Just got my STEP 1 score back

[Burnermed]

Scored a 231. Now, based on this, I want to pick a specialty that will offer me the most money and nice lifestyle. Money more important. What specialties will allow me to match at a decent spot - midwest urban town or maybe close to it, that hits these things.

Psychiatry

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[Surgeon D.O.]

Psychiatry

Psych is still my backup if I decide the OR is not for me.

 

[Splenda88]

I think you should balance passion, interest, lifestyle, and money all in the same discussion. It's also interesting in that there are different types of people who can succeed and do well in different settings. For example, I'd have an easier time working 30 hours a week for 25 years for 250k than working 60 hours a week for 10 years for 500k.
I don't want to hustle for a decade so I can early retire. I'd rather work at a calm and steady pace and downsize as needed.

I would be very hesitant to use the word "passion" when talking about a job. Then again, I am not a native American, so my perspective about having a job to take care of my family is completely different from the average native American.

 

[Drrrrrr. Celty]

I would be very hesitant to use the word "passion" when talking about a job. Then again, I am not a native American, so my perspective about having a job to take care of my family is completely different from the average native American.

I'm not talking about choosing art versus engineering here. We're literally talking about picking a subspecialty that no matter what is going to put you into the top earners. Why not choose a career where you're able to be adjusted and passionate as a result?
And as far as caring for your family. The best thing you can do for your family besides bringing a stable income is bringing an individual who comes home and is actually happy or has time for their kids. That's why a lot of high incomers with a lot of work aren't happy.

 

[deleted1081396]

MEant you can make 400k outpatient.

As a generalist or only if you do a fellowship?

 

[Splenda88]

I'm not talking about choosing art versus engineering here. We're literally talking about picking a subspecialty that no matter what is going to put you into the top earners. Why not choose a career where you're able to be adjusted and passionate as a result?
And as far as caring for your family. The best thing you can do for your family besides bringing a stable income is bringing an individual who comes home and is actually happy or has time for their kids. That's why a lot of high incomers with a lot of work aren't happy.

From my limited experience rotating in IM and its subspecialties, there are about 20 bread and butter stuffs they see everyday, I am not really sure how someone can keep that passion going after doing the same thing for 10+ yrs. I believe that your work environment has more to do with your happiness in the long run.

Even FM or outpatient IM that is supposed to be broad, 80-90% of what they do is managing chronic illnesses, screening and treating minor ailments (UTI, STI, URI, MSK pain etc...)

 

[scoopdaboop]

As a generalist or only if you do a fellowship?

Either or. Fellowship not needed, useful for academics. Some places love neurologists good at EMG's and might help you get a job, but it's no where near radiology "fellowship is a must."

 

[Drrrrrr. Celty]

From my limited experience rotating in IM and its subspecialties, there are about 20 bread and butter stuffs they see everyday, I am not really sure how someone can keep that passion going after doing the same thing for 10+ yrs. I believe that your work environment has more to do with your happiness in the long run.

Even FM or outpatient IM that is supposed to be broad, 80-90% of what they do is managing chronic illnesses, screening and treating minor ailments (UTI, STI, URI, MSK pain etc...)

I think some people can also be passionate about not wanting to see certain things too. For example, I am extremely passionate about never seeing another active variceal bleed at 2am ever again.

 

[Splenda88]

I think some people can also be passionate about not wanting to see certain things too. For example, I am extremely passionate about never seeing another active variceal bleed at 2am ever again.

Lol.

 

[Drrrrrr. Celty]

The benefit of midlevels is that a lot of them tend to be attractive young people... and if you're a guy, that ain't too bad to be around. Clearly all physicians have to live with the reality that midlevels will be here to stay, might as well see the benefits of them.

Don't eat where you ****. And don't date your staff or coworkers.

 

[Surgeon D.O.]

Don't eat where you ****. And don't date your staff or coworkers.

THIS.

Lol this ain't Grey's Anatomy

 

[DOVinciRobot]

THIS.

