a rural hospital for 6 years while getting his greencard.

The hospital is 50 miles outside one of the largest northeast metros, one hour drive from the city. There was nothing rural about his experience. He split the difference and lived in a nice suburb 25 miles outside of town. He was driving into the city multiple times a week, dating in the city, and had access to all its amenities and the international Airport when he wanted to get away. Never asked him how many shifts he worked or how much he made. The hospital is owned by the state university system which is one of the largest in the country so he had plentiful subspecialty support and the ability to divert sicker patients to the university hospital. ICU was open, though pretty low acuity.

I do think you should decide now whether fellowship is in your future or not. Nothing wrong with being a hospitalist for the rest of your life but agree it'll be much more difficult the further you're out.

 

[InternistDO]

I think one thing to consider, as others have kind of pointed out already, is that you really don't have to go to the middle of nowhere to find a high paying nocturnist job. An hour outside a mid-sized metro would probably get you a well paying position--I have friends in Minneapolis who report pretty high hospitalist salaries close to the city there, for example. You may find a more mid-sized rural/suburban type hospital more sustainable than a truly tiny rural site where you and the ED attending are the only doctors in the hospital--and often the truly tiny hospitals can't pay that much anyway.

 

[Osteoth]

I think one thing to consider, as others have kind of pointed out already, is that you really don't have to go to the middle of nowhere to find a high paying nocturnist job. An hour outside a mid-sized metro would probably get you a well paying position--I have friends in Minneapolis who report pretty high hospitalist salaries close to the city there, for example. You may find a more mid-sized rural/suburban type hospital more sustainable than a truly tiny rural site where you and the ED attending are the only doctors in the hospital--and often the truly tiny hospitals can't pay that much anyway.

What is considered a highly paying nocturnist job? Do you think it’s reasonable to equate it to a day time job salary around 1/3 less?

 

[Nocturnist]

What is considered a highly paying nocturnist job? Do you think it’s reasonable to equate it to a day time job salary around 1/3 less?

Here's my take, purely based on my experience in the northeast region:

-low paying: anything less than $150/hr
-mid: 150-175
-good: >175
-high/excellent: >200

Generally nocturnists enjoy a 20-30% shift and/or pay differential compared to days.

This is not including any productivity or quality incentives.

 

[wamcp]

I've been a nocturnist for 8 years, doing 18-20 shifts a month. No burnout whatsoever.

This is true in my experience, no burnout, except, I’m guessing you don’t have kids. After my oldest turned 2+ years it’s not possible to keep working that many hours. Unless you wanna be a sh***y parent. Spending time with your kids when they can begin forming real memories is >>>>> the extra aftertaxed coin of a $3000 night shift

 

[Nocturnist]

This is true in my experience, no burnout, except, I’m guessing you don’t have kids. After my oldest turned 2+ years it’s not possible to keep working that many hours. Unless you wanna be a sh***y parent. Spending time with your kids when they can begin forming real memories is >>>>> the extra aftertaxed coin of a $3000 night shift

Guess again 😉

Only thing I'll add- the vast majority of working professionals work 20-22 days a month.
Most of them do so during their kids' waking hours, so they only get to see their children for an hour before and after work if theyre lucky. By working nights, I'm home for their entire wake window. Yeah, I'm sleeping through about half of it, but being there for the other half of your kids' awake time is much, much more than most parents ever dream of.

 

[Splenda88]

This is true in my experience, no burnout, except, I’m guessing you don’t have kids. After my oldest turned 2+ years it’s not possible to keep working that many hours. Unless you wanna be a sh***y parent. Spending time with your kids when they can begin forming real memories is >>>>> the extra aftertaxed coin of a $3000 night shift

What? I have more non-working time in my hand than most professionals including physicians. I work 65-70 hrs every other week. 3 out of 7 days that I work, I am home by 2:30-3pm and the other 4 days I am home by 6:15pm. Then I have a whole freaking week off.

 

[wamcp]

What? I have more non-working time in my hand than most professionals including physicians. I work 65-70 hrs every other week. 3 out of 7 days that I work, I am home by 2:30-3pm and the other 4 days I am home by 6:15pm. Then I have a whole freaking week off.

Yeah, no.

3 young kids and a wife need time and attention. Unless you pay for a live in nanny, 20+ night shifts a month is impossible to be a good parent without dumping the load onto your spouse (who works as well) and straining your marriage

 

[wamcp]

Guess again 😉

Only thing I'll add- the vast majority of working professionals work 20-22 days a month.
Most of them do so during their kids' waking hours, so they only get to see their children for an hour before and after work if theyre lucky. By working nights, I'm home for their entire wake window. Yeah, I'm sleeping through about half of it, but being there for the other half of your kids' awake time is much, much more than most parents ever dream of.

I have 3 kids all preschool age or younger. This doesn’t work out with a spouse who also is a fulltime professional.

Who is doing pick up drop offs? What happens if kids are sick? Who does the cooking? Bathes them? Dishwashing, laundry, shopping etc. and what about time for going to the gym, your personal self care time etc. are you cutting down your sleep to unhealthy amounts to achieve all this?

are you paying for a live in nanny?

