Job market

[Apoplexy__]

Question: Is there any specialty notorious for a GOOD job market?

It seems that every specialty I look at has an awful job market. Pathology and Radiology are two that come to mind. It even seems like I can just click on a random specialty forum on here and see someone spreading gloom and doom about their job market.

I'm not about to get $350k in debt just to spin my wheels with 3 fellowships after residency, but I also don't want to go into a specialty where I don't love the medicine (choosing it for the job aspect) with all these rapid changes going on in medicine.

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[D elegans]

All things primary care

 

[KinasePro]

some of the best are child psych, general IM/primary care, urology, neurosurgery, general thoracic surgery, trauma/CC, pulm/CC, neuro/CC
Pretty darn good are most other surgical fields, rest of psych, hospital IM, all things peds

 

[DermViser]

Question: Is there any specialty notorious for a GOOD job market?

It seems that every specialty I look at has an awful job market. Pathology and Radiology are two that come to mind. It even seems like I can just click on a random specialty forum on here and see someone spreading gloom and doom about their job market.

I'm not about to get $350k in debt just to spin my wheels with 3 fellowships after residency, but I also don't want to go into a specialty where I don't love the medicine (choosing it for the job aspect) with all these rapid changes going on in medicine.

Depends on how you define good job market and what exactly you want in a specialty: salary, lifestyle, narrow-focus vs. wide-focus, etc. and how many years of residency you're willing to do.

 

[drcrispmd]

There are a ton of family medicine positions available all over the country. And not just out patient only. Many with in and outpatient, in patient only, and some with full scope (out pt, inpt, and OB). Plus most have loan repayment incentives too. Choose your path with what you like. Don't just choose it for the money.

 

[sobored]

There are a ton of family medicine positions available all over the country. And not just out patient only. Many with in and outpatient, in patient only, and some with full scope (out pt, inpt, and OB). Plus most have loan repayment incentives too. Choose your path with what you like. Don't just choose it for the money.

While I agree with this general sentiment, it is becoming almost impossible given the enormous debt burden of medical school these days.

 

[DermViser]

There are a ton of family medicine positions available all over the country. And not just out patient only. Many with in and outpatient, in patient only, and some with full scope (out pt, inpt, and OB). Plus most have loan repayment incentives too. Choose your path with what you like. Don't just choose it for the money.

Most people who do FM don't want to do OB and want a relatively good lifestyle 9-5 after residency (non-inpatient). That's even before all this new PCMH crud.

 

[DermViser]

There are a ton of family medicine positions available all over the country. And not just out patient only. Many with in and outpatient, in patient only, and some with full scope (out pt, inpt, and OB). Plus most have loan repayment incentives too. Choose your path with what you like. Don't just choose it for the money.

In that case those who wish to do Family Med, Gen IM, and Gen Peds, are better off doing NP or PA, instead of being a physician, based on the salary to debt ratio.

 

[Kaputt]

Cards is really bad, apparently

 

[Apoplexy__]

Good posts, thanks. Sounds like primary care is where the jobs are at.

There are a ton of family medicine positions available all over the country. And not just out patient only. Many with in and outpatient, in patient only, and some with full scope (out pt, inpt, and OB). Plus most have loan repayment incentives too. Choose your path with what you like. Don't just choose it for the money.

Unfortunately, that's the issue. The things I want to do for the content are either barred by family-destructive lifestyles or awful job markets.

Anything besides Path and Rads good for that sort of "alone with my work" introverted personality?

 

[DoctwoB]

From what I hear both in the forums and elsewhere, so take it with a grain of salt. It does tend to jive relatively well with what I've seen online e.g. http://fidelismp.com/10-physician-specialties-in-the-highest-demand/

Excellent:
General IM/hospitalist
FM
General peds
Urology
Neurosurgery
critical care (both pulm/trauma)
Psych/child psych
GI
Endocrine

Very good:
Ortho (would be in excellent based on demand but fellowships are becoming a de-facto requirement for most jobs)
ENT
General Surgery, especially trauma (gen surg sub-specialties are highly variable, as things like surg-onc/hpb are mostly at academic centers)
OB-GYN


Pretty good, but saturating quickly
Anesthesia
Rad onc

Not great, but you'll find a good job if you're flexible
Radiology
Cards

Terrible
Path


I have no idea:
Everything else

 

[link2swim06]

I think anything in medicine has a good job market compared to other professions.

