What are the least competitive subspecialties?

[lost777]

For a community IM resident with pretty low board scores...

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[bashwell]

For a community IM resident with pretty low board scores...

Are you a US MD? If so, you could still match into competitive IM subspecialties despite low board scores if you've done well in residency, have good LORs, have done some research, etc.

Here's the data from NRMP (2017):

Cardiology
-U.S. Grads 482/537 (89.8%)
-Total 855/1147 (74.5%)

Endocrinology
-U.S. Grads 103/108 (95.4%)
-Total 270/342 (78.9%)

Gastroenterology
-U.S. Grads 319/377 (84.6%)
-Total 493/742 (66.4%)

Hematology and Oncology
-U.S. Grads 287/332 (86.4%)
-Total 544/729 (74.6%)

Infectious Disease
-U.S. Grads 162/169 (95.9%)
-Total 312/335 (93.1%)

Nephrology
-U.S. Grads 64/68 (94.1%)
-Total 284/308 (92.2%)

Pulmonary and Critical Care
-U.S. Grads 289/323 (89.5%)
-Total 524/742 (70.6%)

Rheumatology
-U.S. Grads 94/114 (82.5%)
-Total 210/332 (63.3%)

 

[EasyRider]

Nephrology. Why would anyone do this when they can work as a Hospitalist and make more money, more free time, less call, and less driving to multiple dialysis units? Not to mention 2 more years making trainee money.

Unless you love Nephrology. It makes no sense to do Nephrology.

 

[Crayola227]

I dunno, as I understand it nephrologists have it way easier than hospitalists, which is why a lot of people use that as an avenue of escape from being a hospitalist, which apparently sucks donkey balls

#things nephrologists have told me

oh yeah, they definitely love the beans, like a lot

 

[EasyRider]

Never heard someone leaving Hospotalist to train as a nephrologist.

Not sure I have heard someone making $250-300k working 26 weeks to go back as a fellow to make $50k for two years to make $200-250k and working 46 weeks a year.

Nephrology easy?

All the acute kidney injuries in the ICU due to pressers and antibiotics get a nephrology consult.

 

[EasyRider]

Hospitalista pan consult and have others manage their patient.

 

[PlutoBoy]

Hospitalista pan consult and have others manage their patient.

Ain't that nice?

 

[lost777]

Are you a US MD? If so, you could still match into competitive IM subspecialties despite low board scores if you've done well in residency, have good LORs, have done some research, etc.

Well im a US DO... does that change my chances by much?

Id be mostly interested in rheum or allergy. and im not sure being a community IM DO will open any doors, let alone when you factor in how uncompetitive i am. and thanks for the info, thats appreciated

 

[UncommonVariable]

Well im a US DO... does that change my chances by much?

Id be mostly interested in rheum or allergy. and im not sure being a community IM DO will open any doors, let alone when you factor in how uncompetitive i am. and thanks for the info, thats appreciated

Rheumatology and allergy are still in the cards for you. While both classically attract less competitive applicants, the competition is increasing across the board. I can say from an allergy standpoint letters of rec are very important. Be sure to do rotations at programs you're interested in.

 

[bronx43]

Well im a US DO... does that change my chances by much?

Id be mostly interested in rheum or allergy. and im not sure being a community IM DO will open any doors, let alone when you factor in how uncompetitive i am. and thanks for the info, thats appreciated

Allergy has always been competitive, and rheumatology is certainly getting more competitive. But, don't let that sway you. The thing with rheumatology is that the competitive pool is still not as strong as the historically competitive subspecialties. Therefore, if you have some research experience or good letters, your chance of matching is very high.

 

[doctorbeastmode]

Being US DO is better than IMG MD for sure, but coming from a community program with low scores (depends on what exactly that means) and applying into rheum won't be a cakewalk. Agreed with @bronx43 that the actual pool of applicants isn't as competitive as the pool in say cardiology, so the 63% match rate above is a little misleading. That being said, I wouldn't say your chance of matching is "very high" if you have low board scores. Check out the rheum thread right now - it's been a rough year for people. If you're going to apply you should apply broadly and expect to make some compromises.


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[Nephro critical care]

Never heard someone leaving Hospotalist to train as a nephrologist.

Not sure I have heard someone making $250-300k working 26 weeks to go back as a fellow to make $50k for two years to make $200-250k and working 46 weeks a year.

Nephrology easy?

All the acute kidney injuries in the ICU due to pressers and antibiotics get a nephrology consult.

If I was getting 240 K as a nephrologist to see 20 pts in 1 hospital on a 7 on 7 off or even M-F 5 days a week with q4 weekend call it would be a good gig. But unfortunately it's not that easy. You have see those 20 pts in 3 hospitals and on the weekend you can be seeing 35 pts in 7 hospitals driving up to 50-100 miles. And starting salary can be 170 K and getting screwed out of partnership after 2 years.

