Job market for different specialties?

[sloop]

I think the point is moreso not trying to comment on the market now but 5 years from now. Isn’t independent pa/np practice still relatively new in New York State. Now there is even more of an incentive for New Yorkers to pursue these degrees. There could be a lag period.

The psych market isn’t significantly threatened.

People paying cash are always going to choose a physician. Nobody is paying hundreds of dollars for an intake with an NP.

Midlevels are generally not comfortable with the complexity of inpatient settings, at least not if they’re managing them independently. In my case, they’re even less comfortable with forensic inpatient settings. Also, they almost always refuse to do any call whatsoever. The facilities need this type of coverage and it is often more cost effective to just hire a full time psychiatrist who is willing to do this coverage as part of the job than to hire a bunch of moonlighters to do it.

Midlevels might encroach a bit on the insurance-reimbursed outpatient market but I have never heard of anybody having a problem filling a practice while accepting insurance. Also, NPs inevitably either refer complicated patients out or they seek a new provider because they’re horribly mismanaged and don’t get better. There are plenty of these patients.

Also (always willing to plug my own field), if you do forensic work, you’re almost entirely safe. Nobody is paying serious money to have an NP write a report/testify for their medicolegal case. Even if they did, they’d get destroyed by an opposing physician expert.

Overall, I just don’t think there is cause for doom and gloom in psychiatry.

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[voxveritatisetlucis]

The psych market isn’t significantly threatened.

People paying cash are always going to choose a physician. Nobody is paying hundreds of dollars for an intake with an NP.

Midlevels are generally not comfortable with the complexity of inpatient settings, at least not if they’re managing them independently. In my case, they’re even less comfortable with forensic inpatient settings. Also, they almost always refuse to do any call whatsoever. The facilities need this type of coverage and it is often more cost effective to just hire a full time psychiatrist who is willing to do this coverage as part of the job than to hire a bunch of moonlighters to do it.

Midlevels might encroach a bit on the insurance-reimbursed outpatient market but I have never heard of anybody having a problem filling a practice while accepting insurance. Also, NPs inevitably either refer complicated patients out or they seek a new provider because they’re horribly mismanaged and don’t get better. There are plenty of these patients.

Also (always willing to plug my own field), if you do forensic work, you’re almost entirely safe. Nobody is paying serious money to have an NP write a report/testify for their medicolegal case. Even if they did, they’d get destroyed by an opposing physician expert.

Overall, I just don’t think there is cause for doom and gloom in psychiatry.

Forensic sounds very interesting. What is the practice setting like? I would assume that you’re in court and or a law office pretty often?

 

[sloop]

Forensic sounds very interesting. What is the practice setting like? I would assume that you’re in court and or a law office pretty often?

Multiple practice settings depending on what you want to do. The treatment side of forensics involves treating patients in high security settings such as correctional settings or forensic hospital settings where people are committed because they’re incompetent to stand trial or they have received an insanity acquittal. The medicolegal side of forensics involves doing evaluations to answer specific legal questions, and they can be either civil or criminal cases. Criminal examples include things like insanity, competency to stand trial, presentence evaluations, etc. Civil examples include things like psychological damages, guardianship, testamentary capacity, etc.

Testimony is definitely part of the job, as is working with attorneys. If you’re doing private forensic evaluations, you may meet people in a law office or in office space the attorney has rented. If it’s an incarcerated defendant, you might meet them in the jail/prison or in a forensic hospital. It’s pretty varied. If you are doing private work, you bill for your travel time.

 

[Lawpy]

Speaking of job markets…

 

[Splenda88]

IM job market is great... Not difficult to make 350k-400k/yr and you dont have to kill yourself.

 

[voxveritatisetlucis]

IM job market is great... Not difficult to make 350k-400k/yr and you dont have to kill yourself.

Is this possible in cities in Midwest or Southeast (ie. Cincinnati, Detroit Minneapolis, Atlanta, Nashville, Miami)?