That would be the only way working 20+ twelve hour night shifts allows all the above to be done harmoniously and leaving you to spend quality time with kids and spouse

Which if you are paying live in nanny - then it negates the extra shifts you work: 5 shifts a month x $1200 after tax income x 12 months = 72000 going straight to the nanny (costing 30/hr and 7.5% payroll taxes etc)

 

[Splenda88]

I have 3 kids all preschool age or younger. This doesn’t work out with a spouse who also is a fulltime professional.

Who is doing pick up drop offs? What happens if kids are sick? Who does the cooking? Bathes them? Dishwashing, laundry, shopping etc. and what about time for going to the gym, your personal self care time etc. are you cutting down your sleep to unhealthy amounts to achieve all this?

are you paying for a live in nanny?

That would be the only way working 20+ twelve hour night shifts allows all the above to be done harmoniously and leaving you to spend quality time with kids and spouse

Which if you are paying live in nanny - then it negates the extra shifts you work: 5 shifts a month x $1200 after tax income x 12 months = 72000 going straight to the nanny (costing 30/hr and 7.5% payroll taxes etc)

It's definitely hard with FT working spouse.

If she/he was working PT 3 days/wk, (8am-4pm), it will work perfectly.

My spouse is not in the workforce so we have no issues raising our kids the way we want to.

 

[Nocturnist]

I have 3 kids all preschool age or younger. This doesn’t work out with a spouse who also is a fulltime professional.

Who is doing pick up drop offs? What happens if kids are sick? Who does the cooking? Bathes them? Dishwashing, laundry, shopping etc. and what about time for going to the gym, your personal self care time etc. are you cutting down your sleep to unhealthy amounts to achieve all this?

are you paying for a live in nanny?

That would be the only way working 20+ twelve hour night shifts allows all the above to be done harmoniously and leaving you to spend quality time with kids and spouse

Which if you are paying live in nanny - then it negates the extra shifts you work: 5 shifts a month x $1200 after tax income x 12 months = 72000 going straight to the nanny (costing 30/hr and 7.5% payroll taxes etc)

I'm the primary breadwinner.
Spouse went per diem when we had kids, works around my schedule. Neither of us cares about having a career, per se. I average 575k/year, so anything spouse makes is gravy. Pre kids we were bringing in mid 700s combined. Post kids in mid-high 600s but like you said spending time with your kids>>money.

No drop off/pick ups. We've never had to hire a nanny, never put them in daycare, actually haven't even had to hire a babysitter yet. We're raising them ourselves, I'm not outsourcing that to some stranger. It's something we're pretty proud of considering most our friends and neighbors with similarly aged children had them at day care or nanny at 6-12 weeks.

I spend alot of time with them when i get back home in the morning, which lets my spouse sleep in nicely. Then they take over while I sleep. When I wake up I play with them more, do bathtime/dinner and let my spouse relax some more before I head to work. Grandparents help out once or twice a week and various family members will rotate watching the monitor (i.e drink our beers and watch our Netflix) when we go for date nights. In laws sometimes join our vacations to help make flights a little more sane.

I've been able to make nearly 5 million in medicine since graduating med school 10.5 years ago. I doubt very many physicians can say the same. We have 6 years mortgage left on our primary home, 10 years left on our vacation house. Net worth scraping 3.5M with about half between retirement and brokerage and half in real estate. Because I'm able to set my schedule, I'll never have to miss a game/recital etc. Yes, I have to work a couple holidays a year. I choose new years so I get to spend Thanksgiving/Xmas at home. We don't really care about the summer holidays as much.

In the next 5 years, we'll be nearly done with paying our home, projected net worth 5-6M and pretty close to financial independence. We'll be able to work as much or little as we want and devote even more time to our kids, travel the world even more. Then we'll coast and work just enough to max retirement accounts and pay the bills til our NW is 10M somewhere in 10-15 years. There's honestly not much I would change in hind sight.

 

[wamcp]

I'm the primary breadwinner.
Spouse went per diem when we had kids, works around my schedule. Neither of us cares about having a career, per se. I average 575k/year, so anything spouse makes is gravy. Pre kids we were bringing in mid 700s combined. Post kids in mid-high 600s but like you said spending time with your kids>>money.

No drop off/pick ups. We've never had to hire a nanny, never put them in daycare, actually haven't even had to hire a babysitter yet. We're raising them ourselves, I'm not outsourcing that to some stranger. It's something we're pretty proud of considering most our friends and neighbors with similarly aged children had them at day care or nanny at 6-12 weeks.

I spend alot of time with them when i get back home in the morning, which lets my spouse sleep in nicely. Then they take over while I sleep. When I wake up I play with them more, do bathtime/dinner and let my spouse relax some more before I head to work. Grandparents help out once or twice a week and various family members will rotate watching the monitor (i.e drink our beers and watch our Netflix) when we go for date nights. In laws sometimes join our vacations to help make flights a little more sane.

I've been able to make nearly 5 million in medicine since graduating med school 10.5 years ago. I doubt very many physicians can say the same. We have 6 years mortgage left on our primary home, 10 years left on our vacation house. Net worth scraping 3.5M with about half between retirement and brokerage and half in real estate. Because I'm able to set my schedule, I'll never have to miss a game/recital etc. Yes, I have to work a couple holidays a year. I choose new years so I get to spend Thanksgiving/Xmas at home. We don't really care about the summer holidays as much.

