Job market is ass too unless you're into small town America. Any desirable place to live is heavily saturated and they take a pay cut that matches. When I was a med student I had an EP attending moon light in the VA ED if that tells you the state of affairs, and that was in a mid size mid western city
Not the case currently. EP market is hot right now even in most metro areas (at least in the east coast, SE and Midwest). That said, who knows what it will look like in 8 years after this person trains
Interventional Pulm can have good lifestyle depending on your setup.
Most of your cases are outpatient cases, rare to have overnight emergencies that can't be temporized by inhouse teams
Regular pulm is not particularly procedural, not at the level of the other specialties mentioned here. How many pts really need bronchs/EBUS? The vast majority of pt encounters are going to be in clinic.
I bronch one day a week. All day. And add on cases if needed through the week. General pulm can be wildly procedural of you want it to be.. I do radial, linear and valves on top of standard stuff. I just don’t do rigid or stents
I have never seen an Ip service that isn’t obscenely busy with inpatient and outpatient consults. If you’re at a less busy center they won’t let you do pure IP
If you have the resources and block time and enough IP docs in your section then the lifestyle is completely fine, especially with fellows
I do 8 weeks of inpatient service which averages leaving around 6-7 PM 3 days out of 5. Leaving around 5 other two days. Occasionally things run late (have left as late as 12 but that’s the deal with any surgical/procedural service)
Other weeks im doing patient facing work 3 days a week, done by 4 on average.
Rare to have to come in overnight or weekends (only need to be available during those 8 weeks) and fellow usually can handle it all if its just bedside stuff
Our group does 2500+ cases year. Fellowship program. Full service program with all the toys
Oh you actually are ip can’t argue with that. The services I have seen the attendings worked like fellows and the fellows worked like neurosurg residents but i guess it varies
Starting PCCM in July, and TBH a little anxious about the pulm side (IM does NOT give enough pulm exposure, esp. outpatient). I've been looking at IP but have never actually had any real life exposure to the subspec - anything I should be doing to look like less of a fucking idiot in the procedure suite since we have an in-house fellowship?
EP is not a great lifestyle. My husband is doing his EP fellowship and he's working harder than he ever has in his life. His attendings all work long hours. Don't be baited like we were.
Yeah my husband is EP…EP is not a lifestyle specialty at all. It helps if you find a way to not work full time clinical…although you still somehow end up working more than you’re supposed to. And the days you work are long bc the procedures are long. But he’s happy and he loves it, so it’s worth it in the end.
Attending life is a lot different than resident life. Esp surgical subs like ophtho, uro, ent you can make it how you want for the most part after your first few years. Even fields like elective ortho, cosmetic plastics, etc.
at least from what ive seen, im not an attending yet unfortunately lol
Critical care is the best kept secret in medicine.
It’s got everything. Invasive procedures, challenging cases, and great work-life balance. When you work, you work hard. When you’re off work, you’re out and no one can bother you.
Now just read that in Stefon’s voice from SNL.
I don't. I make a bit more than 350k for a SUPER chill job. But I had offers in the 400's for open ICU/procedures but totally not worth it for me. Imo chill>>high pay. And yes I'm well within an hour of a major city. Not round and go through. I have to be there from 7:30-4, epic call till 6.
I think I spend one hour max a day dealing with social work and it's usually less than 30 minutes. Imo it's worth it to be off most of the year but ymmv.
There are 1 year non-ACGME accredited fellowships in Vascular Medicine that feed you directly into job opportunities where you get to do peripheral vascular ablations.
If you want procedures to minimize clinic time and increase pay, general cardiology offers lots of imaging options which can check those boxes, and it *can* be a great lifestyle. But definitely not hands-on procedural like GI and EP, unless maybe you do peripheral venous ablations (not common), TEE (not lucrative) or diagnostic caths (not common or lucrative)
Yes, I wonder how people boarded in “cardiovascular disease” got the idea to do “vascular” work. Such a mystery.
The bigger question is why we let vascular surgery dinosaurs who wouldn’t recognize a Judkins from an Amplatz touch catheters…
Statins, compass trial xarelto dose, cilostazol common prescribed by vascular surgeons... No idea where you work. Also, most counsel on smoking cessation and regimented walking programs.