Lol this ain't Grey's Anatomy

Eh, you might be surprised. Everyone seems to be dating someone else in the hospital at my program

 

[bonewizardry101]

Truth right here, you gotta be practical. I myself was super into Rads, did research and all in it. Slowly sinking in that don't have the gas left for training 5+ years and would like to finally do nice things for my family. It's probably IM program into nocturnist gig for me. Plus you can work at med schools as adjunct faculty once per week precepting labs and get paid a nice bonus. And you get to joke around with students and make fun of OMM.

you had me at make fun of OMM

 

[Sardonix]

Cringing at the comments tossing around neurointerventional specialties and radiology as if you can just DO them without a metric f... truck ton of work. Good gravy.

First off, neurology IS a very tough residency. Second off, you need to do an interventional fellowship on top of that to make the money that folks are tossing around here. Same with radiology, where as 1-2 reasonable people have mentioned, fellowship is mandatory. That's bare minimum 5-6 years of post-grad work before you really start to earn, nevermind the logistics, moving, uncertainty involved. Good luck having relationships and children thrown in there too.

Meanwhile, hell, even being a "simple" hospitalist is no walk in the park. 7 on 7 off shifts are HARD and you are ON for all 12hrs. That's 12 hours of codes, admits, pager going off every 5min, and extensive rounding.

Obviously this post is about money, which is fine, but you really do have to weigh what the "worth" of that extra cash is compared to everything else. A good first start is looking at data like MGMA:

MGMA 2018 data

Second off, keep this in mind: In the midwest and with a little negotiating, my current co-resident Family Medicine PGY2s are already looking at contracts for $250-300,000. No OB, no inpatient, no fellowship involved. As you can see in the above link, that's well above the median. Obviously that is not going to be everyone as some people are terrible at negotiating and will take the first offer given to them--from my co-residents' experience, one of the most important things you can do is know what your REAL worth is and do some in depth research so that you can beat the HR recruiter over the head with hard numbers instead of letting them bamboozle you. Then you read some self-help books about business negotiating because they will give you the basic tools to deal with the basic tricks recruiters use on you.

Also I recognize that some people hate the midwest and some people hate FM. Different folks, different strokes (or different stroke specialties, see what I did there?) Whatever. My point is that if you are going into a speciality primarily for the money, the ones with longer and grueling training may not be worth it in the long end given what you need to sacrifice.

But hey, what do I know, I'm just a simple FM resident who won't have to worry about any of this.

 

[DrStephenStrange]

Cringing at the comments tossing around neurointerventional specialties and radiology as if you can just DO them without a metric f... truck ton of work. Good gravy.

First off, neurology IS a very tough residency. Second off, you need to do an interventional fellowship on top of that to make the money that folks are tossing around here. Same with radiology, where as 1-2 reasonable people have mentioned, fellowship is mandatory. That's bare minimum 5-6 years of post-grad work before you really start to earn, nevermind the logistics, moving, uncertainty involved. Good luck having relationships and children thrown in there too.

Meanwhile, hell, even being a "simple" hospitalist is no walk in the park. 7 on 7 off shifts are HARD and you are ON for all 12hrs. That's 12 hours of codes, admits, pager going off every 5min, and extensive rounding.

Obviously this post is about money, which is fine, but you really do have to weigh what the "worth" of that extra cash is compared to everything else. A good first start is looking at data like MGMA:

MGMA 2018 data

Second off, keep this in mind: In the midwest and with a little negotiating, my current co-resident Family Medicine PGY2s are already looking at contracts for $250-300,000. No OB, no inpatient, no fellowship involved. As you can see in the above link, that's well above the median. Obviously that is not going to be everyone as some people are terrible at negotiating and will take the first offer given to them--from my co-residents' experience, one of the most important things you can do is know what your REAL worth is and do some in depth research so that you can beat the HR recruiter over the head with hard numbers instead of letting them bamboozle you. Then you read some self-help books about business negotiating because they will give you the basic tools to deal with the basic tricks recruiters use on you.

