Which IM subspecialties are most in demand?

[sanfran256]

Currently an M4 who just matched into an academic SoCal IM program . I really am not sure if or what to sub-specialize in. One important factor I am considering is demand, considering I will be applying for jobs in a competitive area. Which sub-specialists have the easiest time finding jobs? Thank you!

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[DrStephenStrange]

I am just an M2, but I would imagine the more in demand a specialty is, the more money they make. With this reasoning, Cards and GI would be among the top in demand specialties. I might be completely wrong though.

Edit: Congrats on matching IM in SoCal. That's a huge accomplishment.

 

[KeikoTanaka]

I think it's super geographically biased as to which specialties are needed where.
General IM is probably most in demand, but makes least amount of money, so I don't know if Cards/GI is necessarily most in demand solely based on salaries. These two specialties are extremely procedure heavy, hence, more money.

Rheum, Endo, ID, all don't do nearly as many procedures as Cards/GI.

Infectious Disease is incredibly in need, especially in light of recent events. They don't make much more than a PCP, but are constantly in the top rankings of job satisfaction and happiness.

 

[DennisReynolds]

90% of all peeps I interviewed with who were entering IM were shooting for Cardio and GI.... I wonder why. 😉

Then intern year goes by and you realize you can't handle another 3 years after residency. lol

But in all seriousness, you won't have any problem finding a job in any field in IM... even general IM.

GI and cardio are huge money makers obviously due to the sheer numbers of procedures that are done.

Rheum is solid for 350K+ and all outpatient... but reimbursement for infusions is decreasing apparently...

Allergy, Endo are great options but not gonna make mucho mucho cake.

Nephrology is apparently "dead"... but the nephrologists around my parts are being stated at 400K soooo... who knows.

 

[the argus]

OP, I would strongly suggest that you spend the next 1-1.5 years not spending a single minute thinking about which subspecialties are most in demand, make the most money, etc., and instead figure out what you honestly ENJOY doing.

Choosing a subspecialty based on anything other than what you truly enjoy is a recipe to be burned out and miserable.

 

[deleted859689]

what about CCM?

 

[bronx43]

Covid will change healthcare landscape as we know it. I wouldn’t extrapolate current conditions to your future career opportunities.

 

[VA Hopeful Dr]

Covid will change healthcare landscape as we know it. I wouldn’t extrapolate current conditions to your future career opportunities.

Care to expound upon this?

 

[bronx43]

Care to expound upon this?

As a medicine subspecialist, I have doubts that demand for my specialty will quickly go back to what it was before. I see the same for many other fields, which will ravage the economics of these jobs in terms of income and job market.

Furthermore, if this gets bad enough, I would be surprised if there wasn't some sort of "temporary" Medicare for All, which will then become permanent. Bloomberg already came out with an article talking about the number of people who lost their jobs and are now going without healthcare insurance.

 

[VA Hopeful Dr]

As a medicine subspecialist, I have doubts that demand for my specialty will quickly go back to what it was before. I see the same for many other fields, which will ravage the economics of these jobs in terms of income and job market.

Furthermore, if this gets bad enough, I would be surprised if there wasn't some sort of "temporary" Medicare for All, which will then become permanent. Bloomberg already came out with an article talking about the number of people who lost their jobs and are now going without healthcare insurance.

Ah, so you're talking more economic landscape. That's fair.

 

[Deecee2DO]

90% of all peeps I interviewed with who were entering IM were shooting for Cardio and GI.... I wonder why. 😉

Then intern year goes by and you realize you can't handle another 3 years after residency. lol

But in all seriousness, you won't have any problem finding a job in any field in IM... even general IM.

GI and cardio are huge money makers obviously due to the sheer numbers of procedures that are done.

Rheum is solid for 350K+ and all outpatient... but reimbursement for infusions is decreasing apparently...

Allergy, Endo are great options but not gonna make mucho mucho cake.

Nephrology is apparently "dead"... but the nephrologists around my parts are being stated at 400K soooo... who knows.

