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There is scutwork too right?
Which of the best paying specialties are relatively easy to match into?
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scutwork's reviews are pretty old...
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From people I have talked to, if you basically go to a competitive university IM program and AMG MD, your odds are going up to the 90%ish range for GI/Cards. People keep saying just go to a place that makes you happy, but reputation of an IM program for GI/Cards is tremendously important to improve that 77/83% chance of matching into the big 2.
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Which fields do you think will have a median income of 300K in the future? Pure speculation, but a fun game.
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any surgical subspecialty (maybe gen will be below 300K tho)...
derm will stay there, rad onc...
rads may plummet in the future with computer technology, outsourcing (think IBMs Watson)
I think EM/Gas will be 250-300K
any field with cosmetics. any field that requires a very high level of expertise, so that no mid-level can replace you.
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Dumb pre-med question: I assume Gas = gastroenterology. For some reason I was under the impression that gastro was was an IM fellowship. Has that changed, or was it always like that?
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Gas=Anesthesiology
That part's not true at all. Everyone can be replaced. Nothing requires a "high level of expertise".
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I assume you are talking about Gas being replaced by CRNAs. Be assured they will not be replaced by any means. Once in the OR, you will see the cases given to CRNAs and the ones given to the MD/DOs. Even those cases by the CRNAs are typically supervised.
As for other specialities, there is a reason we go through 4 years of education + a residency/fellowship.
Agreed up cosmetics assuming the economy straightens up.
People have been scared that radiology would be outsourced for years, it won't happen. As for watson, computer aided technology will definitely help radiologist become even more efficient than they already are. But there is no way a Watson could replace them. Rads & Cards will definitely take a pay cut larger than the other fields of medicine.
I agree with Gas and EM, with Gas>EM.
I don't think you can easily teach someone how to diagnose a patient like a radiologist or how to do neurosurgery. That requires years of training. You can easily teach someone how to do a mindless bread-and-butter procedure, but you can't teach them how to think. That's where the MD/DO comes in, imo...
Agree on the radio and neurosurg for now... Waiting for radio to become mindless as their job becomes a matter of medically certifying reads rather than actually making them.
How mindless a procedure becomes is a product of time at technology. Some places are worried about a pulmonologist driving a rigid bronchoscope, some places let PAs use them. Normally, you have to be a 1st year GI fellow to even be allowed to touch a colonoscope (that word sounds wrong).... some places have NP's driving them independently. It's all just a matter of time and technology.
They're coming for us.
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Probably pathology too. But it's only a matter of time for that as well. There are many surgeries that I bet you could teach someone like a PA and NP to do (a mini residency) and if they do enough of them (and especially if they focus on 1-2 of them and do them all day), you could easily see them matching and beating the outcomes of physicians who may do a wider variety of procedures. It's hard to beat practice + experience. It's only a matter of training people until they are comfortable -- I bet very few or any surgery will require to recall any part of Medical Biochemistry in order to do them. With time and practice, anything becomes second nature.
Interestingly, primary care should be the hardest field for the midlevels to do because they handle the widest variety of cases, so you need a wider background, but primary care in this country is not like it is in other countries (in some countries they manage many more complicated cases - specialists are only referred for the really unique/complicated stuff) - it's been gutted by the specialists so anything remotely interesting or procedure oriented gets referred out - which makes it easier for the midlevels to swoop in there as well.
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Note that I don't think the sky is falling or anything, but I do see many of the lines being blurred pretty quickly between physicians and non-physicians in even the more complicated cases. Doubly so if there is tort reform so hospitals might be more willing to cut costs by giving other people besides physicians a go at some things. But even without that. There will always be a place for physicians but the physician lobby, historically, has been really terrible at defending their turf politically - and indeed in the 70s and 80s especially - actually helped create many of these issues because it made short term financial sense from them (no worry about the long term).
Agree completely.
I remember reading about some Hernia Hospital, (in canada?), where they do nothing but hernia repairs. They have the best outcomes, and least complications, by far. And they operate super-fast, under local anesthesia. The key is, all those docs do is hernias.... day in, day out. Practice. The kicker, some of those docs are FPs and OB/Gyns - not general surgeons.
They've had RNFA's for a long time, and theres surgical NPs around now. Its just a matter of time before they start training them to do hernias and appys.
As for the second point. Absolutely. I'm convinced that its harder to be a general internist than it is to be a specialist. Its harder to know a lot about a lot, than a tremendous amount about a little. We've got it backwards here in the US. Generalists can't fully manage their patient's 10 different issues in a 15 minute visit, so they end up referring them out to 10 different specialists. NPs can't fully manage anything anyway, so they fit right in
So, thats the problem.... we physicians decide we dont want to do certain things.... primary care, boring gas cases, fast-track ER, urgent care, routine OB, house/assistant surgeon, midnight radiology reads... so we cut each others throats to avoid doing them as physicians. The ones left doing these jobs are overworked, and so we willingly hand the jobs over to midlevels, and australian docs... and then we whine about it.
