Intern Interested in Rheum and Endo fellow

[bachow]

Hi, I am an intern now in a community hospital. Most of my friends told me to decide the subspecialty now so that I can work on my CV. I am interested in endocrinology and rheumatology. Could anyone tell me the pros and cons of each specialty? And is it really true that their salary will stuck at ~$220k ? Thank you
I am aware that in endo most of the pt will be diabetes, and this year the competitiveness of rheum is like heme-onc (according to NRMP statistic). What would be the future of endo and rheum?
And especially for endo community practice, why choose this subspecialty rather than PCP. I think the scope of practice and patients are pretty similar?and even the salary is also quite similar (most of the time diabetes?)

And can anyone give me insight about superfellowship? I have heard about nephro transplant (which is a superfellowship of nephrologist), but have no idea about endo and rheum superfellowship.

Thank you

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[aafisahar]

endo, not competitive at all. you likely need a thready pulse to match. it's the specialty most like general IM since you manage lots of DM and thyroid.

rheum, getting more competitive, you would need some research and good LORs from rheumatologists. NRMP isn't the whole story since the caliber of applicant isn't similar to heme/onc, cards, GI, despite the relatively low match rate. Still, set yourself up for success.

Personally, I'd set my application up for rheum and if you end up like endo better, you can make an easier transition.

 

[bachow]

Thank you for your reply. I am an IMG without visa. And for the past 3 years no one match into rheum, that is one of my concern. And I think rheum faculty is not too big in my hospital, only 1 doctor. Do you think it is still possible to match in rheum?

 

[IMreshopeful]

Thank you for your reply. I am an IMG without visa. And for the past 3 years no one match into rheum, that is one of my concern. And I think rheum faculty is not too big in my hospital, only 1 doctor. Do you think it is still possible to match in rheum?

Not having rheum faculty at your place or a fellowship is not a good recipe for success as it has become more competitive. It’s pretty easy for people to match IF they set themselves up though - would look at doing away rotations, research year etc.

Just in general what I would say is that simply doing fellowship or subfellowship because it sounds good will not help you. You need to like it. Otherwise for endo (and to some extent rheum) you’re taking a pay cut compared to a hospitalist. The plus side is no emergencies, almost entirely outpatient, and no real call. The choice is yours.

 

[bachow]

I really enjoy both field. But it seems that most of the people are leaning towards rheum.
So the question is, coming from a small community program, if I do away rotations, and make several case reports, will it make me a competitive candidate for rheum?

 

[rokshana]

Your and the poster below you perception of endocrinology is not very accurate.

To the OP have you done a rotation in either? That should be
Your first step in seeing which appeals to you...but endo is not primarily diabetes and certainly not like being a pcp...

In general most people who chose to go into endo (and any of the other non procedural IM subspecialties )do so because of the lifestyle and field itself .

If money is what you are after then do your 3 years and become a Hospitalist. Personally, being a Hospitalist is similar to being a well paid resident and not necessarily a long term career.

And endo is not crazy competitive, but you do need more than a pulse and with the top programs( as with any specialty) are not that easy to get. Find a mentor, do some research or at least present at a National meeting and apply broadly and you shouldn’t have a problem. That goes for rheum as well...rheum is not hem/onc level on competitiveness.

 

[bachow]

Your and the poster below you perception of endocrinology is not very accurate.

To the OP have you done a rotation in either? That should be
Your first step in seeing which appeals to you...but endo is not primarily diabetes and certainly not like being a pcp...

In general most people who chose to go into endo (and any of the other non procedural IM subspecialties )do so because of the lifestyle and field itself .

If money is what you are after then do your 3 years and become a Hospitalist. Personally, being a Hospitalist is similar to being a well paid resident and not necessarily a long term career.

And endo is not crazy competitive, but you do need more than a pulse and with the top programs( as with any specialty) are not that easy to get. Find a mentor, do some research or at least present at a National meeting and apply broadly and you shouldn’t have a problem. That goes for rheum as well...rheum is not hem/onc level on competitiveness.

Thank you for your reply. Nope I have not done a rotation there. People told me to take the rotation that I am interested in during my PGY2 so I would have more knowledge not a fresh intern. I have always been interested in Endo since I was in med school. But I also want to be balance and get good salary. Do you think the salary of endocrinologist can be higher than hospitalist? I read that the salary is trending down from last year. As in rheum, now their salary is trending up (9% from last year according to medscape).

 

[rokshana]

Thank you for your reply. Nope I have not done a rotation there. People told me to take the rotation that I am interested in during my PGY2 so I would have more knowledge not a fresh intern. I have always been interested in Endo since I was in med school. But I also want to be balance and get good salary. Do you think the salary of endocrinologist can be higher than hospitalist? I read that the salary is trending down from last year. As in rheum, now their salary is trending up (9% from last year according to medscape).

That was bad advice on someone’s part...you apply for fellowship in the beginning of 3rd year...not a lot of time to see if you like the field, make connections, go to meetings, present or do research,etc.

If you can still schedule an elective this year, you should or at least try to do it very early in 2nd year so you still have a good portion of the year to build your cv.

Money is what you make it...private practice has no limit...I know someone who makes 500k/yr...he also see like 35 pts a day. Academic will pay less, living in a desirable city will pay less...150-160k not unheard of in a city like Boston or DC...

Medscape not the most accurate...better to look at mgma data

 

[Crayola227]

I really enjoy both field. But it seems that most of the people are leaning towards rheum.
So the question is, coming from a small community program, if I do away rotations, and make several case reports, will it make me a competitive candidate for rheum?

why does it matter if people are leaning towards rheum?

