Most lucrative specialty in 10 years?

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will be very interesting to see how healthcare reform unfolds in coming years.

people keep saying single payer is inevitable, but is it also a foregone conclusion that the single payer's rates would not be reasonable on the whole? Canada's single payer seems to offer reasonable reimbursements...

Also, the public option that was proposed in 09 would have allowed doctors and hospitals to negotiate rates with the HHS (rather than contain medicare rates).
I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
 
I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
Wut? I guarantee you every single physician I have ever worked with or met that isn't already a federal employee would be furious about this.
 
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Some of the salary disparity has to do with the culture of each specialty and what they consider a normal work week, such as how many cases and how much call they take. If a small gen surg group hired several more to push their week to a PCPs schedule, their salaries would look similar too.
 
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I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...

Speaking of naive.....

I hope this wasn't a serious post.
 
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will be very interesting to see how healthcare reform unfolds in coming years.

people keep saying single payer is inevitable, but is it also a foregone conclusion that the single payer's rates would not be reasonable on the whole? Canada's single payer seems to offer reasonable reimbursements...

Also, the public option that was proposed in 09 would have allowed doctors and hospitals to negotiate rates with the HHS (rather than contain medicare rates).

If I recall correctly, doctors there negotiate their salaries year to year. It is most likely why their reimbursements don't suck.
 
And plenty of time to maintain a healthy lifestyle, read books, watch movies, and hang out with friends.
 
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I don't think you understand the difference between branches of the federal government
Did you read my post? I said republicans have crap candidates for president, so there will be a democrat in the white house again (strike against going back to the ways of the past). IN ADDITION TO THAT: republicans have a total identity crisis! They're divided as hell. The democrats are 99% aligned. Hillary and Bernie are pretty damn similar, only difference is that Hillary is bought by wall street and Bernie is angrier. Republican party is filled with radicals/centrists and anywhere in between. What even is their stance on immigration?

Point is, the republican party is seriously struggling overall. In the short run it means a democrat will be the next president (which does matter), and also has implications for the overall strength of republican party all the way down to the local government level. Increasingly states are making serious health decisions (whether to allow CRNAs to be independent or not etc.), so all of this stuff matters. Anyway, if you got the impression I was a "hater" of republicans, you are mistaken.

Written by someone that doesn't have a clue.
You really think ortho-joint, PM&R and gerontology aren't likely to go up? Everyone knows that spine hit is comin, we do like ~20x the number of spine surgeries as other 1st world countries and it shows. Not saying it won't pay well, but I don't think it will pay much better than general ortho for ex. If you disagree, throw in your predictions. No way to know for sure until 10 years from now after all.

Also I don't hate Derm either. It makes laugh (in a "wow this world is pretty ridiculous" way) to see Derm have double the salary growth (as a %!) over pediatrics despite all the hand-waving by politicians saying they're going to help primary care and how specialists will make less etc....Derm...Derm never changes.
 
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Interventional radiology and I expect a new field mixing quantum biology with medicine called quantum medicine that would be a very good speciality

quantam medicine? sounds like a PhD thing to me
 
I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...

again, more naive nonsensical. 90 + % of physicians would oppose that, just like 90 + % of physicians say the AMA doesn't support their views.

I don't even understand what you're saying about surgeons. It's not like the average surgeon makes 500k and in addition the average surgeon is working longer hours and taking on more risk than a PCP does. They also trained for longer and are much more specialized. All of these things are reasons why they would be expected to significantly more money than a PCP.
 
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I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
Dude, you're crazy.
I don't even want to be employed by the hospital or a management company, let alone the government.
Get real.
There will be a govt. takeover eventually, and there will be a private parallel system. Monster health systems that are profitable with huge endowments and cash reserves will survive and transition to private insurance (stay the same really) while floundering and bankrupt systems will collapse under their own weight and become government hospitals. How can the government take over these systems? Won't it be too expensive? Nope, not at all. A bankrupt business that nobody wants goes for pennies on the dollar. First they will make private insurance too expensive for the majority of Americans. That's in process and is unstoppable. More will get subsidized insurance until a tipping point is reached and Medicare for everyone is the only viable system going forward. Fees, particularly facility fees will be cut, bloated profits will be gone as well and the system will continue to limp along. That's when the lean deep pocket mega systems will rise and the rest will fall. Then it's VA care for all and fire sales at the county hospitals.
Today there is a sinking ship in my own city. They've shopped themselves for a merger without success, then they tried to sell. There are a few healthy large hospital systems here, including my own. Everyone took a look, crunched the numbers, and Nobody is interested. It's a money loser in a questionable area and one day the doors will just shut forever. That's the future.
 