There are few professions where you can basically pick your city and have an option of a bunch of jobs. Sure there some specialties like radiology where you cannot 'pick your city and job' but even then there are good jobs in your region of the country.

 

[DermViser]

Good posts, thanks. Sounds like primary care is where the jobs are at.



Unfortunately, that's the issue. The things I want to do for the content are either barred by family-destructive lifestyles or awful job markets.

Anything besides Path and Rads good for that sort of "alone with my work" introspective personality?

You mean introverted personality. Anything like that has a high likelihood of being commoditized - Rads, Path, etc. You can't have it all - there is no magic specialty with all good, and no bad. Medicine is not impervious to extraneous forces.

 

[Apoplexy__]

You mean introverted personality. Anything like that has a high likelihood of being commoditized - Rads, Path, etc. You can't have it all - there is no magic specialty with all good, and no bad. Medicine is not impervious to extraneous forces.

Heh, typo. Multitasking.

Yeah, bummer. Just figured I'd ask. I guess we're fortunate enough that we have such a wide variety of career options in the first place.

Thanks for the particularly great post, DoctwoB.

 

[DermViser]

Heh, typo. Multitasking. Yeah, bummer. Just figured I'd ask. I guess we're fortunate enough that we have such a wide variety of career options in the first place. Thanks for the particularly great post, DoctwoB.

Yes, it's definitely not perfect. I think a lot of starting MS-1s go in believing some specialties are immune to the job market (usually believing that competitive specialties are). Just less than 10 years ago, Radiology was a very hot specialty, and I actually believe it still is competitive if you look at average board scores for those matching. However, it's no longer the case where you're raking in $500K coming out, and get to live in LA/NYC, working 9 to 5. Now all these Teleradiology groups have popped up bc hospitals want 24/7 reads available to them esp. those in rural areas when normally they'd be fighting for an in-house radiologist.

That being said, I don't know one Radiologist who would do primary care or subspecialize after doing an IM residency. They liked the visual nature of the specialty. All the more reason to pick something you like, but more importantly choose something you can tolerate, and are very much ok with the negatives.

 

[calvnandhobbs68]

Really, the majority of medical specialties have good "job markets" in that you'll be able to get a job after residency. It's just that you might have to take a job in Wisconsin or Utah instead of Chicago or LA. I mean, I guess it's a bummer if you want to live in a big city your whole life.

Also the ranking for adult specialties doesnt quite apply to peds as almost all peds specialities are in shortage but that's mostly because you don't make that much more in income than doing general peds for most of them, so people dont want to spend three years on a fellows salary for nothing in return when they could be making attending salary. The shortage can be pretty substantial though...as in people having to wait several months and drive across the state to see a child neurologist for example.

 

[DermViser]

Really, the majority of medical specialties have good "job markets" in that you'll be able to get a job after residency. It's just that you might have to take a job in Wisconsin or Utah instead of Chicago or LA. I mean, I guess it's a bummer if you want to live in a big city your whole life.

Also the ranking for adult specialties doesnt quite apply to peds as almost all peds specialities are in shortage but that's mostly because you don't make that much more in income than doing general peds for most of them, so people dont want to spend three years on a fellows salary for nothing in return when they could be making attending salary. The shortage can be pretty substantial though...as in people having to wait several months and drive across the state to see a child neurologist for example.

I've never understood that myself, as to why pediatric subspecialties aren't paid higher to General Peds relative to the degree from General IM to an IM subspecialty. That being said, in Peds, you tend to have patients that don't have the reams of comorbidities that adults have and can bounce back relatively well (kids). I am not at all shocked that those who go into Pediatrics and its subspecialties are relatively well satisfied.