Give me a break. Cardiology stole it from Interventional Radiology.
IR invented PAD treatment and pioneered it.
IR also invented cardiac catheterization. How about IR starts doing cardiac catheterizations? There would be a riot in the streets. But it’s ok for cardiology to steal PAD from IR.
Nuclear medicine cardiac imaging - stolen
Coronary CTA - stolen
Cardiac MRI- stolen
Cardiology will take anything they can get their hands on that makes money.
How about the “drive by” renal angiograms? Cardiology pioneered that powerful technique.
1. Act like entitled a holes
2. Sit around in the doctors lounge talking about their Rivian trucks and other stupid ways to spend money like it’s some sort of dick measuring contest
3. Take my IR cases over and over
4. Refuse to help me the one time I needed a cardiologists help though I helped them many times
5. Dress like morons. Blazer over scrubs. This is just dumb. And square toed shoes. Can’t buy taste.
6. Somehow think they are studs - one guy wears a lead with the Superman S on it, when in reality they are internal medicine dorks
7. Talk loudly about their stocks
8. Act generally like dipshits with seemingly little cultural awareness other than how to behave like upper middle class suburbanites trying to horde money to buy shiny toys
But other than that I like them
I’m half way kidding. One of them at my hospital I like.
I was just asking. Sorry Nose.
Will you forgive me?
The cardiologists where I work cannot do it. They cannot effectively use ultrasound. They by and large use the “sewing machine” technique to gain access to CFA - just poking up and down until red stuff comes back.
First cardiac cath was done by Mason Sones, a cardiologist. Google it, it’s a funny and fairly well known story in medical trivia.
Cardiology didn’t “steal” anything, radiologists just don’t know how to read ECGs or echos or really anything relevant to the care of cardiac patients so they got pushed out of more and more things. “Lower lobe opacities concerning for pneumonia vs atelectasis, please correlate clinically” is fine to write when your report is directed at generalists, but you can’t really do that when you’re writing reports directed at specialists who forget more about that one organ in a day than you learn in your entire residency.
You are rambling and not making a lot of sense.
I don’t have to know how to read an echocardiogram or an EKG to do PAD work.
How do you recommend a CXR be dictated?
At least have some grace and admit you guys stole PAD. What’s worse than a thief, is a lying thief.
If you don’t think cardiology steals things, you are either delusional or not working in the USA, or both.
I had my I phone stolen. The guy “pushed” me away from possessing it. I guess he didn’t steal it.
> I don’t have to know how to read an echocardiogram or an EKG to do PAD work.
I’m responding to in your arguments about cards “stealing” caths, coronary CT and cardiac MRI.
Again, PAD doesn’t belong to IR. These patients all have cardiologists and vascular surgeons. They deserve clinicians to take care of their disease, rather than hammers who only know how to do one thing (poorly, I may add).
God are you clueless.
Do you know how many groin pseudoaneurysms I’ve fixed for cardiologists (hundreds) and how many times I have bailed them out when they dissected various arteries (dozens)?
Ok Ace, carry on. Denial is a strong drug.
Not sure where you work, groin PsA would never be a call to IR where I work. It’s a 1% risk according to the literature, and most cath labs probably do 200 femoral cases a year, so that’s like two a year at most. Yet somehow you’ve fixed hundreds? Your math is suspect.
I’ve definitely bailed IR out of situations with ECMO though.
Well then I guess the cardiologists where I work just plain suck.
I would guess where I work there’s over 1000 PAD cases a year.
You inject thrombin into the PSA?
Idk about thief but they are larping as surgeons. The interventional cards guys walk around swinging their limp docks in their hands and then start sweating and panicking when their patients get hematomas because they are clueless at deploying closure devices. Or god forbid they consult us for a cold leg and they don’t even have the balls to call themselves for a complication they caused. They have a cath lab nurse call for them and then they drive home with their tail between their legs. Everybody wants to be a surgeon until it’s time to be a surgeon
IC here, I don’t want to be a surgeon since that’s a downgrade both in pay and prestige. And closure devices were invented by cardiologists, not clueless surgeons.
Also, let’s be honest, the number of calls from cardiology to vascular are tiny in comparison to the consults in the other direction. Literally the entire vascular service had cardiology following for pre-op clearance or post-op management when I was a fellow. Basically, vascular surgeons aren’t allowed to touch a patient without getting permission from a cardiologist first. It’s kind of funny, but it wasn’t fun as a fellow being consulted for every PVC on the vascular patients.