Or just rural

 

[Splenda88]

Is this possible in cities in Midwest or Southeast (ie. Cincinnati, Detroit Minneapolis, Atlanta, Nashville, Miami)?

Or just rural

Not Miami, but you can make 350k+ in these other cities ... For instance, a good friend of mine contract is 308k/yr (7 days on/off) in Atlanta suburbia.. can get to 350k picking up a couple of shifts here and there.

I am projected to make 400k+ this year without killing myself (working 17.5 days/month on average seeing an average 17 patients a day). I am a hospitalist and I am in s small city of 60k people

 

[RickyScott]

As an attending, many years removed from medschool, would love to know from a psychological and sociological standpoint why medstudents still consider fields like er and radonc. Granted they are at the bottom of the match, but with so many interesting specialties, why would anyone take the risk of being unemployed or at best totally beholden to an employer because you have no other options? Unemployment was never a scenario I considered during medschool for any specialty. Is it stupidity, gullibility?

 

[Splenda88]

As an attending, many years removed from medschool, would love to know from a psychological and sociological standpoint why medstudents still consider fields like er and radonc. Granted they are at the bottom of the match, but with so many interesting specialties, why would anyone take the risk of being unemployed or at best totally beholden to an employer because you have no other options? Is it stupidity, gullibility?

Most Americans subscribe to the idea that they must do what they love (eyeroll here). The reality is after you do something for 2-3 yrs, it just become routine... and medicine is just like any other job once you got out of the academic bubble.

 

[voxveritatisetlucis]

Many medical students come from money. If one has a significant trust fund, then finding a job is less important and depending on the size, not necessary

 

[RickyScott]

Most Americans subscribe to the idea that they must do what they love (eyeroll here). The reality is after you do something for 2-3 yrs, it just become routine... and medicine is just like any other job once you got out of the academic bubble.

Absolutely agree. There are a a lot of great fields that don’t come with this baggage. You shouldn’t be in medschool if you can’t see yourself ending up in either surg, Im, or several other core specialties. if you can only find a job thousands of miles from family and friends and treated like crap (because you don’t have the option of leaving), you won’t like it.

 

[DOVinciRobot]

As an attending, many years removed from medschool, would love to know from a psychological and sociological standpoint why medstudents still consider fields like er and radonc. Granted they are at the bottom of the match, but with so many interesting specialties, why would anyone take the risk of being unemployed or at best totally beholden to an employer because you have no other options? Unemployment was never a scenario I considered during medschool for any specialty. Is it stupidity, gullibility?

Where I am at there is still the belief that the hype about EM jobs is overblown and that EM docs still make $500k+ working only 12 shifts a month. They just don’t want to believe it, even though the current seniors are struggling to find gigs that aren’t in rural or undesirable areas.

 

[voxveritatisetlucis]

Could an EM doc become a hospitalist if they can’t find an EM job

I know some nephrologists go back to hospital medicine but they did Im residency

 

[RickyScott]

Could an EM doc become a hospitalist if they can’t find an EM job

I know some nephrologists go back to hospital medicine but they did Im residency

I don’t think so. There are some er/Im combined programs which is what I would strongly suggest for anyone considering the field. For radonc, you would have to retrain or drive for Uber.

 

[Darrow O'Lykos]

I don’t think so. There are some er/Im combined programs which is what I would strongly suggest for anyone considering the field.

Even those are 5 year programs, which...yikes. There's really no way to justify going into EM without drastic wide-spread reform.

 

[Ho0v-man]

As an attending, many years removed from medschool, would love to know from a psychological and sociological standpoint why medstudents still consider fields like er and radonc. Granted they are at the bottom of the match, but with so many interesting specialties, why would anyone take the risk of being unemployed or at best totally beholden to an employer because you have no other options? Unemployment was never a scenario I considered during medschool for any specialty. Is it stupidity, gullibility?

