MS3 Specialty Decision (very unoriginal)

[drdawg240]

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Hello all, I am a MS3 trying to decide what specialty to decide to pursue - very original, I know. In terms of residency selection, I am between Neurology, Pediatrics, and IM; would probably try to do either GI or hospitalist if I went with the 2 latter. Some things I am trying to think about:

• Probably want a field where I can do inpatient for part of career, then transition to outpatient.
• Long-term work-life balance and AI resistance are especially important to me. For the most part, I think I could carve out work-life balance in any of these fields though.
• Am most interested in the actual subject matter in Neurology. The "diagnose and adios" mantra seems to be fading, but still more true than in other fields.
• IM seems like the one I would probably enjoy the least of these if I did not do any fellowship, but I could be wrong.
• Peds hospitalist would be more enjoyable than IM but unclear how hard of a requirement the fellowship is. Not a fan of outpatient general peds though
• GI is appealing to have a procedural component. The pathology is interesting, and I like the mix of longitudinal follow up + interventions. Plus Peds GI will likely only be a 2-yr fellowship at many places once I apply.
• I love kids but I don't know that I feel a super strong draw for treating them vs treating adults.

Should I be worried about Neurology and/or Hospitalist roles in terms of AI resistance + scope creep at all? Is it worth going into something to have a procedural component for this reason? I know Neuro's physical exam is still important and gives you some resistance too, but I am unclear how much that is actually driving treatment decisions. Or should I just decide based on vibes from when I rotate? Any advice or other specialty suggestions are welcome, thanks!

 

[TwoDogMed]

In the not too distant future, AI will enable mid levels scope-creep even further in my humble opinion. If you are operating, you are safe for now. Go for a surgical sub like ophthalmology.

 

[drdawg240]

In the not too distant future, AI will enable mid levels scope-creep even further in my humble opinion. If you are operating, you are safe for now. Go for a surgical sub like ophthalmology.

I agree AI will allow mid levels to encroach on cognitive specialties, especially primary care (probably sooner than we realize), but Ophtho is probably not a great example of a field safe from mid-levels lol. Would you say that the procedures in GI protect you almost as much as other surgical fields or no? For neuro, it feels like pay will probably go down (outside of neurocritical care probably), but not sure that job demand will dramatically decrease for a while if I'm willing to go community route.

Also, my grades are solid but other than that I'm probably only moderately competitive, so Ophtho/ENT are out of the question. Those are the only surgical fields I could see myself somewhat enjoying given culture + types of cases + work-life balance of other surgical fields.

 

[hopefulraddaddypls]

GI, optho pays nothing now

 

[TwoDogMed]

GI, optho pays nothing now

Source?

pay attention to the burnout level.

Surgeon Salary by Specialty (2026): Full Pay Comparison

Surgeon salaries by specialty in 2026: general, orthopedic, cardiothoracic, neurosurgery, and more. Real compensation data ranked by median pay.

www.salarydr.com

 

[operaman]

If you are ambivalent about kids, would strongly advise avoiding Peds fields. Pay for all things Peds is much lower than their adult counterparts. Many reasons for this, but holds true across fields.

The other consideration is that most all Peds specialties will tether you to an academic children’s hospital. If that aligns with where you want to live and how you want to practice, great, but something to consider ahead of time. Such places also tend to pay less than comparable adult institutions, and if very academic will come with all the uncompensated extras inherent in academia. So you’ll work as much or more and make half what your adult counterparts are making.

 

[hopefulraddaddypls]

Source?

pay attention to the burnout level.

Surgeon Salary by Specialty (2026): Full Pay Comparison

Surgeon salaries by specialty in 2026: general, orthopedic, cardiothoracic, neurosurgery, and more. Real compensation data ranked by median pay.

www.salarydr.com

View attachment 423060

First I wouldn't trust those salary surverys (even though it proves my point), look at reimbursement trends

 

[VA Hopeful Dr]

First I wouldn't trust those salary surverys (even though it proves my point), look at reimbursement trends

Yeah that chart is nonsense. I'm an FP who works less than 36 hours per week and I make more than ophthalmology based on that chart.

 

[TwoDogMed]

That must be the reason family med is more competitive. I see now.
Trust nothing, especially Sdn.

 

[eyeeye_captain]

First I wouldn't trust those salary surverys (even though it proves my point), look at reimbursement trends

…do you even look at said trends? You know what got cut at about the same percentage as cataracts last year? Colonoscopies. Heck, I got slashed by even more, but I’m making more because E&M and office stuff went up. Surgery doesn’t pay the bills, though the cataract folks at least have cash pay options to improve revenue. The number quoted would be like Year 3+ at a PE job in a big coastal city (read: bad). Good to hear primary care can still pay.

I digress. OP, do neurology. Enjoying the subject matter will give you more career satisfaction and longevity. All the peds stuff above is true, and why do any peds thing if you don’t like the aspect of the job you want to pivot to?

 

[hopefulraddaddypls]

That must be the reason family med is more competitive. I see now.
Trust nothing, especially Sdn.

Med students are not the best at gauging what actually pays or gives you freedom in the real world... Im not FM or optho or any of these fields discussed here, so I don't have a dog in the fight

 

[VA Hopeful Dr]

That must be the reason family med is more competitive. I see now.
Trust nothing, especially Sdn.

A busy ophthalmologist should be making, at minimum, 50% more than what I do based on what I've seen the last couple years. Hence why I think that chart is in no way accurate.

Unless, of course, there are a lot more part-time and semi-retired (non-operative) ophthalmologists than I think there are and they are included in the data.

 

[operaman]

Yeah the chart is so far off as to almost be laughable. My comp in ent is way above the chart and my hours way below. I have ent friends who make much less than the chart and work even more. And anesthesia at $500k?! In today’s market that’s maybe a mommy track position, but most guys I know are at least 50% higher with plenty up in the 7 figures.

I do think FM is a hidden gem of a lifestyle specialty, especially for people who realize there are places to live beyond the Bay Area. Lots of med school friends are doing quite well in it and enjoying bankers hours and minimal to no call. My “rural” FM preceptors in med school were making $400k fifteen years ago (they were listed on the institution’s form 990) back when similar charts said their averages were more like $200k.

Even as an attending, I find the nuances of physician comp to be very challenging. There’s way too much to teach students and junior residents much useful about it. I tend to tell mentees to come find me when they start job hunting and I’ll help them start sorting it out for their particular situation.

 

[VA Hopeful Dr]

Yeah the chart is so far off as to almost be laughable. My comp in ent is way above the chart and my hours way below. I have ent friends who make much less than the chart and work even more. And anesthesia at $500k?! In today’s market that’s maybe a mommy track position, but most guys I know are at least 50% higher with plenty up in the 7 figures.

I do think FM is a hidden gem of a lifestyle specialty, especially for people who realize there are places to live beyond the Bay Area. Lots of med school friends are doing quite well in it and enjoying bankers hours and minimal to no call. My “rural” FM preceptors in med school were making $400k fifteen years ago (they were listed on the institution’s form 990) back when similar charts said their averages were more like $200k.

Even as an attending, I find the nuances of physician comp to be very challenging. There’s way too much to teach students and junior residents much useful about it. I tend to tell mentees to come find me when they start job hunting and I’ll help them start sorting it out for their particular situation.

Yeah I'm in that general vicinity. Technically I work 36 hours but between my 90 minute lunch break and last patient being at 3:45 I'm much closer to 32 hours per week of time in the office.

That said, I am on the higher end for production and I do recognize that my employer is more generous than many others out there. Also not a large (or even medium) sized city.