 

[bachow]

why does it matter if people are leaning towards rheum?

Yeah, I really enjoy both fields (rheum and endo). I think because of the cerebral part of it. But most of the people I asked told me to better go for rheum, especially in regards to the income. Still an intern though, so will explore more about it.

 

[bachow]

That was bad advice on someone’s part...you apply for fellowship in the beginning of 3rd year...not a lot of time to see if you like the field, make connections, go to meetings, present or do research,etc.

If you can still schedule an elective this year, you should or at least try to do it very early in 2nd year so you still have a good portion of the year to build your cv.

Money is what you make it...private practice has no limit...I know someone who makes 500k/yr...he also see like 35 pts a day. Academic will pay less, living in a desirable city will pay less...150-160k not unheard of in a city like Boston or DC...

Medscape not the most accurate...better to look at mgma data

I see. So for private practice it really depends on the physician right. I read that most of the endocrinologists only see 10-20 pt/day. Is that because of they want shorter hour, or because no patients in private practice?

 

[rokshana]

I see. So for private practice it really depends on the physician right. I read that most of the endocrinologists only see 10-20 pt/day. Is that because of they want shorter hour, or because no patients in private practice?

The average wait for a new endo patient is 2-4 months...there are plenty of pts and not enough endocrinologists...there are maybe 250 fellows coming out each year with almost half staying in research...the need is there so finding a job is not hard. It’s not a procedural based specialty so reimbursement is not as high.

Endo and new diabetes pts are complicated and need time, which luckily we can schedule...40-60 mins for new is not unusual, so of course if all you see is new, then at best you can see 8-10 pts in a day. In PP I have seen 30 min new and 15 min established so obviously you can see more.

Again, doing a rotation in endo will help you learn these things first hand.

 

[PlutoBoy]

I don’t know much about endocrinology but you should make around $250,000 in rheumatology.

Lifestyle in rheum is great. I know more than a few rheumatologists (my wife is one) and none of them work five days a week. Most work four days a week.

It’s not a procedural field but no one will touch your patients with rheumatological disease as opposed to endocrinology where a lot of people will end up managing diabetes, thyroid issues, osteoporosis, etc. In other words, your turf is more protected as a rheumatologist.

Both are good. I like them both.

 

[rokshana]

I don’t know much about endocrinology but you should make around $250,000 in rheumatology.

Lifestyle in rheum is great. I know more than a few rheumatologists (my wife is one) and none of them work five days a week. Most work four days a week.

It’s not a procedural field but no one will touch your patients with rheumatological disease as opposed to endocrinology where a lot of people will end up managing diabetes, thyroid issues, osteoporosis, etc. In other words, your turf is more protected as a rheumatologist.

Both are good. I like them both.

uh, thought you didn't know that much about endocrine...and osteoporosis is rheum too you know...and the average wait time for seeing an endocrinologist as a new pt is 2-4 months...there are plenty of patients, thank you.

its like me saying, yeah, those fibromyalgia patients are definitely protected patients for the rheumatologist.

 

[PlutoBoy]

uh, thought you didn't know that much about endocrine...and osteoporosis is rheum too you know...and the average wait time for seeing an endocrinologist as a new pt is 2-4 months...there are plenty of patients, thank you.

its like me saying, yeah, those fibromyalgia patients are definitely protected patients for the rheumatologist.

???

Not a lot of non rheumatologists managing SLE , RA, PsA, etc.

Plenty of PCPs managing diabetes and hypothyroidism.

That is all I’m saying.

 

[rokshana]

???

Not a lot of non rheumatologists managing SLE , RA, PsA, etc.

Plenty of PCPs managing diabetes and hypothyroidism.

That is all I’m saying.

as they should...stable DM and hypothyroidism have no need to be followed by endo...(and i know fibro after a couple fo visit are sent back to the PCP as well since there is not much rheum can do with them) and you would be surprised at how many RA pts are followed by their PCP (at least in the community, maybe not so much in academia).

I see < 15% DM, give me the AI, the thyroid cancers, calcium disorders, and pituitary issues...so much more interesting!

 

[bachow]

as they should...stable DM and hypothyroidism have no need to be followed by endo...(and i know fibro after a couple fo visit are sent back to the PCP as well since there is not much rheum can do with them) and you would be surprised at how many RA pts are followed by their PCP (at least in the community, maybe not so much in academia).

I see < 15% DM, give me the AI, the thyroid cancers, calcium disorders, and pituitary issues...so much more interesting!

Is it because you limit the DM patients (like in academia) or is it a general consensus that endo only see <15% DM?

 

[bachow]

That was bad advice on someone’s part...you apply for fellowship in the beginning of 3rd year...not a lot of time to see if you like the field, make connections, go to meetings, present or do research,etc.

If you can still schedule an elective this year, you should or at least try to do it very early in 2nd year so you still have a good portion of the year to build your cv.

Money is what you make it...private practice has no limit...I know someone who makes 500k/yr...he also see like 35 pts a day. Academic will pay less, living in a desirable city will pay less...150-160k not unheard of in a city like Boston or DC...

Medscape not the most accurate...better to look at mgma data

just realized this post. that is awesome for an endo to make 500k/yr.

 

[gutonc]

just realized this post. that is awesome for an endo to make 500k/yr.

You missed (or ignored) the part about seeing 35 patients a day. That sounds like hell.

 

[Kakoy]

You missed (or ignored) the part about seeing 35 patients a day. That sounds like hell.

Completely undoable if you want some life. I will stick with my $250! Thanks!

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