What field is saturated?

[Ngo3]

Going to which medical specialty would leave you jobless or job in undesirable places? I've head pathology was bad. Anesthesiology has to deal with CRNA.

---

Members don't see this ad.

 

[673441]

Going to which medical specialty would leave you jobless or job in undesirable places? I've head pathology was bad. Anesthesiology has to deal with CRNA.

LOL. Anesthesiologists will exist as long as the need for patients surviving surgeries exists as well... No residency or medical specialty will leave you jobless. Contrary to what you might see on these forums or on blogs, medicine is still the most coveted career path among many based on its job-security.

 

[jd989898]

Radiation oncology

 

[Manual Disimpaction]

 

[tymont12]

No specialty will leave you jobless, but some may leave you struggling to find a job in a certain market. I.E., good luck being an ophthalmologist in a major city without getting thrown over a log.

For the past decade I feel like everyone has been saying the Path job market is awful, but I wonder how much of it is folklore. Everyone was saying rads, family medicine and anesthesia were dead but look at those fields now.

I've heard that ortho oncs usually have to line up a specific job before doing the fellowship.

 

[tyler_durden]

Dentistry

 

[postbacpremed87]

No specialty will leave you jobless, but some may leave you struggling to find a job in a certain market. I.E., good luck being an ophthalmologist in a major city without getting thrown over a log.

For the past decade I feel like everyone has been saying the Path job market is awful, but I wonder how much of it is folklore. Everyone was saying rads, family medicine and anesthesia were dead but look at those fields now.

I've heard that ortho oncs usually have to line up a specific job before doing the fellowship.

Most people (on this thread/current residents) I talk to think Pathology is beyond saving. It's NRMP match statistics show how far the field has fallen. What a shame.

 

[OnePunchBiopsy]

[QUOTE="tymont12, post: 18750806, member: 407293]
For the past decade I feel like everyone has been saying the Path job market is awful, but I wonder how much of it is folklore.[/QUOTE]

Having spoken with a young cytopathologist recently, he told me that you are guaranteed to have to do a fellowship after residency. After that, of you are a friendly and well-to-do person, you could end up at a community hospital easily. It could be thougher in big cities where everyone wants to live.

 

[deleted716403]

None.

 

[AlmostAnMD]

ALL OF THEM

NONE OF THEM

etc

 

[Warderino92]

Eh, there's almost always a constant discussion on the rad Onc subforum about instead of getting to choose two of lifestyle money or location you can only pick one a days now because residency slots keep expanding without a corresponding need increase in rad oncs. Something to think about.

 

[Ngo3]

I heard primary care is pretty bad because of PAs and NPs, anethesiology because of CRNA taking up much more than they can handle, pathology from a post ive read, nephrology. I dont know what else. Maybe in 4 years, primary care would be saturated even more.

 

[Lee]

I heard primary care is pretty bad because of PAs and NPs, anethesiology because of CRNA taking up much more than they can handle, pathology from a post ive read, nephrology. I dont know what else. Maybe in 4 years, primary care would be saturated even more.

No, there is a tremendous shortage of primary care providers. As a board-certified family medicine or general internal medicine physician, you can pretty much work wherever you want. The problem is the effort required to be a primary care physician leads to a lot of burnout.

 

[ConfusedChemist]

LOL. Anesthesiologists will exist as long as the need for patients surviving surgeries exists as well... No residency or medical specialty will leave you jobless. Contrary to what you might see on these forums or on blogs, medicine is still the most coveted career path among many based on its job-security.

Unless you're in any kind of surgical/procedure-heavy IM specialty in Canada. The joys of being at the mercy of the government to fund OR's....

 

[Ngo3]

No, there is a tremendous shortage of primary care providers. As a board-certified family medicine or general internal medicine physician, you can pretty much work wherever you want. The problem is the effort required to be a primary care physician leads to a lot of burnout.

Sorry, but you can you expand a little bit on the "effort required to be a primary care physician"? I seem to be a bit ignorant in this area.

 

[doctorskywalker]

Sorry, but you can you expand a little bit on the "effort required to be a primary care physician"? I seem to be a bit ignorant in this area.