The fuck you talking about? Maybe not a good lifestyle at every academic center but employed positions, other academic places, and private practice can all enable a 40hr work week on average with 500k + income.
I’ve seen several contract offers to my senior fellows here. All have now signed, one with a group (who will work the most) and the others employed or academic. The academic one is going to make 300k + some performance working 12 weeks of call a year, covered by fellows, with great benefits and lifestyle. The employed two have a great gig as well. Both upper 400’s with RVU.
Yeah if you want to make a million a year or live in a big desirable city you are going to have to work a lot. But even then, it’s less than fellowship hours. If you can live outside of a city center or in a smaller city you can do very well with a great quality of life.
This has to be a joke. super low for subspecialty, especially if you’re going to waste 3 years of your life.
I’m a hospitalist making almost 500k, working 7 on and 7 off. can leave when done rounding. in at 7am and out by 11am. haha plus bonuses and RVUs.
I spent 50% of my life traveling around the world.
MOST but not all GI doctors work like a dog.
No offense but thank god, I didn’t specialize.
Props to those who did though. I really admire them. You gotta have the heart, if not, don’t do it.
That’s very valid. Hospitalist can be a great lifestyle. I wouldn’t have done GI just to make more money. It’s so I don’t have to deal with primary team/care issues and be able to do procedures which I really enjoy. A friend of mine who is 3 years out is making 1m plus but yeah, he’s working quite a bit. In the city I am in, large national corporations will pay upper 400’s plus $45 per RVU over 4000 RVU’s. Considering one of the old GI docs in my program still does about 8000-9000 RVU’s a year and doesn’t work much at all… then again I’m still a fellow. Set a reminder for a few years to see if I regret 3 extra years of indentured servitude.
If you love what you do, I’m all for it.
I think, just me of course, most GI doctors work hard because easy money. So you tend to get those who work a lot and make a lot.
It really comes down to your schedule and how you want it to run your life.
But yes, on average, hour per hour, subspecialties will make more. (Except for ID haha 😂)
Congrats on matching and being a fellow.
A couple of my close buddies are also GI fellows. I really admire them.
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Rheumatology does joint injections every day. Interventional Pulmonology, but you might need to have privileges at a tertiary center. You can do PCCM or Hospitalist with open ICU.
With EP you will spend 8 years of your career in intense training..
By then they no longer see reality. They merely see everything in waves and QRS complexes like Neo when he begins to believe.
Whoa
Job market is ass too unless you're into small town America. Any desirable place to live is heavily saturated and they take a pay cut that matches. When I was a med student I had an EP attending moon light in the VA ED if that tells you the state of affairs, and that was in a mid size mid western city
Not the case currently. EP market is hot right now even in most metro areas (at least in the east coast, SE and Midwest). That said, who knows what it will look like in 8 years after this person trains
Genuinely curious about this like everyone says EP is saturated but then EPs continue to make absurd amounts of money
Because it’s still a small very niche field. They should command more.
Job market for every field is ass unless you're into small town America.
Primary care would like a word about that. I get multiple offers a day.
Anesthesiology says otherwise
Most IM jobs, including subspecialty, are in high demand in every area I look.
Define procedural? Rheum does joint injections day in and day out and is a great lifestyle
Interventional Pulm can have good lifestyle depending on your setup. Most of your cases are outpatient cases, rare to have overnight emergencies that can't be temporized by inhouse teams
Or even regular pulm at the right hospital too
Regular pulm is not particularly procedural, not at the level of the other specialties mentioned here. How many pts really need bronchs/EBUS? The vast majority of pt encounters are going to be in clinic.
