Which subspecialties are in demand now and in the future? Especially in SoCAL?

[Gpan]

I plan to practice in Southern California when I finish with my training. I'm doing Hospitalist track but thinking about specialize. What specialty should I consider? Or should I stick with being hospitalist to be able to get a job easily and fairly compensated in SoCAL ?

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[LoudBark]

No specialties are in demand in SoCal. That is the most saturated market in all of the US.

 

[gutonc]

You should do what you would be happy doing. No amount of money or location is enough to make up for putting a bullet in your head because of a job you hate.

Also...SoCal is pretty saturated in just about any specialty. Not that you won't be able to find a job, just that you'll have to give up something (money, location, etc).

 

[jdh71]

You could actually still find some good pulm/crit jobs in SoCal - though if you're looking at SantaB or La Jolla . . . plan to work for peanuts

 

[lungdocCA]

I picked Pulmonary/Critical Care because I liked the Cardiopulmonary Physiology and work in Critical Care. The sad thing is that the reality is not what I expected. Outpatient Pulmonary is high in overhead, poor in compensation and basically seeing endless patients that have diseases that are either end-stage or for which you can do very little. Therefore I became hospital based and find that I am doing primarily Hospitalist or hospital based medicine to make a living. This is fine but what sense is there in doing 3 years of extra training and multiple boards to be a glorified Hospitalist?

As far as Internal Medicine Procedural specialties Cardiology and Gastroenterology are hands down the best. Other than that I would pick a field that you like but don't make the mistake I did.

I am thinking about either re-training in another speciality or just doing office based Internal Medicine!

 

[Gpan]

I picked Pulmonary/Critical Care because I liked the Cardiopulmonary Physiology and work in Critical Care. The sad thing is that the reality is not what I expected. Outpatient Pulmonary is high in overhead, poor in compensation and basically seeing endless patients that have diseases that are either end-stage or for which you can do very little. Therefore I became hospital based and find that I am doing primarily Hospitalist or hospital based medicine to make a living. This is fine but what sense is there in doing 3 years of extra training and multiple boards to be a glorified Hospitalist?

As far as Internal Medicine Procedural specialties Cardiology and Gastroenterology are hands down the best. Other than that I would pick a field that you like but don't make the mistake I did.

I am thinking about either re-training in another speciality or just doing office based Internal Medicine!

Thank you so much for ur post. Pulm/CC is actually on my list of possible fellowship along with Cards and GI. But location to me is the MOST important factor in my life right now. I might steer away from pulm/CC now after what u said. It's already low on my list anyways.

Do u think had u done another fellowship instead of pulm/CC, say GI u would have been better off and happier? What about not doing any more training and be a hospitalist? It seems to be what ur doing anyways minus the 3 extra years of slavery.

 

[jdh71]

Thank you so much for ur post. Pulm/CC is actually on my list of possible fellowship along with Cards and GI. But location to me is the MOST important factor in my life right now. I might steer away from pulm/CC now after what u said. It's already low on my list anyways.

Do u think had u done another fellowship instead of pulm/CC, say GI u would have been better off and happier? What about not doing any more training and be a hospitalist? It seems to be what ur doing anyways minus the 3 extra years of slavery.

Don't listen to someone who is all bitter about their choice. Talk to people who like what they do to see what it would be like.

 

[2012ABIM]

I am a hospitalist in SoCal, It's true that it's very difficult to get a satisfactory position in Socal.

When I started applying for job, I submitted my application to many employers and recruiters and realized that lots of them are crap (like working 45h/ week and 2 weekends/month and get 150k/year for outpatient, or 1000$/ busy day shift (20 pts +3-5 admits) and 1050$/night shift (10-15 admits) for hospitalist. Some employers have very bad ATTITUDES and showed no respects to doctors so my friend and me politely gave them a reason to leave early during the interview.

