realistic view on endo?

[europeanIMG]

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Hi,

I am considering going into endo.

My picture of endo is that I will easily get into a fellowship in a nice city (Boston , NYC e.g.) and then just as easily get an interesting work in academics or private practice.

My job will be almost only to see outopatients. I will work 40 hours a week plus some call. I will earn about 200 k a year.

Realistic or too optimistic?

 

[Pir8DeacDoc]

Well sounds like you're going into it for the right reasons....


You'll have to tell folks a little more about yourself. Are you currently a resident? If so, then how competitive is your program? How is their placement with endo? Reality is there aren't too many things to drag an endocrinologist into the hospital at night, so I imagine your lifestyle view is right on. I don't know anything about the money aspect.

 

[dragonfly99]

Not sure it will be that easy to get an endo fellowship in Boston or NYC as a foreign medical grad. That will probably depend on how good an IM residency you get into.
40 hrs/week can be done as an endocrinologist, but if you are in private practice would need to be practicing just 3-4 days a week to make those hours, I would think. I'm not sure the 200k takehome is realistic for someone working only 40 hrs/week, but I'm really not sure. If you are academics in Boston or NYC, would think that you would get <<200k, but again I'm not sure. If you do academics might be hard to work just 40 hrs/week, as they likely will want you doing research, or participating in academic committees, etc.

I agree that endocrinologists don't see a lot of inpatients. However, likely in academics you'd have to rotate on the hospital service. As a cards fellow, I rarely ever see an endo fellow in the hospital at night. You can expect some rounding on weekends during fellowship, however, and likely as an attending. Would think that in private practice most do hospital consults, but I'm really not sure...

 

[michaelrack]

Call in endo will depend a lot on your practice situation, but often involves a lot of phone calls from diabetics calling in with high/low blood sugar readings.

 

[staylor21]

Perhaps those who are attendings can chime in, but *working* 40 hours/week and making 200k seems slightly optimistic. Some back of the envelope calculations:

1) A level III office visit pays $100/half hour=$200/hr.
2) You bill for the time seeing a patient, not for time spent charting+ all the other administrative stuff associated with running a practice. So, say you work 8 hrs to bill 6. This means billing $1200/day.

$1400/day*5days*48 weeks (1 month for vacation-can't bill then!)=revenue of $288,000/yr.

From that, take out malpractice, costs of office staff, rent, supplies, etc. I suppose 200k is possible, but seems a little optimistic.

Like I said, what do I know, but $200k is probably what the average endo guy earns, and I have this sense that the average endo guy works more than 40h/wk.

 

[deleted87716]

A level III office visit pays $100/half hour=$200/hr.

Anyone who spends 30 minutes seeing a patient and only codes it as a 99213 is an idiot.

Complexity aside, you could bill that based on time and code a 99214.

 

[europeanIMG]

Not sure it will be that easy to get an endo fellowship in Boston or NYC as a foreign medical grad. That will probably depend on how good an IM residency you get into.
40 hrs/week can be done as an endocrinologist, but if you are in private practice would need to be practicing just 3-4 days a week to make those hours, I would think. I'm not sure the 200k takehome is realistic for someone working only 40 hrs/week, but I'm really not sure. If you are academics in Boston or NYC, would think that you would get <<200k, but again I'm not sure. If you do academics might be hard to work just 40 hrs/week, as they likely will want you doing research, or participating in academic committees, etc.

I agree that endocrinologists don't see a lot of inpatients. However, likely in academics you'd have to rotate on the hospital service. As a cards fellow, I rarely ever see an endo fellow in the hospital at night. You can expect some rounding on weekends during fellowship, however, and likely as an attending. Would think that in private practice most do hospital consults, but I'm really not sure...

What do you mean by rotate on the hospital service? Do you mean rounding regular IM units or only endo units?

 

[gutonc]

What do you mean by rotate on the hospital service? Do you mean rounding regular IM units or only endo units?

Depends. I'm not sure I've every heard of an "endo unit." Some places (academic, County, VA in particular) will have specialists do a stint on the general IM inpatient service. Otherwise, you will have to round on consults when you're on service. It's certainly possible to have a job without hospital privileges (and therefore no inpatient duty) but it'll be a lot harder to get new patients in that kind of a setting.

 

[adam6]

Hi,

I am considering going into endo.

My picture of endo is that I will easily get into a fellowship in a nice city (Boston , NYC e.g.) and then just as easily get an interesting work in academics or private practice.

My job will be almost only to see outopatients. I will work 40 hours a week plus some call. I will earn about 200 k a year.

Realistic or too optimistic?

