Is IM the worst specialty?

[Handsome88]

Here's what one person once said:

"Stay clear of Internal Medicine. I went into this S!%$ to become a cardiologist and finished with no opportunity to specialize. Life style sucks. Pay sucks. You compete with Family Docs and Nurse Practitioners for patients. Usually you get old, crazy or poor ones. It became a dumping ground for all specialists. When they are finished with "wallet biopsy" you need to take care of the rest including most of the complications of someone else work. Your services are always in demand but rarely paid for. You will have to provide most of uncompensated care.Some of IM attendings drive worse cars than nurses. Even if you like it now, you will hate it before you retire."

Regardless of what this person says, I think IM is one of the few options I have as I will be an IMG in a few years (though from a top 50 school). And I'm also hoping to subspecialize in Cards (even though the pay is now relatively low, but I love cards) to pay off my $350k debt (yes 350, not a typo). His words scare me a little.
I just want to know how I could respond to these claims. Kind of depressing to hear people like these. What are you're thoughts on this?
Thanks.

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[MedicalDoctorV]

Here's what one person once said:

"Stay clear of Internal Medicine. I went into this S!%$ to become a cardiologist and finished with no opportunity to specialize. Life style sucks. Pay sucks. You compete with Family Docs and Nurse Practitioners for patients. Usually you get old, crazy or poor ones. It became a dumping ground for all specialists. When they are finished with “wallet biopsy” you need to take care of the rest including most of the complications of someone else work. Your services are always in demand but rarely paid for. You will have to provide most of uncompensated care.Some of IM attendings drive worse cars than nurses. Even if you like it now, you will hate it before you retire."

Regardless of what this person says, I think IM is one of the few options I have as I will be an IMG in a few years (though from a top 50 school). And I'm also hoping to subspecialize in Cards (even though the pay is now relatively low, but I love cards) to pay off my $350k debt (yes 350, not a typo). His words scare me a little.
I just want to know how I could respond to these claims. Kind of depressing to hear people like these. What are you're thoughts on this?
Thanks.

I'm sorry you have that much debt - I am stressed about $200K-odd debt. As someone once said to me: the only reason to become a Doctor is because you want to be a Doctor. There are easier ways to earn money, faster ways and less painful ways.

Secondly, WTF? " I think IM is one of the few options I have as I will be an IMG in a few years." Don't get down on yourself. There aren't plenty of IMGs in "lucrative" fields, but there are more than a fistfull.

This is going to sound cheesy - but I think the worst specialty is the one that you find yourself in and living a life that you hate.

Despite the money, tons of people go into IM because they love it. My Heme/Onc fellow told me he had a Derm spot and didn't take it - instead went into IM. I was on ICU a few months ago and it was like a Service of traitors - I quit Ophthalmology after a year, my coresident quit Radiology, and our intern left the ENT spot she had matched into without even starting it. People leave other fields to come to IM all the time, despite the "horrendous" earning potential, the crappy hours, the paperwork, and the PAs and NPs that think they can do your job as well as you (i agree, they can perform certain essential functions - that's another post though).

I think you're gonna be fine in IM. If you truly believe otherwise - then there really are other options (and i am not being facetious). Go into Finance - it may be like residency at first - but i guarantee in the long run you'll earn more than any Dermatologist or Plastic Surgeon or even Radiation Oncologist. If you want to stay a doctor, and IM really worries you, take a year or two off and do research and apply to one of those fields "other fields" - some program, somewhere will take you in Radiology. If that's what makes you happy and pays the bills - then do it! If on the other hand someone hands you a $500 000 check each year to do something you hate, I personally - don't think it would be worth it. Others may disagree...

 

[Handsome88]

I'm sorry you have that much debt - I am stressed about $200K-odd debt. As someone once said to me: the only reason to become a Doctor is because you want to be a Doctor. There are easier ways to earn money, faster ways and less painful ways.

Secondly, WTF? " I think IM is one of the few options I have as I will be an IMG in a few years." Don't get down on yourself. There aren't plenty of IMGs in "lucrative" fields, but there are more than a fistfull.

This is going to sound cheesy - but I think the worst specialty is the one that you find yourself in and living a life that you hate.

Despite the money, tons of people go into IM because they love it. My Heme/Onc fellow told me he had a Derm spot and didn't take it - instead went into IM. I was on ICU a few months ago and it was like a Service of traitors - I quit Ophthalmology after a year, my coresident quit Radiology, and our intern left the ENT spot she had matched into without even starting it. People leave other fields to come to IM all the time, despite the "horrendous" earning potential, the crappy hours, the paperwork, and the PAs and NPs that think they can do your job as well as you (i agree, they can perform certain essential functions - that's another post though).

