Residency Competitiveness correlating with compensation

[afib123]

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Everyone in medicine keeps saying don't pick a field based on the money. But, then, is there a reason the most competitive fields like ortho, plastics, dermatology are also the most well paid fields? Even when it comes to IM fellowships, Cards and GI are the most competitive and the fields with the highest compensation.

Is this just a correlation or did these fields become competitive because they are the most well paid? Do people even follow the rule "don't pick a field based on money" when it comes to competitive specialities?

 

[droliver]

Everyone in medicine keeps saying don't pick a field based on the money. But, then, is there a reason the most competitive fields like ortho, plastics, dermatology are also the most well paid fields?

I think students have some misconceptions on dermatology and plastic surgery. Plastics and Derm often/usually make substantially less then busy General Surgery, Orthopedics, ENT, Vascular Surgery, GI, Cardiology, Radiology, and Neurosurgery but the hours are better (Derm much better) and patients usually healthier (although some recon patients in Plastics are pretty sick).

 

[libertyyne]

Everyone in medicine keeps saying don't pick a field based on the money. But, then, is there a reason the most competitive fields like ortho, plastics, dermatology are also the most well paid fields? Even when it comes to IM fellowships, Cards and GI are the most competitive and the fields with the highest compensation.

Is this just a correlation or did these fields become competitive because they are the most well paid? Do people even follow the rule "don't pick a field based on money" when it comes to competitive specialities?

Yes, because superstars could end up in ent, neurosurgery, ortho , derm, or good im programs. That is the point, the basics for getting into any of those fields is the same. But superstars do end up in other fields as well, because they want to . The best student in my schools previous class went into primary care last year. The point is that after a certain threshold money impacts your happiness less and what you do, and quality of life will impact your happiness a lot more. So rather than get burnt out in the 6th year of Neurosurgery residency and quit , it is better to find out what drives you and what you would like to do for the rest of your life. after your loans are paid off and you are making 300k vs 500k will make very little impact in your day to day life. The second part is those fields are competitive because some of them come with very good lifestyles and pay compared to family practice. The last part is scarcity of those training, they are competitive just because there are more people who even after all is said and done want to go into them.

 

[IMreshopeful]

Everyone in medicine keeps saying don't pick a field based on the money. But, then, is there a reason the most competitive fields like ortho, plastics, dermatology are also the most well paid fields? Even when it comes to IM fellowships, Cards and GI are the most competitive and the fields with the highest compensation.

Is this just a correlation or did these fields become competitive because they are the most well paid? Do people even follow the rule "don't pick a field based on money" when it comes to competitive specialities?

You can make lots of cash money in most fields of medicine (peds is perhaps harder to do so). You can be a family doctor working his butt off and grossing over 500k rural. You can also be a dermatologist working two or three days a week and grossing 200k.

The difference is that the competitive fields usually (a) attract a very specific type of candidate - neurosurgery, ortho, etc - who self select for those fields and (b) tend to have better lifestyles - usually, something with high procedural volume and quick turnaround (think GI with screening colos, ophtho and lasik, etc).

So the answer is - yes, of course lifestyle and pay make a huge difference in how competitive a field is. That’s life. But you ultimately should choose something that either interests or satisfies you because doing something you hate for a few more bucks isn’t worth it

 

[DoctwoB]

The importance of scarcity of spots is majorly overlooked. There is no inherent reason why people should be interested in family med, peds, or IM at such higher rates then surgical fields or other sub specialties, but the number of spots are an order of magnitude larger. Viewed through that lens it makes a lot more sense that the smaller fields will generally be more competitive simply through number of spots. Of course lifestyle, perceived prestige, and compensation factor in also, but really it’s mostly a supply side issue.

 

[libertyyne]

The importance of scarcity of spots is majorly overlooked. There is no inherent reason why people should be interested in family med, peds, or IM at such higher rates then surgical fields or other sub specialties, but the number of spots are an order of magnitude larger. Viewed through that lens it makes a lot more sense that the smaller fields will generally be more competitive simply through number of spots. Of course lifestyle, perceived prestige, and compensation factor in also, but really it’s mostly a supply side issue.

Scarcity does correlate to competitiveness, but it is not a perfectly linear relationship and is largely confounded by compensation and lifestyle /prestige as is evidenced by path, child psych etc.

