Who has the potential to make more money? General surgery or interventional cardiology?

[Simba699]

I understand making money in medicine is totally dependent on patient volume so perhaps the question is who can amass better procedural volumes? I think surgeons will get paid more per procedure and that IC has more chances to book procedures all day. Also IC doesn’t have the disadvantage surgeons do of having to follow all post op follow ups for free.


Basically the question is if a general surgeon and interventional cards are both trying to load the bank for some time and are working hard to do it, who would make more?


Thoughts?

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[TheOther]

The one with an MBA.

 

[SunsFun]

That’s not how reimbursements work. There are multiple models for each respective specialty. Some are bundled, some are based on RVU, some are salaried. All those things are variable for each specialty, not even discussing the differences between specialties. Taking this forther and talking about all those things in the future, at which point any variable could easily change would require knowledge of black magic or a very good crystal ball.

 

[nlax30]

Not sure there is one answer to your question. I’m sure there some general surgeons who may loads more than a typical IC and then some ICs who make loads more than the typical general surgeon.

Too many variables here.

 

[Simba699]

Bump.

I understand there’s no concrete way to answer this question. Sure there’s multiple ways payments work so let’s compare similar ones. If someone is in private practice then who can bill more total money for their procedures give they’re putting in the same Amt of time?

 

[Dr.LeoSpaceman]

I think you're missing the point. It's not an interesting (or helpful) question, which is the real reason you aren't getting answers.

Choosing a specialty solely for financial reasons is unlikely to go well for you (or anyone else). If you don't have an interest in what you're doing, then the potential monetary benefits become less relevant. Since interventional cardiology and general surgery are substantially different fields, it's hard to imagine someone could both to a degree where compensation levels become a meaningful basis for selection.

 

[Money Moniker]

I'm going to do the unthinkable, OP. Jaws are going to fall to the floor and some people may very well drop dead on the spot when they see this from sheer shock, but in an unprecedented move that no SDN-regular could have predicted, I'm actually going to answer your question!

Who makes more money, General Surgeons or Interventional Cardiologists? Inteventional cardiologists, no matter which way you slice it.

What is the median income of a mid-career General Surgeon? 430k
What is the median income of a mid-career Interventional Cardiologist? 580k

Ok, median incomes are nice and good, but what about who has the higher earning potential, realistically speaking? Let's look at the 90th percentile earnings:

What is the 90th percentile income of a mid-career General Surgeon? 670k
What is the 90th percentile income of a mid-career Interventional Cardiologist? 950k

This data is from a 2015 salary survey, let's see whether it more or less matches up with what's on the job market today. Merritt Hawkins isn't the most comprehensive physicians jobs site, but it's like the only one that quotes salary information, so let's have a look:

Interventional Cardiology:
merritthawkinscom/candidates/job-search/k-cardiology-interventional-l-/
First 5 results I see are 900k,650k,1000k,600k,700k

General Surgery:
merritthawkinscom/candidates/job-search/k-general-surgery-l-/
First 5 results I see are 550k,500k, 420k,500k,380k

Not exactly the most scientific process, that, and with a sample size of 10 the statistical power of our job board study is...lacking, but it does back up the salary survey results from a few years ago. I hope this helps.

PS: realize though that interventional cards is at minimum 7 years of training post med school and typically 8, whereas general surgery is just 5 so you lose a cool $1.5mil from lost salary that you have to recoup before you start getting financially ahead with the cards route.

 

[Simba699]

I'm going to do the unthinkable, OP. Jaws are going to fall to the floor and some people may very well drop dead on the spot when they see this from sheer shock, but in an unprecedented move that no SDN-regular could have predicted, I'm actually going to answer your question!

Who makes more money, General Surgeons or Interventional Cardiologists? Inteventional cardiologists, no matter which way you slice it.