I think you're gonna be fine in IM. If you truly believe otherwise - then there really are other options (and i am not being facetious). Go into Finance - it may be like residency at first - but i guarantee in the long run you'll earn more than any Dermatologist or Plastic Surgeon or even Radiation Oncologist. If you want to stay a doctor, and IM really worries you, take a year or two off and do research and apply to one of those fields "other fields" - some program, somewhere will take you in Radiology. If that's what makes you happy and pays the bills - then do it! If on the other hand someone hands you a $500 000 check each year to do something you hate, I personally - don't think it would be worth it. Others may disagree...

Thanks for the wise words. I agree with you 100%. If I cared that much about money I wouldn't be spending that much of it to study medicine. I do not want to make half a million a year. I just want enough to pay off my debts while enjoying the rest of my life. And the only specialties that can do that for me are the very competitive ones. I liked EM until this year when it became super competitive and too risky for me. My second option would be either IM or neuro. IM seems to be a wiser choice as there's room for improvement if I subspecialize. I like the idea of it as a field but I do not like the inconveniences mentioned above that come with it.

Can you explain to me the reasons behind why you and all these people switched from their highly desirable specialties to IM? Why did you/they love it so much when it seems to have the worst of both worlds (lifestyle and pay). Excuse my ignorance but I'm still in my pre-clinical years.

I don't know if I would be able to go through 3 years (or 5 in Canada) of IM just to end up not being able to get that fellowship, and end up doing IM all my life.

 

[Brachyury]

Here's what one person once said:

"Stay clear of Internal Medicine. I went into this S!%$ to become a cardiologist and finished with no opportunity to specialize. Life style sucks. Pay sucks. You compete with Family Docs and Nurse Practitioners for patients. Usually you get old, crazy or poor ones. It became a dumping ground for all specialists. When they are finished with “wallet biopsy” you need to take care of the rest including most of the complications of someone else work. Your services are always in demand but rarely paid for. You will have to provide most of uncompensated care.Some of IM attendings drive worse cars than nurses. Even if you like it now, you will hate it before you retire."

Regardless of what this person says, I think IM is one of the few options I have as I will be an IMG in a few years (though from a top 50 school). And I'm also hoping to subspecialize in Cards (even though the pay is now relatively low, but I love cards) to pay off my $350k debt (yes 350, not a typo). His words scare me a little.
I just want to know how I could respond to these claims. Kind of depressing to hear people like these. What are you're thoughts on this?
Thanks.

What?

 

[pntgrd]

It is stupid to pick a specialty so that you can pay your debt off (how did you end up with that much anyway?)
Furthermore, you could make over 300k as an internist in the extra years you'd be doing a cardiology fellowship.

 

[knor30]

Here's what one person once said:

Take N of 1 statements with a grain of salt. It's also risky to choose a field based on what will position you best for debt repayment. You'd need to enjoy, or at least tolerate, the field in order to continue long enough to start making legitimate money.

 

[Handsome88]

What?

I'm referring to the IMG friendly specialties. I do not want to apply to a specialty only to end up not matching anywhere. And as an IMG that's like a death sentence. That's why I want to take the safe route.
What other specialties could an IMG apply to?

 

[Handsome88]

It is stupid to pick a specialty so that you can pay your debt off (how did you end up with that much anyway?)
Furthermore, you could make over 300k as an internist in the extra years you'd be doing a cardiology fellowship.

An internist with 300k? That's the first time I hear such a number. I've always heard numbers from 150-230k...nowhere near 300k. Is that even possible for a general internist?

I will have a ~350k debt by the time I finish residency because I'm studying at a school with tuition fees over 45k per year (a 5 yr program!).

Also, I am not talking about pay only. I'm talking about pay per hour worked. IM has one of the worst hours AND a bad pay, making it the worst specialty. So far no one has proved this wrong.

 

[smarty666]

An internist with 300k? That's the first time I hear such a number. I've always heard numbers from 150-230k...nowhere near 300k. Is that even possible for a general internist?

I will have a ~350k debt by the time I finish residency because I'm studying at a school with tuition fees over 45k per year (a 5 yr program!).

I think he meant 300k for an Internist over a 3 year period that a Cardio fellow would be training in, not 300k a year for a Internist.

 

[Handsome88]

I think he meant 300k for an Internist over a 3 year period that a Cardio fellow would be training in, not 300k a year for a Internist.

Oh I see. But again, I don't care about making that much money. I don't mind making 180k as long as I have good working conditions and a good lifestyle/working hours. IM doesn't seem to have that. Cards may have a bad lifestyle too but at least you are getting a little more compensation for your work.
I know this is the wrong board to ask this, but anyone knows if neuro has the same problem?

 

[lipstikisntfood]

I would recommend learning the difference between you're and your as a first step, before trying to choose a specialty. Good communication skills, including good written communication skills, are important for doctors in all fields.