In the next 5 years, we'll be nearly done with paying our home, projected net worth 5-6M and pretty close to financial independence. We'll be able to work as much or little as we want and devote even more time to our kids, travel the world even more. Then we'll coast and work just enough to max retirement accounts and pay the bills til our NW is 10M somewhere in 10-15 years. There's honestly not much I would change in hind sight.

Looks like we’re similar but my wife is full time doc and not per diem. So 20+ shifts is out of the question especially when our 3rd kid was born.

I had cut out moonlighting months ago but even then for the calendar year despite scaling back, our combined W2 income is hitting above 900K. I will take in 550K but she got some hefty productivity bonuses- no moonlighting needed for her! My taxable trading account is at 1.4M this year in gains but it’s all short term so gonna get hit hard by the IRS and state next April.

Aggressive goal right now is for both of us to retire before age 40…just a few more years away. We’ll see how the markets pan out

 

[Splenda88]

Looks like we’re similar but my wife is full time doc and not per diem. So 20+ shifts is out of the question especially when our 3rd kid was born.

I had cut out moonlighting months ago but even then for the calendar year despite scaling back, our combined W2 income is hitting above 900K. I will take in 550K but she got some hefty productivity bonuses- no moonlighting needed for her! My taxable trading account is at 1.4M this year in gains but it’s all short term so gonna get hit hard by the IRS and state next April.

Aggressive goal right now is for both of us to retire before age 40…just a few more years away. We’ll see how the markets pan out

Wow...

 

[Splenda88]

People should NOT listen to others in SDN that are saying not to do hospital medicine (HM).

Almost ALL my classmates who are doing HM are saying the job is better than they imagined.

 

[Nocturnist]

People should NOT listen to others in SDN that are saying not to do hospital medicine (HM).

Almost ALL my classmates who are doing HM are saying the job is better than they imagined.

I dont see it that way. As long as they're respectful about it, everyone has a room at this table and should feel comfortable sharing their experience.

Don't forget that riddle about the two pilots flying in the sandstorm trying to make out their location by whatever they can see through their window. One sees a triangle while the other sees a square, but both are looking at the same object.

...theyre both looking at the same pyramid, just through different angles.

SDN is for folks to share their experience and give other folks in all stages of medicine advice.
I hope everyone feels free and welcome to share their subjective experience, good, bad, or ugly. The more data points we have, the closer we get to the truth, as seen through all our lenses.

A few prominent hospitalists on this forum including myself have been accused of having unicorn jobs, not representative of the profession. I welcome all others to come by and write about their own experience. No love lost, it doesn't change my positive one.

 

[Splenda88]

I dont see it that way. As long as they're respectful about it, everyone has a room at this table and should feel comfortable sharing their experience.

Don't forget that riddle about the two pilots flying in the sandstorm trying to make out their location by whatever they can see through their window. One sees a triangle while the other sees a square, but both are looking at the same object.

...theyre both looking at the same pyramid, just through different angles.

SDN is for folks to share their experience and give other folks in all stages of medicine advice.
I hope everyone feels free and welcome to share their subjective experience, good, bad, or ugly. The more data points we have, the closer we get to the truth, as seen through all our lenses.

A few prominent hospitalists on this forum including myself have been accused of having unicorn jobs, not representative of the profession. I welcome all others to come by and write about their own experience. No love lost, it doesn't change my positive one.

I agree but the issue is their advice is very negative toward HM and most of these docs were never hospitalists. Had I listened to people in SDN I would have never become a hospitalist.

I dont have a unicorn job compared to some of my classmates that get to work by 8/8:30 am and out by 2pm everyday, but my job is more than ok.

When it comes to flexility, there is not that many specialties in medicine that beat HM.

 

[rokshana]

I agree but the issue is their advice is very negative toward HM and most of these docs were never hospitalists. Had I listened to people in SDN I would have never become a hospitalist.

I dont have a unicorn job compared to some of my classmates that get to work by 8/8:30 am and out by 2pm everyday, but my job is more than ok.

When it comes to flexility, there is not that many specialties in medicine that beat HM.

Just as you say people give advice about HM but not having done HM… you haven’t done any other subspecialty to be able to make that statement.

 

[Splenda88]

Just as you say people give advice about HM but not having done HM… you haven’t done any other subspecialty to be able to make that statement.

That is fair.

 

[dozitgetchahi]

Just as you say people give advice about HM but not having done HM… you haven’t done any other subspecialty to be able to make that statement.

Yeah. I’m fairly certain that I’d be miserable as a hospitalist. Even with the magical unicorn hospitalist jobs described on SDN. (I have no interest whatsoever in being a nocturnist after watching my mother ruin her health for 20 years as a night shift nurse. The health threat is real. Also, being awake when everyone else is asleep sucks. I hated night float with a rabid passion when I was a resident. Not sure a modest pay increase is worth a massive decrease in QOL, and after the ****tery that was residency/fellowship, QOL is really important to me.) But YMMV.