 

[afib123]

Interesting viewpoints. I agree, especially looking at it from a supply perspective.

 

[TypeADissection]

This is why you should consider Vascular Surgery. Mad money. Mad chicks. Mad cush hours.

 

[Psai]

This is why you should consider Vascular Surgery. Mad money. Mad chicks. Mad cush hours.

I signed up for the chicks

Still waiting on them tho

 

[getdown]

I signed up for the chicks

Still waiting on them tho

You don't want those kinds of chicks. They'll just get your seed and then demand alimony payments. Happened to many a naive doctor. If on a one night stand remember to take your condom with you. I've heard stories of "self innoculation" afterwards. Can't be too careful around gold diggers man.

 

[libertyyne]

thought this was an interesting question.

 

[Frogger27]

@libertyyne Awesome chart. Guessing you used NRMP data? Where did you get the step score for Urology because a 236 is much lower than what I have seen/heard

 

[libertyyne]

@libertyyne Awesome chart. Guessing you used NRMP data? Where did you get the step score for Urology because a 236 is much lower than what I have seen/heard

I couldnt find the stupid Uro data, so i went by this. I should have put an * next to it.
Specialty Choice: Urology | Career Advising | Boonshoft School of Medicine | Wright State University

And yes i used the NRMP data plus the san fran match and the uro match for number of positions.


If any one has good hourly salary data I would love to put it next to it .

 

[Frogger27]

I couldnt find the stupid Uro data, so i went by this. I should have put an * next to it.
Specialty Choice: Urology | Career Advising | Boonshoft School of Medicine | Wright State University

And yes i used the NRMP data plus the san fran match and the uro match for number of positions.


If any one has good hourly salary data I would love to put it next to it .

Ah yeah that's pretty outdated. From the Uro match spreadsheet, it looks like the average matched score from the last two matches was between 245-246 (n=145).

 

[afib123]

Coming down to less spots + high compensation or good life style = high competition. Just less spots doesn't explain why fields with average compensation like child neurology or PM&R aren't super competitive. Of course ppl might find ortho, derm to be more interesting but I think child neurology or PM&R would also become super competitive if their salaries were to go up significantly.

 

[IMreshopeful]

There are more people matching IM with a 250+ step score (530 students) than there are people matching uro with any score (about 320). Less than half of students matching uro have 250+ (So IM has more than 3 times the number of 250+ scoring residents), but it’s harder to match urology overall than IM.

I’d bet that if you counted it up, the majority of competitive applicants (defined as step score >250), aren’t going into uro/ortho/neurosurg/plastics/derm/ENT. These fields accept so few students that they naturally require inflated stats to match, but plenty of competitive people are doing other things.

Agreed with this - I would say a top tier IM program is probably on the level of competitiveness as any major competitive specialty.

Ultimately again the compensation means jack **** if you hate what you’re doing. I (probably) could have matched a lifestyle specialty or surgical specialty (aside from having to get letters of rec, sub Is etc) but decided on IM because I liked it. Most folks I know didn’t go into neurosurgery for the money, they genuinely liked it.

 

[Psai]

You don't want those kinds of chicks. They'll just get your seed and then demand alimony payments. Happened to many a naive doctor. If on a one night stand remember to take your condom with you. I've heard stories of "self innoculation" afterwards. Can't be too careful around gold diggers man.

I'm a broke ***** though

 

[getdown]

I'm a broke ***** though

The smart ones aren't looking at your broke ass resident paycheck but that nice 300K+ future attending paycheck.

 

[QueenJames]

Well.. what sounds cooler..?

"I'm a family medicine doctor" or "I'm a neurosurgeon/dermatologist/plastic surgeon/etc."

A lot of med students want clout and attention these days because it's the social media age.

Look at all of the medical students who have IG accounts and are trying to become "influencers" these days.

I get it if you post motivational stuff.. that's cool.. do ur thing. Not judging you.

From my experience, the weirdos in my class who are always posting pics in their white coat, scrubs, and stupid highlighter and desk set-up projecting this false image that they are "killing medical school" or "beasting boards" or "busting my butt to save yours" are the same ones who are chasing these "luxurious" fields WHEN I PERSONALLY KNOW they are barely passing classes and didn't take USMLE but are giving advice on how to study for the damn exam....? WTF?