 

[gutonc]

Oh I see. But again, I don't care about making that much money. I don't mind making 180k as long as I have good working conditions and a good lifestyle/working hours. IM doesn't seem to have that. Cards may have a bad lifestyle too but at least you are getting a little more compensation for your work.
I know this is the wrong board to ask this, but anyone knows if neuro has the same problem?

If you're asking whether neuro has clueless pre-meds/MS1-2s coming on to their board making poorly researched blanket statements like "you can't make any money in IM and the lifestyle sucks," then yes, they probably do have the same problem.

I'm not sure who you're listening to (or why) about IM and the lifestyle/salary issue but perhaps talking to some internists and hospitalists as well as some IM specialists would be a better use of your time. Hospitalist gigs pay pretty well ($150K-275K depending on location and type of practice) and generally have something like a 7-on/7-off schedule although there are plenty of other staffing models with and without nights. I have a friend who is a PCP in the Kaiser system. He works 4.5 days/wk, no nights, no weekends, no inpatient duties unless he chooses to moonlight for $1400/shift and his base salary (starting) is $175K not including bonuses. I have other friends doing PP primary care making similar or better money with similar work hours.

Clearly these are just anecdotes as well, but they are anecdotes with numbers attached unlike your (clearly unhappy) source.

As for which specialty you should choose, as an IMG (and way to be vague on the school...it does matter), your options will be more limited than a US MD or DO student with similar Step scores and CV. So if you really want to do Cards (just as competitive if not moreso for IMGs as EM is), you better be sure you can be happy with general IM if that's the way the chips fall for you.

 

[gutonc]

I would recommend learning the difference between you're and your as a first step, before trying to choose a specialty. Good communication skills, including good written communication skills, are important for doctors in all fields.

Actually, I couldn't find a place where the OP used them incorrectly.

 

[bronx43]

Actually, I couldn't find a place where the OP used them incorrectly.

First post, last line... not that I care.

 

[gutonc]

First post, last line... not that I care.

At least he didn't write "ur" or "yr" or something equally painful.

 

[Bonza Debogian]

Wow. Don't forget about neurology, ob/gyn, family medicine, peds, emergency med, PMNR - all clearly more sucky than IM. Many others debatable. Moreover, sub-specialties should not be your goal now. Work on IM - I'm working as a hospitalist now for one year before starting a cards fellowship. Gunna make >$200,000 this year, working a little more than half the year. Question all the time why I'm taking a pay cut for 3-4 years to train more.

 

[Handsome88]

Wow. Don't forget about neurology, ob/gyn, family medicine, peds, emergency med, PMNR - all clearly more sucky than IM. Many others debatable. Moreover, sub-specialties should not be your goal now. Work on IM - I'm working as a hospitalist now for one year before starting a cards fellowship. Gunna make >$200,000 this year, working a little more than half the year. Question all the time why I'm taking a pay cut for 3-4 years to train more.

Sorry but I don't understand why FM and EM are worse. FM has lower pay but their lifestyle is better (more flexibility). EM is much higher pay, with equal if not better lifestyle. I like IM, but I don't know why Dr's in that field can't ask for a higher pay for the job they're doing! They obviously work harder than Dermatologists. They're saving peoples lives everyday and their pay is less than that of a psychologist who can hardly figure out the problem let alone the treatment. IM should have at least 50k additional compensation.
Did you already get the fellowship? If so then congrats.

 

[kafkaontheshore]

Sorry but I don't understand why FM and EM are worse. FM has lower pay but their lifestyle is better (more flexibility). EM is much higher pay, with equal if not better lifestyle. I like IM, but I don't know why Dr's in that field can't ask for a higher pay for the job they're doing! They obviously work harder than Dermatologists. They're saving peoples lives everyday and their pay is less than that of a psychologist who can hardly figure out the problem let alone the treatment. IM should have at least 50k additional compensation.
Did you already get the fellowship? If so then congrats.

I respectfully submit that none of these specialties are "worse" than one another.

There is too much emphasis in today's culture on objective rankings (see US News) - am I buying the "best" things? am I getting the "best" education? am I going to the "best" hospital? It's a concept that sells well, but I'm doubtful as to its actual value.

I think it is helpful to realize that while there are objective measures that can help you better understand your personal fit with a particular job, in the end, the determination is just that - personal.

IM may be the best for you, or EM, or FM, but you will have to figure that out yourself, and after a certain point no one on a board or in a magazine will be able to help you.

 

[guj]

I respectfully submit that none of these specialties are "worse" than one another.

There is too much emphasis in today's culture on objective rankings (see US News) - am I buying the "best" things? am I getting the "best" education? am I going to the "best" hospital? It's a concept that sells well, but I'm doubtful as to its actual value.