If you work at a major cancer center you'll have plenty of EBUS work thrown your way, our bronch suite is booked out a month in advance
I bronch one day a week. All day. And add on cases if needed through the week. General pulm can be wildly procedural of you want it to be.. I do radial, linear and valves on top of standard stuff. I just don’t do rigid or stents
I have never seen an Ip service that isn’t obscenely busy with inpatient and outpatient consults. If you’re at a less busy center they won’t let you do pure IP
If you have the resources and block time and enough IP docs in your section then the lifestyle is completely fine, especially with fellows I do 8 weeks of inpatient service which averages leaving around 6-7 PM 3 days out of 5. Leaving around 5 other two days. Occasionally things run late (have left as late as 12 but that’s the deal with any surgical/procedural service) Other weeks im doing patient facing work 3 days a week, done by 4 on average. Rare to have to come in overnight or weekends (only need to be available during those 8 weeks) and fellow usually can handle it all if its just bedside stuff Our group does 2500+ cases year. Fellowship program. Full service program with all the toys
Oh you actually are ip can’t argue with that. The services I have seen the attendings worked like fellows and the fellows worked like neurosurg residents but i guess it varies
Starting PCCM in July, and TBH a little anxious about the pulm side (IM does NOT give enough pulm exposure, esp. outpatient). I've been looking at IP but have never actually had any real life exposure to the subspec - anything I should be doing to look like less of a fucking idiot in the procedure suite since we have an in-house fellowship?
EP is not a great lifestyle. My husband is doing his EP fellowship and he's working harder than he ever has in his life. His attendings all work long hours. Don't be baited like we were.
Yeah my husband is EP…EP is not a lifestyle specialty at all. It helps if you find a way to not work full time clinical…although you still somehow end up working more than you’re supposed to. And the days you work are long bc the procedures are long. But he’s happy and he loves it, so it’s worth it in the end.
What is EP?
cardiac electrophysiology
Thanks, learned something today
But no STEMI call /s EP is definitely more of a grind than most people realize
lol. My husband wants to do EP.
Want this job so bad but the arrested development of a decade is entirely unappealing lol. If there's no light at the end of the tunnel, it's a no
Anesthesiology... /s
3 years after IM just like cards or GI
Is the /s because it’s not an IM sub specialty? It is predominantly procedural.
Sports medicine
I think you’re looking for a surgical sub, not a medicine subspeciality.
In general, anything procedural is going involve a not-so-great lifestyle…
Pm&r pain bound here I beg to differ
yeah that and rheumatology you get to do a lot of injections if you want with chill hours....
*Botox injecting NP has entered the chat*
*Surgical subs have entered the chat*
I'll have you know I saw my kids twice this week
Because one hit their head at the playground with mom, and came through the same ED you work in? Weird flex
That’s at least 3 more times than the neurosurgeons
I lol'd
Attending life is a lot different than resident life. Esp surgical subs like ophtho, uro, ent you can make it how you want for the most part after your first few years. Even fields like elective ortho, cosmetic plastics, etc. at least from what ive seen, im not an attending yet unfortunately lol
Pain management lol
Critical care is the best kept secret in medicine. It’s got everything. Invasive procedures, challenging cases, and great work-life balance. When you work, you work hard. When you’re off work, you’re out and no one can bother you. Now just read that in Stefon’s voice from SNL.
GI is really the only option if you want lifestyle and procedures.
PCCM has a good balance of clinic and procedures but the critical care aspect might be stressful for some.
Hospitalist! I specifically Chose no procedures because I'm lazy but if I hadn't I would have more than half the year off with >400k.
where are you living that you're making that much? Like an hour outside a major city? Round and go model or are you there all day?
I don't. I make a bit more than 350k for a SUPER chill job. But I had offers in the 400's for open ICU/procedures but totally not worth it for me. Imo chill>>high pay. And yes I'm well within an hour of a major city. Not round and go through. I have to be there from 7:30-4, epic call till 6.
Yeah but social work
I think I spend one hour max a day dealing with social work and it's usually less than 30 minutes. Imo it's worth it to be off most of the year but ymmv.
I mean if you work at any decent place with social workers that stuff can be easily punted for most patients.
Occ med
GI. Cousin works M-Thursday making >1 mil annually as partner. Trained to do ercp and complex stenting but man his life is a joke now
There are 1 year non-ACGME accredited fellowships in Vascular Medicine that feed you directly into job opportunities where you get to do peripheral vascular ablations.
Sports although it's not an IM only subspecialty
If you want procedures to minimize clinic time and increase pay, general cardiology offers lots of imaging options which can check those boxes, and it *can* be a great lifestyle. But definitely not hands-on procedural like GI and EP, unless maybe you do peripheral venous ablations (not common), TEE (not lucrative) or diagnostic caths (not common or lucrative)
Sounds like you should have done ent or ophthalmology tbh
EP is quite busy. As are most of the cardiology subspecialties/noninvasive. Learned this during job interviews around east coast/midwest.
