What Job offers are current residents getting?

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Compared to 2014, the number of international medical graduates (IMGs) who participated in the Match decreased by 95, and the number of IMGs who matched to first-year positions decreased by 55. Of the 12,387 IMGs who participated in the 2015 Match, 6,302 (50.9%) matched. In the 2014 Match, 6,357 (50.9%) IMGs were matched to first-year positions. (The preceding data include a small number of Fifth Pathway applicants who participated in the 2014 and 2015 Matches. For 2015, these data include seven Fifth Pathway participants who are not represented in the data below.)

Of the 7,366 IMG participants who were not U.S. citizens, 3,641 (49.4%) obtained first-year positions. The number of non-U.S. citizen IMGs who obtained positions in 2015 increased for the fourth year in a row, this year by eight.

Of the 5,014 U.S. citizen IMG participants, 2,660 (53.1%) were matched to first-year positions, a decrease of 62 from last year. This decrease marks an end to 11 consecutive years which saw increases in the number of U.S. citizen IMGs matching to first-year positions.

- See more at: http://www.ecfmg.org/news/2015/03/27/img-performance-in-the-2015-match/#sthash.Sn2cMl6Q.dpuf
 
The number of residency positions is growing by less than 1% a year while the number of medical students is growing by almost 2%, Grover said. Osteopathic medicine programs have grown by 8% to 10%, he noted
 
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Everything is relative and must be compared to other options. Which option would put you in higher demand in PP resulting in greater compensation: a general cardiologist or an anesthesiologist with a double fellowship in Peds and Cardiac? Both options require 6 years of training after med school.
 
Carbocation1 said:
Everything is relative and must be compared to other options. Which option would put you in higher demand in PP resulting in greater compensation: a general cardiologist or an anesthesiologist with a double fellowship in Peds and Cardiac? Both options require 6 years of training after med school.
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I would choose the former in a heartbeat. You need an office, an EKG- and maybe an echo machine.

Beyond a certain number, one needs a lot more money for a little more happiness.
 
Carbocation1 said:
Wow. Can you please elaborate why?
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One can always become independent. If one is not obsessed with making big money, and minimizes office staff and is selective about insurance plans. Not everybody, but the really good ones. And even when one is an employee, the employer values a cardiologist more.

As an anesthesiologist, one will always be the bird cleaning the teeth of the crocodile. The crocodile eats well, so one will never go hungry, until it finds a cheaper bird so it can pocket the difference. Just a well-paid servant for the surgeon. This wouldn't be a problem, except there is an overproduction of birds.

As a cardiologist, one is no crocodile, but at least one is a wolf. Smaller meals, but able to hunt alone or in packs. Same applies to pain management. The limiting factor is the number of patients willing to pay out of pocket or go out of network for one's services.

Don't just look at where things are today. Imagine how they will change in 10-20 years based on market forces. Cardiology is a better bet, if one can get it. To answer your question more specifically: in most countries, pedi specialties end up being the stepchildren of the system, so adult cardiology should be a better bet long term.

Whatever you end up choosing, spread your bets: don't marry someone from the same specialty.

P.S. Of course, this is a very narrow and incomplete comparison of the two specialties. Just food for thought, really.
 
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Carbocation1 said:
The bottom of the heap has been going into internal medicine, pediatrics, neurology etc. for quite some time... Those fields aren't ending.
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Carbocation1 said:
Everything is relative and must be compared to other options. Which option would put you in higher demand in PP resulting in greater compensation: a general cardiologist or an anesthesiologist with a double fellowship in Peds and Cardiac? Both options require 6 years of training after med school.
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just curious, but have you read this from Ildestriero-