I think it is helpful to realize that while there are objective measures that can help you better understand your personal fit with a particular job, in the end, the determination is just that - personal.

IM may be the best for you, or EM, or FM, but you will have to figure that out yourself, and after a certain point no one on a board or in a magazine will be able to help you.

I agree with this post.............In the end everybody has to figure out what is best for himself/herself and then stick with it.
In every field, in the starting you are gonna hate it but if you somehow sail trough the beginning you will soon realize the positive sides of your choice.

 

[gutonc]

Sorry but I don't understand why FM and EM are worse. FM has lower pay but their lifestyle is better (more flexibility). EM is much higher pay, with equal if not better lifestyle. I like IM, but I don't know why Dr's in that field can't ask for a higher pay for the job they're doing! They obviously work harder than Dermatologists. They're saving peoples lives everyday and their pay is less than that of a psychologist who can hardly figure out the problem let alone the treatment. IM should have at least 50k additional compensation.

Holy crap! Are you remaining clueless on purpose or do you have some selective reading problems that may need to be addressed before you graduate med school?

FM has lower pay but their lifestyle is better (more flexibility).

Lower pay than what? More flexible than what?

EM is much higher pay, with equal if not better lifestyle.

Higher than what, better than what? Define your terms. Also, you need to start quoting something vaguely related to data or just stop talking.

They obviously work harder than Dermatologists.

My dad...a former automobile mechanic on disability whose day consists of channel surfing and weeding the garden works harder than a Dermatologist. So what?

They're saving peoples lives everyday and their pay is less than that of a psychologist who can hardly figure out the problem let alone the treatment.

Holy non sequitir Batman! I don't even know what to do with this.

IM should have at least 50k additional compensation.

Compared to?

Maybe you missed my post above where I mentioned several general IM docs I know who make ~200K 1-2y out from residency. I'm sure they'd all love an extra $50K (who wouldn't) but I don't think any of them are starving to death.

 

[Handsome88]

Holy crap! Are you remaining clueless on purpose or do you have some selective reading problems that may need to be addressed before you graduate med school?



Lower pay than what? More flexible than what?



Higher than what, better than what? Define your terms. Also, you need to start quoting something vaguely related to data or just stop talking.



My dad...a former automobile mechanic on disability whose day consists of channel surfing and weeding the garden works harder than a Dermatologist. So what?



Holy non sequitir Batman! I don't even know what to do with this.


Compared to?

Maybe you missed my post above where I mentioned several general IM docs I know who make ~200K 1-2y out from residency. I'm sure they'd all love an extra $50K (who wouldn't) but I don't think any of them are starving to death.

Why are you so anal about grammar? The topic is obviously about IM, and so all my comparisons are with IM. I can find grammar mistakes in your posts as well:

"My dad...a former automobile mechanic on disability whose day consists of channel surfing and weeding the garden works harder than a Dermatologist."
The garden works harder than a dermatologist? You're missing a comma in there.

I did read your post but it still did not refute the fact that IM has a low salary compared to its ****ty lifestyle. Sure some students choose it because "they like it" but doesn't change the fact that it is still bad.

Sure SOME general IM docs make 200+k. But what I'm talking about are average salaries.

You want sources? http://www.medfriends.org/images/salary,%20work%20hours.jpg This shows IM having one of the lowest salaries while having the most work hours with uncontrollable lifestyle. Give me one other specialty that has a higher work hours with a lower AVERAGE salary than IM. This only proves that it IS the worst specialty in terms of pay to work hours/lifestyle ratio. Prove me wrong, or is it that when you are unable to refute the claim you start bashing and mocking the post.

 

[bronx43]

Wow. Don't forget about neurology, ob/gyn, family medicine, peds, emergency med, PMNR - all clearly more sucky than IM. Many others debatable. Moreover, sub-specialties should not be your goal now. Work on IM - I'm working as a hospitalist now for one year before starting a cards fellowship. Gunna make >$200,000 this year, working a little more than half the year. Question all the time why I'm taking a pay cut for 3-4 years to train more.

Wtf, how are all those specialties "clearly" more "sucky" than IM? To even make such a comparison, you'll need to delineate the exact criteria you use. Are you going purely by compensation? Hours worked? The intensity of said hours? The way you measure intensity of said hours?
As the other guy said, you would be hard pressed to make an argument that any specialty is inherently better than any other, especially with the criteria that seems to be entrenched in students' minds. Compensation and "hours worked" are inherently tied together, and is nothing but an artificial assignment of value/price by third parties, entirely removed from any free market forces. There's really no coherent argument anyone can make why a certain procedure is reimbursed the way it is.