+1

 

[Ngo3]

Bump

 

[SLC]

I heard primary care is pretty bad because of PAs and NPs, anethesiology because of CRNA taking up much more than they can handle, pathology from a post ive read, nephrology. I dont know what else. Maybe in 4 years, primary care would be saturated even more.

I'm about to enter my 3rd year of FM residency. Every day I get no less than 20 job advertisements in my email (unsolicited). And there are an abundance of FM jobs in every location I've ever bothered to look.

 

[Warderino92]

I'm about to enter my 3rd year of FM residency. Every day I get no less than 20 job advertisements in my email (unsolicited). And there are an abundance of FM jobs in every location I've ever bothered to look.

All the family medicine docs in my area are at a cap of patients and can't take any more because of how booked they are. It's definitely wide open for jobs for a new physician here.

 

[673441]

All the family medicine docs in my area are at a cap of patients and can't take any more because of how booked they are. It's definitely wide open for jobs for a new physician here.

The real question is if they're being fairly compensated... the cap could be just them giving up or being too burned out as stated above.

 

[Astra]

I was looking into the revenue-to-hospital vs compensation of various physicians, and FM docs have an insane ratio... like 2 million revenue for 180k salary.

There were surgical subspecialties that brought in less yet get paid more, which left me very confused.

Just something to think about.

What's the profit after operating costs?

 

[673441]

I was looking into the revenue-to-hospital vs compensation of various physicians, and FM docs have an insane ratio... like 2 million revenue for 180k salary.

There were surgical subspecialties that brought in less yet get paid more, which left me very confused.

Just something to think about.

I'm sure the revenue is great for an established practice. However, I'm told by many that private practices (even in large groups) will be on the steady decline unless some sort of legislation is introduced that allows collective bargaining of some sort. Even tho you're under the illusion that you are a small business owner when you're in private practice, you pretty much aren't. You work for the insurance companies/large hospital affiliate which can drop you at any time in which case FYL. Not to mention the insane overhead that docs have to pay alongside a 30+% taxable income.

 

[JamaicanHerb]

What's the profit after operating costs?

Come on...

 

[CompensationExpert]

@mcfruits You bring up a good point but it depends on how the revenue is being distributed and allocated. Family medicine for example has a significant amount of downstream in all areas whether it be labs, other physicians, or hospital facility fees. The biggest problem though is figuring out whether that revenue is directly attributable to the care and services of the family physician. For example, a referral to a GI physician from a FM physician would result in more tests, procedures, and revenue. Who then is it attributable to? For surgeons it is much more straight forward. There is a professional fee portion and a facility fee portion. For each surgery, it is very easy to see what the facility fee portion is which largely takes care of the overhead. In FM, there is not a direct correlation or at least it is tougher to understand. You make a great point though.

 

[SLC]

The real question is if they're being fairly compensated... the cap could be just them giving up or being too burned out as stated above.

My first contract will net me ~$300k/year, $60k in annual loan repayment, and comes with a $160k/year pension at 20years of service. I'd call that fair.

 

[snot]

My first contract will net me ~$300k/year, $60k in annual loan repayment, and comes with a $160k/year pension at 20years of service. I'd call that fair.

?!?! Had no idea FM could pay that much. What region of the U.S. are you working?

 

[Raryn]

I was looking into the revenue-to-hospital vs compensation of various physicians, and FM docs have an insane ratio... like 2 million revenue for 180k salary.

There were surgical subspecialties that brought in less yet get paid more, which left me very confused.

Just something to think about.

Revenue-to-hospital is different than the actual billings from the physician.

Basically, the primary care docs *control* a lot of spending in that they order a lot of lab tests, imaging studies, referrals to other specialties, whatever. So each doctor makes decisions that impact a few million dollars in hospital/other doctors revenue, easy. But the actual billed revenue that a typical PCP gets for their work (and thus actually "brings in" themselves) is roughly double the typical income. That is, overhead, including malpractice, benefits, rent, ancillary staff, whatever, is typically somewhere around half of collected billings.

 

[SLC]

?!?! Had no idea FM could pay that much. What region of the U.S. are you working?

West, rural.

 

[libertyyne]

I was looking into the revenue-to-hospital vs compensation of various physicians, and FM docs have an insane ratio... like 2 million revenue for 180k salary.