Finally, I got a job, during the interview they told me about the work and schedule but when I started to work it's totally different. I have a feeling of being cheated and understood why many hospitalists left the group so early (after some months, even there was 1 hospitalist to leave the group after 1 shift only). I plan to leave the group and started to search hospitalist jobs in the expected area but it's not easy at all.

If you see a group that shows their ads in the internet all around the year and everywhere (esp, big group, big name..), be careful because they have very high turn-over. You may be unhappy with the group like other doctors.

However, if you are a resident, just got any job then look for a desired job later. DO NOT BE JOBLESS ANY TIME AFTER RESIDENCY.

Just my experience.

 

[lungdocCA]

I feel you have to see what your priorities are. If the highest priority is to stay in SoCal than you will likely have to face competition and a tendency to decreased income. If your highest priority is lifestyle than shift work or a low intensity subspecialty may be the way to go.
I think that I would have been happier in another specialty such as GI. It has a very reasonable lifestyle, great reimbursement (at least relative to most of the other Internal Medicine subspecialties except Cardiology) and the prestige of being a subspecialist.
The draw back of Pulmonary/Critical Care is high acuity, bad call, and modest reimbursement not commensurate with the field. It is also probably one of the most litigious specialties as well. I would never recommend it unless you had a burning desire for the field and plan a career in academics.
I know that many people will criticize me for being so blunt. I wish I would have been exposed to such bluntness when I was making my specialty decision.

 

[medstud2005]

Don't listen to someone who is all bitter about their choice. Talk to people who like what they do to see what it would be like.

Why NOT?

S/he needs to listen to both who are "bitter about their choice" and to those "who like what they do".

 

[jdh71]

Why NOT?

S/he needs to listen to both who are "bitter about their choice" and to those "who like what they do".

Because you can always find someone who's not happy with regards to any and every job. I don't think information from bitter people is actually very helpful in most cases. You hear why "they" - the person - don't like the job, and they tend to paint very broadly based on their experiences.

 

[trppo]

Hospitalist is not a bad option, if you enjoy doing it..

Believe me, it's not worth it doing a fellowship just because "you did not want to be a Hospitalist any more".

 

[Doublecortin]

I feel you have to see what your priorities are. If the highest priority is to stay in SoCal than you will likely have to face competition and a tendency to decreased income. If your highest priority is lifestyle than shift work or a low intensity subspecialty may be the way to go.
I think that I would have been happier in another specialty such as GI. It has a very reasonable lifestyle, great reimbursement (at least relative to most of the other Internal Medicine subspecialties except Cardiology) and the prestige of being a subspecialist.
The draw back of Pulmonary/Critical Care is high acuity, bad call, and modest reimbursement not commensurate with the field. It is also probably one of the most litigious specialties as well. I would never recommend it unless you had a burning desire for the field and plan a career in academics.
I know that many people will criticize me for being so blunt. I wish I would have been exposed to such bluntness when I was making my specialty decision.

Thanks for your honest response. I've also been hearing from many residents and fellows in IM that with future cuts to specialists, it may not make financial sence to specialize, even in the traditional cash cow fields such as GI and cards.

What about allergy/immunology? I've seen a recent JAMA article that showed A/I is one of the top specialties in terms of $$$/hour. Is there much market for A/I in SoCal? What about less desired locations? Can you still make bank there?

 

[LoudBark]

Thanks for your honest response. I've also been hearing from many residents and fellows in IM that with future cuts to specialists, it may not make financial sence to specialize, even in the traditional cash cow fields such as GI and cards.

What about allergy/immunology? I've seen a recent JAMA article that showed A/I is one of the top specialties in terms of $$$/hour. Is there much market for A/I in SoCal? What about less desired locations? Can you still make bank there?

I have a solution for you. Do dermatology. Set up a cash only practice in Hollywood and be a dermatologist for the stars. I think you will be happy.

 

[Extracts]

Thanks for your honest response. I've also been hearing from many residents and fellows in IM that with future cuts to specialists, it may not make financial sence to specialize, even in the traditional cash cow fields such as GI and cards.