 

[gutonc]

Why are you so anal about grammar? The topic is obviously about IM, and so all my comparisons are with IM. I can find grammar mistakes in your posts as well:

Oy with the reading comprehension problems again. I'm beginning to understand why you had to go offshore in the first place. I'm actually the one who defended your grammar (and, as long as you don't post in txtspk, I don't really care)

I did read your post but it still did not refute the fact that IM has a low salary compared to its ****ty lifestyle. Sure some students choose it because "they like it" but doesn't change the fact that it is still bad.

Sure SOME general IM docs make 200+k. But what I'm talking about are average salaries.

I'm not sure where you keep getting the idea of crappy lifestyle and pay in IM.

You want sources? http://www.medfriends.org/images/salary,%20work%20hours.jpg This shows IM having one of the lowest salaries while having the most work hours with uncontrollable lifestyle. Give me one other specialty that has a higher work hours with a lower AVERAGE salary than IM. This only proves that it IS the worst specialty in terms of pay to work hours/lifestyle ratio. Prove me wrong, or is it that when you are unable to refute the claim you start bashing and mocking the post.

So...
Thing 1: If you're going to post sources, you should post the primary data which is from a nearly 10 year old JAMA study (published in 2003 so data collected in 2000-2002).

Thing 2: From the same link you sent (backed up to the main site, then clicking on the Physician Salaries link on the left side, then headed to the most recent Physician Compensation Survey - 2006, 5 years old), I found this: http://cejka.force.com/PhysicianCompensation. This puts median IM compensation at ~$215K/year which, while not nearly the highest, is also clearly not the lowest.

But honestly...do what you want to do, forget the money. No matter how much money you make or how few hours you work to get it, if you hate it, you'll be miserable. If you love EM (once you actually do your clinicals and have some experience with it), then go for EM. If you love IM (or Peds or Gen Surg or Gyn or Psych or whatever), then go for that.

Don't get hung up on the money - you said you weren't interested in that but that seems to be your only concern - if you do, you'll be miserable.

 

[WorkaholicsAnon]

Here's what one person once said:

"Stay clear of Internal Medicine. I went into this S!%$ to become a cardiologist and finished with no opportunity to specialize. Life style sucks. Pay sucks. You compete with Family Docs and Nurse Practitioners for patients. Usually you get old, crazy or poor ones. It became a dumping ground for all specialists. When they are finished with “wallet biopsy” you need to take care of the rest including most of the complications of someone else work. Your services are always in demand but rarely paid for. You will have to provide most of uncompensated care.Some of IM attendings drive worse cars than nurses. Even if you like it now, you will hate it before you retire."

Regardless of what this person says, I think IM is one of the few options I have as I will be an IMG in a few years (though from a top 50 school). And I'm also hoping to subspecialize in Cards (even though the pay is now relatively low, but I love cards) to pay off my $350k debt (yes 350, not a typo). His words scare me a little.
I just want to know how I could respond to these claims. Kind of depressing to hear people like these. What are you're thoughts on this?
Thanks.

Well I mean it depends on what you're looking for from your profession.

It's true i hear that the medical business environment is not the best out there these days. But the great plus of internal medicine is there are 1000 different career paths you can take with it. Even if you choose to do a private primary care practice, a lot of the issues he complains about can be ameliorated with a little bit of business acumen (which I know we as physicians are painfully lacking). Take a part time MBA course, or alternatively, hire a good business manager (perhaps the more practical way to go), market your practice. A good way to not become bitter is to have a patient-focused attitude. But i know it's hard to do that when you're worried about meeting your overhead and when you have to fight with insurance companies who dont feel the need to appropriately compensate your time, efforts, and expertise because they want to make a nice big profit. Someone mentioned to me that a good business manager who is well versed in medical insurance lingo and practices can handle those issues for you.

it sounds like this guy just didn't set up his practice too optimally, or works for a group that isn't set up well. No two clinics are alike. No two hospitals are alike. Being a hospitalist in one hospital can be a way different experience from being a hospitalist in another hospital.

 

[SeekerOfTheTree]

You guys are funny. I like this thread. I love IM, that's all I gotta say.

 

[Handsome88]

You guys are funny. I like this thread. I love IM, that's all I gotta say.

Hey can you tell me why you love it? I love it too but I read things like what I've said in my original post and it worries me. I want something to respond to those people from residents and practicing doctors. Some of the posts above makes it sound better than what it seems! So thanks for the contributions.

 

[gutonc]

Hey can you tell me why you love it? I love it too but I read things like what I've said in my original post and it worries me. I want something to respond to those people from residents and practicing doctors. Some of the posts above makes it sound better than what it seems! So thanks for the contributions.

Why do you need to justify your decision to others? If it's what you want to do, then do it. Tell everybody else (including your parents) to suck it.

 

[abcabc1]

I respectfully submit that none of these specialties are "worse" than one another.