There were surgical subspecialties that brought in less yet get paid more, which left me very confused.

Just something to think about.

Where is this data available?

 

[Nave]

View attachment 216389

Took me a few seconds to understand haha...

 

[673441]

https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/mha2013revenuesurveyPDF.pdf

This. Blew. My. Effin. Mind.

 

[Raryn]

This. Blew. My. Effin. Mind.

Once again, amount of spending you control doesn't correlate that well with the amount of revenue you personally bill for.

Oncologists control millions of dollars of drug costs each, but I don't think @gutonc makes seven figures. They typically bill in the high six figures and take home half that.

 

[673441]

Once again, amount of spending you control doesn't correlate that well with the amount of revenue you personally bill for.

Oncologists control millions of dollars of drug costs each, but I don't think @gutonc makes seven figures. They typically bill in the high six figures and take home half that.

So what would you say a FM doc who brought in 2+ million in revenue would take home?

 

[Raryn]

So what would you say a FM doc who brought in 2+ million in revenue would take home?

Depends on his insurance mixture and location, but probably somewhere around $250k would be typical of a non-academic full time, productive FM outside SF/NYC/etc.

 

[smq123]

Sorry, but you can you expand a little bit on the "effort required to be a primary care physician"? I seem to be a bit ignorant in this area.

+1

Being a good primary care physician is tough, and it requires a certain type of personality.

- There's a lot of variety. Which is nice, but it means that you have to know at least something about a lot of things. In any given day, you can see a patient with a cardiac problem, followed by a patient with a derm problem, followed by a patient with an ENT problem, followed by a patient with a psych problem.

- There are a lot of gray areas. By the time a patient gets to the oncologist, for example, the diagnosis is often pretty clear and then they just have to decide on treatment. In primary care, almost nothing comes to you solved. This also means that you have to have your "spidey sense" up so that you don't miss anything important. For example - is that stomach pain really just because the patient had some bad egg salad? Or does he have a hernia or a tumor or an H. pylori infection or IBS or or or... Etc.

- You're never going to be the expert on anything. Some people are ok with that, some are not.

I like being in primary care, but I'm also aware that it's not for everyone. My spouse is a specialist and if he had to do primary care, he'd hate his life. It all boils down to personality.

 

[673441]

Depends on his insurance mixture and location, but probably somewhere around $250k would be typical of a non-academic full time, productive FM outside SF/NYC/etc.

Depends on his insurance mixture and location, but probably somewhere around $250k would be typical of a non-academic full time, productive FM outside SF/NYC/etc.

Wait, so you're telling me that of the revenue brought in, the doctor barely takes home 10%?!?!???

 

[Raryn]

Wait, so you're telling me that of the revenue brought in, the doctor barely takes home 10%?!?!???

Because the doctor doesn't bring that revenue in directly. The lab, imaging department, whatever bill the insurance and get paid that revenue. The money never touches the physician or his office. Only his billings do.

Quoting the linked PDF:

In the case of primary care physicians (defined as family
practitioners, general internists, and pediatricians),
survey respondents were asked to determine revenue
from direct admissions, procedures performed, lab tests, etc

The hospital would not get that revenue if no one ordered it, but that is not money being paid to the physician for services he performed. That is money being paid to the hospital for services he *ordered*.

Outside of a very few circumstances where the physician income is directly subsidized by the hospital (certain hospitalist groups, EM groups, anesthesia groups, and doctors in their first 1-2 years of practice) so the hospital can function, physicians do NOT get paid out of hospital revenue. They get paid out of their personal/group billed revenue net of costs.

 

[Maskchamp]

Is cardiology quite saturated? I've heard mixed things. If anyone has a good/straight answer that'd be great. Not looking into cities too, but mostly mountain towns like Rockies, etc. Thanks!

 

[drkristy85]

West, rural.

Rural areas pay great
And out West salaries are generally higher (states like Kansas, Nebraska, Idaho, Montana, etc)

 

[drkristy85]

Eh, there's almost always a constant discussion on the rad Onc subforum about instead of getting to choose two of lifestyle money or location you can only pick one a days now because residency slots keep expanding without a corresponding need increase in rad oncs. Something to think about.