IlDestriero said:
One problem that is unique to anesthesia is that when surgeons take Medicare for a procedure they usually get more than 2/3 of private insurance rates. A fair discount. Unfortunately anesthesia services are unfairly discounted to about 1/3 of private rates. The anesthesia society has been lobbying to fix this unfair penalty forever, but they have had very limited success as once it was done, they have to take the money from somewhere else to fix the problem. They acknowledge it, but can't seem to (want to) fix it.
If you have a good payer mix you can do fine at that rate, but a high percentage of government payers, which would obviously happen with a single payer system, will be very disruptive to the field. They may have to do something about it at that point. Or just continue to ignore it and effectively lose all research and turn the field over to FMGs and CRNAs.
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user3 said:
just curious, but have you read this from Ildestriero-
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I've read it, and I believe it. ;)
It's a built in way to crush anesthesiologist income in the single payor system.
The Surgical Home bull shït won't help that any more than it will bundled payments.
I'm hoping for a 2 tiered British style system with private hospitals. I've aligned myself with a hospital and system that will certainly find itself in the latter group if the music stops before I retire.
 
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The future doesn't look bright, I get it. But the rest of medicine is on the same boat. Cards has been hit really hard if I understand correctly. Echo and EKG reimburse peanuts compared to a decade ago. Just confused about what solid options are available to the medical student who doesn't want to take on the risk of operating on people.
 
aneftp said:
M

i dunno about those with a pulse (U.S. Aamc med schools) are guaranteed spots these days anymore.

It used to be almost any aamc (those 120 plus med schools in USA) basically got a residency spot.

Because residency spots are limited because of Medicare funding. And U.S. Schools have increased slots for medical students (rom 1975-2000 ish). The only "new" aamc med school that opened was University of South Florida. (Opened in 1976 I believe)

But I believe in the past 15 years we've had 7-10 new aamc med schools open. This plus DO schools and IMG and limited residency slots means the bottom of heap isn't guaranteed a slot anymore
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This is coming straight from the charting outcomes 2014 information. 70% of US seniors with Step 1s between 191-200 and 89% of seniors between 201-210 matched. My point was to say that those other specialties have the "bottom of the barrel" applicants while acting like anesthesia doesn't get a decent amount of those same applicants isn't exactly true. Anesthesia, just like the other large specialties, has great applicants and not so great applicants, most of whom get spots somewhere.
 
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calvnandhobbs68 said:
This is coming straight from the charting outcomes 2014 information. 70% of US seniors with Step 1s between 191-200 and 89% of seniors between 201-210 matched. My point was to say that those other specialties have the "bottom of the barrel" applicants while acting like anesthesia doesn't get a decent amount of those same applicants isn't exactly true. Anesthesia, just like the other large specialties, has great applicants and not so great applicants, most of whom get spots somewhere.
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These same applicants with a Step of 210 from a bottom residency program will graduate and compete in the market place against all of you. They will be hungry for those AMC or salaried positions and will take whatever the market pays. This leaves the "superstars" competing for an ever smaller slice of the lucrative Private Practice market. Only 25% of soon to be PGY-1 Anesthesia Residents will find a lucrative PP job. Let's hope that stellar Step-1 score is good for something otherwise you will be in the same boat as the guy/gal who scored 210 on his/her Step 1.

This means you must leverage that Step-1 score for something tangible; e.g, a fellowship at Hopkins or MGH doing Cardiac. Alternatively, a Pain Fellowship or Peds Fellowship. Other Residents will use their Top 10-15 program to make connections to secure that lucrative PP gig.
Remember, the Ortho or Neurosurgery graduate will walk out of any Residency Program and be in demand with a high salary. Anesthesiology is different these days so one must develop a plan which puts you ahead of the average resident.
 
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FFP said:
Whatever you end up choosing, spread your bets: don't marry someone from the same specialty.
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I don't think that's the way normal people choose a wife.
 
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urge said:
I don't think that's the way normal people choose a wife.
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That came out just wrong. :)

What I meant to say is try not to choose the same specialty as the spouse. Don't put all your eggs in one basket. Obviously there are also advantages to being in the same specialty.
 
BLADEMDA said:
Great response. I couldn't imagine choosing my spouse or anyone's spouse based on his/her specialty.
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Well my best buddy just went through a $300k divorce/child custody battle with his orthopedic (now) ex wife.