There is too much emphasis in today's culture on objective rankings (see US News) - am I buying the "best" things? am I getting the "best" education? am I going to the "best" hospital? It's a concept that sells well, but I'm doubtful as to its actual value.

I think it is helpful to realize that while there are objective measures that can help you better understand your personal fit with a particular job, in the end, the determination is just that - personal.

IM may be the best for you, or EM, or FM, but you will have to figure that out yourself, and after a certain point no one on a board or in a magazine will be able to help you.

This post is spot on. We really need to treat people as INDIVIDUALS and realize that what's good for one person is not good for another. There are people who could get into Medical School, graduate without much debt and make a lot of money who don't even consider Medicine because it doesn't interest them. Other people would be happy as Physicians making < $100K/annum, so long as the finances worked out.

Rankings can be used as a reference and they are valid in the sense that it's not hard to make the case that MIT has a stronger Math program than University of Tennessee, but pouring over which program is #5 vs #11, etc is probably a bit too much. You certainly don't want to give the staff at US News & World Report too much authority over the decisions you make.

The problem in Medicine is that Educational costs are skyrocketing while incomes are stagnating (at best). If nothing changes, it wouldn't surprise me if elite Medical Schools are begging people to attend 30+ years down the road. A simple FV calculation in Excel gave me a cost of $1.2 M for a Medical Degree in 30 years with an annual inflation of 5% and current cost of $70K.

I don't have the answer, but these costs need to come down. Some people say the easy credit is the cause; there is no way Universities could charge so much if it weren't so easy to borrow these insane amounts of money. This would force Universities to lower their charges or cease to exist.

 

[Arb]

What a frustrating thread. You really need to calm down with posts like these (which are getting annoying) and concentrate on getting a proper education.

But, to maybe ease your mind, in Ontario Canada the average general internal hospitalist salary was $320K in 2006. I worked with family doctors in Northern Ontario who had starting salaries of $450k working 40hrs a week and guaranteed 8 weeks vacation. Met the CEO and recruiter and was urged to do FM and work for them after. Money will be available if you're willing to look for the opportunity.

 

[heathen]

The above IM salaries sound reasonable for a GP. I've heard of people making 300k in Orlando, practicing general IM. In the end, like many of my attendings have said, it comes down to how you invest your money and how much you need to support your lavish lifestyle. It sucks that you'll have 350k in loans, but maybe you could work in an under-served area to help pay off your loans. None of my attendings ever bitched about their loans. Realize we're in a great profession, with a guaranteed base salary that is in the top 5 or so percentile. Sure, Rads make more money and have a "better lifestyle". But, research each field and talk to folks in it before jumping on a specialty bandwagon. Lastly, wait till the end of 3rd year to make your decision, and take it easy for now.

 

[Handsome88]

What a frustrating thread. You really need to calm down with posts like these (which are getting annoying) and concentrate on getting a proper education.

But, to maybe ease your mind, in Ontario Canada the average general internal hospitalist salary was $320K in 2006. I worked with family doctors in Northern Ontario who had starting salaries of $450k working 40hrs a week and guaranteed 8 weeks vacation. Met the CEO and recruiter and was urged to do FM and work for them after. Money will be available if you're willing to look for the opportunity.

Sorry to bring out my frustration on the boards here.
These numbers are for Canada, where IM is not primary care (which gives FP more job opportunities to do). I like the Canadian system more and hope US could look into their system as it seems to be working better (I hear that doctor shortages will be over by 2017 in Canada), that's why I am trying my best to go back to Canada, US is my back-up plan. EM for example is more of a primary care in Canada and there rest of the world, where as in the US they are considered specialists?

Anyways, again I don't mean to sound annoying with my posts, I know I'm going a little overboard.

P.S. Do you mind giving me the source of these stats? Thanks!

 

[Shah_Patel_PT]

Why are you so anal about grammar? The topic is obviously about IM, and so all my comparisons are with IM. I can find grammar mistakes in your posts as well:

"My dad...a former automobile mechanic on disability whose day consists of channel surfing and weeding the garden works harder than a Dermatologist."
The garden works harder than a dermatologist? You're missing a comma in there.

I did read your post but it still did not refute the fact that IM has a low salary compared to its ****ty lifestyle. Sure some students choose it because "they like it" but doesn't change the fact that it is still bad.

Sure SOME general IM docs make 200+k. But what I'm talking about are average salaries.

You want sources? http://www.medfriends.org/images/salary,%20work%20hours.jpg This shows IM having one of the lowest salaries while having the most work hours with uncontrollable lifestyle. Give me one other specialty that has a higher work hours with a lower AVERAGE salary than IM. This only proves that it IS the worst specialty in terms of pay to work hours/lifestyle ratio. Prove me wrong, or is it that when you are unable to refute the claim you start bashing and mocking the post.