 

[anonperson]

Night shift work is a risk factor for heart attack, stroke, and metabolic disturbances. It is also considered a probable carcinogen.

There is a pay differential but there is a reason for that.

I'm impressed with the poster who works 20+ shifts but still has enough energy to play with the kids etc while the spouse sleeps in. I don't think this is the norm though.

Some NFL coaches infamously get by with just 4 hours of sleep and do fine.

 

[rokshana]

Yeah. I’m fairly certain that I’d be miserable as a hospitalist. Even with the magical unicorn hospitalist jobs described on SDN. (I have no interest whatsoever in being a nocturnist after watching my mother ruin her health for 20 years as a night shift nurse. The health threat is real. Also, being awake when everyone else is asleep sucks. I hated night float with a rabid passion when I was a resident. Not sure a modest pay increase is worth a massive decrease in QOL, and after the ****tery that was residency/fellowship, QOL is really important to me.) But YMMV.

I actually like nights in residency, and after a year of hospitalist work, transitioned to nocturnist work exclusively… little to no social issues to deal with and my job was basically to keep the pts alive til the morning…but agree…now 10 years later, just can’t even think about doing hospitalist work…I work the same amount of time as a specialist and make about $250k/ yr… not hospitalist pay, but not shabby for 2 weeks/month.

 

[wamcp]

Night shift work is a risk factor for heart attack, stroke, and metabolic disturbances. It is also considered a probable carcinogen.

There is a pay differential but there is a reason for that.

I'm impressed with the poster who works 20+ shifts but still has enough energy to play with the kids etc while the spouse sleeps in. I don't think this is the norm though.

Some NFL coaches infamously get by with just 4 hours of sleep and do fine.

Yeah I don’t plan to do nocturnist work past my forties. It’s very bad for your health.

Goal right now is retire before age 40.

7 more years to go. If we didn’t have kids- would be retired by now but having 3 changes a lot. If that fails, hoping can reach my nest egg goals by before 50.

So glad I made bank the first 5 years moonlighting crazily to build up investment and trading capital.

 

[sloh]

Yeah I don’t plan to do nocturnist work past my forties. It’s very bad for your health.

Goal right now is retire before age 40.

7 more years to go. If we didn’t have kids- would be retired by now but having 3 changes a lot. If that fails, hoping can reach my nest egg goals by before 50.

So glad I made bank the first 5 years moonlighting crazily to build up investment and trading capital.

Nice net worth at 33 yo. Much respect.

 

[wamcp]

Nice net worth at 33 yo. Much respect.

Thanks. Would not be possible if had not gone to 6yr ba/md. Even with our 400K loans at residency graduation- the 2 “extra” years of earning power makes a huge difference

 

[Cyclogon]

Sounds reasonable to me.
I've been a nocturnist for 8 years, doing 18-20 shifts a month. No burnout whatsoever. You can easily make 400-500k and still have the time to travel back to your country (or anywhere else) every month.

All my colleagues have been at it for 10-20+ years. You've done multiple months of pure nights in residency by now and if you're a nightowl and didn't mind them, you'll likely thrive as a nocturnist. Nothing more sustainable about days IMO. I rounded for one day as an attending as a favor to a colleague and promised myself coming home exhausted and beat up that night I'll never do that again in my life.

Your mileage may vary but you can find rural J1 visa jobs that don't completely suck.
My colleague worked as a nocturnist under a J1 visa at a rural hospital for 6 years while getting his greencard.

The hospital is 50 miles outside one of the largest northeast metros, one hour drive from the city. There was nothing rural about his experience. He split the difference and lived in a nice suburb 25 miles outside of town. He was driving into the city multiple times a week, dating in the city, and had access to all its amenities and the international Airport when he wanted to get away. Never asked him how many shifts he worked or how much he made. The hospital is owned by the state university system which is one of the largest in the country so he had plentiful subspecialty support and the ability to divert sicker patients to the university hospital. ICU was open, though pretty low acuity.

I do think you should decide now whether fellowship is in your future or not. Nothing wrong with being a hospitalist for the rest of your life but agree it'll be much more difficult the further you're out.

It sounds as though nocturnist work can be very lucrative, provided it's something that suits you and you can sustain long-term. If I may ask, at the time of your retirement, which of the IM specialties and sub-specialties do you think you will have out-earned, and which do you think will have caught up or surpassed you? It's generally agreed that, whilst specialties such as endo, rheumatology, ID, and nephrology offer a lot of positives in terms of work/life balance, they will rarely catch up financially with a career hospitalist. But how do the likes of general cards, interventional cards, electrophysiology, hem-onc, and pulm-crit compare to a hospitalist who's willing to work similar hours to them?

I'm in two minds as to whether to go down the hospitalist route or whether to try and pursue a cardiology fellowship (with the intention of doing general cards), but I'm unsure whether it's worthwhile from a financial perspective. Obviously fellowship is not a purely financial consideration, but it's still something I need to seriously think about.