Also I recognize that some people hate the midwest and some people hate FM. Different folks, different strokes (or different stroke specialties, see what I did there?) Whatever. My point is that if you are going into a speciality primarily for the money, the ones with longer and grueling training may not be worth it in the long end given what you need to sacrifice.

But hey, what do I know, I'm just a simple FM resident who won't have to worry about any of this.

Lol we assumed that OP knew that he needs a fellowship and that residency sucks no matter the specialty.

Also, it seems like OP doesn't even want to settle for 400K let alone 250K-300K, so OP may not be happy in FM either.

 

[Sardonix]

Lol we assumed that OP knew that he needs a fellowship and that residency sucks no matter the specialty.

Also, it seems like OP doesn't even want to settle for 400K let alone 250K-300K, so OP may not be happy in FM either.

Fair. But that's kinda what the second half of my post is cautioning about. Money is important. But to quote poet and warrior, the esteemed Mr. B.I.G, "The more financial wealth the more challenges and problems one may be required to be deal with."

 

[catnip12]

Cringing at the comments tossing around neurointerventional specialties and radiology as if you can just DO them without a metric f... truck ton of work. Good gravy.

First off, neurology IS a very tough residency. Second off, you need to do an interventional fellowship on top of that to make the money that folks are tossing around here. Same with radiology, where as 1-2 reasonable people have mentioned, fellowship is mandatory. That's bare minimum 5-6 years of post-grad work before you really start to earn, nevermind the logistics, moving, uncertainty involved. Good luck having relationships and children thrown in there too.

Meanwhile, hell, even being a "simple" hospitalist is no walk in the park. 7 on 7 off shifts are HARD and you are ON for all 12hrs. That's 12 hours of codes, admits, pager going off every 5min, and extensive rounding.

Obviously this post is about money, which is fine, but you really do have to weigh what the "worth" of that extra cash is compared to everything else. A good first start is looking at data like MGMA:

MGMA 2018 data

Second off, keep this in mind: In the midwest and with a little negotiating, my current co-resident Family Medicine PGY2s are already looking at contracts for $250-300,000. No OB, no inpatient, no fellowship involved. As you can see in the above link, that's well above the median. Obviously that is not going to be everyone as some people are terrible at negotiating and will take the first offer given to them--from my co-residents' experience, one of the most important things you can do is know what your REAL worth is and do some in depth research so that you can beat the HR recruiter over the head with hard numbers instead of letting them bamboozle you. Then you read some self-help books about business negotiating because they will give you the basic tools to deal with the basic tricks recruiters use on you.

Also I recognize that some people hate the midwest and some people hate FM. Different folks, different strokes (or different stroke specialties, see what I did there?) Whatever. My point is that if you are going into a speciality primarily for the money, the ones with longer and grueling training may not be worth it in the long end given what you need to sacrifice.

But hey, what do I know, I'm just a simple FM resident who won't have to worry about any of this.

I’m not sure which parts of the OP’s comments you are not seeing. He is operating in the first order. This is way more analysis than OP is asking for.

As for OP. Do Rads. Maybe Cards if you play it right.

 

[Neopolymath]

I’m not sure which parts of the OP’s comments you are not seeing. He is operating in the first order. This is way more analysis than OP is asking for.

As for OP. Do Rads. Maybe Cards if you play it right.

Frankly, OP probably can't handle working hard for that long based on his posting history here over the years. Maybe I'm wrong about his IRL persona. I don't think a long training pathway with significant emphasized self-study is going to work out in rads and I don't thinking going for GI or cards can work given one has to actually try to get into a good IM program and then keep grinding to get into a competitive fellowship.

Psych is the answer here from a work life and money standpoint and from a competitive standpoint. It also benefits from being shorter and not as big of a grind to get into a special fellowship or something.

 

[Sardonix]

I’m not sure which parts of the OP’s comments you are not seeing. He is operating in the first order. This is way more analysis than OP is asking for.