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Hasn't ortho been at the top for a long time? I feel that this will be the case for a long time.
 
Hasn't ortho been at the top for a long time? I feel that this will be the case for a long time.

Ya, people keep saying the hammer is going to drop any day. But the fact still remains that total joints are a very quick, elective procedures with great outcomes and extremely satisfied patients. I don't think ortho is going anywhere.
 
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Surgeons barely have enough time to see their kids or remember what their faces look like. Think they have the time or will to lobby? They just sit around between OR cases complaining about the state of medicine just like every other doctor.

Fortunately, this just isn't true. Remember those gunners you knew in med school who went into surgery? Turns out they use that same intensity to protect their profession and are not the types to sit around and complain when something can be done about a problem. Some of the most politically active physicians I know are surgeons.

Sorry to derail from the payer/system debate above, just thought this jab needed to be addressed.
 
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Fortunately, this just isn't true. Remember those gunners you knew in med school who went into surgery? Turns out they use that same intensity to protect their profession and are not the types to sit around and complain when something can be done about a problem. Some of the most politically active physicians I know are surgeons.

Sorry to derail from the payer/system debate above, just thought this jab needed to be addressed.

that makes absolutely no sense. the people who are gunners aren't politically active at all. people that are gunners are extremely tunnel minded and have zero to little hobbies or interests outside of medicine, hence the desire to solely define their self worth as a student to the point where they actively sabotage others.

and " most politically active physician" is like saying the skinniest fat chick you know. as a whole, physicians are very very very unorganized and poor at putting up organized fronts to represent their interests
 
Ya, people keep saying the hammer is going to drop any day. But the fact still remains that total joints are a very quick, elective procedures with great outcomes and extremely satisfied patients. I don't think ortho is going anywhere.

Spine, on the other hand, is full of terrible outcomes. That will get slashed.

Fortunately, this just isn't true. Remember those gunners you knew in med school who went into surgery? Turns out they use that same intensity to protect their profession and are not the types to sit around and complain when something can be done about a problem. Some of the most politically active physicians I know are surgeons.

Sorry to derail from the payer/system debate above, just thought this jab needed to be addressed.

I agree with PL198. The gunners I know all were looking out for #1 and had no sense of what was going on in the real world.

At my medical school's big academic surgery department, virtually all of the general surgeons were miserable and complained all day and did nothing about the issues they were complaining about. It sounded like a lot of it stemmed from working for "the man"...aka...the big evil hospital that was paying them less and hiring incompetent staff that they had to deal with.

It's worse though in my current specialty, radiology. Everyone is so passive and willing to be steamrolled.
 
I don't think many physicians will be mad if all physicians become federal employees... I am guessing some of them are not happy that a few specialties (surgical) are milking the cow while others (especially primary care) are getting the end of the stick...
I trained for more years than a PCP.

I worked much longer hours during that training than a PCP.

I work longer hours now.I haven't had a single day off in the last 19 days and haven't been home before 8 pm this week. I'm on call this weekend as well so it won't be until next Saturday that I have a day off.

My malpractice is higher.

A well run FM practice can make in excess of $300k/year.

So tell me again why I'm "milking it" and should make less?
 
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that makes absolutely no sense. the people who are gunners aren't politically active at all. people that are gunners are extremely tunnel minded and have zero to little hobbies or interests outside of medicine, hence the desire to solely define their self worth as a student to the point where they actively sabotage others.

and " most politically active physician" is like saying the skinniest fat chick you know. as a whole, physicians are very very very unorganized and poor at putting up organized fronts to represent their interests

Being politically active to protect your practice is hardly an "interest outside of medicine" but I see how I shouldn't have compared med students to attendings--they have different goals. As a student getting grades and a residency is your life so you apply yourself 100% to it. *From what I've seen* many of those motivated individuals that are "tunnel minded and have zero to little hobbies or interests outside of (being a medical student)" apply the same focus to their profession once they are practicing.

I agree with PL198. The gunners I know all were looking out for #1 and had no sense of what was going on in the real world.

At my medical school's big academic surgery department, virtually all of the general surgeons were miserable and complained all day and did nothing about the issues they were complaining about. It sounded like a lot of it stemmed from working for "the man"...aka...the big evil hospital that was paying them less and hiring incompetent staff that they had to deal with.
.

Yeah I shouldn't have used the term gunners, wasn't really the population I was trying to describe.