 

[drcrispmd]

Most people who do FM don't want to do OB and want a relatively good lifestyle 9-5 after residency (non-inpatient). That's even before all this new PCMH crud.

I did not say all the jobs had OB, some do. I know not all FM wants to do OB (I am finishing up my residency this month). Basically from family med you can do whatever type of practice FM do because the jobs are available. From my FM residency, residents are doing ER, urgent care, outpt only, full scope (outpt, inpt, and OB), in and out pt, and hospitalist. Some did Sports med fellowship. My job this fall isn't 9-5 buy 8-5 isn't bad with no weekends or call. Also I get $105k toward loans on top of my salary. After that 3 year contract, I'll be eligible for NHC loan repayment. But do not choose primary care just because the market is good. You will end up miserable if you do not like it.

 

[Psai]

I've never understood that myself, as to why pediatric subspecialties aren't paid higher relative to General Peds relative to the degree from General IM to an IM subspecialty. That being said, in Peds, you tend to have patients that don't have the reams of comorbidities that adults have and can bounce back relatively well (kids). I am not at all shocked that those who go into Pediatrics and its subspecialties are relatively well satisfied.

Maybe it's because they have a reasonable amount of time to talk to their patients and their families so they see fewer patients.

 

[DermViser]

Maybe it's because they have a reasonable amount of time to talk to their patients and their families so they see fewer patients.

But how would General Peds get any more time per outpatient visit than General IM?

 

[Priapism4tooLong]

From what I hear both in the forums and elsewhere, so take it with a grain of salt. It does tend to jive relatively well with what I've seen online e.g. http://fidelismp.com/10-physician-specialties-in-the-highest-demand/

Excellent:
General IM/hospitalist
FM
General peds
Urology
Neurosurgery
critical care (both pulm/trauma)
Psych/child psych
GI
Endocrine

Very good:
Ortho (would be in excellent based on demand but fellowships are becoming a de-facto requirement for most jobs)
ENT
General Surgery, especially trauma (gen surg sub-specialties are highly variable, as things like surg-onc/hpb are mostly at academic centers)
OB-GYN


Pretty good, but saturating quickly
Anesthesia
Rad onc

Not great, but you'll find a good job if you're flexible
Radiology
Cards

Terrible
Path


I have no idea:
Everything else

good list, anesthesia is getting super saturated. Primary care by far is the best thing to go into for job opportunities.

 

[calvnandhobbs68]

But how would General Peds get any more time per outpatient visit than General IM?

They don't in general. One of the pediatricians here told me about one epic day where he saw 60 patients .

It has more to do with Medicaid reimbursement than anything else. Medicaid reimburses less for everything than Medicare and a lot of peds patients are on Medicaid. Even some who would be eligible for parents insurance are Medicaid bc it's free/cheaper than what they'd pay.

Peds Medicaid still reimburses better than adult Medicaid though...

 

[DermViser]

They don't in general. One of the pediatricians here told me about one epic day where he saw 60 patients .

It has more to do with Medicaid reimbursement than anything else. Medicaid reimburses less for everything than Medicare and a lot of peds patients are on Medicaid. Even some who would be eligible for parents insurance are Medicaid bc it's free/cheaper than what they'd pay.

Peds Medicaid still reimburses better than adult Medicaid though...

Yes, but Psai said, "Maybe it's because they have a reasonable amount of time to talk to their patients and their families so they see fewer patients." -- I doubt that is the case.

 

[Psai]

But how would General Peds get any more time per outpatient visit than General IM?

I meant peds subspecialties vs peds. I don't have a ton of experience but I shadowed a pediatric pulmonologist who had at least 30 minutes for follow up visits and an hour for new patients. It was pleasant to see a nice, thorough history being done on a kid with down syndrome with all the parental worries being addressed completely.