They think they’re special and that the rules don’t apply to them. Most of them have never had a job and have thus never had to worry about bills.

Could an EM doc become a hospitalist if they can’t find an EM job

I know some nephrologists go back to hospital medicine but they did Im residency

People go into EM with the specific goal of never doing hospitalist medicine ever again. Most would rather be unemployed and bankrupt than to deal with that BS.

 

[RickyScott]

noticed in both er and radonc, that there are decent initiatives to increase the number of URM applying as the fields are tanking due to oversupply/lack of jobs.

 

[imidazzle92]

IM job market is great... Not difficult to make 350k-400k/yr and you dont have to kill yourself.

even in the northeast (near Boston MA, Providence RI, etc.)?

 

[voxveritatisetlucis]

I’m from the northeast and I highly doubt it. Doctors in New England (besides Maine and Vermont and NH but to a lesser extent m) make nothing compared to colleagues in other regions. Too much oversupply, which is compounded by the fact that COL is prohibitive.

In my old neighborhood which has very modest houses (1500-2000 sq ft.), it would be difficult to find one below 1.5 million in this market.

 

[imidazzle92]

I’m from the northeast and I highly doubt it. Doctors in New England (besides Maine and Vermont and NH but to a lesser extent m) make nothing compared to colleagues in other regions. Too much oversupply, which is compounded by the fact that COL is prohibitive.

In my old neighborhood which has very modest houses (1500-2000 sq ft.), it would be difficult to find one below 1.5 million in this market.

Are there specific specialties that don't take huge paycut in the NE? (not going to base my decision off this...just curious)

 

[voxveritatisetlucis]

I would imagine that all docs in these areas take a pay cut but a cardiologist, gastroenterologist or plastic surgeon taking a pay cut has less effect on lifestyle than a hospitalist or PCP taking a pay cut.

But this is only a gut feeling. I’m sure that @RickyScott and @Splenda88 can offer more insight on the type of docs that don’t take a pay cut in the northeast (or California for that matter)

 

[RickyScott]

I would imagine that all docs in these areas take a pay cut but a cardiologist, gastroenterologist or plastic surgeon taking a pay cut has less effect on lifestyle than a hospitalist or PCP taking a pay cut.

But this is only a gut feeling. I’m sure that @RickyScott and @Splenda88 can offer more insight on the type of docs that don’t take a pay cut in the northeast (or California for that matter)

In highly desirable locations, almost every doc takes a large pay cut. The key factor is supply/demand (seems obvious but there are a lot of idiot-yet-intellectuals who have great difficulty understanding this). Procedure driven specialties that responsibly manage their resident numbers/supply will always have the best saleries and job prospects. Urology/ortho are examples.

Btw: any “mentor” in medical school that basically tells you to ignore supply/demand is a total fraud.

 

[Splenda88]

even in the northeast (near Boston MA, Providence RI, etc.)?

Yes...

But not NY city or Boston

 

[qwerty89]

I’m from the northeast and I highly doubt it. Doctors in New England (besides Maine and Vermont and NH but to a lesser extent m) make nothing compared to colleagues in other regions. Too much oversupply, which is compounded by the fact that COL is prohibitive.

In my old neighborhood which has very modest houses (1500-2000 sq ft.), it would be difficult to find one below 1.5 million in this market.

This will be the first generation of docs who, by themselves, may not earn enough money even when working a full time job to afford a house for years after graduation.

Anecdotally every pediatrician I know is female and married $$$.
God bless those primary breadwinner pediatricians working in major metros like SF, LA or NYC.

 

[Postictal Raiden]

Most Americans subscribe to the idea that they must do what they love (eyeroll here). The reality is after you do something for 2-3 yrs, it just become routine... and medicine is just like any other job once you got out of the academic bubble.

What I love is being with my family, eating, traveling.

Work, no matter what kind, is money in exchange for my time and energy.