It's one thing if you are ACTUALLY super smart and doing well and not trying to paint this pic on social media that you are God's gift to earth... do your thing.

Not judging them but the point I am trying to make is that everything is all about image dude.

Image ---> Attention ---> more likes and views ----> feeds their narcissistic and depressed little souls.

 

[libertyyne]

Well.. what sounds cooler..?

"I'm a family medicine doctor" or "I'm a neurosurgeon/dermatologist/plastic surgeon/etc."

A lot of med students want clout and attention these days because it's the social media age.

Look at all of the medical students who have IG accounts and are trying to become "influencers" these days.

I get it if you post motivational stuff.. that's cool.. do ur thing. Not judging you.

From my experience, the weirdos in my class who are always posting pics in their white coat, scrubs, and stupid highlighter and desk set-up projecting this false image that they are "killing medical school" or "beasting boards" or "busting my butt to save yours" are the same ones who are chasing these "luxurious" fields WHEN I PERSONALLY KNOW they are barely passing classes and didn't take USMLE but are giving advice on how to study for the damn exam....? WTF?

It's one thing if you are ACTUALLY super smart and doing well and not trying to paint this pic on social media that you are God's gift to earth... do your thing.

Not judging them but the point I am trying to make is that everything is all about image dude.

Image ---> Attention ---> more likes and views ----> feeds their narcissistic and depressed little souls.

Competitive fields were competitive long before social media and the internet.

 

[QueenJames]

Competitive fields were competitive long before social media and the internet.

Rightfully so but nowadays... what gets more attention?

The FM doc or the pimple popper.

Let's be real.

LOL

 

[libertyyne]

Rightfully so but nowadays... what gets more attention?

The FM doc or the pimple popper.

Let's be real.

LOL

dr. mike seems to have a lot of followers. Attention ****** will be attention ****** regardless of specialty. Its just weird to blame social media on competitiveness of specialties.

 

[QueenJames]

dr. mike seems to have a lot of followers. Attention ****** will be attention ****** regardless of specialty. Its just weird to blame social media on competitiveness of specialties.

Not saying it's social media's fault persay.

But a lot of these students are infatuated with the type of lifestyle associated with these fields and shoot for the "prestige" that comes with them.

Who wants to be a family med doc when being a "-ologist" is so much fancier????

 

[aafisahar]

Not saying it's social media's fault persay.

But a lot of these students are infatuated with the type of lifestyle associated with these fields and shoot for the "prestige" that comes with them.

Who wants to be a family med doc when being a "-ologist" is so much fancier????

Are you dense? The competitive fields have been competitive for decades. This is not a new thing.

It's a combination of making more money, working less, and controlling your patient population. No one but your grandmother cares that your an "-ologist".

 

[QueenJames]

Are you dense? The competitive fields have been competitive for decades. This is not a new thing.

It's a combination of making more money, working less, and controlling your patient population. No one but your grandmother cares that your an "-ologist".

Are YOU dense?

BAHAHA.

Not with the changes in medicine that are coming up.

By the time we all get out, you will be working longer, harder, and seeing more patients as a specialist. Procedures are still the name of the game but even those are being cut.

Caths used to MINT dough.

They have been cut 9-10X lower.

I know this because I have family in CMS and in medicine that are on the other side.

You spent an extra 3-4 years after residency to specialize and are only making 100-200K more on average than the internist who has been out.

Not to mention call.

Not to mention consolidation.

Reimbursements are declining. Do your research.

Lifestyle is also relative.

Cardiologists making 400-500K sounds good until you realize you are on call every 3-4 days and are being abused by senior partners to "pay your dues".

Specializing really isn't worth it unless you REALLY want to do it.

 

[libertyyne]

BAHAHA.

Not with the changes in medicine that are coming up.

By the time we all get out, you will be working longer, harder, and seeing more patients as a specialist. Procedures are still the name of the game but even those are being cut.

Caths used to MINT dough.

They have been cut 9-10X lower.

I know this because I have family in CMS and in medicine that are on the other side.

You spent an extra 3-4 years after residency to specialize and are only making 100-200K more on average than the internist who has been out.

Not to mention call.

Not to mention consolidation.