For the rest, I'm sure a lot of it depends on your practice setting. For as many surgeons that are out there able to put resources towards activism, there are probably many more as you described above that don't have the opportunity/energy/motivation to try and change anything. In my initial post I was just trying to point out that "no time for life and sit around and complain" line was a gross over-generalization.
 
I trained for more years than a PCP.

I worked much longer hours during that training than a PCP.

I work longer hours now.I haven't had a single day off in the last 19 days and haven't been home before 8 pm this week. I'm on call this weekend as well so it won't be until next Saturday that I have a day off.

My malpractice is higher.

A well run FM practice can make in excess of $300k/year.

So tell me again why I'm "milking it" and should make less?

To pile on (and remember here that I AM a federal employee with rather left-wing political views), I don't pretend that the fact that the feds can offer me a competitive salary isn't due to the fact they have to recruit and compete with the privates for physicians. I have some trade-offs to the lessened earning potential where I am now that are quite nice, but it's not for everyone.

Besides, given the current political and structural realities of the country, federalization of payment is far more likely than total federalization of the health-care system.
 
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Besides, given the current political and structural realities of the country, federalization of payment is far more likely than total federalization of the health-care system.
First one, then the other. Decreased facility payments will bankrupt small, independent and struggling community hospitals. Bankrupt businesses sell for pennies on the dollar.
The rise of the mean, lean and profitable, future parallel private system is already happening.
Trump is unelectable, and Jeb! has so little charisma that he's losing to The Donald. Even with the !, he's still jeb who? 8 more years of a democratic agenda is moving up the time table. If you're looking for a long term career job, make sure you're with one of the big boys.
 
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With the rate at which baby boomers are going to get skin cancers as they get older I say Mohs Surgery.
 
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First one, then the other. Decreased facility payments will bankrupt small, independent and struggling community hospitals. Bankrupt businesses sell for pennies on the dollar.
The rise of the mean, lean and profitable, future parallel private system is already happening.
Trump is unelectable, and Jeb! has so little charisma that he's losing to The Donald. Even with the !, he's still jeb who? 8 more years of a democratic agenda is moving up the time table. If you're looking for a long term career job, make sure you're with one of the big boys.

Regardless of the other political things in your post, the community hospitals in high-poverty areas are already closing shop near me. The causes for which tend to involve more than just left/right political reasons.
 
According to AAMC-CiM, step1 average is 225 and step2 231... But they still make a lot of money--404k/year. Surgeons always win!:(

Not that many butt emergencies that you need to wake up in the middle of the night for compared to other things in gen surg.

though yeah, there's a lot of poop.
 
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According to AAMC-CiM, step1 average is 225 and step2 231... But they still make a lot of money--404k/year. Surgeons always win!:(
Surgeons work extremely hard.
Not to mention, what does step 1 have to do with payment at all?
 
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What is your issue with surgeons?

Don't you think the increased liability and training requirements are worth something?

I have no issues with surgeons to be honest, I just want the system to be a little bit more fair... I am ok with surgeons making more money than PCP, but I am not sure it's fair for them to be making double and triple/quadruple in some cases... I was told that the panel who decides medicare reimbursement is full with surgeons. Don't you think there is some conflict of interest in that?
 
Surgeons work extremely hard.
Not to mention, what does step 1 have to do with payment at all?
I know surgeons work hard, so are most physicians...

Regarding colorectal surgery, I was just answering to someone who said it is competitive... Is it that bad when someone is advocating fore a more equitable system in term of reimbursement?
 
We all knew the what reimbursements were going to be (more or less) when we chose our fields. Want to make more? Choose a field or location where that will happen.
 
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We all knew the what reimbursements were going to be (more or less) when we chose our fields. Want to make more? Choose a field or location where that will happen.
I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...
 
I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...
well, there you go again pointing fingers at certain physician specialties.

ive commited myself to never sh***ing on any specialty. It's not good to be fragmented. If you want to argue that primary care should make more, do it by giving reasons that don't involve "specialty x and y do this and make this, therefore..."
 
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I'm gonna be honest with you--genuinely so. As a SICU/recovery RN, I was actually surprised that a number of surgeons didn't make more. That's a lot of years of a lot of stress and hell--and loss of wages to be skilled enough to make essentially what PCPs make and have many times more the risk of liability and hours. Ah, I'm sorry. No way. No how. NO sane person would do this.
 
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I have no issues with surgeons to be honest, I just want the system to be a little bit more fair... I am ok with surgeons making more money than PCP, but I am not sure it's fair for them to be making double and triple/quadruple in some cases... I was told that the panel who decides medicare reimbursement is full with surgeons. Don't you think there is some conflict of interest in that?