He was wishy washy on choosing his high school sweetheart (community college) and orthopedic resident at time.

In the end choosing orthopedic wife was a nightmare. Ended up costing him a ton and he's the one paying child support even though she's the one making 200k more a year to the tune of $4000/month cause she has custody of kids 60% of the time.

Just love the American family courts.

U figure choosing orthopedic doc as spouse would be cheaper than regular non medical homemaker.

Women cost money regardless.
 
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aneftp said:
Well my best buddy just went through a $300k divorce/child custody battle with his orthopedic (now) ex wife.

He was wishy washy on choosing his high school sweetheart (community college) and orthopedic resident at time.

In the end choosing orthopedic wife was a nightmare. Ended up costing him a ton and he's the one paying child support even though she's the one making 200k more a year to the tune of $4000/month cause she has custody of kids 60% of the time.

Just love the American family courts.

U figure choosing orthopedic doc as spouse would be cheaper than regular non medical homemaker.

Women cost money regardless.
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I've heard quite a few stories like this. US courts are still stuck in the 1920's when it comes to child custody/support issues. Ive got a friend that pays $3500/month child support for one child even though the child lives with him 55% of the time.
 
I have to step in here and point out that child support while it is given to the former spouse (in this case, an orthopedic surgeon who is making $200k more than her ex), the money is for the child. The courts aren't "behind the times" on this because this isn't maintenance being paid to the other spouse to support a lifestyle to which they had become accustomed. This is money the child is entitled to for said lifestyle. If there was no child, my guess is that both parties would go their separate way and all would be right with the world (depending on the state in which they live, the circumstances that made the divorce happen, and just how vindictive the parties involved wanted to be) but they procreated. Do that, and sometimes you bring "unpleasant" burdens upon yourself (he said, tongue firmly planted in cheek). And one of those is ensuring that your child lives a life similar to what they'd be living if you (not you specifically, but you generally) and your partner had not split. The easiest way to do that is to count the bennies and divvied them up. /shrug
 
Physio Doc 2 Be said:
I have to step in here and point out that child support while it is given to the former spouse (in this case, an orthopedic surgeon who is making $200k more than her ex), the money is for the child. The courts aren't "behind the times" on this because this isn't maintenance being paid to the other spouse to support a lifestyle to which they had become accustomed. This is money the child is entitled to for said lifestyle. If there was no child, my guess is that both parties would go their separate way and all would be right with the world (depending on the state in which they live, the circumstances that made the divorce happen, and just how vindictive the parties involved wanted to be) but they procreated. Do that, and sometimes you bring "unpleasant" burdens upon yourself (he said, tongue firmly planted in cheek). And one of those is ensuring that your child lives a life similar to what they'd be living if you (not you specifically, but you generally) and your partner had not split. The easiest way to do that is to count the bennies and divvied them up. /shrug
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Then the ortho doc should also be paying the non ortho husband.

If the ortho doc made 200k more, she's a larger part of that lifestyle... So she should be contributing more to this "child pool" than the non ortho husband. And since she's not...that math doesn't work.

1920s it is!
 
Wolverines83 said:
Then the ortho doc should also be paying the non ortho husband.

If the ortho doc made 200k more, she's a larger part of that lifestyle... So she should be contributing more to this "child pool" than the non ortho husband. And since she's not...that math doesn't work.

1920s it is!
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Not if the child is living with her, or however their custody arrangement is worked out. The person who isn't the primary caregiver to the child is the one that has to pay. So if the kid is with the ortho doc, then non-ortho doc has to provide support to child via child support payments to ortho doc. And we're back in the 2010s.
 
Physio Doc 2 Be said:
Not if the child is living with her, or however their custody arrangement is worked out. The person who isn't the primary caregiver to the child is the one that has to pay. So if the kid is with the ortho doc, then non-ortho doc has to provide support to child via child support payments to ortho doc. And we're back in the 2010s.
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Lol I don't think we're gonna see eye to eye on this one
 
Physio Doc 2 Be said:
Not if the child is living with her, or however their custody arrangement is worked out. The person who isn't the primary caregiver to the child is the one that has to pay. So if the kid is with the ortho doc, then non-ortho doc has to provide support to child via child support payments to ortho doc. And we're back in the 2010s.
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Yes. This is the way it was explained to my buddy. The primary caregiver gets the money for child support on a sliding scale (depending on state laws) from the non custody parent.