What about allergy/immunology? I've seen a recent JAMA article that showed A/I is one of the top specialties in terms of $$$/hour. Is there much market for A/I in SoCal? What about less desired locations? Can you still make bank there?

A/I is not all about lifestyle and money. If you don't have some interest in it. You will struggle with the immunology portion.

I have friends in LA who are in A/I and are doing quite good with their income and lifestyle.

Do what interests you and if you're good, you can find a job anywhere.

 

[tartesos]

Thanks for your honest response. I've also been hearing from many residents and fellows in IM that with future cuts to specialists, it may not make financial sence to specialize, even in the traditional cash cow fields such as GI and cards.

What about allergy/immunology? I've seen a recent JAMA article that showed A/I is one of the top specialties in terms of $$$/hour. Is there much market for A/I in SoCal? What about less desired locations? Can you still make bank there?

A/I
It's one of the toughest fellowship to get btw. Few spots, high demand, and competing with all those women
Don't discard Pulm Ccm for one opinion only if you like it. If it was that bad, no one would do it.
Ask your icu docs if they would do it again and most would say yes.

 

[Whatsyourname]

Rheum has spots open in SoCal
Rheum has spots almost everywhere, but you won't be making millions

 

[bronx43]

Rheum has spots open in SoCal
Rheum has spots almost everywhere, but you won't be making millions

Financial prospects for rheumatology are better than people think. Sure, the compensation surveys aren't all that impressive, but a lot of these people are working 35 hours a week. There are a bunch of new drugs on the horizon (and new rheum indications for existing drugs) and many are biologics that will require infusion centers. You can also fill half your clinic with just joint injections if you play your cards right. There was also a large jump in compensation last year if you look at the medscape survey.
At the end of the day, pick something you think you would like doing for 25-30 years. With the way things are going, the per hour income for things like cardio/pulm and rheum aren't all that big, so I wouldn't pick based on TOTAL compensation at the current moment. Keep in mind that size of job market is incredibly important when you are starting your actual career in whichever field you pick. The job market not only dictates where you can live and work, but it also reflects supply and demand for your specialty, and supply and demand ultimately influences your financial potential. People early on in their training disregard this, but you start to realize the importance the closer you get to completion.

A/I is competitive, but I don't think people realize that the job market is anemic to say the least. Not that you can't find a job after you're done, but you won't have many options and good luck getting one in a locale you would like to live. Sure, the incumbent allergists in an area are doing well, but that doesn't mean much for you as a young grad. Same thing for a lot of fields with tight job markets. Radiology fellows are doing 2-3 fellowships without finding a job, but the older radiologists with stable gigs are still pulling 400k.
Pulm/CC and GI seem to have great job prospects. All those fellows that I've spoken to were knee deep in recruiter solicitations.

 

[ferning]

Infusion centers for biologics and churning out joint injections, scary

You realize 90% of people who get these dont need them, until those treatments cause problems. Rheum more so, though not much, has people coming to ur office for the dope rx, disability income purposes or they are perimenopausal women depressed and psychosomatic. Looking for a diagnosis with a treatment.

Just be a PArt time hospitalist and open a practice where u actively wean people off these treatments. Lupus, lymes, mild osteo and rheumatoid are not doing better with expensive/invasive biologics or steroid injections. Sipping the medicine kool aid bro too heavily. Advil, weight loss, exercise, and counseling.

 

[drkristy85]

I am a hospitalist in SoCal, It's true that it's very difficult to get a satisfactory position in Socal.

When I started applying for job, I submitted my application to many employers and recruiters and realized that lots of them are crap (like working 45h/ week and 2 weekends/month and get 150k/year for outpatient, or 1000$/ busy day shift (20 pts +3-5 admits) and 1050$/night shift (10-15 admits) for hospitalist. Some employers have very bad ATTITUDES and showed no respects to doctors so my friend and me politely gave them a reason to leave early during the interview.