 

[Nocturnist]

It sounds as though nocturnist work can be very lucrative, provided it's something that suits you and you can sustain long-term. If I may ask, at the time of your retirement, which of the IM specialties and sub-specialties do you think you will have out-earned, and which do you think will have caught up or surpassed you? It's generally agreed that, whilst specialties such as endo, rheumatology, ID, and nephrology offer a lot of positives in terms of work/life balance, they will rarely catch up financially with a career hospitalist. But how do the likes of general cards, interventional cards, electrophysiology, hem-onc, and pulm-crit compare to a hospitalist who's willing to work similar hours to them?

I'm in two minds as to whether to go down the hospitalist route or whether to try and pursue a cardiology fellowship (with the intention of doing general cards), but I'm unsure whether it's worthwhile from a financial perspective. Obviously fellowship is not a purely financial consideration, but it's still something I need to seriously think about.

Oh boy, you've opened up a real pandora's box.
We've discussed this extensively in prior posts, these threads tend to turn tribal and heated real quick, mostly everybody is defending their choice as you'd expect for anyone that invested close to 15 years to get to their position. Folks particularly in PCCM get butthurt pretty quickly that they'll never outearn me, even while working in rural/undesirable areas and having to pull several nights a month in a rotating schedule. Feel free to search my prior posts for some more info.

That said, as you've mentioned all the endo/ID/nephro/rheum are likely in the range of 250-350k and so are never going to catch up.

You can probably find calculators out there to figure out the opportunity cost and salary needed for a specialist who trained 3-5 years more to outearn me. Thats 1.5-2.5M of income to catch up to. Of course, it doesn't include the compounding my money has done in the stock market during that time or the fact I was able to buy my homes at prices and interest rates that'll never be seen again. Also don't underestimate the opportunity cost of 3-5 years of living life. You've already given up your 20s, now you're looking at giving up half your 30s as well. I was abroad every single month before having kids, you don't get too many years of an outrageous salary, all the freedom and time in the world to spend it, and no kids tying you down if you're not done training til your mid 30s at best. Those specialists may catch up to me in income, but not in life experiences. Not til their 60s or 70s, if they're lucky.

That said-Cards and GI? Very likely. EP/interventional? Most definitely. I wouldn't hesitate to go into those from a financial perspective. Onc? Depends on your volume/partner status, and whether chemo reimbursement rates may change in the future. PCCM? Unlikely unless youre moonligting in a unit for 15-20 shifts a month. But that's just my case and if you don't want to keep your foot on the pedal for as long as I have, take it a little bit easier and only make in the 400s, the equation changes.

As I've mentioned before, especially as a foreign grad- if you're thinking at all about specializing, do it now. Don't wait. Attendings know you personally, (hopefully) they like you. They know your work ethic and quality of work. Where you're from/where you trained is secondary to knowing this is a fellow they trust will succeed and they want to work with. The further out you are from residency- people forget about you. You become a distant acquaintance instead of a colleague. Just do it now. Hospitalist will always be there if it doesn't work out.

 

[Splenda88]

I don't think general cards worth it in term of the opportunity cost for the amount of work they do.

 

[dozitgetchahi]

Oh boy, you've opened up a real pandora's box.
We've discussed this extensively in prior posts, these threads tend to turn tribal and heated real quick, mostly everybody is defending their choice as you'd expect for anyone that invested close to 15 years to get to their position. Folks particularly in PCCM get butthurt pretty quickly that they'll never outearn me, even while working in rural/undesirable areas and having to pull several nights a month in a rotating schedule. Feel free to search my prior posts for some more info.

That said, as you've mentioned all the endo/ID/nephro/rheum are likely in the range of 250-350k and so are never going to catch up.

You can probably find calculators out there to figure out the opportunity cost and salary needed for a specialist who trained 3-5 years more to outearn me. Thats 1.5-2.5M of income to catch up to. Of course, it doesn't include the compounding my money has done in the stock market during that time or the fact I was able to buy my homes at prices and interest rates that'll never be seen again. Also don't underestimate the opportunity cost of 3-5 years of living life. You've already given up your 20s, now you're looking at giving up half your 30s as well. I was abroad every single month before having kids, you don't get too many years of an outrageous salary, all the freedom and time in the world to spend it, and no kids tying you down if you're not done training til your mid 30s at best. Those specialists may catch up to me in income, but not in life experiences. Not til their 60s or 70s, if they're lucky.

That said-Cards and GI? Very likely. EP/interventional? Most definitely. I wouldn't hesitate to go into those from a financial perspective. Onc? Depends on your volume/partner status, and whether chemo reimbursement rates may change in the future. PCCM? Unlikely unless youre moonligting in a unit for 15-20 shifts a month. But that's just my case and if you don't want to keep your foot on the pedal for as long as I have, take it a little bit easier and only make in the 400s, the equation changes.

As I've mentioned before, especially as a foreign grad- if you're thinking at all about specializing, do it now. Don't wait. Attendings know you personally, (hopefully) they like you. They know your work ethic and quality of work. Where you're from/where you trained is secondary to knowing this is a fellow they trust will succeed and they want to work with. The further out you are from residency- people forget about you. You become a distant acquaintance instead of a colleague. Just do it now. Hospitalist will always be there if it doesn't work out.

Meanwhile, I earned $502k this year as an outpatient only PP rheumatologist. My partner hit $800k. I work 4.5 days a week.

Don’t always believe the salary surveys. I’ve never been asked to fill one out.