To be fair, this isn’t only an issue for Radiation Oncology. Most fields you either get money or you get location.

Highly desirable location=no money
Less desirable location= lots of money

 

[RTC19]

Being a good primary care physician is tough, and it requires a certain type of personality.

- There's a lot of variety. Which is nice, but it means that you have to know at least something about a lot of things. In any given day, you can see a patient with a cardiac problem, followed by a patient with a derm problem, followed by a patient with an ENT problem, followed by a patient with a psych problem.

- There are a lot of gray areas. By the time a patient gets to the oncologist, for example, the diagnosis is often pretty clear and then they just have to decide on treatment. In primary care, almost nothing comes to you solved. This also means that you have to have your "spidey sense" up so that you don't miss anything important. For example - is that stomach pain really just because the patient had some bad egg salad? Or does he have a hernia or a tumor or an H. pylori infection or IBS or or or... Etc.

- You're never going to be the expert on anything. Some people are ok with that, some are not.

I like being in primary care, but I'm also aware that it's not for everyone. My spouse is a specialist and if he had to do primary care, he'd hate his life. It all boils down to personality.

While we are on the topic, if you happen to have a minute, may I ask you to expound a little more on what sort of personality you think is well suited to enjoying primary care and being a good PCP?

My absolute favorite part of my healthcare experience thus far has been longitudinal patient relationships, so I could see myself really liking what you do.

Odd question, but do you have to be intrinsically good at motivating people or is this something they teach you?

 

[drkristy85]

My first contract will net me ~$300k/year, $60k in annual loan repayment, and comes with a $160k/year pension at 20years of service. I'd call that fair.

That pension is Incredible! You can retire after only working for 20 years and still earn $160,000 per year in retirement! Wow. Most physicians are forced to work into their 70’s and 80’s. You got a great great deal here.

 

[smq123]

While we are on the topic, if you happen to have a minute, may I ask you to expound a little more on what sort of personality you think is well suited to enjoying primary care and being a good PCP?

My absolute favorite part of my healthcare experience thus far has been longitudinal patient relationships, so I could see myself really liking what you do.

Odd question, but do you have to be intrinsically good at motivating people or is this something they teach you?

I think that most good PCPs look at the "big picture." I don't particularly like reading or thinking about things in excessive detail or too much depth; it's not the way my mind works. Compare this to my spouse, who is an oncologist, who can read about a topic almost obsessively until he knows every last little detail about it. And that's fine, because that's what a specialist needs to do. I don't; I don't need to know every single last detail about which chemo drug does what, or how they work.

I'm good at juggling multiple issues or questions at once; some people really don't enjoy doing that.

I can't stress enough that you have to be decisive in the face of uncertainty. Patients will come to you with vague symptoms, and often you don't know what they have or what is causing their symptoms. But you still have to decide what to do, despite not having much information.

Longitudinal patient relationships are an important part of many fields, not just primary care. I rotated with a urologist who had patients who had been seeing him for decades. Same with a cardiologist; he had some patients he had been seeing for over 20 years.

And no, you'll learn how to motivate patients with practice and experience. 🙂

 

[RTC19]

I think that most good PCPs look at the "big picture." I don't particularly like reading or thinking about things in excessive detail or too much depth; it's not the way my mind works. Compare this to my spouse, who is an oncologist, who can read about a topic almost obsessively until he knows every last little detail about it. And that's fine, because that's what a specialist needs to do. I don't; I don't need to know every single last detail about which chemo drug does what, or how they work.

I'm good at juggling multiple issues or questions at once; some people really don't enjoy doing that.

I can't stress enough that you have to be decisive in the face of uncertainty. Patients will come to you with vague symptoms, and often you don't know what they have or what is causing their symptoms. But you still have to decide what to do, despite not having much information.

Longitudinal patient relationships are an important part of many fields, not just primary care. I rotated with a urologist who had patients who had been seeing him for decades. Same with a cardiologist; he had some patients he had been seeing for over 20 years.

And no, you'll learn how to motivate patients with practice and experience. 🙂

THANK YOU SO MUCH! 🙂 🙂 I really appreciate the thoughtful reply! 🙂

Sent from my SM-J320V using SDN mobile