Here is 2010 Data on Internal Medicine Hospitalists across the country.

 

[SoulinNeed]

Here is 2010 Data on Internal Medicine Hospitalists across the country.

Does that study include IM sub-specialties (Cardiology, etc.)? Or just straight IM docs, because it seems pretty damn high.

 

[IMDoc2010]

If you read the text above the table, it states HOSPITALIST/Internal Medicine hence they do NOT include subspecialists.

Does that study include IM sub-specialties (Cardiology, etc.)? Or just straight IM docs, because it seems pretty damn high.

 

[Pkboi24]

Does that study include IM sub-specialties (Cardiology, etc.)? Or just straight IM docs, because it seems pretty damn high.

With a 50/50 base salary/production model at a private nonteaching hospital in the South, $250-300k would not be surprising. If you're going into a medicine subspecialty for money, it seems the time investment would be better made elsewhere. With the extra 3 years, I'm guessing you may be able to make an extra $100k, if even that. If someone can prove me wrong, please do.

 

[Shah_Patel_PT]

Does that study include IM sub-specialties (Cardiology, etc.)? Or just straight IM docs, because it seems pretty damn high.

Does not include cards.

Cards average salary for non-invasive cards starts at 300K.

 

[vir0n]

.

 

[Pkboi24]

Pkboi24, I made an analysis of hospitalist vs specialist earnings (over 30 years) taking into consideration training time in a spreadsheet form just for you. You can plug in numbers as you wish - just change the numbers in red. I didn't look for accurate salary data since a lot of it is location, private/academic, etc.

let me know if you notice errors

Wow, I'm so flattered that you took such troubles. Although admittedly, it took some courage to download a file from the internetz uploaded by a guy name vir0n.

Anyhoo, I took a look at it and supposing this is close to real life salary increases, the difference looks to be about 2-3 million. But you'd also have to take into account that a Cardiologist is probably working 1.5-2X as much as a hospitalist and doing procedures that are higher risk with higher malpractice insurance premiums. Personally, I still think that you're getting paid less to do more...

 

[vir0n]

Wow, I'm so flattered that you took such troubles. Although admittedly, it took some courage to download a file from the internetz uploaded by a guy name vir0n.

Anyhoo, I took a look at it and supposing this is close to real life salary increases, the difference looks to be about 2-3 million. But you'd also have to take into account that a Cardiologist is probably working 1.5-2X as much as a hospitalist and doing procedures that are higher risk with higher malpractice insurance premiums. Personally, I still think that you're getting paid less to do more...

Looking at a "per hour basis" will make things different. It would be easy to throw that into the spreadsheet taking into account some assumptions with regards to time being made. This spreadsheet shows one's pure reward for their efforts. Now what happens to the time sacrificed to earn it, well, that's up for those wanting to specialize to decide.

 

[Pkboi24]

Looking at a "per hour basis" will make things different. It would be easy to throw that into the spreadsheet taking into account some assumptions with regards to time being made. This spreadsheet shows one's pure reward for their efforts. Now what happens to the time sacrificed to earn it, well, that's up for those wanting to specialize to decide.

Seeing how most Hospitalists now work different schedules. From roughly 14 - 26 days a month, it would be interesting to see a break down of the compensation per unit of work time.

 

[Cirrus83]

What a frustrating thread. You really need to calm down with posts like these (which are getting annoying) and concentrate on getting a proper education.

But, to maybe ease your mind, in Ontario Canada the average general internal hospitalist salary was $320K in 2006. I worked with family doctors in Northern Ontario who had starting salaries of $450k working 40hrs a week and guaranteed 8 weeks vacation. Met the CEO and recruiter and was urged to do FM and work for them after. Money will be available if you're willing to look for the opportunity.

Yeah but those kinds of figures only come when you live in a pretty damned rural part of Ontario. And FP's up there have to do a lot more work since they're basically the only docs around in those places. It's basically hazard pay for living in a super cold rural area. If you like that kind of surrounding it's great and I know lots of people who wanna go for that but most people would probably rather live a lot closer to a big city. Income taxes are also a bit higher in Canada, not to mention that whenever you want to spend money you'll be hit with a lot more sales tax than in the U.S. At the end of the day everyone lives a similarly comfortable lifestyle to be honest.

 

[Bostonredsox]

An internist with 300k? That's the first time I hear such a number. I've always heard numbers from 150-230k...nowhere near 300k. Is that even possible for a general internist?

I will have a ~350k debt by the time I finish residency because I'm studying at a school with tuition fees over 45k per year (a 5 yr program!).

Also, I am not talking about pay only. I'm talking about pay per hour worked. IM has one of the worst hours AND a bad pay, making it the worst specialty. So far no one has proved this wrong.