Reimbursements are declining. Do your research.

Lifestyle is also relative.

Cardiologists making 400-500K sounds good until you realize you are on call every 3-4 days and are being abused by senior partners to "pay your dues".

Specializing really isn't worth it unless you REALLY want to do it.

When salaries and lifestyles get worse competitiveness gets worse. Nephro used to be super competitive and now isnt, heme onc had a similar cycle, rads was the hardest thing to get into in early 2000's. Since we are hypothesizing about the future, why are you excluding the possibility of midlevels and possible impact on family practice?

Lifestyle and earning potential definately drive some of the competitiveness and so does scarcity of the training available. That being said, people's interests are the most important aspect of this and should not be excluded. People are still going into ID even though it pays less than straight up im.

 

[QueenJames]

When salaries and lifestyles get worse competitiveness gets worse. Nephro used to be super competitive and now isnt, heme onc had a similar cycle, rads was the hardest thing to get into in early 2000's. Since we are hypothesizing about the future, why are you excluding the possibility of midlevels and possible impact on family practice?

Lifestyle and earning potential definately drive some of the competitiveness and so does scarcity of the training available. That being said, people's interests are the most important aspect of this and should not be excluded. People are still going into ID even though it pays less than straight up im.

Because midlevels DON'T WANT to do primary care.

They are entering specialties that are more procedurally-oriented.

Primary care for them is a mere stepping stone to other fields like derm, neurosurgery, etc. because they have the freedom to shop around and bounce around.

P.S.

Midlevels really aren't threatening. They cannot manage 20+ patients a day and they manage the simple stuff that a 3rd year med student probably could in all honesty.

All the NPs I saw during my FM rotation (if there were any hired) were for the simple f/u appointments and only managed 11-12 patients PER DAY.

My preceptor was consistently seeing 30+.

There's a difference but the SDN nerds on here just love to be skeptical of everything.

But hey... if y'all wanna spend 7-10 years after med school specializing to clear more cake and jump more hoops in the face of declining reimbursements that may not even pan out to what y'all expect to make after... Gotta have some faith right???

Props to y'all!

There's folks out there like me that just wanna give them that lisinorpil, SSRI, and metformin and send them on their way.

 

[libertyyne]

Because midlevels DON'T WANT to do primary care.

They are entering specialties that are more procedurally-oriented.

Primary care for them is a mere stepping stone to other fields like derm, neurosurgery, etc. because they have the freedom to shop around and bounce around.

P.S.

Midlevels really aren't threatening. They cannot manage 20+ patients a day and they manage the simple stuff that a 3rd year med student probably could in all honesty.

All the NPs I saw during my FM rotation (if there were any hired) were for the simple f/u appointments and only managed 11-12 patients PER DAY.

My preceptor was consistently seeing 30+.

There's a difference but the SDN nerds on here just love to be skeptical of everything.

But hey... if y'all wanna spend 7-10 years after med school specializing to clear more cake and jump more hoops in the face of declining reimbursements that may not even pan out to what y'all expect to make after... Gotta have some faith right???

Props to y'all!

There's folks out there like me that just wanna give them that lisinorpil, SSRI, and metformin and send them on their way.

Come on dude dont just make up stuff. 60% of Nps work in primary care. Who cares how many patients a doc is seeing when you could hire an NP for half the price, next they will be fighting for equal reimbursement. Nothing wrong with primary care, but dont just paint every specialty to be dying. There has been doom and gloom about medical specialties for the past two decades yet physican salaries have continued to go up. You gotta respect other people's hustles for them to respect yours. Frankly, it comes off as a little grapes are sour.

 

[QueenJames]

Come on dude dont just make up stuff. 60% of Nps work in primary care. Who cares how many patients a doc is seeing when you could hire an NP for half the price, next they will be fighting for equal reimbursement. Nothing wrong with primary care, but dont just paint every specialty to be dying. There has been doom and gloom about medical specialties for the past two decades yet physican salaries have continued to go up. You gotta respect other people's hustles for them to respect yours.

Your hospital admins do.

Your CEO of your private practice medical group who's gonna sell out to the hospital mentioned above does.

More patients = more RVUS = more billing = more insurance money to be sucked from the teet of medicare and medical and PPOs and HMOs.