 

[Winged Scapula]

I meant peds subspecialties vs peds. I don't have a ton of experience but I shadowed a pediatric pulmonologist who had at least 30 minutes for follow up visits and an hour for new patients. It was pleasant to see a nice, thorough history being done on a kid with down syndrome with all the parental worries being addressed completely.

At that rate, it's no wonder the peds superspecialists don't make any money.

 

[Priapism4tooLong]

At that rate, it's no wonder the peds superspecialists don't make any money.

how much do peds super specialists make?? i could have sworn they made a killing. There's a Peds GI in my hospital that drives a bentley.

 

[Winged Scapula]

how much do peds super specialists make?? i could have sworn they made a killing. There's a Peds GI in my hospital that drives a bentley.

I have no idea but I'd think a procedural specialty is not the norm.
Only plastics (and 80s rock stars) here drive Bentleys.

I always hear the people say that sometimes the peds subspecialties
can actually make less than straight peds: we're talking about neo, endocrinology, nephrology etc.

 

[Priapism4tooLong]

I have no idea but I'd think a procedural specialty is not the norm.
Only plastics (and 80s rock stars) here drive Bentleys.

I always hear the people say that sometimes the peds subspecialties
can actually make less than straight peds: we're talking about neo, endocrinology, nephrology etc.

yeah i have no idea what this guy does on the side. Pretty sure no one else in peds makes as much as him. Plastics/optho usually have the nicest cars in our garage lol.

 

[NickNaylor]

I have no idea but I'd think a procedural specialty is not the norm.
Only plastics (and 80s rock stars) here drive Bentleys.

I always hear the people say that sometimes the peds subspecialties
can actually make less than straight peds: we're talking about neo, endocrinology, nephrology etc.

This seems to be corroborated with what you see on the MGMA salary surveys - flawed though they may be.

 

[user3]

I did not say all the jobs had OB, some do. I know not all FM wants to do OB (I am finishing up my residency this month). Basically from family med you can do whatever type of practice FM do because the jobs are available. From my FM residency, residents are doing ER, urgent care, outpt only, full scope (outpt, inpt, and OB), in and out pt, and hospitalist. Some did Sports med fellowship. My job this fall isn't 9-5 buy 8-5 isn't bad with no weekends or call. Also I get $105k toward loans on top of my salary. After that 3 year contract, I'll be eligible for NHC loan repayment. But do not choose primary care just because the market is good. You will end up miserable if you do not like it.

pardon me as I am new to this, but I was reading some of the specialty forums and it seems like "loan repayment" assistance from employers is kind of a gimmick. from the employer's perspective, what is the point in not making these loan repayment monies just part of one's usual salary (apparently you have to report it as ordinary income anyway)? Do most jobs that offer this usually have lower base salary (or less of other benefits) to compensate?

 

[Xenoblade]

Well, if job security is your thing, then don't go into nuclear medicine. Many pure nucs say they cannot find jobs.

 

[DermViser]

how much do peds super specialists make?? i could have sworn they made a killing. There's a Peds GI in my hospital that drives a bentley.

Not surprising due to procedures. Definitely the exception. That being said, those in Peds tend to rank highest in satisfaction, which is very understandable.

 

[varsityblue]

Not surprising due to procedures. Definitely the exception. That being said, those in Peds tend to rank highest in satisfaction, which is very understandable.

My understanding is that pediatric orthopods can make an upwards of $400K treating scoliosis. The downsides are malpractice insurance, long residency training, and hospital-based care. You can't just set up a scoliosis center and expect the patients to come to you; you have to hustle to get hospital referrals if you try to go private practice.

I also know that pediatric psychiatrists in private practice have nearly unlimited earning potential. The downside is that you need both pedigree and community ties to attract trust fund babies.

Either way, don't pick a field based on money. Life is too short. My cousin just finished her spine fellowship at HSS, and she's still single, and childless. Yeah, she's going to make $600+K, but she's past the point of having a "normal" family life. Do what feels best, and leave the rest up to God.