Don’t do work that you hate, but you also don’t need to only do what you love.

 

[RickyScott]

What I love is being with my family, eating, traveling.

Work, no matter what kind, is money in exchange for my time and energy.

Don’t do work that you hate, but you all’s don’t need to only do what you love.

Not everything was my cup of tea in medical school, but there are plenty of interesting fields and nobody should pursue something where future unemployment is a possibility. They all become a job and a bit monotonous after 10 years. If you are a “passionate” person you will grow into most specialties.
What I can say is that location is extremely important to almost all of us. Not many willing to spend their life in a place they hate, far from family and friends, just for a job.(future/present spouse may also have their own limitations). If you are URM, you may not want to live/raise your kids in MAGA country. I can tell you that in my own field, women are often reluctant to relocate to locations where their husband will have to become a stay at home dad. (Which is a disproportionate number of the available jobs)

‘Do What You Love’ Is Terrible Advice

If passion is a job requirement, says writer Miya Tokumitsu, employees have little room to complain about mistreatment at work.

www.theatlantic.com

‘Find Your Passion’ Is Awful Advice

A major new study questions the common wisdom about how we should choose our careers.

www.theatlantic.com

‘Follow Your Passion’ Is The Worst Career Advice—Here’s Why

It’s a cliché as old as time: When it comes to your career, people often say to “follow your passion.” Here's why that's bad advice.

www.forbes.com

 

[Splenda88]

What I love is being with my family, eating, traveling.

Work, no matter what kind, is money in exchange for my time and energy.

Don’t do work that you hate, but you also don’t need to only do what you love.

My advice to med student these days, do something you dont hate (different from what you love/passionate) that you can make a lot of $$$ quick.

From what I have seen now, a lot of the IM subspecialties (even general cardiology) are waste of time IMO. You will be working 70+ hr as a fellow in cardio and make 60k-70k/yr. If I work 60+ hrs/wk average as a hospitalist right now, I will make 500k+/yr. GI/oncology is another story because these people have a $$$ printing machine while enjoying a reasonable lifestyle.

 

[Postictal Raiden]

My advice to med student these days, do something you dont hate (different from what you love/passionate) that you can make a lot of $$$ quick.

From what I have seen now, a lot of the IM subspecialties (even general cardiology) are waste of time IMO. You will be working 70+ hr as a fellow in cardio and make 60k-70k/yr. If I work 60+ hrs/wk average as a hospitalist right now, I will make 500k+/yr. GI/oncology is another story because these people have a $$$ printing machine while enjoying a reasonable lifestyle.

Agree.

Financially, only heme/onc and GI are worth the investment

 

[voxveritatisetlucis]

Isn’t the work in most IM subspecialties a bit more stimulating though? Is it possible to do any of these in two rather than three?

 

[Splenda88]

Isn’t the work in most IM subspecialties a bit more stimulating though? Is it possible to do any of these in two rather than three?

Stimulating for 2-3 yrs... After that, everyone in the physician lounge is talking about where they gonna go on their next trip, how much money they have invested in the market and they plan to buy a Tesla Plaid or a Ferrari or a Porsche next month. Lol

 

[imidazzle92]

My advice to med student these days, do something you dont hate (different from what you love/passionate) that you can make a lot of $$$ quick.

From what I have seen now, a lot of the IM subspecialties (even general cardiology) are waste of time IMO. You will be working 70+ hr as a fellow in cardio and make 60k-70k/yr. If I work 60+ hrs/wk average as a hospitalist right now, I will make 500k+/yr. GI/oncology is another story because these people have a $$$ printing machine while enjoying a reasonable lifestyle.

Can't private practice cardio have decent hours (though probably won't get paid as much as GI)?

 

[Splenda88]

Can't private practice cardio have decent hours (though probably won't get paid as much as GI)?

Yes they can. But you spend an additional 3 yrs to make 400-450/yr...