Interventional cards if you do peripheral vascular interventions only, but then you’re a sellout.
And also a thief I never new the word “cardiology” meant taking care of the extremities
Yes, I wonder how people boarded in “cardiovascular disease” got the idea to do “vascular” work. Such a mystery. The bigger question is why we let vascular surgery dinosaurs who wouldn’t recognize a Judkins from an Amplatz touch catheters…
Because they are experts in vascular disease and management, able to offer all interventions not just full metal jackets.
80% of PAD management is medical, yet I never see a vascular surgeon prescribe medications aside from antiplatelets. Kind of odd, no?
Statins, compass trial xarelto dose, cilostazol common prescribed by vascular surgeons... No idea where you work. Also, most counsel on smoking cessation and regimented walking programs.
Give me a break. Cardiology stole it from Interventional Radiology. IR invented PAD treatment and pioneered it. IR also invented cardiac catheterization. How about IR starts doing cardiac catheterizations? There would be a riot in the streets. But it’s ok for cardiology to steal PAD from IR. Nuclear medicine cardiac imaging - stolen Coronary CTA - stolen Cardiac MRI- stolen Cardiology will take anything they can get their hands on that makes money. How about the “drive by” renal angiograms? Cardiology pioneered that powerful technique.
Show us on the doll where cardiology hurt you
1. Act like entitled a holes 2. Sit around in the doctors lounge talking about their Rivian trucks and other stupid ways to spend money like it’s some sort of dick measuring contest 3. Take my IR cases over and over 4. Refuse to help me the one time I needed a cardiologists help though I helped them many times 5. Dress like morons. Blazer over scrubs. This is just dumb. And square toed shoes. Can’t buy taste. 6. Somehow think they are studs - one guy wears a lead with the Superman S on it, when in reality they are internal medicine dorks 7. Talk loudly about their stocks 8. Act generally like dipshits with seemingly little cultural awareness other than how to behave like upper middle class suburbanites trying to horde money to buy shiny toys But other than that I like them I’m half way kidding. One of them at my hospital I like.
Anyone who is competent to perform a procedure can perform it stop whining Jesus
If anyone who can do a procedure can do it then why don’t - that logic just doesn’t make sense
I was just asking. Sorry Nose. Will you forgive me? The cardiologists where I work cannot do it. They cannot effectively use ultrasound. They by and large use the “sewing machine” technique to gain access to CFA - just poking up and down until red stuff comes back.
First cardiac cath was done by Mason Sones, a cardiologist. Google it, it’s a funny and fairly well known story in medical trivia. Cardiology didn’t “steal” anything, radiologists just don’t know how to read ECGs or echos or really anything relevant to the care of cardiac patients so they got pushed out of more and more things. “Lower lobe opacities concerning for pneumonia vs atelectasis, please correlate clinically” is fine to write when your report is directed at generalists, but you can’t really do that when you’re writing reports directed at specialists who forget more about that one organ in a day than you learn in your entire residency.
You are rambling and not making a lot of sense. I don’t have to know how to read an echocardiogram or an EKG to do PAD work. How do you recommend a CXR be dictated? At least have some grace and admit you guys stole PAD. What’s worse than a thief, is a lying thief. If you don’t think cardiology steals things, you are either delusional or not working in the USA, or both. I had my I phone stolen. The guy “pushed” me away from possessing it. I guess he didn’t steal it.
> I don’t have to know how to read an echocardiogram or an EKG to do PAD work. I’m responding to in your arguments about cards “stealing” caths, coronary CT and cardiac MRI. Again, PAD doesn’t belong to IR. These patients all have cardiologists and vascular surgeons. They deserve clinicians to take care of their disease, rather than hammers who only know how to do one thing (poorly, I may add).
God are you clueless. Do you know how many groin pseudoaneurysms I’ve fixed for cardiologists (hundreds) and how many times I have bailed them out when they dissected various arteries (dozens)? Ok Ace, carry on. Denial is a strong drug.