While I appreciate your bravado and boasting on your earnings here, just know that most of us have zero desire to live the “lifestyle” you live. Honestly, I’d rather quit medicine than work as a nocturnist. You’re ruining your health doing this. (My mother did 20 years of night shift nursing and has declined steadily health wise ever since she started.)

 

[Splenda88]

Meanwhile, I earned $502k this year as an outpatient only PP rheumatologist. My partner hit $800k. I work 4.5 days a week.

Don’t always believe the salary surveys. I’ve never been asked to fill one out.

Honestly, I’d rather quit medicine than work as a nocturnist. You’re ruining your health doing this.

100% agree.

As @Nocturnist said, @Cyclogon opened up a pandora box.

 

[Nocturnist]

Meanwhile, I earned $502k this year as an outpatient only PP rheumatologist. My partner hit $800k. I work 4.5 days a week.

Don’t always believe the salary surveys. I’ve never been asked to fill one out.

While I appreciate your bravado and boasting on your earnings here, just know that most of us have zero desire to live the “lifestyle” you live. Honestly, I’d rather quit medicine than work as a nocturnist. You’re ruining your health doing this. (My mother did 20 years of night shift nursing and has declined steadily health wise ever since she started.)

Sorry to hear you feel that working nights did that to your mom. I'm not saying it didnt wreck her health, I'm just saying that every single person who ever confused correlation with causation eventually ended up dying...

I control what I can control. Getting 7 hours of sleep, working out before every shift, and eating clean are non negotiables. I've never been able to fall asleep before 1-2 am, my body is naturally wired for nights. I can tell you I never felt worse than when I had to wake up at 630am for residency. I've never felt better than now.

If you also don't mind me asking for transparency- how many years in practice are you? Have you always been making 500 and 800k respectively since coming out of fellowship, or if not-how much were you making earlier in your career? What part of the country are you at?

Lastly, what do I care what lifestyle most desire? My life isn't a popularity contest, i don't have to find the lifestyle that makes the most amount of people happy- just myself. I'm happy you found the setting that works best for you! I'd similarly rather quit medicine than work in an office. And there's nothing wrong with that. Isn't the whole point of this forum to provide info for others to make an informed decision? If it resonates with others- great. If it doesn't- no love lost. I wish them luck on their pursuit of happiness.

 

[chessknt]

Meanwhile, I earned $502k this year as an outpatient only PP rheumatologist. My partner hit $800k. I work 4.5 days a week.

Don’t always believe the salary surveys. I’ve never been asked to fill one out.

While I appreciate your bravado and boasting on your earnings here, just know that most of us have zero desire to live the “lifestyle” you live. Honestly, I’d rather quit medicine than work as a nocturnist. You’re ruining your health doing this. (My mother did 20 years of night shift nursing and has declined steadily health wise ever since she started.)

Yep, people appreciate accurate information but around here it tends to come with a heavy dose of bull**** from some people. Claiming you make 800k working nights but neglecting to mention working 1.6 FTE to get there is what makes that information stupid. The metric people should care about is pay per hour or shift (including # of hours per shift), not maximal possible earnings.

I get paid about 285/hr doing ICU work, a little more doing clinic work (but that includes off hours stuff like answering calls). Anesthesia locums are clearing 600/hr right now, CT surgeons where I worked clear north of 1k/hr 1.5-2M/yr easily yet never see that listed on a survey. $ independent of the time it took took to earn that money is useless information which is why the salary surveys are all generally useless as well.

 

[Osteoth]

Meanwhile, I earned $502k this year as an outpatient only PP rheumatologist. My partner hit $800k. I work 4.5 days a week.

Don’t always believe the salary surveys. I’ve never been asked to fill one out.

While I appreciate your bravado and boasting on your earnings here, just know that most of us have zero desire to live the “lifestyle” you live. Honestly, I’d rather quit medicine than work as a nocturnist. You’re ruining your health doing this. (My mother did 20 years of night shift nursing and has declined steadily health wise ever since she started.)

How?

 

[Nocturnist]

Meanwhile, I earned $502k this year as an outpatient only PP rheumatologist. My partner hit $800k. I work 4.5 days a week.

Don’t always believe the salary surveys. I’ve never been asked to fill one out.

While I appreciate your bravado and boasting on your earnings here, just know that most of us have zero desire to live the “lifestyle” you live. Honestly, I’d rather quit medicine than work as a nocturnist. You’re ruining your health doing this. (My mother did 20 years of night shift nursing and has declined steadily health wise ever since she started.)

I’m in a PP group and I’m clearing $400k this year. You?

Your salary jumped from 400k to 502k since September 20th? That's incredible. Did you happen to do some overnight moonlighting in the past couple months or something?😉

OP, my first marriage was like this.

Married the summer before senior year of college. She had just graduated nursing school.
First wife started griping about moving to start medical school, even before we moved (it was in a different state than college).
Her pushback against time spent studying got worse once medical school started. Her expectations were very unrealistic.
First wife pushed me into having our first child halfway through medical school, even though I did not think it was a good idea and we did not have the time or wherewithal for it (we didn’t live near family).
She left and moved back to home state with my daughter one week after she was born…while I was on my IM rotation.
She didn’t follow me to residency, which was in a third state. We lived apart for years, with me driving back and forth almost 5 hours each way whenever I had a free moment to try to bail out what was clearly a sinking ship. Divorce followed when I was in fellowship, after we hadn’t lived together in 5 years.