 

[painballer27]

My advice to med student these days, do something you dont hate (different from what you love/passionate) that you can make a lot of $$$ quick.

In what fields can you make a lot quick?

 

[Splenda88]

In what fields can you make a lot quick?

IM/FM, neurology, psychiatry if you are a little bit flexible geographically.

 

[Postictal Raiden]

IM/FM, neurology, psychiatry if you are a little bit flexible geographically.

I would add anesthesiology. Despite the CRNA doom and gloom, many fresh grads have no problems finding $400k jobs.

 

[GadRads]

I would add anesthesiology. Despite the CRNA doom and gloom, many fresh grads have no problems finding $400k jobs.

I’m surprised CRNAs haven’t been especially bad for the field of anesthesiology. Their job market is probably better than that of radiology which has no mid level threat (and no real AI threat).

 

[RickyScott]

I’m surprised CRNAs haven’t been especially bad for the field of anesthesiology. Their job market is probably better than that of radiology which has no mid level threat (and no real AI threat).

Anesthesia crnas were a thing 20 + years ago. Bill Clinton’s mom was one (rumor when I was in school that she was pushing for expanded role) and supposedly deregulation was going to hurt the field back then. It didnt.

 

[voxveritatisetlucis]

Is there any chance that CRNAs could cut that pay by the time entering med students complete residency.

I was reading this earlier

Wisconsin Hospital Replaces All Anesthesiologists with CRNAs.

https://www.beckershospitalreview.com/hospital-ph… Don't know how I feel about this.

www.wallstreetoasis.com

Though, I do think it’s positive that there is a bunch of skeptics in the thread. Might mean the public is actually aware of doc vs crna


Though some comments are more concerning. For example,

I have experience looking at heathcare deals, this has a lot less to do with power grabs from conspiring nursing cabals and a lot more to do with doctors being far more expensive. If I'm a hospital and can pay a CRNA $120k-$150k to do most of what I'd pay an anesthesiologist $500k to do, that's a lot better for everyone economically.


You typically still need the physician for more specialized work (this is the first I've seen of going all nurses), but it usually lets you cut down the total number of docs you need. This hospital may just have low need for the specialized skillset and just end up using locums when they need it.

This is all increasingly relevant as we move from fee-for-service care to value-based payments. They can't pass the cost along? Then they cut the cost

 

[Splenda88]

Anesthesia. 4 years, no fellowship required, start at 400-450k. I would argue it’s a better deal than all IM fellowships and even Rads

Not GI, and probably heme onc... These people can command 600k+ while having a reasonable lifestyle.

Rad is good as well. They can't even get a general rad at my place for 500k according the rad department head. Rad at my place read from home on weekend.

 

[scoopdaboop]

Yes they can. But you spend an additional 3 yrs to make 400-450/yr...

Interventional cards tho...

 

[Splenda88]

Interventional cards tho...

I think interventional card worth it. It's another 1 extra year fellowship. I heard they can make anywhere from 600k to 800k. However, I was told the job market is tight right now.

 

[painballer27]

IM/FM, neurology, psychiatry if you are a little bit flexible geographically.

Why do you have to be geographically flexible? I understand that the job market for all those you listed is quite good. Also, why is neurology not more popular among students? Get to be a specialist after only four years, money is not bad, can do outpatient which affords a pretty good lifestyle

 

[Kuratz]

Rad/IR job market wide open right now. Fellows taking good jobs in their desired locations. Can be hit or miss on the private practice vs private equity opportunities but right now if a priority can avoid those PE rats. Private practice partner salary can still be very high with ~12 weeks vacation. Can PM with exact partner numbers.

 

[Splenda88]

Why do you have to be geographically flexible? I understand that the job market for all those you listed is quite good. Also, why is neurology not more popular among students? Get to be a specialist after only four years, money is not bad, can do outpatient which affords a pretty good lifestyle

More $$$. Avoid part of the Northeast, the West and Florida.