What is the median income of a mid-career General Surgeon? 430k
What is the median income of a mid-career Interventional Cardiologist? 580k

Ok, median incomes are nice and good, but what about who has the higher earning potential, realistically speaking? Let's look at the 90th percentile earnings:

What is the 90th percentile income of a mid-career General Surgeon? 670k
What is the 90th percentile income of a mid-career Interventional Cardiologist? 950k

This data is from a 2015 salary survey, let's see whether it more or less matches up with what's on the job market today. Merritt Hawkins isn't the most comprehensive physicians jobs site, but it's like the only one that quotes salary information, so let's have a look:

Interventional Cardiology:
merritthawkinscom/candidates/job-search/k-cardiology-interventional-l-/
First 5 results I see are 900k,650k,1000k,600k,700k

General Surgery:
merritthawkinscom/candidates/job-search/k-general-surgery-l-/
First 5 results I see are 550k,500k, 420k,500k,380k

Not exactly the most scientific process, that, and with a sample size of 10 the statistical power of our job board study is...lacking, but it does back up the salary survey results from a few years ago. I hope this helps.

PS: realize though that interventional cards is at minimum 7 years of training post med school and typically 8, whereas general surgery is just 5 so you lose a cool $1.5mil from lost salary that you have to recoup before you start getting financially ahead with the cards route.

Haha. Thank you so much for answering my question. Clearly IC is a better route financially, all other things being equal. Obviously no one should choose a specialty on this alone but it is important to know.

 

[TypeADissection]

Late to the show. I was just going to answer IC hands down but not cite sources like Monkey Monier. But this is the right answer. Beyond the dollars though is a different patient base, different ways you're going to spend your days and different things you'll be woken up in the middle of the night for. If you're trying to decide on a career, these are the questions you should be asking. Cheers.

 

[Simba699]

Beyond the dollars though is a different patient base, different ways you're going to spend your days and different things you'll be woken up in the middle of the night for. If you're trying to decide on a career, these are the questions you should be asking. Cheers.

Can you elaborate a bit on this? I'm an MS2 who wants procedures and acuity. I understand going through IM->Cards to get to IC will be rough but perhaps worth it if IC is my dream job.

Patient Base: Would it be fair to say IC will have an older patient base on average? Is IC all old people or obese diabetic smokers? Surely some patients have CAD without being too old or poor lifestyle decisions, but how common are they? I think GS will see plenty of young patients but I doubt IC will ever get anyone younger than 35. How about the quality of patient? Do you think IC or GS patients are generally easier to deal with or more gratifying to heal? Am I giving too much slack to GS patients in terms of being young and otherwise healthy?

How they spend their days: GS and even many subspecialties thereof will be mostly operating but will also be taking consults and follow ups depending on their APP arrangement. IC will be in the cath lab as well as working up cardiac patients. I guess this is the most variable part and I have to decide do I need to be doing open surgeries or am I happy doing perc interventions. One thing I have noticed though is that Surgeons seem more dependent on getting referrals to have their business succeed.

Waking up in the middle of the night: IC = STEMI call, Surgery = Trauma call. Surgery would have to be in-house for this though, right? Personally I think IC wins in this regard because of how non operative trauma surgery is becoming, whereas STEMI = emergent cath lab PCI.

 

[Simba699]

But I really don't get why you are asking. These fields are so completely different, I can't believe someone is choosing between them. Maybe if you were asking whether CT surgeons or vascular surgeons make more it would make sense, but I dunno.

I don't know about that. I think IC and Vascular Surgery have more in common than vascular surgery and CT surgery, especially now that the IC docs are doing peripheral work. Also CT surgery has plenty in common with IC, especially now that IC docs are doing structural heart work.

I explained in the previous post why I like these two specialties and they're not as different as you are making them seem. They are both procedural, but different routes of training. Of course the procedure may be very different too, but the impact on the patient may be similar.

 

[Dares Dareson]

Can you elaborate a bit on this? I'm an MS2 who wants procedures and acuity. I understand going through IM->Cards to get to IC will be rough but perhaps worth it if IC is my dream job.