Let a NP see 30 patients a day.

Hell... Hire 10 NPs and let them all see 10 patients a day and see how much of everything gets referred out or missed on history and physical and see the extraneous expensive workups they call for.

It's not gonna fly because they really don't know much compared to physicians.

And yes. Salaries have gone up because people are seeing more patients and putting in more time. CMS has also made a switch to reimbursing more for FQHCs and the like.

How is this not common sense business 101?

Jesus.

 

[libertyyne]

Your hospital admins do.

Your CEO of your private practice medical group who's gonna sell out to the hospital mentioned above does.

More patients = more RVUS = more billing = more insurance money to be sucked from the teet of medicare and medical and PPOs and HMOs.

Let a NP see 30 patients a day.

Hell... Hire 10 NPs and let them all see 10 patients a day and see how much of everything gets referred out or missed on history and physical and see the extraneous expensive workups they call for.

It's not gonna fly because they really don't know much compared to physicians.

And yes. Salaries have gone up because people are seeing more patients and putting in more time. CMS has also made a switch to reimbursing more for FQHCs and the like.

How is this not common sense business 101?

Jesus.

If that was the case no one would ever hire an NP, yet they get jobs everyday with increasing salaries. Get a grip man.

Doom and gloom for everything except primary care. lol.

 

[theonlytycrane]

@QueenJames

Sorry this is really random, but I always find your posting style to be super funny (in a good way!).

I have to ask- is your handle "QueenJames" and your slang more of an internet thing or is it legit? (If legit, you're the swaggiest med student xD)

 

[QueenJames]

If that was the case no one would ever hire an NP, yet they get jobs everyday with increasing salaries. Get a grip man.

Doom and gloom for everything except primary care. lol.

Doom and gloom is for MEDICINE in general my man. I'm really not arguing with you.

Medicine in general is going downhill.

and yes.

NPs get jobs.

You know where?

In the middle of goddamn nowhere where the definition of "fine dining" is a Little Caesar's pizza chain and with a community that barely has a 6th grade reading level in its entirety.

As soon as docs branch out to these areas and set up shop, they'll be straight.

But with all of these bratty-ass privileged millenials entering medicine who won't even consider residency in a spot without a Chipotle, Starbucks, or coffee shop with no free wi-fi sticking their nose up at such places because there's "nothing to dooo.. OMGG... I'm gonna die of boredom in residency with all the free time I'll have".

gimme a damn break.

 

[QueenJames]

@QueenJames

Sorry this is really random, but I always find your posting style to be super funny (in a good way!).

I have to ask- is your handle "QueenJames" and your slang more of an internet thing or is it legit? (If legit, you're the swaggiest med student xD)

a bit of both.

but I stay the hell away from my entire student body so they don't really get to see the greatness and swag that your boy has to offer.

🙂

Happy New Year to you cutie patootie. Wish you nothing but the best!

 

[libertyyne]

Doom and gloom is for MEDICINE in general my man. I'm really not arguing with you.

Medicine in general is going downhill.

and yes.

NPs get jobs.

You know where?

In the middle of goddamn nowhere where the definition of "fine dining" is a Little Caesar's pizza chain and with a community that barely has a 6th grade reading level in its entirety.

As soon as docs branch out to these areas and set up shop, they'll be straight.

But with all of these bratty-ass privileged millenials entering medicine who won't even consider residency in a spot without a Chipotle, Starbucks, or coffee shop with no free wi-fi sticking their nose up at such places because there's "nothing to dooo.. OMGG... I'm gonna die of boredom in residency with all the free time I'll have".

gimme a damn break.

1. Stop buying NP propoganda. They are only slightly more likely to practice in rural areas 16% vs 11% in physicans. A majority of NPs work in urban and suburban areas.
2. Stop blaming everything on Millennials. They didnt create primary care maldistribution or **** up the economy.
3. People dont want to live in rural areas because those areas are in decline.
4. PC pay in urban and suburban areas where there is oversupply is closer to 200.
5. Doom and gloom about all of medicine have been going on since the 90's yet salaries have continued to go up above inflation for the past two decades.
7. I dont pretend to know the future, but you could literally say that every industry is in decline.
8. There is literally only one oecd country where pcp are paid more compared to specialists.
Physician Compensation Worldwide

 

[IMreshopeful]

Are YOU dense?