How long before we get bored of appies, hernias, choleys...?
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There's no way this will happen I think at any time in the near future. The software to read this stuff is no where near the level it needs to be. If it could be done we'd be seeing at least the beginning of it now. It's just not there at all as far as I know though I am sure someone is trying to see what they can do. However, you have to realize that for someone to be able to develop software to read, say a cxr, it would have to be done by a person with expert knowledge in reading those films (or access to some who has said knowledge) and then with the expert knowledge to develop software to be able to pick up every small little detail that needs to be picked up (or access to the money to pay someone to do it) while not missing anything. The error rate would need to be lower than that of a human radiologist for people to trust it. Also you gotta wonder if there is even a demand for this technology right now. I'm not really sure there is. I don't think we as a society are ready to really start entrusting such decisions to software programs.
Also, general surgery fill rates (i.e. the number of spots filled vs spots available) are pretty low I think from my own quick glances. I see gen surg payments to rise in the future. I have heard the "pendulum" is swinging back in the direction of IM/gen surg being more competitive and this may be one of the reasons - future payments staying high vs other fields.
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I don't know about that to be honest. Most aircraft landings are now fully automated for example. If you prove that a computer is better at doing something than an expert in a scientific way, there is no way a human will keep doing for for the long term.
Yeah, but there are still pilots in the cockpit (or at least I hope so, since I'm supposed to fly in a couple of days).
I think outsourcing, whether its to mid-levels or AI, is a moot point. All of these reimbursements were determined eons ago when Medicare came up with its payouts divined by a secret council of warlocks and orthopods. Its just a matter of time before another council of wizened "experts" gather and decide which procedures should be paid what. The specialties that will thrive are those that have already found a market being paid out-of-pocket. For example, the top orthopedists, diagnostic cardiologists, non-emergency GI, uro, derm, ENT, maybe the shrewder psychiatrists and concierge physicians. Subsequently, the anesthesiologists and radiologists who work with these groups during/before the big procedures. Keep in mind these are only the top physicians in their respective specialties who can get away with this.
So I don't think there will be one specialty, per se, that keeps getting paid >300k, but a class of physician who is talented enough that they don't need to be beholden to insurance companies.
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Why in the world would these dianostic cardiologist, ENT, orthopedists who have revenues that are mainly out of pocket pay the radiologists and anesthesiologists so much more than market value? Seems like a bad business decision with little upside - unless somehow the skillset of these radiologists and anesthesiologists is so much superior to the 'average' BC anesthesiologist or radiologist. Hell, I'd think that most people operating with outpatient or other minor procedures would be the first to dump an anethesiologist all together to improve their own bottom line.
I saw a news clip within the last couple of years which says that the council of wizened experts still contains a significant number of orthopods, and a few warlocks. There were a few lawyers who sympathetic to NPs as well (though Im not sure if they were on the committee, or just commenting). Not many primary care docs. I forget the name of the committee, but its not CMS.... I'm not hopeful.
A lot of the time the anesthesiologist will bill separately (they're not necessarily employees of the surgeon/specialist), and charge out-of-pocket. If you still want to have the procedure done by that world-renowned polyp remover, then you're just going to have to deal with it. I'm not sure how it works with radiologists or at the private ambi-care centers, but I know at least a couple of people who got stuck with the gas bill without even realizing it.
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Yea but generally patients don't pick out their anesthesiologist when they go in for a surgery, like they pick their plastic surgeon or whatever. Like, I want this plastic surgeon, and can you please get this Anesthesiologist from 20 miles away to administer anesthesia. At least I haven't heard many instances of it. It doesn't make sense that the surgeon would have that type of contract with a more expensive anesthesiologist for no reason whatsoever. It just makes the patient pay more without any of it going to him.
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cowme
I hope that came out wrong, and you don't actually think that cardiologists, etc. pay radiologists for their reads.
They don't read films themselves because they weren't trained for four years to read those films and know that they are far more likely to miss something and get sued than a radiologist. Cardiologists see patients, ent doctors operate. There is simply too much imaging volume for them to do what radiologists do as well. This is why the concept of specialties evolved, because doctors preferred to focus on what they do best. Radiologists read films best because they are trained to do so. Cardiologists are the experts of cardiac issues because they were trained to do so. If they feel comfortable that they can take an imaging modality from a radiologist, they will (which is what happened with echocardiograms).