As an endo fellow, I can tell you that your residency program, residency performance, and research will determine how "easily" you will obtain a fellowship. Endocrine is becoming more popular and I can tell you that there were plenty of well-qualified applicants from very good programs on the interview trail (ie: chief-residents, publications, etc etc) -- especially for the programs in Boston and NYC.

As for the job market, I echo that academics will provide a salary closer to 100K. In private practice, starting/pre-production based salaries (ie: guaranteed time/salary for 1-2 yrs) start at 150-250K. This will typically entail ~8-9 half-day clinics with the rest as administrative time. You'd probably be closer to 45-50 hrs/week. Once you move to a productivity model, it will depend on you to generate the bucks. Endo has taken a mild hit, as have other specialities, in that the "new consult" billing code for medicare patients has been removed. Ways to boost your income include working with an inpatient hyperglycemia service and/or participating in a thyroid biopsy clinic.

Academic positions are not easy to come by in big cities - and most will come from word of mouth. Generally, if you are just out of fellowship, your best bet is at your home program. Most academic programs do not need/want "run-of-the-mill" clinicians (insulting as that may sound) - but rather want someone who can fill a niche.

Private practice positions are plentiful due to the big shortage of endo docs. Again, there is saturation of big urban markets - so you may find more suburban positions rather than downtown NYC/Boston.

Call (beeper, hospital) will depend on the position/practice. You can look for outpatient only positions - they do exist. Personally, I would steer away from jobs requiring IM coverage in addition to endo.

Hope this helps.

 

[adam6]

Perhaps those who are attendings can chime in, but *working* 40 hours/week and making 200k seems slightly optimistic. Some back of the envelope calculations:

1) A level III office visit pays $100/half hour=$200/hr.
2) You bill for the time seeing a patient, not for time spent charting+ all the other administrative stuff associated with running a practice. So, say you work 8 hrs to bill 6. This means billing $1200/day.

$1400/day*5days*48 weeks (1 month for vacation-can't bill then!)=revenue of $288,000/yr.

From that, take out malpractice, costs of office staff, rent, supplies, etc. I suppose 200k is possible, but seems a little optimistic.

Like I said, what do I know, but $200k is probably what the average endo guy earns, and I have this sense that the average endo guy works more than 40h/wk.

I rarely bill level III. Most patients have complexities that legitimately warrant level IV or V billing.

 

[europeanIMG]

Call (beeper, hospital) will depend on the position/practice. You can look for outpatient only positions - they do exist. Personally, I would steer away from jobs requiring IM coverage in addition to endo.

Hope this helps.

They do exist, sounds like they are rare to me? Correct?

What exactly do endo docs do at the hospital if they are in private practice? Take consults from IM docs? Does that mean they have to take their car into a hospital just to see one or two patients? I am used to a different medical system, so I apologize for my ignorance.

IM coverage sounds no fun to me either, agree.



Some more Qs from a guy who doesn´t know the US system too well.:

1. Is it possible/common to work as a hospitalist for let´s say three years b4 you go into endo?

2. Can you go from academics to private practice and/or the other way around? In my country it is very common that ppl start in academics and after a few years when they have some experience start working in private practice.

3. Is it common in endo and other specialties to start working in private practice right away after fellowship? I know you guys got excellent training, that´s why I want to specialize in the US, but it seems to me like even in the US a guy who just got out of fellowship would not be able to do the same job as someone with 20 years of experience. How does that work? Do you start as a trainee sort of and earn less than the other docs in the group and work your way up?

Thanks again for answering all these stupid questions from a European colleague.

 

[dragonfly99]

Yes, generally you take your car to the hospital probably just to see a few patients/consults. Then you would go to your office and see your outpatients.

People do move from academics to private practice. Usually it is hard to move back from private practice to academics once you've left academia.

 

[adam6]

1. Consults: this model will vary depending upon the practice and the number of other endo docs with whom you'll work. If you are in a small private practice, the model can be as Dragonfly described. This is the traditional model. As endo becomes more of a "lifestyle" specialty, more people are seeking the "outpatient-only" jobs. Some large endo groups may emulate some IM models and designate one person "on-call" for the hospital(s)' consults. This person may have a 50% clinic schedule for that consult week - or even have no clinic for the week (depending upon the general consult volume). To describe another extreme, I will be staying in academics and will have, at most, 2-4 inpatient consult weeks per year. This is because we have sooo many other endo attendings (30+). Additionally, the endo fellows cover all phone calls after 5pm and on weekends - so it is a pretty sweet gig, in that respect.

2. Transition: much easier to move from academics to pp ->much harder in reverse, as mentioned.

3. Hospitalist: you should be able to do this for a few years...I'm not sure if it is seen as a positive or negative when applying.