Lucky for my buddy the child custody was in Maryland courts even those spouse moved to New York. In New York courts it would have cost him $5000 instead of $4000. (Morale of story, don't have child custody fight in New York!)

It was just a nasty custody battle (and still fighting). Very vindictive. Even when she's working and my buddy has 3 day weekend like Memorial Day. She won't even give up the kids to Monday afternoon at 4pm. Because that's what the courts say.

She'd rather have the kids with the nanny than with the father.
 
Wolverines83 said:
Then the ortho doc should also be paying the non ortho husband.

If the ortho doc made 200k more, she's a larger part of that lifestyle... So she should be contributing more to this "child pool" than the non ortho husband. And since she's not...that math doesn't work.

1920s it is!
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Just not the way it work.

Spousal support and child support are determined differently.

And if both incomes are greater than $150k a year My buddy attorney says the "poorer" spouse isn't entitled to alimony or spousal support.

You even see if in the mega billionaire divorce of two hedge fund people. The "poorer" spouse got denied spousal support. So she's going the child support method and trying to demand $400k a month in child support.
 
aneftp said:
Just not the way it work.

Spousal support and child support are determined differently.

And if both incomes are greater than $150k a year My buddy attorney says the "poorer" spouse isn't entitled to alimony or spousal support.

You even see if in the mega billionaire divorce of two hedge fund people. The "poorer" spouse got denied spousal support. So she's going the child support method and trying to demand $400k a month in child support.
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I'm not arguing what the courts say. I'm arguing that the way the courts work is unfair. If we just blindly accepted courts as fair, women and blacks wouldn't be voting.

Think of what happened to your buddy. That's garbage. Its legal but its garbage. Legal and moral aren't the same thing.
 
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aneftp said:
Yes. This is the way it was explained to my buddy. The primary caregiver gets the money for child support on a sliding scale (depending on state laws) from the non custody parent.

Lucky for my buddy the child custody was in Maryland courts even those spouse moved to New York. In New York courts it would have cost him $5000 instead of $4000. (Morale of story, don't have child custody fight in New York!)

It was just a nasty custody battle (and still fighting). Very vindictive. Even when she's working and my buddy has 3 day weekend like Memorial Day. She won't even give up the kids to Monday afternoon at 4pm. Because that's what the courts say.

She'd rather have the kids with the nanny than with the father.
Click to expand...

Hell hath no fury...
 
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Physio Doc 2 Be said:
I have to step in here and point out that child support while it is given to the former spouse (in this case, an orthopedic surgeon who is making $200k more than her ex), the money is for the child. The courts aren't "behind the times" on this because this isn't maintenance being paid to the other spouse to support a lifestyle to which they had become accustomed. This is money the child is entitled to for said lifestyle. If there was no child, my guess is that both parties would go their separate way and all would be right with the world (depending on the state in which they live, the circumstances that made the divorce happen, and just how vindictive the parties involved wanted to be) but they procreated. Do that, and sometimes you bring "unpleasant" burdens upon yourself (he said, tongue firmly planted in cheek). And one of those is ensuring that your child lives a life similar to what they'd be living if you (not you specifically, but you generally) and your partner had not split. The easiest way to do that is to count the bennies and divvied them up. /shrug
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What I meant by saying the legal system is "behind the times" in matters of child support is that these laws were written taking in account a time when women did not commonly work and men were the only bread winners in the family. Obviously, this is hardly the case now. But still this is the reason for such excessive amounts of child support. Also, yes child support is supposed to entirely go for the child's expenses but it rarely works out that way. This is because the courts do not require any sort of documentation of how the mother spends the money. I have seen the mother buying new cars and going on vacations when the child is with the father. Now, no way do I mean that the father should have a reduced financial responsibility but I have also seen the father offer to pay for ALL child expenses directly instead of giving the money to the mother. This was also not allowed because all the money is required to go through the mother. I dont know about you, but it doesn't seem very fair to me.
 