So I was under the impression Allergy makes decent money comparatively somewhere around 325K+ which surpasses Endo and ID which are considered the lowest paid. Also didnt think Rheum made 350K+ that seems reeeeealllly high for Rheum. If thats true thats amazing but I just have never seen Rheum salaries above 300K

 

[bronx43]

So I was under the impression Allergy makes decent money comparatively somewhere around 325K+ which surpasses Endo and ID which are considered the lowest paid. Also didnt think Rheum made 350K+ that seems reeeeealllly high for Rheum. If thats true thats amazing but I just have never seen Rheum salaries above 300K

Eh, it's all variable. Academic rheum make like 140k-180k. I know PP rheum making 7 figures. Median full time PP is probably 300-500k.

 

[sanfran256]

Thanks all! To be clear, I would not do a specialty that I don't like just for money/ease of finding a job! At the same time I genuinely think I could be happy in a lot of fields . So just something I am considering.. I don't want to have to uproot and move across the country just to find a job. Also im really trying not to let money influence me but its hard with 300k of loans :/

 

[Drrrrrr. Celty]

As a medicine subspecialist, I have doubts that demand for my specialty will quickly go back to what it was before. I see the same for many other fields, which will ravage the economics of these jobs in terms of income and job market.

Furthermore, if this gets bad enough, I would be surprised if there wasn't some sort of "temporary" Medicare for All, which will then become permanent. Bloomberg already came out with an article talking about the number of people who lost their jobs and are now going without healthcare insurance.

So worse or better...?

I mean obviously anticipating is impossible, but this is vague haha.

 

[bronx43]

So worse or better...?

I mean obviously anticipating is impossible, but this is vague haha.

Huh? Not sure which part suggests better.

 

[HemeOncBound87]

As a medicine subspecialist, I have doubts that demand for my specialty will quickly go back to what it was before. I see the same for many other fields, which will ravage the economics of these jobs in terms of income and job market.

Furthermore, if this gets bad enough, I would be surprised if there wasn't some sort of "temporary" Medicare for All, which will then become permanent. Bloomberg already came out with an article talking about the number of people who lost their jobs and are now going without healthcare insurance.

I am curious what subspecialties you think will be in less demand. I can see ID + pulm/crit being more in demand IF this does get bad enough. I see how this is probably affecting a lot of outpatient based specialties but surely this is just for the short term right?

 

[bronx43]

I am curious what subspecialties you think will be in less demand. I can see ID + pulm/crit being more in demand IF this does get bad enough. I see how this is probably affecting a lot of outpatient based specialties but surely this is just for the short term right?

Pulm CC and hospital medicine for sure. ID can work with admin to come up with response plans and hospital epidemiology but they don’t add much clinically. There’s nothing they can do that any internist can’t. I’m not sure you need THAT many more of them.

I’m talking more outpt specialties like rheum, endo, allergy, etc.

 

[HemeOncBound87]

hmmm wonder if I should still pursue heme/onc but I guess it is too early to tell at this point. Curious to see what impact this will have on the healthcare landscape.

 

[Drrrrrr. Celty]

Huh? Not sure which part suggests better.

I mean why are they going to be less in demand? Like because money will be tight or because a lot of those patients may not survive this?

Like I really anticipate a lot of specialties conforming more towards telephone meetings. Which for healthy young folks might legitimately be a pro.

 

[bronx43]

I mean why are they going to be less in demand? Like because money will be tight or because a lot of those patients may not survive this?

Like I really anticipate a lot of specialties conforming more towards telephone meetings. Which for healthy young folks might legitimately be a pro.

Because a lot of private practice is “treating” the worried well, chronic management of stable disease, or ailments that are non life threatening. Unless someone knows that they are immune, I suspect a lot will have second thoughts about going to clinic.

In rheum for example, I expect a big drop off in osteoarthritis, fibro, and other msk visits. Even stable pts with rheumatic diseases will opt to space out their visits.

 

[sanfran256]

hmmm wonder if I should still pursue heme/onc but I guess it is too early to tell at this point. Curious to see what impact this will have on the healthcare landscape.

I personally would think H/O is safe. Unfortunately people will continue to get cancer, which necessitates frequent appointments

 

[gutonc]

hmmm wonder if I should still pursue heme/onc but I guess it is too early to tell at this point. Curious to see what impact this will have on the healthcare landscape.

Cancer, STEMI, transplant and trauma are about the only non-COVID related stuff going on in hospitals and clinics these days. Draw your own conclusions.

 

[tantacles]

Because a lot of private practice is “treating” the worried well, chronic management of stable disease, or ailments that are non life threatening. Unless someone knows that they are immune, I suspect a lot will have second thoughts about going to clinic.