As for OP. Do Rads. Maybe Cards if you play it right.

And I'm not sure why you think MGMA data is "too much" for someone asking for income ranges by specialty and geography. That aside, there's basically never a time I will not tell someone to seek out MGMA data regarding specialty income levels. The more students, residents, and attendings know their worth, the better.

The rant about FM, though normally irrelevant, is actually QUITE relevant here given OP specifically asked for what specialties make the most money with a nice lifestyle. FM a hidden gem in that regard, as it doesn't require slaving away for 5+ years minimum and income has huge potential to go up in coming years, especially if one haggles well.

 

[unexpectedcomplications]

Can someone speak to the pros and cons of FM vs. IM? I get that FM is a little of everything and you'll have to work up whatever CC the patient comes in with. IM seems like mostly very sick patients but they'll already be worked up and you need to manage for discharge. A lot of the PCPs by my nice surburb are IM trained doctors. Does that mean IM is a good road to burnout?

 

[Splenda88]

Can someone speak to the pros and cons of FM vs. IM? I get that FM is a little of everything and you'll have to work up whatever CC the patient comes in with. IM seems like mostly very sick patients but they'll already be worked up and you need to manage for discharge. A lot of the PCPs by my nice surburb are IM trained doctors. Does that mean IM is a good road to burnout?

IM opens more doors for fellowship and that is the most glaring pro IMO.

FM is better trained than IM in outpatient medicine but I think IM can become good in ~6 months if they decide to do outpatient. Conversely, IM is better trained than FM in inpatient medicine but I think FM can be as good as the average IM in ~1 yr if they decide to do inpatient.


Self disclosure: I am an IM doc.

 

[catnip12]

And I'm not sure why you think MGMA data is "too much" for someone asking for income ranges by specialty and geography. That aside, there's basically never a time I will not tell someone to seek out MGMA data regarding specialty income levels. The more students, residents, and attendings know their worth, the better.

The rant about FM, though normally irrelevant, is actually QUITE relevant here given OP specifically asked for what specialties make the most money with a nice lifestyle. FM a hidden gem in that regard, as it doesn't require slaving away for 5+ years minimum and income has huge potential to go up in coming years, especially if one haggles well.

I was being facetious given what I’ve seen of OPs comments elsewhere and esp in this thread. I wasn’t really undermining your efforts. In any case, we’ve probably never interacted on here (esp cause I lurk way more than comment) so you wouldn’t have known that. That was my bad.

That's pretty low, I've seen easily like 500K +, and no way I'm working that crappy schedule working 7 12's for 400k lol. You can make that outpatient neurology.

 

[Sardonix]

I was being facetious given what I’ve seen of OPs comments elsewhere and esp in this thread. I wasn’t really undermining your efforts. In any case, we’ve probably never interacted on here (esp cause I lurk way more than comment) so you wouldn’t have known that. That was my bad.

Dang, guns away boys, we'll get em' next time.

 

[JimBone905]

For peeps that are suggestion IM fellows, isn't it fairly difficult to land a good fellowship? Are there charting outcomes for fellowship placement?

 

[scoopdaboop]

Frankly, OP probably can't handle working hard for that long based on his posting history here over the years. Maybe I'm wrong about his IRL persona. I don't think a long training pathway with significant emphasized self-study is going to work out in rads and I don't thinking going for GI or cards can work given one has to actually try to get into a good IM program and then keep grinding to get into a competitive fellowship.

Psych is the answer here from a work life and money standpoint and from a competitive standpoint. It also benefits from being shorter and not as big of a grind to get into a special fellowship or something.

Na . Rads is speaking to me every day. I already hate rotations. Like loathe it. Part of the problem is it’s surgery right now and it seems like I’m standing 10 hours a day, my feet are crying at like hour 5 no matter what I wear. Waking up at 330 to study a bit and round is such BS. Studying for m1-m2 was a 100x more enjoyable than this as was board exams. Third year as a whole is probably just a waste of time. I already figured out what I want to do within the last few days. Let me skip the rest.