sleepallday said:
What I meant by saying the legal system is "behind the times" in matters of child support is that these laws were written taking in account a time when women did not commonly work and men were the only bread winners in the family. Obviously, this is hardly the case now. But still this is the reason for such excessive amounts of child support. Also, yes child support is supposed to entirely go for the child's expenses but it rarely works out that way. This is because the courts do not require any sort of documentation of how the mother spends the money. I have seen the mother buying new cars and going on vacations when the child is with the father. Now, no way do I mean that the father should have a reduced financial responsibility but I have also seen the father offer to pay for ALL child expenses directly instead of giving the money to the mother. This was also not allowed because all the money is required to go through the mother. I dont know about you, but it doesn't seem very fair to me.
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"I have seems moms buying new cars w child support" is a worthless argument for obvious reasons.

Bottom line is that one had to provide financial support to offspring, I'm sure his ex is too.
 
Just waiting for it to come full circle to Obama, guns, and eventually ibanking. :corny:
 
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If you are paying your ex wife's mortgage so that your kid can grow up in a house he's accustomed to, you should be getting equity in the house to sell when he's 18. She should make no money off the exchange even indirect money through home equity. It's child support so she should have nothing to show for it when the child is an adult.

Moral of the story. A. Don't get married or have kids. B. If you violate rule A, make sure she's a keeper.
 
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On topic... the psych guys are currently stating that anesthesiologists routinely pull in over a million per year on the "why psych is not competitive" thread... One dude was complaining about exorbitant epidural fees during his wife's pregnancy.
 
SaltyDog said:
Just waiting for it to come full circle to Obama, guns, and eventually ibanking. :corny:
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Well it's not specific to Obama but I can certainly go the anti-government route and explain how it serves no purpose for any American except the super wealthy. I mean we can go into how elections are bought, candidates are selected before we even get a chance to "vote" for them and then lobbyists ensure the oligarchy in washington passes legislation that benefits them...at the expense of the average american. And how the government keeps pumping "USA USA USA" "Merica!!" into peoples minds to keep them proud of a country that only serves to siphon the hard work and money off everyday Americans...and how the 2nd amendment was specifically written for situations like this.....But, I won't go there!

I don't know much about ibanking...

(seriously, I'm just being facetious, no interest in this conversation!)
 
Carbocation1 said:
On topic... the psych guys are currently stating that anesthesiologists routinely pull in over a million per year on the "why psych is not competitive" thread... One dude was complaining about exorbitant epidural fees during his wife's pregnancy.
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No we BILL for a million dollars but get paid $250k while $750 goes to an unnecessary middle man. Being an unnecessary middle man getting rich off other people's work- it's the new American dream!

Dang Obama/Hillary Rodham.

Should have been a banker, lawyer, real estate mogul, rock star, professional golfer/driver/etc., or lobbyist.
 
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nolagas said:
If you are paying your ex wife's mortgage so that your kid can grow up in a house he's accustomed to, you should be getting equity in the house to sell when he's 18. She should make no money off the exchange even indirect money through home equity. It's child support so she should have nothing to show for it when the child is an adult.

Moral of the story. A. Don't get married or have kids. B. If you violate rule A, make sure she's a keeper.
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Or make sure you're a keeper.

Can't tell you how frequently I interact with physicians and think "boy, I feel sorry for this person's spouse."
 
One of our surgeons is incredibly slow, but operates at regular pace at an ambulatory surgery center doing the same orthopedic cases. He has been known to have dinner in the lounge for no apparent reason at the end of the day. He confided that he would rather have his wife take care of the kids and get them to bed, so he stays late on his main OR days. What a catch. How about finishing at full speed and catching a nap in your office, douche. We don't need to stay late because you have marital problems.
Why he does this at all instead of doing anything else is a mystery. I avoid his room like the plague as it is almost as painful as watching paint dry and he is deliberately painfully slow. Eventually his nonsense will lead to a positioning injury, etc. I'm sure he will blame us...
 