That marriage took a major toll on my health and wellness, and continues to be a distracting waste of energy and money even years after it has ended.


I wish I had gotten out of that first ****show marriage before it turned into a chronic toxic mess.

Sorry to have to dig this one up, I promise I'm not trying to capitalize on your heartache. It's just that from where I'm standing, it's starting to sound a little like the kettle calling the pot unhealthy? Maybe even a touch of projecting, one might say. And yet, you even got married again! You know there's this old saying in Tennessee that goes something like "fool me once, shame on you. Fool me twice — you can't get fooled again."
Great for you for finding your happiness-professional and personal. I love that for you. I'm just not sure you're exactly the right person to disrespect other folks' honest personal choices..

happily married nocturnist vs bitterly divorced rheumatologist paying child support.
I guess we'll just have to get together to compare health outcomes in a few decades..

 

[Cyclogon]

I think one of the main psychological hang-ups I’m having about pursuing fellowship is the fact that I’m a bit older than those who followed a more traditional/linear route. I’ll be 35 when I finish IM residency and 38 when I finish fellowship. There’s a part of me that thinks, “Am I seriously going to delay making real money until I’m 38? Most adults have been earning for around 15 years by this point - get a move on!” There’s only so much delayed gratification that a person can take, haha.

Objectively speaking, though, I think that these insecurities are probably irrational given that: 1) I have the fortune of having a relatively small amount of student debt (~40K), so that likely levels the financial playing field when compared to US MDs who got through training a bit faster, and 2) I would be well compensated in general cards, so I could set myself up financially with a few years of living below my means and investing aggressively. Although a hospitalist can likely match a general cardiologist‘s salary by doing extra shifts and/or nights, I think I need to consider the question of long-term sustainability and what I can realistically see myself doing for ~25 years. I think I could do a standard hospitalist schedule consistently for a career (i.e. 7 on, 7 off, days, especially if it’s round-and-go), but I don’t know if I’d have it in me to do ~20 night-shifts per month for more than maybe 3-5 years. So in that sense, I suspect I would personally come out ahead financially doing cards, even with the opportunity cost of three years.

May I ask what the rest of you think about my current situation? Is doing a cards fellowship between 35-38 in any way atypical, or am I overthinking this? Would you have any reservations about doing a fellowship at my age? I’d also have to do my visa-waiver job after my fellowship, but, from people I’ve spoken to, these aren’t too difficult to find if you look early and are flexible on location.

 

[gutonc]

I think one of the main psychological hang-ups I’m having about pursuing fellowship is the fact that I’m a bit older than those who followed a more traditional/linear route. I’ll be 35 when I finish IM residency and 38 when I finish fellowship. There’s a part of me that thinks, “Am I seriously going to delay making real money until I’m 38? Most adults have been earning for around 15 years by this point - get a move on!” There’s only so much delayed gratification that a person can take, haha.

Objectively speaking, though, I think that these insecurities are probably irrational given that: 1) I have the fortune of having a relatively small amount of student debt (~40K), so that likely levels the financial playing field when compared to US MDs who got through training a bit faster, and 2) I would be well compensated in general cards, so I could set myself up financially with a few years of living below my means and investing aggressively. Although a hospitalist can likely match a general cardiologist‘s salary by doing extra shifts and/or nights, I think I need to consider the question of long-term sustainability and what I can realistically see myself doing for ~25 years. I think I could do a standard hospitalist schedule consistently for a career (i.e. 7 on, 7 off, days, especially if it’s round-and-go), but I don’t know if I’d have it in me to do ~20 night-shifts per month for more than maybe 3-5 years. So in that sense, I suspect I would personally come out ahead financially doing cards, even with the opportunity cost of three years.

May I ask what the rest of you think about my current situation? Is doing a cards fellowship between 35-38 in any way atypical, or am I overthinking this? Would you have any reservations about doing a fellowship at my age? I’d also have to do my visa-waiver job after my fellowship, but, from people I’ve spoken to, these aren’t too difficult to find if you look early and are flexible on location.

You're overthinking this. If you want to be a cardiologist, be a cardiologist, if you want to be a hospitalist, be a hospitalist.

I'm an oncologist. I considered diverting to either hospital medicine or CCM during residency, but went ahead and completed a fellowship and am quite happy doing what I do. I don't think I'd be nearly as happy as a hospitalist or ICU doc. And I don't think 2-3 years of more money would change that for me.

I also started my first attending job 4 weeks after my 40th birthday. That's how my life went. Nothing to be done about it now.

 

[Splenda88]

I think one of the main psychological hang-ups I’m having about pursuing fellowship is the fact that I’m a bit older than those who followed a more traditional/linear route. I’ll be 35 when I finish IM residency and 38 when I finish fellowship. There’s a part of me that thinks, “Am I seriously going to delay making real money until I’m 38? Most adults have been earning for around 15 years by this point - get a move on!” There’s only so much delayed gratification that a person can take, haha.