BAHAHA.

Not with the changes in medicine that are coming up.

By the time we all get out, you will be working longer, harder, and seeing more patients as a specialist. Procedures are still the name of the game but even those are being cut.

Caths used to MINT dough.

They have been cut 9-10X lower.

I know this because I have family in CMS and in medicine that are on the other side.

You spent an extra 3-4 years after residency to specialize and are only making 100-200K more on average than the internist who has been out.

Not to mention call.

Not to mention consolidation.

Reimbursements are declining. Do your research.

Lifestyle is also relative.

Cardiologists making 400-500K sounds good until you realize you are on call every 3-4 days and are being abused by senior partners to "pay your dues".

Specializing really isn't worth it unless you REALLY want to do it.

I’m not sure what your deal is with specialists but you might want to stop generalizing the deal with cardiology

General cards in most areas do not make 500K+ base salary first thing - usually it’s more rural places which offer that.

Secondly the reimbursement models are different depending on practice because it’s a procedural and imaging based specialty. Sure cath reimbursement and RVU is less than it used to be. So what? We also have echo, TEE, nuclear, vascular, CT and so much more. Depending on your reimbursement model this can be very lucrative. PCI and TAVR, devices, ablation all reimburse well despite cuts. The evidence has gotten better, so we do a lot less PCI than in the past but for more appropriate reasons.

Third, yes we don’t make much more than 100k more compared to primary care. However I would 100x over do cardiology over primary care. I am glad not to take care of vague MSK complaints, deal with social issues of patients and endless paperwork, deal with coordinating 100 specialists, and managing things I have no interest in (IBS, depression, GERD for a start). Give me your heart failure, CAD, and arrhythmias all day. I also don’t want to deal with the in and out nonsense of a hospitalist even with the sweet salary and schedule. Compensation is just a small part of the picture.

Fourth - call can be very variable. Yes, IC docs take STEMI call which can suck. Gen cards doc can have busy call. However in many practices you are reimbursed for taking call and frankly I’d rather come in for a STEMI than for something terrible like writing HD orders. The trade off is that im doing something I like. Also 1:4 call isn’t bad. It sounds roughly once a week and once a month - much better than many docs have it.

Don’t misrepresent specialties even if you don’t like them

 

[IMreshopeful]

Doom and gloom is for MEDICINE in general my man. I'm really not arguing with you.

Medicine in general is going downhill.

and yes.

NPs get jobs.

You know where?

In the middle of goddamn nowhere where the definition of "fine dining" is a Little Caesar's pizza chain and with a community that barely has a 6th grade reading level in its entirety.

As soon as docs branch out to these areas and set up shop, they'll be straight.

But with all of these bratty-ass privileged millenials entering medicine who won't even consider residency in a spot without a Chipotle, Starbucks, or coffee shop with no free wi-fi sticking their nose up at such places because there's "nothing to dooo.. OMGG... I'm gonna die of boredom in residency with all the free time I'll have".

gimme a damn break.

Rural areas appeal to some and not others. That’s not a reason to demean people’s choices

 

[deleted87051]

Cardiology has made more and less in the past and the lifestyle has always been terrible but it has always been extremely competitive. It regularly attracts some of the smartest, most innovative, and most proactive doctors around. I think it has more to do with saving lives, exciting technology, and all that.

 

[deleted87051]

The trade off is that im doing something I like.

This.

 

[Phaco]

Are YOU dense?

BAHAHA.

Not with the changes in medicine that are coming up.

By the time we all get out, you will be working longer, harder, and seeing more patients as a specialist. Procedures are still the name of the game but even those are being cut.

Caths used to MINT dough.

They have been cut 9-10X lower.

I know this because I have family in CMS and in medicine that are on the other side.

You spent an extra 3-4 years after residency to specialize and are only making 100-200K more on average than the internist who has been out.

Not to mention call.

Not to mention consolidation.

Reimbursements are declining. Do your research.

Lifestyle is also relative.

Cardiologists making 400-500K sounds good until you realize you are on call every 3-4 days and are being abused by senior partners to "pay your dues".

Specializing really isn't worth it unless you REALLY want to do it.