Patient Base: Would it be fair to say IC will have an older patient base on average? Is IC all old people or obese diabetic smokers? Surely some patients have CAD without being too old or poor lifestyle decisions, but how common are they? I think GS will see plenty of young patients but I doubt IC will ever get anyone younger than 35. How about the quality of patient? Do you think IC or GS patients are generally easier to deal with or more gratifying to heal? Am I giving too much slack to GS patients in terms of being young and otherwise healthy?

How they spend their days: GS and even many subspecialties thereof will be mostly operating but will also be taking consults and follow ups depending on their APP arrangement. IC will be in the cath lab as well as working up cardiac patients. I guess this is the most variable part and I have to decide do I need to be doing open surgeries or am I happy doing perc interventions. One thing I have noticed though is that Surgeons seem more dependent on getting referrals to have their business succeed.

Waking up in the middle of the night: IC = STEMI call, Surgery = Trauma call. Surgery would have to be in-house for this though, right? Personally I think IC wins in this regard because of how non operative trauma surgery is becoming, whereas STEMI = emergent cath lab PCI.

0/10. "quality of patients" gave it away. Troll elsewhere.

 

[Simba699]

0/10. "quality of patients" gave it away. Troll elsewhere.

Perhaps you should leave this thread if you have nothing to contribute. I'm just trying to get my questions answered and they are being answered.

 

[TypeADissection]

Patient Base: Would it be fair to say IC will have an older patient base on average? Is IC all old people or obese diabetic smokers? Surely some patients have CAD without being too old or poor lifestyle decisions, but how common are they? I think GS will see plenty of young patients but I doubt IC will ever get anyone younger than 35. How about the quality of patient? Do you think IC or GS patients are generally easier to deal with or more gratifying to heal? Am I giving too much slack to GS patients in terms of being young and otherwise healthy?

How they spend their days: GS and even many subspecialties thereof will be mostly operating but will also be taking consults and follow ups depending on their APP arrangement. IC will be in the cath lab as well as working up cardiac patients. I guess this is the most variable part and I have to decide do I need to be doing open surgeries or am I happy doing perc interventions. One thing I have noticed though is that Surgeons seem more dependent on getting referrals to have their business succeed.

Waking up in the middle of the night: IC = STEMI call, Surgery = Trauma call. Surgery would have to be in-house for this though, right? Personally I think IC wins in this regard because of how non operative trauma surgery is becoming, whereas STEMI = emergent cath lab PCI.

I need to throw some qualifying statements out first that I have truly very little knowledge of the day-to-day life of an IC. I really can only speak as general surgery resident in my final year and someone who will be starting vascular surgery fellowship this summer. Now that's out of the way, let's see what kind of damage I can do:

Patient Base Q's:
- Would it be fair to say IC will have an older patient base on average? - Probably, because the bulk of IC is acquired heart disease. Having said that, GS is full of older people with colon, breast, thyroid and other cancers. GS does have a steady flux of younger patients with hernias.
- Is IC all old people or obese diabetic smokers? Surely some patients have CAD without being too old or poor lifestyle decisions, but how common are they? - I don't know. Probably fairly common I'd imagine though. Lots of hypertension, lots of managing anticoagulation, etc. The nice thing about GS is that I really don't have to worry about that stuff, I let the medicine people do their medicine thing and I do the surgery thing.
- How about the quality of patient? - Fairly sick.
- Do you think IC or GS patients are generally easier to deal with or more gratifying to heal? - No idea what this question even means.
- Am I giving too much slack to GS patients in terms of being young and otherwise healthy? - Yes. Lots of old people with sigmoid volvulus, toxic megacolon, etc.

How they spend their days:
- Hard to say since I don't know how IC works on a daily basis, but both specialties require referrals to maintain business. You will not be sitting on your hands in either specialty. You will be managing patients though in your clinic, make no mistake about that. Whether or not surgery is for you is also a major question you need to answer. There are other surgery fields besides GS, each with their own pain and pleasure.