Objectively speaking, though, I think that these insecurities are probably irrational given that: 1) I have the fortune of having a relatively small amount of student debt (~40K), so that likely levels the financial playing field when compared to US MDs who got through training a bit faster, and 2) I would be well compensated in general cards, so I could set myself up financially with a few years of living below my means and investing aggressively. Although a hospitalist can likely match a general cardiologist‘s salary by doing extra shifts and/or nights, I think I need to consider the question of long-term sustainability and what I can realistically see myself doing for ~25 years. I think I could do a standard hospitalist schedule consistently for a career (i.e. 7 on, 7 off, days, especially if it’s round-and-go), but I don’t know if I’d have it in me to do ~20 night-shifts per month for more than maybe 3-5 years. So in that sense, I suspect I would personally come out ahead financially doing cards, even with the opportunity cost of three years.

May I ask what the rest of you think about my current situation? Is doing a cards fellowship between 35-38 in any way atypical, or am I overthinking this? Would you have any reservations about doing a fellowship at my age? I’d also have to do my visa-waiver job after my fellowship, but, from people I’ve spoken to, these aren’t too difficult to find if you look early and are flexible on location.

I think you are overthinking it. You essentially don't have student loan, which make things more doable for you.

If you genuinely like cards, you should go ahead and do it.

If $$$ is your primary "motive", I think hospital medicine (HM) might be better. The $ per hr for HM is better than most specialties because most hospital medicine physicians don't truly work 84 hrs every other week. Many places are round and leave.

 

[Cyclogon]

I think you are overthinking it. You essentially don't have student loan, which make things more doable for you.

If you genuinely like cards, you should go ahead and do it.

If $$$ is your primary "motive", I think hospital medicine (HM) might be better. The $ per hr for HM is better than most specialties because most hospital medicine physicians don't truly work 84 hrs every other week. Many places are round and leave.

May I ask, what time are you typically clocking in and out on a standard day shift? And how many additional day shifts would you need to pick up on your off week to get into the 400K range?

 

[Splenda88]

May I ask, what time are you typically clocking in and out on a standard day shift? And how many additional day shifts would you need to pick up on your off week to get into the 400K range?

There is no such thing as clock in/out. Some people got there 7:45-8:00 am but they just do it surreptitiously. I kind of like to follow rules.

Here is a typical day for me:

I usually get to work ~7:15 am. Get my coffee and do some chart review in the physicians' lounge for 45mins day1 and probably 30 mins subsequent days.

See patients from 8-10:30am. Then Talk to social workers and case managers re: potential discharges if everything are set

Then put discharge orders in and write some notes. I later eat lunch and finish all the notes. I can take whatever time I want to eat lunch because I don't have a patient waiting in small cubicle to be seen at 12:30 or 1pm.

When I am short calls (3 out of the 7 days), I leave 2-3 pm because short calls don't admit. On long call days (4 out of 7), I leave a 6:00pm because I have to admit. Average admits on long call is probable ~2.

I work ~17 days/month on average this year. Just looked my last paystub and "year-to-date" income is $401,425.00 for the year of 2023.

Daily rate is $1920/day. Any extra day I pick up above my contractual obligation (15 days/month) is paid at $2365/day.

Bear in mind that some people go home around 1-2pm even if they are long calls. If they got a call to admit, they just place the admission orders at home and then come to the hospital around 5-6pm to see the patients and then go back home. I dont do that because once I am home, I don't want to go back to the hospital.

It's a small city of 60k people so almost all of us live w/in 10-15 mins from the hospital.

For instance, today (12/20) I worked extra, I started with 16 patients, discharged 3 and admit 1.

My lifestyle is the best it has been.

By the way, I have 3 of my former co-residents (also friends) who have better setting than myself because it's round and leave (no admits). They told me they got to work around 8:00-8:30 am and by 2-3pm, they are out.

Of course, we all have to answer phone calls from nurses until 7pm.

Hospitalist is not for everyone especially for physicians with big ego. But the people I work with and my former co-residents (also friends) told me they dont't see themselves working a Monday thru Friday (or Thursday) job going in and out of cubicles seeing patient every 20 minute.

 

[chessknt]

May I ask, what time are you typically clocking in and out on a standard day shift? And how many additional day shifts would you need to pick up on your off week to get into the 400K range?

If you like a subspec but are worried about earning potentially you are going to out-earn nocturnist/HM by specializing. You will work harder at first but Onc/cards/GI can all own facilities and earn massive ancillary revenue (think one visit for chest pain on exertion that might only pay $300 for the consult but you also order and read a stress test + echo that bill for a combined $5-6k, maybe something is abnormal so get a cMRI for another $5k so that is now potentially $10k for a patient that you only spend a few hours on and lose 20-35% to overhead). Rheum/endo/pulm gonna be tougher but have some potential to out-earn inpt depending on your set up. HM is heavily subsidized and will be prone to plummeting reimbursement in the future whereas cards/gi/onc are not.

 

[Osteoth]

I had a financial adviser who works with physicians only tell me for every Hospitalist making $400k there is a cardiologist making $800k. Averages are averages for all specialties. You can’t take the 90% Hospitalist and compare to 25% cardiologist.