 

[Ho0v-man]

Na . Rads is speaking to me every day. I already hate rotations. Like loathe it. Part of the problem is it’s surgery right now and it seems like I’m standing 10 hours a day, my feet are crying at like hour 5 no matter what I wear. Waking up at 330 to study a bit and round is such BS. Studying for m1-m2 was a 100x more enjoyable than this as was board exams. Third year as a whole is probably just a waste of time. I already figured out what I want to do within the last few days. Let me skip the rest.

I’m a rads TY right now. But even I’ll say it’s short-sighted to do like a week of a gen surg rotation and write off all of clinical medicine.

BTW, psych has stupid crazy income potential. In addition to just working your normal hours, you can be a “medical director” of a bunch of Geri psych type places and just see the patients once a week in the afternoon. It makes bank. Plus the freedom to just do cash pay only.

FWIW, my psych preceptor in third year got her loans forgiven by the state for working at an addiction rehab facility. She said this was already the highest paying job she’s ever had and she has no intention of quitting anyway lol.

 

[Prehealth1011]

For peeps that are suggestion IM fellows, isn't it fairly difficult to land a good fellowship? Are there charting outcomes for fellowship placement?

Yes

 

[scoopdaboop]

I’m a rads TY right now. But even I’ll say it’s short-sighted to do like a week of a gen surg rotation and write off all of clinical medicine.

BTW, psych has stupid crazy income potential. In addition to just working your normal hours, you can be a “medical director” of a bunch of Geri psych type places and just see the patients once a week in the afternoon. It makes bank. Plus the freedom to just do cash pay only.

FWIW, my psych preceptor in third year got her loans forgiven by the state for working at an addiction rehab facility. She said this was already the highest paying job she’s ever had and she has no intention of quitting anyway lol.

I’m not actually interested in anything psychiatry tho. I see the pros and cons, but I am interested in neurology and definetly radiology cuz I’ve spoken to many. I realize I can study at home for 5 hours a day and go to the gym etc and enjoy that way more than anything hospital related...even if it’s short sighted right now.

 

[Ho0v-man]

I’m not actually interested in anything psychiatry tho. I see the pros and cons, but I am interested in neurology and definetly radiology cuz I’ve spoken to many. I realize I can study at home for 5 hours a day and go to the gym etc and enjoy that way more than anything hospital related...even if it’s short sighted right now.

Cool. Id consider anesthesia too. They mostly have a similar mentality and a shorter residency.

 

[Splenda88]

I’m a rads TY right now. But even I’ll say it’s short-sighted to do like a week of a gen surg rotation and write off all of clinical medicine.

BTW, psych has stupid crazy income potential. In addition to just working your normal hours, you can be a “medical director” of a bunch of Geri psych type places and just see the patients once a week in the afternoon. It makes bank. Plus the freedom to just do cash pay only.

FWIW, my psych preceptor in third year got her loans forgiven by the state for working at an addiction rehab facility. She said this was already the highest paying job she’s ever had and she has no intention of quitting anyway lol.

You found your cash cow.

 

[drducky.]

And I'm not sure why you think MGMA data is "too much" for someone asking for income ranges by specialty and geography. That aside, there's basically never a time I will not tell someone to seek out MGMA data regarding specialty income levels. The more students, residents, and attendings know their worth, the better.

The rant about FM, though normally irrelevant, is actually QUITE relevant here given OP specifically asked for what specialties make the most money with a nice lifestyle. FM a hidden gem in that regard, as it doesn't require slaving away for 5+ years minimum and income has huge potential to go up in coming years, especially if one haggles well.

Is MGMA usually the most accurate data for different specialty salaries? I've never thought about money too much but I'm definitely starting to think about it more with my loans piling up fast.

 

[Sardonix]

Is MGMA usually the most accurate data for different specialty salaries? I've never thought about money too much but I'm definitely starting to think about it more with my loans piling up fast.

It's the best data you'll get without paying for it, I suppose.