Waking up in the middle of the night:
- Surgery would have to be in-house for this though, right? - Depends. There are different levels of trauma and at a level one center, you'll be in-house. At level two-three, you can be at home, come in to stabilize and then ship them out if you're not comfortable dealing with whatever comes through the door. But there will be a lot of other things to keep you busy with GS - pneumothoraces, need for central lines, appys, SBOs, etc. Trauma has become increasingly non-operative except for the major urban centers that get high-volume penetrating stuff.

Anyway, I don't know if this helped. You have a lot of experiences ahead to help make these decisions. At the end of the day, it comes down to how you want to spend your days and nights. If you want to just be a technician and have minimal responsibility managing patients, you should take a look at IR now that they have direct residencies. Cheers.

 

[Simba699]

I need to throw some qualifying statements out first that I have truly very little knowledge of the day-to-day life of an IC. I really can only speak as general surgery resident in my final year and someone who will be starting vascular surgery fellowship this summer. Now that's out of the way, let's see what kind of damage I can do:

Patient Base Q's:
- Would it be fair to say IC will have an older patient base on average? - Probably, because the bulk of IC is acquired heart disease. Having said that, GS is full of older people with colon, breast, thyroid and other cancers. GS does have a steady flux of younger patients with hernias.
- Is IC all old people or obese diabetic smokers? Surely some patients have CAD without being too old or poor lifestyle decisions, but how common are they? - I don't know. Probably fairly common I'd imagine though. Lots of hypertension, lots of managing anticoagulation, etc. The nice thing about GS is that I really don't have to worry about that stuff, I let the medicine people do their medicine thing and I do the surgery thing.
- How about the quality of patient? - Fairly sick.
- Do you think IC or GS patients are generally easier to deal with or more gratifying to heal? - No idea what this question even means.
- Am I giving too much slack to GS patients in terms of being young and otherwise healthy? - Yes. Lots of old people with sigmoid volvulus, toxic megacolon, etc.

How they spend their days:
- Hard to say since I don't know how IC works on a daily basis, but both specialties require referrals to maintain business. You will not be sitting on your hands in either specialty. You will be managing patients though in your clinic, make no mistake about that. Whether or not surgery is for you is also a major question you need to answer. There are other surgery fields besides GS, each with their own pain and pleasure.

Waking up in the middle of the night:
- Surgery would have to be in-house for this though, right? - Depends. There are different levels of trauma and at a level one center, you'll be in-house. At level two-three, you can be at home, come in to stabilize and then ship them out if you're not comfortable dealing with whatever comes through the door. But there will be a lot of other things to keep you busy with GS - pneumothoraces, need for central lines, appys, SBOs, etc. Trauma has become increasingly non-operative except for the major urban centers that get high-volume penetrating stuff.

Anyway, I don't know if this helped. You have a lot of experiences ahead to help make these decisions. At the end of the day, it comes down to how you want to spend your days and nights. If you want to just be a technician and have minimal responsibility managing patients, you should take a look at IR now that they have direct residencies. Cheers.

Thank you for all your expertise and answers. Nice to know that I was wrong that the GS patient population would be much younger and healthier compared to IC patient population. I thought about IR, but I do want my own patients. Do you mind me asking how and when you knew GS was for you? Also how about vascular surgery?

 

[badasshairday]

In a typical community practice IC makes more on average but also has a worse lifestyle.

 

[neusu]

If money, procedures, and quality patients is your prerogative, why not ortho, ENT, ophtho, or derm?

 

[nlax30]

If you're looking at procedural based specialties and considered interventional then I'll throw out there EP (Electrophysiology) which is very highly procedural based and pretty much on par with interventional in terms of reimbursement/salary. A different skill set and high learning curve compared to other fields though as of now involves 8 years of post-graduate training....

 

[Simba699]

If money, procedures, and quality patients is your prerogative, why not ortho, ENT, ophtho, or derm?

Because no offense to those specialties, but I do want to be saving lives. Actually neurosurgery fits pretty well but I worry I may not be competitive enough and I worry about the patient outcomes in neurosurgery. Are they really as bad as everyone makes it out to be?