Finally, I got a job, during the interview they told me about the work and schedule but when I started to work it's totally different. I have a feeling of being cheated and understood why many hospitalists left the group so early (after some months, even there was 1 hospitalist to leave the group after 1 shift only). I plan to leave the group and started to search hospitalist jobs in the expected area but it's not easy at all.

If you see a group that shows their ads in the internet all around the year and everywhere (esp, big group, big name..), be careful because they have very high turn-over. You may be unhappy with the group like other doctors.

However, if you are a resident, just got any job then look for a desired job later. DO NOT BE JOBLESS ANY TIME AFTER RESIDENCY.

Just my experience.

Good advice

 

[KLycos]

Bump...definitely interested to hear what people think about the future of Rheum. It's so hard to find people that know much about the field.

 

[dozitgetchahi]

Rheum is...awesome!?

I'm applying to rheum fellowship this year. Let me list the positives...

- It's seriously underserved. You'll have no difficulty finding a job.
- Many rheumatologists are working 35 hours (4 days) a week. Money hungry? Work 5 days a week.
- Income is increasing (fellows at my home program are getting offers for $235-275k, with $25-50k signon bonuses)
- Call is extremely low impact. You don't even have to round on hospital pts if you don't want to (many/most rheumatologists don't)
- In recent surveys, rheumatologists have been cited as being the happiest and most satisfied physicians
- With modern therapies, you can actually get most of your pts feeling/doing better (don't listen to the ignorant dupe above who thinks lupus and RA can be treated with Advil...go talk to anyone who had RA through the 1950s-1990s and see how well that went, dip****. And lupus? Ya gotta be kidding me.)
- The coolest pathology in other specialties is usually rhematologic, but you'll be able to do this all day long.
- You don't have to deal with fibro and OA if you don't want to - you can easily bounce this back to the PCPs if this isn't your thing

And so on. It's an awesome specialty.

 

[bashwell]

Rheum is...awesome!?

I'm applying to rheum fellowship this year. Let me list the positives...

- It's seriously underserved. You'll have no difficulty finding a job.
- Many rheumatologists are working 35 hours (4 days) a week. Money hungry? Work 5 days a week.
- Income is increasing (fellows at my home program are getting offers for $235-275k, with $25-50k signon bonuses)
- Call is extremely low impact. You don't even have to round on hospital pts if you don't want to (many/most rheumatologists don't)
- In recent surveys, rheumatologists have been cited as being the happiest and most satisfied physicians
- With modern therapies, you can actually get most of your pts feeling/doing better (don't listen to the ignorant dupe above who thinks lupus and RA can be treated with Advil...go talk to anyone who had RA through the 1950s-1990s and see how well that went, dip****. And lupus? Ya gotta be kidding me.)
- The coolest pathology in other specialties is usually rhematologic, but you'll be able to do this all day long.
- You don't have to deal with fibro and OA if you don't want to - you can easily bounce this back to the PCPs if this isn't your thing

And so on. It's an awesome specialty.

Cool, that's awesome! I assume the $235-275k income is starting salary? If so, I don't suppose you might know what a mid-career salary might look like?

 

[bronx43]

Cool, that's awesome! I assume the $235-275k income is starting salary? If so, I don't suppose you might know what a mid-career salary might look like?

"Mid-career" salary nowadays depends on your volume and bonus structure. That's why it's so important to get down to the nitty-gritty when signing your contract. Some institutions will just give you a salary and that's that. You just have to hit a minimal productivity and anything above won't be rewarded accordingly. Other hospitals will offer you a lower "base" but give you a bigger cut of the revenue that you generate after all overhead expenses are paid for. For the less productive providers, you can actually see your income go DOWN after the initial 1-2 years of guaranteed income, since the hospital is essentially giving you a subsidy in order to entice you to sign. Afterwards, they expect you to pay for your own salary.