What surgeons do you think are making 600k+?? The only ones I can think of are private practice neurosurgery or ortho spine, and there really aren't that many of either of those, and the ones who are making that much are working 80+ hour weeks anyway. Anyone else making that much is probably in the latter half of their career anyway.
 
I have no issues with surgeons to be honest, I just want the system to be a little bit more fair... I am ok with surgeons making more money than PCP, but I am not sure it's fair for them to be making double and triple/quadruple in some cases... I was told that the panel who decides medicare reimbursement is full with surgeons. Don't you think there is some conflict of interest in that?
Let's clarify who you mean when you say "surgeons".

You mean Orthopedic surgeons. Traditionally, they have been overrepresented on panels deciding reimbursement and it is true that Ortho and Neuro Spine can make significantly more than a PCP or other surgical specialties, for that matter. Do they deserve it? I think they do given the patient population, the skill required and the liability involved. I think a guy who could paralyze you (as one well known Neuro Spine guy in Texas did...more than once) should be well paid.

Physician reimbursement is based on RVUs. Its not a bunch of surgeons sitting around going, "we deserve more, so let's tell CMS to pay us moar!!!"

The Medicare Resource-Based Relative Value Scale (RBRVS) is the method by which Medicare sets reimbursement rates for each Current Procedural Terminology (CPT) code assigned to every physician encounter; thus physicians’ services are counted in RVU’s. For example, a level one office visit may be assigned an RVU of 1, a level three office visit might be assigned an RVU of 1.5, and a surgical procedure might be assigned an RVU of 20.

I make more on office visits than someone does who routinely bills a Level 3, because I bill more Level 4 and 5 visits - more complex visits, longer visits pay more. Seems fair to me.

RVUs are published in the Federal Register each November. Medicare bases RVUs on the following: (i) Physician work, which takes into account the physician’s expertise, the time and technical skill spent in performing the entire service including the mental effort and judgment expended by the physician prior to, during and after the patient encounter terminates, including documentation of the service; (ii) Practice expense, which accounts for the cost to operate a medical practice; and (iii) Professional liability insurance expense, which estimates the relative risk of services/cost to insure against the risk of loss in providing the service.

Each component of the relative value unit (work, practice expense and professional liability) assigned to each CPT Code, is then multiplied by the Geographic Practice Cost Index (GPCI) for each Medicare locality, which takes the cost of delivery of health care services based on locale into account, and which is further adjusted by a conversion factor that is set by the Centers for Medicare and Medicaid Services (“CMS”) on an annual basis. The Medicare Conversion Factor (CF) is a national value that converts the total RVUs into the dollar amounts paid by Medicare to physicians for the services they provide.

In New York City Suburbs/Long Island, New York the GPCI for the Work RVU, PE and Malpractice are 1.051, 1.289, and 1.235 respectively. The Physician practice conversion factor for calendar year 2010 was $36.0846. Thus, the formula for deriving the dollar amounts paid by Medicare for any service performed by a physician would be as follows:

[(Work RVU x 1.051) + (PE RVU x 1.289) + (MP RVU x 1.235)] x 36.0846.

To paraphrase an old joke, "when it came time to decide CMS reimbursement, a fight broke out amongst the specialists. The Orthopedic surgeons showed up to the fight with a gun, the radiologists showed up with a knife and the general surgeons didn't show up at all -- they were busy in the ED taking care of patients." The point? Not all surgeons are paid those ridiculous 7 figure salaries that pre-med students are so fond of quoting. The vast majority of surgeons, even Ortho and Neuro spine, are not making 3-4 times what a FM physician is making.

Is there a conflict of interest? Perhaps and there are steps to rectify the imbalance between the specialties. But rather than cry about surgeons, who take longer to train, have much high malpractice insurance (mine cost more than 100K per year in Pennsylvania), and more liability than the average PCP, making too much money why not advocate for every one to make more.

I don't decry my colleagues making $800K per year when they take a huge hit on malpractice and they work hard. I do look askance at some of the specialties (and you know who you are) who don't work after 5 and don't work weekends, living in multi million dollar homes next to professional athletes but its jealousy.
 
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I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...

Dude you have no clue what you're talking about. You've probably never even stepped foot in an operating room or a dermatology clinic. Your opinions are invalid and make you look really stupid
 
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Everyone's also forgetting, it's not only about working hard...it's about working smart. If you think your income is linearly correlated to the hours you work (and you want to make money), you'll burn out and reach your limit of earnings very quickly. In the real world there is no linear, straight forward correlation if youre smart about it.
If not, you just arn't being innovative
 
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Let's clarify who you mean when you say "surgeons".