In rheum for example, I expect a big drop off in osteoarthritis, fibro, and other msk visits. Even stable pts with rheumatic diseases will opt to space out their visits.

I guess the problem is that you're a worried well person until you have a significant problem, and then you are the appropriately worried sick. That's not to say that every patient who is worried about rheumatic disease should go to a rheumatologist, but less is not always more, and I've certainly seen patients hospitalized with what seemed like a trivial complaint who ended up with catastrophic diseases.

Common? No. But we've all seen it.

 

[Tesselate]

Hmm, if you're looking to make a lot of money with less "school" just do hospitalist w high paying locums or alternatively high paying perm nocturnist in the middle of nowhere which is what my colleague is doing making 500k right out of residency. If you don't mind fellowship for more money, GI and cards prolly the way to go.

 

[bronx43]

I guess the problem is that you're a worried well person until you have a significant problem, and then you are the appropriately worried sick. That's not to say that every patient who is worried about rheumatic disease should go to a rheumatologist, but less is not always more, and I've certainly seen patients hospitalized with what seemed like a trivial complaint who ended up with catastrophic diseases.

Common? No. But we've all seen it.

Sure, but a non-insignificant portion of the people who come to a specialist know deep down they're probably ok, but just want reassurance by a specialist. A lot of these people (and I would argue ESPECIALLY these people) would not come to a doctor's office if there's the threat of covid.

 

[tantacles]

Sure, but a non-insignificant portion of the people who come to a specialist know deep down they're probably ok, but just want reassurance by a specialist. A lot of these people (and I would argue ESPECIALLY these people) would not come to a doctor's office if there's the threat of covid.

The question is do they know they are ok, or do they just know they're more ok than they would be if they got covid?

 

[gutonc]

Sure, but a non-insignificant portion of the people who come to a specialist know deep down they're probably ok, but just want reassurance by a specialist. A lot of these people (and I would argue ESPECIALLY these people) would not come to a doctor's office if there's the threat of covid.

These are actually the ones I can't get to stay away right now. The met colon and lung cancer patients are all "f*** that man, there's COVID out there, I'll come see you in a few months".

 

[bronx43]

These are actually the ones I can't get to stay away right now. The met colon and lung cancer patients are all "f*** that man, there's COVID out there, I'll come see you in a few months".

I have some of those too, but a lot canceled. As a whole, I just don't see how this can be anything but bearish for most specialties.

 

[bronx43]

The question is do they know they are ok, or do they just know they're more ok than they would be if they got covid?

From a business standpoint, there really isn't much of a difference.

 

[tantacles]

From a business standpoint, there really isn't much of a difference.

yup!

 

[Splenda88]

I guess IM will see a jump in step1/2...

 

[tantacles]

I guess IM will see a jump in step1/2...

Nope! Step 1 is going to pass/fail. So maybe step 2. :-D

 

[throwaway1000000]

I guess IM will see a jump in step1/2...

Haha doubt it. I think what makes IM easy to get is the large number of spots.

If you restricted IM spots to like ortho, derm, neurosurgery number of spots...IM would be extremely competitive. Top 20 IM programs are as competitive as any surgical subspeciality.
Or if you have direct pathway to cards and GI, those would become very competitive too

 

[medsc1]

I don't mean to hijack OP's thread, but do you guys think there will be good opportunities for IM docs to practice outpatient primary care in a big city in the midwest like Chicago?

I just matched into a community IM program and have recently become very interested in outpatient primary care. I was regretting not going for FM residency. Correct me if Im wrong, but I was under the assumption that primary care groups in bigger cities prefer FM trained docs over IM?

 

[tantacles]

Many primary care groups in large cities use internal medicine doctors; family medicine physicians are far more utilized in more rural areas because in most rural areas, there are few pediatricians, so they fill in that gap, but both internal medicine and family medicine physicians are generally in demand for adult primary care in all areas.

 

[InternistDO]

Correct me if Im wrong, but I was under the assumption that primary care groups in bigger cities prefer FM trained docs over IM?

I’ve never heard this before in my life. If anything I’ve heard the opposite.

In big cities the advantages of FM are pretty minimal—there are enough pediatricians to see the kids and enough OBGYNs to deliver the babies. All the FM doctors I rotated with in a big city has practices identical to the IM attendings—all adults.