 

[neusu]

Because no offense to those specialties, but I do want to be saving lives. Actually neurosurgery fits pretty well but I worry I may not be competitive enough and I worry about the patient outcomes in neurosurgery. Are they really as bad as everyone makes it out to be?

Word if advice, if you have to preface a statement with "no offense," or "I'm not racist but," whatever you are about to say is offensive or racist and you'd be better off keeping it to yourself.

Neurosurgery is both not as bad, and far far worse, than everyone makes it seem. In the good days, it's easy to delete great and smirk because everyone else thinks you're working so hard and have such a tough life, but here you are eating ice cream and kicking your feet up. On the bad days it is far worse than anyone who has never done it could even begin to understand. Those days haunt people, and change them forever. We tend to put them behind us, and try to move on, but they are there, and in neurosurgery not infrequent.

 

[TypeADissection]

Do you mind me asking how and when you knew GS was for you? Also how about vascular surgery?

Search my post history. I think that's a function. Too many words and already typed out in other places. Cheers.

 

[Simba699]

Word if advice, if you have to preface a statement with "no offense," or "I'm not racist but," whatever you are about to say is offensive or racist and you'd be better off keeping it to yourself.

Neurosurgery is both not as bad, and far far worse, than everyone makes it seem. In the good days, it's easy to delete great and smirk because everyone else thinks you're working so hard and have such a tough life, but here you are eating ice cream and kicking your feet up. On the bad days it is far worse than anyone who has never done it could even begin to understand. Those days haunt people, and change them forever. We tend to put them behind us, and try to move on, but they are there, and in neurosurgery not infrequent.

Would you mind giving an example of these horrid days? Do you mean working for a couple days straight or do you mean a patient outcome that tore you apart?

Is there truth to the saying that the brain is never the same after air hits it? I read somewhere that you can do a textbook craniotomy for a relatively straightforward case and the patient still wakes up with a horrid outcome. Would you say this is one of the examples of what you mentioned about the worst days?

Do you have any cranial cases where the patient has equal function after the case compared to before and how common is this vs. unexpected severe deficits?

I read your entire AMA and you said NSGY has the highest highs and the lowest lows so that’s exactly what we’re taking about here I guess. I just wonder what the percentage of highs and lows are roughly.

 

[neusu]

Word of advice, never take this advice. Don't let the perpetually offended determine what you can or can't say. Those people are cancer.

I'm not one to pull punches, or blow rainbows up precious snowflakes asses, but there is no need to be a jerk as a status quo. Rather, it reaks of insecurity.

My advice stands.

 

[neusu]

Would you mind giving an example of these horrid days? Do you mean working for a couple days straight or do you mean a patient outcome that tore you apart?

All of the above. Add to that a toxic or malignant environment or nasty families, staff, and colleagues and it's a lonely dark place.

Is there truth to the saying that the brain is never the same after air hits it? I read somewhere that you can do a textbook craniotomy for a relatively straightforward case and the patient still wakes up with a horrid outcome. Would you say this is one of the examples of what you mentioned about the worst days?

I don't suspect air has any last effect on the brain. It was just the title of a popular book. There are cases that seem to go exceptionally well that inexplicably turn in to a slow motion train wreck. Knowing that you, personally, made an error that irreparably and permanently affected a previously normal person in a harmful way is a tough pill to swallow.

Do you have any cranial cases where the patient has equal function after the case compared to before and how common is this vs. unexpected severe deficits?

It is routine for cases to go well.

I read your entire AMA and you said NSGY has the highest highs and the lowest lows so that’s exactly what we’re taking about here I guess. I just wonder what the percentage of highs and lows are roughly.

I'm flattered you read the whole thing. I'd be guessing at percentage, but the vast majority of our elective cases are uneventful. I tend to be an optimistic and happy person, so I suppose I tend to have far more highs than lows. Even so, the lows certainly are low. We get over it, and move on.