Like doz said, rheumatology is relatively in demand, which bodes well for all aspects of the field. That plus the great potential for new therapies. I honestly think it's a buy-low AND can't miss specialty these days. I'm pretty sure I will be making more per hour (especially if you calculate for post-tax dollars) than my pulm or cardio colleagues.

 

[bronx43]

- You don't have to deal with fibro and OA if you don't want to - you can easily bounce this back to the PCPs if this isn't your thing

And so on. It's an awesome specialty.

Lol, so true. Many of the attendings at my institution don't see fibro patients. Once they diagnose the patient with fibro, they send back to PCP and don't schedule a f/u.

But to be honest, fibro is f***ing easy to deal with. So much easier than chronic back pain or the slew of other BS complaints you get in primary care. You diagnose fibro, explain to them it's not treated with narcotics, put them on neurontin or lyrica, tell them to exercise, then see them back in 6 months. Rinse and repeat.

 

[dozitgetchahi]

"Mid-career" salary nowadays depends on your volume and bonus structure. That's why it's so important to get down to the nitty-gritty when signing your contract. Some institutions will just give you a salary and that's that. You just have to hit a minimal productivity and anything above won't be rewarded accordingly. Other hospitals will offer you a lower "base" but give you a bigger cut of the revenue that you generate after all overhead expenses are paid for. For the less productive providers, you can actually see your income go DOWN after the initial 1-2 years of guaranteed income, since the hospital is essentially giving you a subsidy in order to entice you to sign. Afterwards, they expect you to pay for your own salary.

Like doz said, rheumatology is relatively in demand, which bodes well for all aspects of the field. That plus the great potential for new therapies. I honestly think it's a buy-low AND can't miss specialty these days. I'm pretty sure I will be making more per hour (especially if you calculate for post-tax dollars) than my pulm or cardio colleagues.

All that while working a reasonable number of hours a week. It's like the dermatology of IM - except that unlike derm (and its medical counterpart A&I), it doesn't take an act of god to match into the specialty at the moment.

 

[bashwell]

All that while working a reasonable number of hours a week. It's like the dermatology of IM - except that unlike derm (and its medical counterpart A&I), it doesn't take an act of god to match into the specialty at the moment.

Thanks guys. By the way, I'm a dual American/Australian, did med school in Australia, thinking about coming back to the US after working a year or two Down Under (in Australia people don't normally start residency until PGY2-PGY3 but sometimes later if it's a very competitive specialty and they have to do more to strengthen their CV/resume). But I never quite understood the lack of love for rheum back home in the US. I could be wrong since I haven't applied or anything, but my understanding from others is that it's now a pretty competitive subspecialty to get into in Australia.

 

[premedk]

.

 

[FootballFoot]

Financial prospects for rheumatology are better than people think. Sure, the compensation surveys aren't all that impressive, but a lot of these people are working 35 hours a week. There are a bunch of new drugs on the horizon (and new rheum indications for existing drugs) and many are biologics that will require infusion centers. You can also fill half your clinic with just joint injections if you play your cards right. There was also a large jump in compensation last year if you look at the medscape survey.
At the end of the day, pick something you think you would like doing for 25-30 years. With the way things are going, the per hour income for things like cardio/pulm and rheum aren't all that big, so I wouldn't pick based on TOTAL compensation at the current moment. Keep in mind that size of job market is incredibly important when you are starting your actual career in whichever field you pick. The job market not only dictates where you can live and work, but it also reflects supply and demand for your specialty, and supply and demand ultimately influences your financial potential. People early on in their training disregard this, but you start to realize the importance the closer you get to completion.

A/I is competitive, but I don't think people realize that the job market is anemic to say the least. Not that you can't find a job after you're done, but you won't have many options and good luck getting one in a locale you would like to live. Sure, the incumbent allergists in an area are doing well, but that doesn't mean much for you as a young grad. Same thing for a lot of fields with tight job markets. Radiology fellows are doing 2-3 fellowships without finding a job, but the older radiologists with stable gigs are still pulling 400k.
Pulm/CC and GI seem to have great job prospects. All those fellows that I've spoken to were knee deep in recruiter solicitations.