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nimbus said:
This may be the most tangential thread ever.
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all i wanted to know was what job offers current residents are getting? i get dooms day and divorce, gotta love sdn lol
 
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Carbocation1 said:
The future doesn't look bright, I get it. But the rest of medicine is on the same boat. Cards has been hit really hard if I understand correctly. Echo and EKG reimburse peanuts compared to a decade ago. Just confused about what solid options are available to the medical student who doesn't want to take on the risk of operating on people.
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I would pick something both relatively broad as well as something that is able to be done on a cash basis AND have people willing to pay cash for your services. I can't say I have the answer to that exactly, but you should be able to make a short list. There is a whole revolution just starting with direct primary care or what is also called 'concierge' medicine. It just might be a viable alternative and even cheaper than the extremely large co-pays that many middle class folks are struggling with right now. Of course 100% of primary care can be done by nurses (according to the nurses, just like in anesthesia) so there is that too. I would stay away from exclusively hospital based specialties for now.
 
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2ndyear said:
I would pick something both relatively broad as well as something that is able to be done on a cash basis AND have people willing to pay cash for your services. I can't say I have the answer to that exactly, but you should be able to make a short list. There is a whole revolution just starting with direct primary care or what is also called 'concierge' medicine. It just might be a viable alternative and even cheaper than the extremely large co-pays that many middle class folks are struggling with right now. Of course 100% of primary care can be done by nurses (according to the nurses, just like in anesthesia) so there is that too. I would stay away from exclusively hospital based specialties for now.
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Bingo. Hospital based specialties will get ravaged. Hopefully, some of you will have an exit strategy.
 
Carbocation1 said:
New NYT article bashing physicians: http://mobile.nytimes.com/2015/05/2...f-nursing-autonomy-debate.html?referrer=&_r=0

Stay away from the comments section unless you have an alcoholic beverage at hand.
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Looks like the psychiatric nurse practitioner works in a place that would be my version of a lonely, sparsely populated hell. I don't know any doctor who would move there to provide the needed services. So in my view she is doing a good thing. More power to her.
 
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nimbus said:
Looks like the psychiatric nurse practitioner works in a place that would be my version of a lonely, sparsely populated hell. I don't know any doctor who would move there to provide the needed services. So in my view she is doing a good thing. More power to her.
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Agree. What I have a problem is with those who deny that this is almost always a step down in level of care.
 
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If I had a need for mental health care I would prefer a nurse practitioner to no care.

As a matter of interest, the article seems to suggest that there is no doctor in town when according to one comment there is an internist who has worked there for 20 years.
 
Carbocation1 said:
New NYT article bashing physicians: http://mobile.nytimes.com/2015/05/2...f-nursing-autonomy-debate.html?referrer=&_r=0

Stay away from the comments section unless you have an alcoholic beverage at hand.
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Sounds like it was just another piece of well-planned, sensationalist propaganda:
Ethan Campbell Brooklyn, NY
It's funny that this article makes Ainsworth, Nebraska look like a town with no doctor and substandard medical care, with only a frightened nurse practitioner and a doctor who stops in once a month from another state.

Funny because my dad, Melvin Campbell, has worked as a doctor there for the past 37 years. He speaks highly of his NP, she's very capable -- and the only time she's on her own is when he's on vacation (that is, rarely). Yeah, the hospital has been trying to recruit a doctor since 2012 -- not because they don't have one, but because my dad can't work as the sole physician in the county forever.

In fact, he had a conversation with Ms. Tavernise when she was writing this article, which does shine light on the problem of rural communities with limited healthcare options. But come on. She wanted to make rural Nebraska look isolated, and doctors look like jerks, and the problem look scary for dramatic effect, and she had to ignore a few facts that didn't fit that storyline.
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