You mean Orthopedic surgeons. Traditionally, they have been overrepresented on panels deciding reimbursement and it is true that Ortho and Neuro Spine can make significantly more than a PCP or other surgical specialties, for that matter. Do they deserve it? I think they do given the patient population, the skill required and the liability involved. I think a guy who could paralyze you (as one well known Neuro Spine guy in Texas did...more than once) should be well paid.

Physician reimbursement is based on RVUs. Its not a bunch of surgeons sitting around going, "we deserve more, so let's tell CMS to pay us moar!!!"

The Medicare Resource-Based Relative Value Scale (RBRVS) is the method by which Medicare sets reimbursement rates for each Current Procedural Terminology (CPT) code assigned to every physician encounter; thus physicians’ services are counted in RVU’s. For example, a level one office visit may be assigned an RVU of 1, a level three office visit might be assigned an RVU of 1.5, and a surgical procedure might be assigned an RVU of 20.

I make more on office visits than someone does who routinely bills a Level 3, because I bill more Level 4 and 5 visits - more complex visits, longer visits pay more. Seems fair to me.

RVUs are published in the Federal Register each November. Medicare bases RVUs on the following: (i) Physician work, which takes into account the physician’s expertise, the time and technical skill spent in performing the entire service including the mental effort and judgment expended by the physician prior to, during and after the patient encounter terminates, including documentation of the service; (ii) Practice expense, which accounts for the cost to operate a medical practice; and (iii) Professional liability insurance expense, which estimates the relative risk of services/cost to insure against the risk of loss in providing the service.

Each component of the relative value unit (work, practice expense and professional liability) assigned to each CPT Code, is then multiplied by the Geographic Practice Cost Index (GPCI) for each Medicare locality, which takes the cost of delivery of health care services based on locale into account, and which is further adjusted by a conversion factor that is set by the Centers for Medicare and Medicaid Services (“CMS”) on an annual basis. The Medicare Conversion Factor (CF) is a national value that converts the total RVUs into the dollar amounts paid by Medicare to physicians for the services they provide.

In New York City Suburbs/Long Island, New York the GPCI for the Work RVU, PE and Malpractice are 1.051, 1.289, and 1.235 respectively. The Physician practice conversion factor for calendar year 2010 was $36.0846. Thus, the formula for deriving the dollar amounts paid by Medicare for any service performed by a physician would be as follows:

[(Work RVU x 1.051) + (PE RVU x 1.289) + (MP RVU x 1.235)] x 36.0846.

In these days of physician hospital integration, hospitals are using RVU’s as a measure of physician productivity in order to calculate physician compensation. The advantage of using RVUs as a measure of productivity is that the RVU is independent of the physician’s charge schedules, patients’ insurance coverage, the reimbursement fee schedules assigned by any payor for any CPT code, or the practitioner’s ability to collect reimbursement revenue for any physician encounter. In addition, the RVU method of measuring productivity reflects the reality that every patient encounter is not equal.

To paraphrase an old joke, "when it came time to decide CMS reimbursement, a fight broke out amongst the specialists. The Orthopedic surgeons showed up to the fight with a gun, the radiologists showed up with a knife and the general surgeons didn't show up at all -- they were busy in the ED taking care of patients." The point? Not all surgeons are paid those ridiculous 7 figure salaries that pre-med students are so fond of quoting. The vast majority of surgeons, even Ortho and Neuro spine, are not making 3-4 times what a FM physician is making.

Is there a conflict of interest? Perhaps and there are steps to rectify the imbalance between the specialties. But rather than cry about surgeons, who take longer to train, have much high malpractice insurance (mine cost more than 100K per year in Pennsylvania), and more liability than the average PCP, making too much money why not advocate for every one to make more.

I don't decry my colleagues making $800K per year when they take a huge hit on malpractice and they work hard. I do look askance at some of the specialties (and you know who you are) who don't work after 5 and don't work weekends, living in multi million dollar homes next to professional athletes but its jealousy.


Thanks Winged Scapula. This was like a partial refresher course of a course I took on Healthcare Economics. :)
 
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I am pretty sure that most physicians don't choose their specialty based on how much money they will be making (derm might be an exception)...

maybe, maybe not, but you're supposed to be an adult and make a decision about what your future career prospects will involve. Picking a medical specialty is no different than choosing whether or not to go to that second tier law school or dropping that engineering degree for a BA in interdisciplinary studies. "Do what you love" isn't going to pay the bills. You're responsible for your decisions.
 
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