 

[bronx43]

If I was getting 240 K as a nephrologist to see 20 pts in 1 hospital on a 7 on 7 off or even M-F 5 days a week with q4 weekend call it would be a good gig. But unfortunately it's not that easy. You have see those 20 pts in 3 hospitals and on the weekend you can be seeing 35 pts in 7 hospitals driving up to 50-100 miles. And starting salary can be 170 K and getting screwed out of partnership after 2 years.

With that kind of volume, who is keeping all the money that you generate? The partners? Is the job market that saturated that the partners can just screw young grads out of money that easily?

 

[Nephro critical care]

Yes . The partners will make at least 500 K if not more. But the new grads especially IMGs will get screwed , cheap labor for 2 years and then not deemed fit for partnership or have huge buy-ins. We had couple of Pakistani brothers who were entrepreneurial and they built a large practice. They would also work very hard and come in around 430am . They would get a couple of guys for 2 years who couldn't handle the low pay and work and quit to become hospitalist again.

 

[rheum18]

For the 2017 Match, Rheumatology had the lowest percentage match rate (percentage of applicants match) of any IM Subspecialty.

 

[rokshana]

For the 2017 Match, Rheumatology had the lowest percentage match rate of any IM Subspecialty.

No that would be nephrology...something like 64%

 

[doctorbeastmode]

Rheumatology had the lowest percentage of applicants match - nephrology had the lowest percentage of spots filled. They're on opposite ends of your question. Nephrology is without a doubt the least competitive. Rheum is becoming more competitive and had the lowest percentage of applicants match, but the pool of applicants in rheumatology is almost certainly less competitive than the pool of applicants in some of the other specialties like cardiology and G.I.


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[mercaptovizadeh]

The very least competitive specialties would probably be renal, palliative, and ID, slightly more competitive are endo and rheum, after that come pulm/CCM and allergy/immuno, then heme/onc, and then cards and GI.

My sense is that rheum is due for some pay expansion given all the new biologics but for some reason they have not been able to tap into that the way oncology has on chemo. Also, there is a slew of new biologics that will come on the market in allergy which could potentially increase incomes further.

 

[bronx43]

The very least competitive specialties would probably be renal, palliative, and ID, slightly more competitive are endo and rheum, after that come pulm/CCM and allergy/immuno, then heme/onc, and then cards and GI.

My sense is that rheum is due for some pay expansion given all the new biologics but for some reason they have not been able to tap into that the way oncology has on chemo. Also, there is a slew of new biologics that will come on the market in allergy which could potentially increase incomes further.

I don't think you understand how this works exactly... just because new drugs come out for your field doesn't necessarily mean that your income will go up. Physicians are paid by clinical volume, procedures, and ancillary services. Rheumatologists, in the past, were able to make money when Infliximab came out, because they were able to set up an infusion suite and bill for nursing services of the actual infusion. However, these days, there are more and more drugs out there and fewer and fewer reasons to HAVE to have infusions, since most of the biologics can be self administered at home. Most patients prefer this method. Only Medicare patients are stuck having to drag themselves to the infusion suite, because of the idiotic way pharmaceuticals are covered. Another way you can make some money with infusions is to make a small upcharge fee on the medication when you administer it, but this upcharge was drastically cut in the last few years.
I would in fact argue that if a biologic came out that revolutionizes A/I, it would actually HURT allergists, because it would take away the need for their cash cow - allergy shots.

 

[rokshana]

Rheumatology had the lowest percentage of applicants match - nephrology had the lowest percentage of spots filled. They're on opposite ends of your question. Nephrology is without a doubt the least competitive. Rheum is becoming more competitive and had the lowest percentage of applicants match, but the pool of applicants in rheumatology is almost certainly less competitive than the pool of applicants in some of the other specialties like cardiology and G.I.


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I don't think that is the best way to gauge competitiveness... for the Uber competitive specialties...gi, cards, maybe even hem/onc people tend to self select out...meaning that while they may want to apply they don't because they think or know they aren't competitive enough...with the others people apply even if they really aren't that competitive. And since it's so easy to apply through eras, there are plenty of people who apply that realistically won't get a spot. It would be interesting to compare how many applied vs how many submitted a rol.

 

[doctorbeastmode]

Yes... that's exactly my point. The rheum pool of applicants is less competitive than the GI or cards pool of applicants - lots of top applicants choose to do more lucrative specialties (cards, GI, HONC), lots of less competitive applicants self select out of those specialties bc they don't think they'll match, and lots of less competitive applicants do stuff like rheum because they still have a decent chance.


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[doctorbeastmode]

For all those reasons I (and many others on these threads) have been saying rheum is still not as competitive as its low match rate suggests.


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[thierryhenry]

Never heard someone leaving Hospotalist to train as a nephrologist.

Not sure I have heard someone making $250-300k working 26 weeks to go back as a fellow to make $50k for two years to make $200-250k and working 46 weeks a year.

Nephrology easy?

All the acute kidney injuries in the ICU due to pressers and antibiotics get a nephrology consult.

I have..

Hospitalists leaving to become Nephrologists, because as someone else said being a hospitalist is not all that its made out to be