Lol, so true. Many of the attendings at my institution don't see fibro patients. Once they diagnose the patient with fibro, they send back to PCP and don't schedule a f/u.

But to be honest, fibro is f***ing easy to deal with. So much easier than chronic back pain or the slew of other BS complaints you get in primary care. You diagnose fibro, explain to them it's not treated with narcotics, put them on neurontin or lyrica, tell them to exercise, then see them back in 6 months. Rinse and repeat.

All that while working a reasonable number of hours a week. It's like the dermatology of IM - except that unlike derm (and its medical counterpart A&I), it doesn't take an act of god to match into the specialty at the moment.

Do you think Endocrinology is similar to Rheum and A/I in that it's the "derm" of IM? Or does it face lower compensation/job market/lifestyle issues?

 

[heretics]

Thanks for your answer.
Did you have difficulty finding a job as a PCCM doctor?

I picked Pulmonary/Critical Care because I liked the Cardiopulmonary Physiology and work in Critical Care. The sad thing is that the reality is not what I expected. Outpatient Pulmonary is high in overhead, poor in compensation and basically seeing endless patients that have diseases that are either end-stage or for which you can do very little. Therefore I became hospital based and find that I am doing primarily Hospitalist or hospital based medicine to make a living. This is fine but what sense is there in doing 3 years of extra training and multiple boards to be a glorified Hospitalist?

As far as Internal Medicine Procedural specialties Cardiology and Gastroenterology are hands down the best. Other than that I would pick a field that you like but don't make the mistake I did.

I am thinking about either re-training in another speciality or just doing office based Internal Medicine!

 

[drfunktacular]

If a specialty is underserved in one area it tends to be relatively underserved in all areas and the rheumatology workforce is facing some serious potential shortages in the next decade or two. That bodes well for anyone looking to practice rheumatology. The lifetyle, workload, patient population, etc is favorable in my opinion, and my personal experience is more or less in line with the descriptions above. My impression is that endocrinology is quite similar to rheumatology in terms of lifestyle factors, but the disease processes and patient populations are somewhat different so you have to decide which appeals to you more. Personally I think immunology is very interesting, whereas I hate thinking about all the negative/positive feedback loops of the various hormonal axes so that was never a possibility for me

A/I faces a few unique challenges, not least among them that there is currently a rampant trend toward corporations contracting out allergy pod practices to primary care offices. The result of that being that the typical bread and butter of an A/I practice (testing and shots) will increasingly be done by PCPs because they want that revenue. Not favorable for the future compensation and patient volume of allergists....

 

[FootballFoot]

If a specialty is underserved in one area it tends to be relatively underserved in all areas and the rheumatology workforce is facing some serious potential shortages in the next decade or two. That bodes well for anyone looking to practice rheumatology. The lifetyle, workload, patient population, etc is favorable in my opinion, and my personal experience is more or less in line with the descriptions above. My impression is that endocrinology is quite similar to rheumatology in terms of lifestyle factors, but the disease processes and patient populations are somewhat different so you have to decide which appeals to you more. Personally I think immunology is very interesting, whereas I hate thinking about all the negative/positive feedback loops of the various hormonal axes so that was never a possibility for me

A/I faces a few unique challenges, not least among them that there is currently a rampant trend toward corporations contracting out allergy pod practices to primary care offices. The result of that being that the typical bread and butter of an A/I practice (testing and shots) will increasingly be done by PCPs because they want that revenue. Not favorable for the future compensation and patient volume of allergists....

Do you think it's feasible to match IM if you fail to match Dermatology and then transition into Rheumatology fellowship if there's a lot of Derm stuff on your CV?

 

[bronx43]

Do you think it's feasible to match IM if you fail to match Dermatology and then transition into Rheumatology fellowship if there's a lot of Derm stuff on your CV?