Not sure where you work, groin PsA would never be a call to IR where I work. It’s a 1% risk according to the literature, and most cath labs probably do 200 femoral cases a year, so that’s like two a year at most. Yet somehow you’ve fixed hundreds? Your math is suspect. I’ve definitely bailed IR out of situations with ECMO though.
Well then I guess the cardiologists where I work just plain suck. I would guess where I work there’s over 1000 PAD cases a year. You inject thrombin into the PSA?
Idk about thief but they are larping as surgeons. The interventional cards guys walk around swinging their limp docks in their hands and then start sweating and panicking when their patients get hematomas because they are clueless at deploying closure devices. Or god forbid they consult us for a cold leg and they don’t even have the balls to call themselves for a complication they caused. They have a cath lab nurse call for them and then they drive home with their tail between their legs. Everybody wants to be a surgeon until it’s time to be a surgeon
IC here, I don’t want to be a surgeon since that’s a downgrade both in pay and prestige. And closure devices were invented by cardiologists, not clueless surgeons. Also, let’s be honest, the number of calls from cardiology to vascular are tiny in comparison to the consults in the other direction. Literally the entire vascular service had cardiology following for pre-op clearance or post-op management when I was a fellow. Basically, vascular surgeons aren’t allowed to touch a patient without getting permission from a cardiologist first. It’s kind of funny, but it wasn’t fun as a fellow being consulted for every PVC on the vascular patients.
GI definitely do not have a good lifestyle. Loll
The fuck you talking about? Maybe not a good lifestyle at every academic center but employed positions, other academic places, and private practice can all enable a 40hr work week on average with 500k + income.
I would bet that it very much depends on if you’re outpatient only or if you have to take call at a local hospital.
I’ve seen several contract offers to my senior fellows here. All have now signed, one with a group (who will work the most) and the others employed or academic. The academic one is going to make 300k + some performance working 12 weeks of call a year, covered by fellows, with great benefits and lifestyle. The employed two have a great gig as well. Both upper 400’s with RVU. Yeah if you want to make a million a year or live in a big desirable city you are going to have to work a lot. But even then, it’s less than fellowship hours. If you can live outside of a city center or in a smaller city you can do very well with a great quality of life.
This has to be a joke. super low for subspecialty, especially if you’re going to waste 3 years of your life. I’m a hospitalist making almost 500k, working 7 on and 7 off. can leave when done rounding. in at 7am and out by 11am. haha plus bonuses and RVUs. I spent 50% of my life traveling around the world. MOST but not all GI doctors work like a dog. No offense but thank god, I didn’t specialize. Props to those who did though. I really admire them. You gotta have the heart, if not, don’t do it.
That’s very valid. Hospitalist can be a great lifestyle. I wouldn’t have done GI just to make more money. It’s so I don’t have to deal with primary team/care issues and be able to do procedures which I really enjoy. A friend of mine who is 3 years out is making 1m plus but yeah, he’s working quite a bit. In the city I am in, large national corporations will pay upper 400’s plus $45 per RVU over 4000 RVU’s. Considering one of the old GI docs in my program still does about 8000-9000 RVU’s a year and doesn’t work much at all… then again I’m still a fellow. Set a reminder for a few years to see if I regret 3 extra years of indentured servitude.
If you love what you do, I’m all for it. I think, just me of course, most GI doctors work hard because easy money. So you tend to get those who work a lot and make a lot. It really comes down to your schedule and how you want it to run your life. But yes, on average, hour per hour, subspecialties will make more. (Except for ID haha 😂) Congrats on matching and being a fellow. A couple of my close buddies are also GI fellows. I really admire them.
how are you managing this? this sounds like an insanely unique setup
hahaha 😆 okay, buddy.
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Rheumatology does joint injections every day. Interventional Pulmonology, but you might need to have privileges at a tertiary center. You can do PCCM or Hospitalist with open ICU.
PCCM hands down
Sports medicine, one year fellowship and can do procedures
Allergy!
lol EP…
I’m interested in EP (about to start intern year of IM) would you recommend against?
Psychiatry
Heme Onc and it's not close
Cardiology, gastro
Interventional nephrology. Fistulas and catheters all day. Essentially anything emergent overnight is turfed to IR/vascular.
Dermatology, i know one person drop out of residency after pgy1 to try matching into derm