I have many friends making between 250k-315k in average size cities in upstate NY, NC, VA and PA as hospitalsits. None of them work more than 50 hours a week and they all got signing bonuses. They all have also said they have opportunites to moonlight if they wanted too. I am going to be an internist with aspirations of pulm/cc, but will likely become a hospitalist atleast for the short-term and I also have 350k in debt...and kids. There are lots of opportunities to make 300k with good hours as a hospitalist.

 

[Leforte]

A bit off topic, but thought I'd get out of the surgery area for a few minutes -

To the OP - You can do well in IM. I have several close colleagues who do as well as I do as a surgical subspecialist. They also have far more flexibility to take time off and pursue other things outside of the hospital. I would also say that a good IM physician is worth their weight in gold and have saved me on more than one occasion. If you are a hospitalist and provide great care, you will be sought out from people from other specialties for inpt consults, etc, which is how you increase your RVUs and subsequently, your reimbursement. While you may feel as if you are competing against FP and NPs, you are not. There is a clear difference in knowledge that is recognized by any competent physician/surgeon and they will want that knowledge and expertise when you are consulted to help manage their patient. Indeed, there are hospitalist that I specifically consult to help with my patients and others that I prefer stay away, not necessarily due to lack of knowledge, but more due to lack of communication.

While I try to not "dump" on IM physicians and I would admit that I occasional do request that they manage a pt with dehydration during primary chemoradiation or other similar problem, I do think that these people are best managed by an IM physician - moreover, due to their complexity, it is quite easy for the hospitalists to bill for a much higher level of care.

I would have to agree with some of the earlier comments - you have gotten one person's opinion of their practice. This does not necessarily relate to how you will feel in your practice once you get past your training. While your debt is high, you will make enough to pay it once you are done. There are plenty of positions post training that either will assist with loan repayment or have a higher salary which can be used to pay down your debt. The issue I have seen with new grads is the desire to cash in early in their career and on top of their student loan debt, quickly amass the McMansion, Beamer, etc soon after residency. You sound more grounded, and as long as you stay away from that temptation, it will all work out OK.

In anycase, sorry to hijack an IM thread, but was bored and surfing around.

PS - I hope I got the "your" and "you're" correct....

 

[Arb]

A common misconception. A few hours outside of Toronto is hazardous? Granted, these clinics and hospitals are in small towns but you should visit Northern Ontario to see what it's really like. It's quite nice actually. Family doctors at the places you are alluding can make $700K/year and still be near cities like Thunder Bay. My point is that for those who are stressed about money, there will be opportunities to make big money. There's no lifetime contract so you can make in 5 years what would take you 15-20 years to make in Toronto and then move to wherever you want.

Yeah but those kinds of figures only come when you live in a pretty damned rural part of Ontario. And FP's up there have to do a lot more work since they're basically the only docs around in those places. It's basically hazard pay for living in a super cold rural area. If you like that kind of surrounding it's great and I know lots of people who wanna go for that but most people would probably rather live a lot closer to a big city. Income taxes are also a bit higher in Canada, not to mention that whenever you want to spend money you'll be hit with a lot more sales tax than in the U.S. At the end of the day everyone lives a similarly comfortable lifestyle to be honest.

 

[NOsquid]

Some of IM attendings drive worse cars than nurses.

 

[Bostonredsox]

Some people don't value nice cars much. I know attendings who drive 25k honda accords and live in 800k homes on a lake in a primetime area. It's all about what you want in life.

 

[NOsquid]

Exactly. The OP should have taken up rapping if he wanted to stunt.

I'll never spend big money on a car or home, to each his own.

 

[HeartsHearts]

I've gotta say that IM is the best ... because it was the one I liked, lol. Just do what you like because I've gotta tell you, the alternative is so painful that no amount of $$$ makes up for it. My one week of radiology made me die inside.

... yeah its the touchy feel-y answer. But seriously, IMO radiology = death of happiness. Death. of Happiness.

 

[guj]

... yeah its the touchy feel-y answer. But seriously, IMO radiology = death of happiness. Death. of Happiness.[/QUOTE]


I agree about that. The problem these days is people decide on speciality depending more on the pay and lifestyle and importantly peer pressure instead on the interest and liking. (eg my class mates will think I am a loser if I choose to pursue family medicine or Internal medicine etc etc)

Maybe our generation is more $$$ crazy but I do feel still no matter whatever you do FIRST and FOREMOST is whether you enjoy it or not. But it is very hard to understand these complex issues especially at this crucial and stressful time of our life time.

 

[Bostonredsox]

I'm IM-->Pulm/CC. Hours suck. Length of training blows. Lot's of your patients die. In-house call as an attending is common. Pay is 1/2 cards and GI. Bottom line....I love the ICU.