You mean scramble into IM after failed derm match? I mean, it's possible, but you will be picking from the bottom of the barrel in terms of IM programs. Rheum is getting more competitive nowadays, and I expect it to become even mores. Therefore, I would try to get into the best IM program, especially if you want a good rheum program down the line.

Like Funktacular said, immunology is interesting and I would add exciting. The biggest advancements in medicine are related to immunology.

 

[drfunktacular]

You mean scramble into IM after failed derm match? I mean, it's possible, but you will be picking from the bottom of the barrel in terms of IM programs. Rheum is getting more competitive nowadays, and I expect it to become even mores. Therefore, I would try to get into the best IM program, especially if you want a good rheum program down the line.

Like Funktacular said, immunology is interesting and I would add exciting. The biggest advancements in medicine are related to immunology.

I think you are slightly overestimating the competitiveness of rheumatology. It will likely never be as competitive as dermatology, cardiology, GI, etc. If you "scramble" into IM after failing to match in derm you would still have a quite realistic chance of matching into rheumatology provided that you perform well in IM residency, express interest in rheumatology, and get some networking and/or research done in the field

Personally I find rheumatology much more interesting than dermatology, but of course to each their own

 

[bronx43]

I think you are slightly overestimating the competitiveness of rheumatology. It will likely never be as competitive as dermatology, cardiology, GI, etc. If you "scramble" into IM after failing to match in derm you would still have a quite realistic chance of matching into rheumatology provided that you perform well in IM residency, express interest in rheumatology, and get some networking and/or research done in the field

Personally I find rheumatology much more interesting than dermatology, but of course to each their own

Oh you can certainly match into A rheumatology program if you scramble into some third tier medicine residency. My point is that if you want to maximize your ability to get into a "good" rheumatology program, then you may need to hustle considerably more now compared to 3-4 years ago. Though obviously you don't need to come from a "good" program to do private practice.

 

[UncommonVariable]

Big demand for immunologist. Surprisingly, most AI trained physicians do not manage immunodeficient patients.

As far as allergy being taken over by primary care physicians, I have not found this to be the case. I have seen specific IgE labs ordered a number of times by primary care physicians, which did not jive with the patient's history....allergy is a field based on the motto treat the patient, not the labs. Antibiotic stewardship has allergy in big demand right now, too. If someone is sincerely interested in what AI encompasses, I encourage them to look into it. The future of AI is quite bright if you're willing to work hard during residency and fellowship.

Also, and this shouldn't be the main reason of why you choose a field, one of our fellows was offered $300k a year with partnership in 1 year, 4 day work week, less than 30 minutes outside of a major city in the Northeast (not by any means the norm).

 

[drfunktacular]

Big demand for immunologist. Surprisingly, most AI trained physicians do not manage immunodeficient patients.

As far as allergy being taken over by primary care physicians, I have not found this to be the case. I have seen specific IgE labs ordered a number of times by primary care physicians, which did not jive with the patient's history....allergy is a field based on the motto treat the patient, not the labs. Antibiotic stewardship has allergy in big demand right now, too. If someone is sincerely interested in what AI encompasses, I encourage them to look into it. The future of AI is quite bright if you're willing to work hard during residency and fellowship.

Also, and this shouldn't be the main reason of why you choose a field, one of our fellows was offered $300k a year with partnership in 1 year, 4 day work week, less than 30 minutes outside of a major city in the Northeast (not by any means the norm).

I think part of the reason most AI docs don't manage immunodeficiency is that 1) they're just uncommon and 2) many of them end up being managed in specialty centers, particularly if they are congenital or of pediatric onset

I did not say PCPs do allergy well, just that they are doing it increasingly. So a significant pool of referrals that would've otherwise gone to an A/I doc is now being kept in house. Similar to when ENTs started getting more into A/I

But I most certainly agree that people should choose a specialty or career based on what they enjoy and find rewarding, NOT based on income or perceived future job opportunities because those are subject to so many exogenous factors that you shouldn't plan your life around them. If you like what you do, you'll like what you do