Not sure why neurology is not popular TBH... Maybe exposure. We only had 2 wks of neuro clerkship where I attended med school

 

[RickyScott]

More $$$. Avoid part of the Northeast, the West and Florida.

Not sure why neurology is not popular TBH... Maybe exposure. We only had 2 wks of neuro clerkship where I attended med school

Other than epilepsy, they really can’t treat anything.

 

[Splenda88]

Other than epilepsy, they really can’t treat anything.

Lol...

But the $$$ is not bad and they are specialists with a relatively short residency...

 

[RickyScott]

Lol...

But the $$$ is not bad and they are specialists with a relatively short residency...

Lifestyle and money are important and tend to be underemphasized in medical school (in overly polite circles), but you still need to have a basic interest/passion for the specialty. I love my field, still find it interesting, and never intend to retire (could work part time) - that is also worth a lot financially. A common flaw in the thinking of medical students is that there is only one field in which they would be truly happy/interested, almost a “calling”. This is BS. Need to find a good balance of what you like, salary, lifestyle, and future job market, and geographic prospects. For me, in the early 2000s, this was med/rad onc, cards, gi, pulm, anesthesia, uro, and optho. I am sure I would have been fine in any of these. A lot of what can influence medstudents comes down to the attendings/residents they connect with. (This is random and try to see through it. Just because an attending is a prick doesn’t mean you should hate the specialty and visa verse)

Btw: Today, would cross my own specialty, radonc, off the list due to oversupply/terrible job market and geographic limitations combined with a rapidly declining footprint in oncology.

 

[Splenda88]

Lifestyle and money are important and tend to be underemphasized in medical school (in overly polite circles), but you still need to have a basic interest/passion for the specialty. I love my field, still find it interesting, and never intend to retire (could work part time) - that is also worth a lot financially. A common flaw in the thinking of medical students is that there is only one field in which they would be truly happy/interested, almost a “calling”. This is BS. Need to find a good balance of what you like, salary, lifestyle, and future job market, and geographic prospects. For me, in the early 2000s, this was med/rad onc, cards, gi, pulm, anesthesia, uro, and optho. I am sure I would have been fine in any of these. A lot of what can influence medstudents comes down to the attendings/residents they connect with. (This is random and try to see through it. Just because an attending is a prick doesn’t mean you should hate the specialty and visa verse)

Btw: Today, would cross my own specialty, radonc, off the list due to oversupply/terrible job market and geographic limitations combined with a rapidly declining footprint in oncology.

For many (probably most) med students, residency is the first actual job they have. Just like you say, I would have been ok doing FM/IM/Psych/Neurology, but I chose IM in the end because years in training, flexibility, and the ease to make 300k+/yr which was my target salary. Anyone in medicine who says they can only see themselves ?happy (whatever that means) doing only [insert specialty] is just immature.

 

[voxveritatisetlucis]

For many (probably most) med students, residency is the first actual job they have. Just like you say, I would have been ok doing FM/IM/Psych/Neurology, but I chose IM at the end because years in training, flexibility, and the ease to make 300k+/yr which was my target salary. Anyone in medicine who says they can only see themselves ?happy (whatever that means) doing only [insert specialty] is just immature.

Don’t neurohospitals usually make a bit more than hospitalists though. For how much is the extra year of training worth it?
I also think that neuro has a bit more of a moat from np/pa than im/fm

 

[Splenda88]

Don’t neurohospitals usually make a bit more than hospitalists though. For how much is the extra year of training worth it?
I also think that neuro has a bit more of a moat from np/pa than im/fm

From what I was told, median salary for neurohospitalist is ~325k... IM hospitalist ~280k. Close to 50k difference. My exposure to neuro was very minimal; that was one of the reasons I did not go neuro.

I agree that neuro is more protected from midlevel encroachment, but I knew I was gonna go into IM with a plan to have f... you money in 10 yrs.