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You are missing my point. Obviously the radiologist is the one doing the reading. The discussion was about falling reimbursements and only those people who have a cash based practice continuing to make a lot of money. The comment was that specialties (for example a FM concierge practice) that deal with cash will make money. However it was said that specialties like radiology or anesthesiology that attach themselves to such practices will also be paid more. I understood why say a concierge medicine physician makes more money but not how the radiologist would. Meaning if that concierge physician orders some test, why would he or the patient have it read from a radiologist that charges way above market value?
Im assuming that by "radiology and and anesthesiology that attach themselves", you're talking about the ones that work in private practice imaging or surgi- centers, instead of hospitals..... and contract with other PPs, such as concierge FPs, yes?
If thats the case, then the answer is... they dont. They charge the standard reimbursement rate, like everyone else.
It just so happens that the reimbursement rates were set a long time ago, and haven't changed with the "market", if you will. So for example, what was complicated for a radiologist decades ago - such as a CT reading - was reimbursed at a higher rate. These days, CTs are routine yet the old premium on them is still on the price tag. So, radiologist now make a steady fortune from something that just used to be a bonus. This is why people keep saying that "radiologists are in for a huge paycut". Once the government catches wind of this, they'll cut the reimbursement rate for what is the currently routine imaging.
Unless they are charging cash like the FP.... in which case, I don't think they can.... I dont know really.
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They don't call it Plenty of Money & Relaxation for nothing, I suppose.
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Yup, exactly, that was my point.
The person I was disagreeing with said that the radiologist would charge a lot more than the standard, like concierge FP might charge a lot more than standard.
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Yeah PM&R looks like a cool field. Definitely friendlier to non-MD applicants. Definitely controllable hours. Pretty good pay. And low stress.
Even considering just that set of criteria that the OP put forward, I still think you have room to think about other things that you might be doing for the next decades.
Do you like the patient population and the nature of the work? For instance.
I have looked at PMR pretty hard. One thing I don't like is the split intern year. Having moved across the country three times in the last several years. That's a major down side. Secondly I am not sure I'm interested in the patients' problems in this field.
Whereas I am in psych's. And psych offers tremendous career flexibility.
In short, I think the OP's criteria is too weak to be selective enough.
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cowme
Radiology reimbursements have been significantly cut since 2000. They make similar salaries than they did back then, but that is only because technology has advanced incredibly since then and radiologists work MUCH harder than they did back then. Salaries will likely continue to dip, but by staying on the cutting edge of technology, this effect won't be as pronounced, as say, and orthopedic surgeon whose hip replacement reimbursement is cut in half.
Edit: lol, sorry shaggy, didn't mean to quote your comment there. This post was just meant to address the above comments about radiology reimbursement cuts.
Edit: lol, sorry shaggy, didn't mean to quote your comment there. This post was just meant to address the above comments about radiology reimbursement cuts.
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...ok?
Salpingo said:
The post is what I was responding to, not how much they make in general or whether their average salaries will go up down or stay the same (which is irrelevant to the discussion).
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You guys are kidding yourselves if you think PMRs make that much money - go read the PMR forum here. They might make that in "fly-over" America, but nowhere near the coasts or anywhere desirable!
There is no "high paying" field that's "easy to match into." If they were high paying, they are going to be competitive. It's as simple as that.
You're right, the patients DON'T pick their anesthesiologist. My only point was that there ARE anesthesiologists who charge out-of-pocket, and they're able to do so because they have a partnership/contract with a hotshot plastic surgeon (or whoever). A lot of the time, the patient doesn't even know that they'll have to pay out-of-pocket for the anesthesiologist, and by that time they've already established a long relationship/invested heavily in seeing whoever is doing the procedure. And to be honest, doctor's have a fairly bad track record of looking out for the patient's best financial interest. It kind of goes to the core of a major problem in healthcare. There are no visible price tags you can look at before you go to the cash register. All of the payments occur AFTER the transaction. Since there seems to be very little reform pushing for price transparency (in fact, the general philosophy seems to be the opposite), I don't see this changing any time soon. For the record, this doesn't mean that these anesthesiologists charge MORE than the standard fee, just they don't have to deal with insurance hassles, and they have some income stability when there's a big medicare/insurance shake-up.
Now, I don't have any firsthand knowledge of radiologists who do this, so I'm willing to back away from the claim that they're in a good position for the future. Maybe there'll be a rush into IR or private premium imaging not covered by insurance.
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Yes guys. Radiology will plummet big time. Job market already stinks. No med student should do it, it is a terrible career choice! It is especially terrible in certain locations already, namely California, Chicago, Miami. Do NOT apply to those locations for residency if you want a job coming out!
more spots for me!
more spots for me!