 

[Winged Scapula]

pardon me as I am new to this, but I was reading some of the specialty forums and it seems like "loan repayment" assistance from employers is kind of a gimmick. from the employer's perspective, what is the point in not making these loan repayment monies just part of one's usual salary (apparently you have to report it as ordinary income anyway)? Do most jobs that offer this usually have lower base salary (or less of other benefits) to compensate?

Absolutely. I've never seen a job (but they probably exist) that offered loan repayment or a buy-in to the practice without offering a lower salary.

 

[Priapism4tooLong]

My understanding is that pediatric orthopods can make an upwards of $400K treating scoliosis. The downsides are malpractice insurance, long residency training, and hospital-based care. You can't just set up a scoliosis center and expect the patients to come to you; you have to hustle to get hospital referrals if you try to go private practice.

I also know that pediatric psychiatrists in private practice have nearly unlimited earning potential. The downside is that you need both pedigree and community ties to attract trust fund babies.

Either way, don't pick a field based on money. Life is too short. My cousin just finished her spine fellowship at HSS, and she's still single, and childless. Yeah, she's going to make $600+K, but she's past the point of having a "normal" family life. Do what feels best, and leave the rest up to God.

Ha, there are a lot of people who give up their life for money. A lot tend to regret it later. There are only so many things you can buy yourself after all. And all those things tend to get boring.

 

[starstarie]

My understanding is that pediatric orthopods can make an upwards of $400K treating scoliosis. The downsides are malpractice insurance, long residency training, and hospital-based care. You can't just set up a scoliosis center and expect the patients to come to you; you have to hustle to get hospital referrals if you try to go private practice.

I also know that pediatric psychiatrists in private practice have nearly unlimited earning potential. The downside is that you need both pedigree and community ties to attract trust fund babies.

Either way, don't pick a field based on money. Life is too short. My cousin just finished her spine fellowship at HSS, and she's still single, and childless. Yeah, she's going to make $600+K, but she's past the point of having a "normal" family life. Do what feels best, and leave the rest up to God.

I also heard of a peds urologist that is apparently making tons of money and basically does circumcisions all day.


So when you guys are saying that IM/FM has a great job market, are you implying that their salaries are going to start going up because they are in such demand?

 

[Psai]

I also heard of a peds urologist that is apparently making tons of money and basically does circumcisions all day.


So when you guys are saying that IM/FM has a great job market, are you implying that their salaries are going to start going up because they are in such demand?

lol
educate yourself on how physicians are paid

 

[Priapism4tooLong]

lol
educate yourself on how physicians are paid

Are you saying a peds urologist wouldn't do a simple circumcision to get money? But rather more complex procedures?

 

[starstarie]

lol
educate yourself on how physicians are paid

yeah, what??

obviously, I am exaggerating. I am sure that he doesn't literally only do circumcisions. I am supporting the idea that peds specialists can make significant amounts of money.

 

[sazerac]

Our esteemed colleague @Psai is scoffing at the idea that physicians are paid based upon supply and demand.

That is not how physician reimbursement is determined.

 

[Winged Scapula]

yeah, what??

obviously, I am exaggerating. I am sure that he doesn't literally only do circumcisions. I am supporting the idea that peds specialists can make significant amounts of money.

A pediatric urologist is NOT a "peds specialist"; this is a subspecialty of Urology.

We are talking about specialties completed after Pediatrics training. Those tend not to be more highly reimbursed than general peds.

 

[DermViser]

I also heard of a peds urologist that is apparently making tons of money and basically does circumcisions all day.


So when you guys are saying that IM/FM has a great job market, are you implying that their salaries are going to start going up because they are in such demand?

A pediatric urologist is a surgical subspecialist under Urology, not Pediatrics. You can't do Peds and then specialize in Pediatric urology.

 

[DoctwoB]

I also heard of a peds urologist that is apparently making tons of money and basically does circumcisions all day.
So when you guys are saying that IM/FM has a great job market, are you implying that their salaries are going to start going up because they are in such demand?