Not a student. Been an MD (ophtho) for 16 years.
In doctors lounge, different specialties interact. When comparing lifestyle/income, I have never heard a specialist wishing he were a FP/IM. However, if I had a nickel every time a primary care says "Man, I chose the wrong field"....

 

[Tenk]

Cardiology has made more and less in the past and the lifestyle has always been terrible but it has always been extremely competitive. It regularly attracts some of the smartest, most innovative, and most proactive doctors around. I think it has more to do with saving lives, exciting technology, and all that.

Unless it’s 3 am and the patient needs to go to the cath lab.

 

[Mad Jack]

Everyone in medicine keeps saying don't pick a field based on the money. But, then, is there a reason the most competitive fields like ortho, plastics, dermatology are also the most well paid fields? Even when it comes to IM fellowships, Cards and GI are the most competitive and the fields with the highest compensation.

Is this just a correlation or did these fields become competitive because they are the most well paid? Do people even follow the rule "don't pick a field based on money" when it comes to competitive specialities?

I could have matched much more competitive fields than psych but like... I would damn near rather die than do anything that isn't psych. Plenty of people with similar feels in other fields

 

[QueenJames]

I'm really not trying to crap on any specialty.

I'm just saying that medicine in general is on the way down.

So choose what you like and don't worry about the prestige or name behind it.

I'll see myself out.

Happy New Year to y'all.

 

[operaman]

Agree wholeheartedly with the above the number of available spots is a major driver of perceived competitiveness. Money is obviously a big factor as well as is lifestyle. Truthfully there is nearly limitless income potential in most fields for people with the right business sense and willingness to find the right market. Number of slots is by far the biggest factor in my mind. Look at integrated plastics -- considered a highly competitive field. Then look at plastics fellowships following general surgery residency -- there are many of these and overall isn't considered one of the most competitive surgical fellowships. Same can be said of vascular as well. Same board certification and scope of practice opportunities, but is highly competitive out of med school and minimally competitive out of residency. Same potential for pay and lifestyle and whatnot, but available positions and number of interested candidates is vastly different.

I would caution people to be careful when looking at salary numbers too, especially starting salary numbers. This probably deserves its own post, but in short there are tons of hidden nuances to those numbers that don't get discussed until you start actually talking turkey with potential employers. I'm trying to think of where to start but it's just too big a subject. As someone who's beginning to stick his toe in the waters, trust me that there's so much more than starting salary that should be considered when evaluating any opportunity.

 

[NickNaylor]

Money is important and something to consider when choosing your field, but it's not the end-all, be-all. Even if you go into a relatively (key word there) low-paying field and into a low-paying setting (for example, a FQHC), you will still be making good money in the big scheme of things. Above a certain point, more money has only diminishing returns.

I think it's easy to assume that you're fine with working endlessly to make the cheddar, but the reality is that you may have a different view after slaving away in residency and, if you so choose, settling down and having a family. The importance of making a huge amount of money may fall and other things may take a higher priority.

 

[IMreshopeful]

Cardiology has made more and less in the past and the lifestyle has always been terrible but it has always been extremely competitive. It regularly attracts some of the smartest, most innovative, and most proactive doctors around. I think it has more to do with saving lives, exciting technology, and all that.

Agreed, it’s extremely popular for a number of reasons that have less to do with money than the appeal of the work.

Also people underestimate how good the lifestyle of gen cards can be... there are jobs which are pure outpatient with no call, there are some with call of 1:8-10, etc. Even call 1:4-6 isn’t bad. Most cardiology issues short of a STEMI can be dealt with over the phone (for which the gen cards person won’t come anyway)... even as a fellow I got pretty good at triaging this. Compensation varies greatly but has less to do with call frequency and more with how versatile you are with modalities, how busy you are day to day, and what the pay structure is.

 

[IMreshopeful]

Money is important and something to consider when choosing your field, but it's not the end-all, be-all. Even if you go into a relatively (key word there) low-paying field and into a low-paying setting (for example, a FQHC), you will still be making good money in the big scheme of things. Above a certain point, more money has only diminishing returns.

I think it's easy to assume that you're fine with working endlessly to make the cheddar, but the reality is that you may have a different view after slaving away in residency and, if you so choose, settling down and having a family. The importance of making a huge amount of money may fall and other things may take a higher priority.

100% agreed