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No one is saying that.Yes guys. Radiology will plummet big time. Job market already stinks. No med student should do it, it is a terrible career choice! It is especially terrible in certain locations already, namely California, Chicago, Miami. Do NOT apply to those locations for residency if you want a job coming out!
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You missed the important part, Shaggy.
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Yes guys. Radiology will plummet big time. Job market already stinks. No med student should do it, it is a terrible career choice! It is especially terrible in certain locations already, namely California, Chicago, Miami. Do NOT apply to those locations for residency if you want a job coming out!
more spots for me!
I concur with this statement 100%. Do not go into radiology. You've got Watson to contend with.
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To be totally honest, radiology really isn't a great career choice because the job market truly does stink right now which is why everyone is doing a fellowship..... or two. Also the cushy image of the field is from 10-15 years ago. With the advent of PACS and decrease in reimbursement, radiologists are working much harder and longer hours. Also in radiology residency you will read a TON of books, more than any other specialty other than pathology.
And to add onto all of this, Watson is coming out. But then again currently Watson has it's sights on being a diagnostician in the realm of the traditional History & Physical. In that regard, we are all ****ed.
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+1
It also depends on the job market and the subspecialty you go into (my info based on the PMR forum).
-1 : while I agree with you, I still think PM&R makes a lot of money.
I think people have different ideas of what "a lot" of money is, and then overemphasize the $ amount in comparison with other things. "Highest paying" often has more to do with the physician than the specialty.
To me, the difference between 180K and 220K is MUCH more significant than 300K vs. 340K. Once you're past about 225K, I think you're rich and thats all. I'd just draw a cutoff at 200K, and separate them into low-paying and high-paying... just as a reference point.
What the salary surveys dont take into account is how long you work, or if you do procedures (and can jack up your income at will). Medicine allows you to control your income to an extent. And so, those surveys give you an indication of how much those doctors want to make. Of course, thats within a range, and thats why distribution and quartiles are important.... especially the 25%. While most of those are probably part-timers, its helps to see what happens if you work the bare minimum, and compare it to the max.
The minimum you can do, and still stay in business is important, especially when you want a life outside of medicine. By minimum, I mean - You need X amount of patients to "break even". With each patient you need Y hours to properly manage. X*Y= minimum hours to break even. Talking to a lot of internists and sub-specialists, that minimum amounts to about 60 hours per week. Theres an average work-hours survey somewhere out there if you're curious.
So, whether you're low vs. high paid on $ alone.... I think you should factor in the minimum hours, and that can really bump a specialty like PM&R from low to high. Though they average the same as primary care in some places, they work 2/3 of the hours.
Then, you need to factor in - is the salary a result of how much the specialty pays... or a result of the physicians in that specialty routinely doing some procedure. Extreme example, Endocrinology and GI pay about the same, until you add endoscopy to the equation. I want the specialty to pay me. I dont want to have to go out of my way to do procedures. It's the "Rich Dad - Poor Dad" idea of not having to go out and earn your money. Not at all saying I don't like procedures. I just dont consider the profession to be high paying, when I'm the one doing the work. If you havent read Kiyosaki's book, you should. Especially all you "what is the best paying specialty" gunners.
Off the top of my head -
An average psychiatrist can make 225K working 40-45hrs, and a wealthy psychiatrist is not doing any more procedures than the others - its just longer hours, and maybe concierge
An average ER doc can make 225K for 36-48hrs, and again, a wealthy ER doc is working longer hours or seeing patients faster (if thats they pay-model)
IMO, both of these docs are "highly paid", especially compared to primary care, which averages 180K for 60 hours or so. 1.Hour for hour, the psychiatrist and ER doc are making more more. 2.Their minimum hours is lower. 3.Their avg. salary is higher. 4.that salary is without any procedural money-making scheme.
PM&R falls into the same category, and has the option of doing interventional or pain.
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My guess is that in most specialties, the 25%tile is probably academic salaries rather than the part time salaries.
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I'm drooling over the technical fee that a Watson would bring in.
True.... I usually have primary care on the brain, so I was thinking of all the part-time FP and Peds.
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I was reading the whole education department is cracking down on for profit colleges article over at the new york times, and this part jumped out at me:
A program would lose eligibility for federal aid only if: fewer than 35 percent of its graduates are repaying principal on their student loans three years out, and, for the typical graduate, loan payments exceed 30 percent of discretionary income as well as 12 percent of total earnings.
I wonder if they will ever apply the second clause to medical school loans, haha.
A program would lose eligibility for federal aid only if: fewer than 35 percent of its graduates are repaying principal on their student loans three years out, and, for the typical graduate, loan payments exceed 30 percent of discretionary income as well as 12 percent of total earnings.
I wonder if they will ever apply the second clause to medical school loans, haha.
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