In most surgical sub-specialties (including Ortho, Uro, and Neuro), peds definitely takes a pay cut relative to adult. Lots of children are on SCHIP/medicaid, which pays terribly, and there tends to be more clinic work/follow up relative to OR cases for kids, hence the reason why there's s a definite shortage of pediatric surgical specialists. There are exceptions to everything, maybe your aforementioned pedi-uro guy has a cash concierge circumcision business, but on average the point stands.

And unfortunately supply and demand for doctors isn't the sole determinant of salary. Say that a busy full time family physician can bill enough RVUs to net 150k after overhead. Now it could be that lots of hospitals/offices have more demand (patient volume) then they can satisfy, and would like another family doc. However, despite the shortage, if they offered a higher salary then the RVUs would justify, then they would be losing money by hiring said PCP. Incidentally, many hospitals still do this (lose money on incentives to primary care doctors) in order to keep the higher paying specialty referrals, lab-work, and procedures in house, but the point still stands.

 

[KinasePro]

Pediatric urologists definitely do not do circumcisions all day. Uro brahs, do they even do circs at all? -- our OBs do the vast majority of newborn circs here.

Ped's uro is a solid field though. Think renal malformations that need reconstruction, retroperitoneal masses, ectopic ureters, all types of hypospadias or whateverelse-spadias, urethral strictures, cryptorchism, trauma etc... Lots of skill, tiny operative fields, always wear loupes, pretty happy people.

 

[starstarie]

A pediatric urologist is NOT a "peds specialist"; this is a subspecialty of Urology.

We are talking about specialties completed after Pediatrics training. Those tend not to be more highly reimbursed than general peds.

Excuse my terminology error. I was building on someone who brought up a peds orthopedic surgeon and I was under the impression we were discussing those who work with peds. I guess the issue here is that if you want to work with kids and make the momo don't start with peds.

 

[mvenus929]

how much do peds super specialists make?? i could have sworn they made a killing. There's a Peds GI in my hospital that drives a bentley.

Peds GI is not one of the higher paying specialties, because there aren't nearly as many procedures in Peds GI as there are in adult GI. Most of the clinic patients you see have some variation of constipation, functional abdominal pain, or IBD.

I always hear the people say that sometimes the peds subspecialties
can actually make less than straight peds: we're talking about neo, endocrinology, nephrology etc.

Neo is not one of them. PICU, NICU, and Cards are the three specialties that it is monetarily beneficial to do the fellowship, accounting for attending salary lost during fellowship. Part of this is because ALL pediatric fellowships are 3 years. pediatrics.aappublications.org/content/127/2/254.short?rss=1

Of course, that study looks at faculty salaries (since 2/3rds of peds subspecialists are on faculty somewhere), so private practice might make the decision more lucrative in some cases. You just have to live somewhere where you'll have a large enough patient base and not be directly competing with the Children's hospital in the area. Or continue to practice general peds as well.

 

[Winged Scapula]

Neo is not one of them. PICU, NICU, and Cards are the three specialties that it is monetarily beneficial to do the fellowship, accounting for attending salary lost during fellowship. Part of this is because ALL pediatric fellowships are 3 years. pediatrics.aappublications.org/content/127/2/254.short?rss=1

Yes, that was pointed out to me above and I thanked the person who explained that Neo is higher paying. I did not mention NICU or Cards because I knew those were higher paying than general peds.

 

[mvenus929]

Yes, that was pointed out to me above and I thanked the person who explained that Neo is higher paying. I did not mention PICU or Cards because I knew those were higher paying than general peds.

Thought you and others might like the reference *shrug*

 

[Winged Scapula]

Thought you and others might like the reference *shrug*

Thank you - it was a bit buried in the thread and I didn't notice it.

 

[Anastomoses]

Pediatric urologists definitely do not do circumcisions all day. Uro brahs, do they even do circs at all? -- our OBs do the vast majority of newborn circs here.

Yeah, why in the world would anyone have them do circumcisions? A moyle is cheaper.