Tweet
I agree with the others, focus on studying hard and crush step 1. You'll get more exposure to specialties as you go along and you can start figuring out what interests you, whether you prefer outpatient, inpatient, or doing procedures, being in the OR, shift work, lifestyle, etc. I'm of the camp that you should do something you're at least somewhat interested in, as opposed to doing something only for the money. It's hard to say where reimbursements will go, and what specialties will get affected. There was a thread here awhile back regarding the future of medicine, technology, AI, etc. which may be worth a read (https://www.whitecoatinvestor.com/forums/topic/should-doctors-be-afraid/). However, I don't think you necessarily need to avoid a specialty because of money. For example, PCP isn't considered lucrative, but there are ways to make it work, obviously living below your means, moving to less desirable but higher paying area, moonlighting, etc.
-
-
Primary care getting more compensation than specialties? Never.
Some specialties getting hammered to the point of primary care? Possible.
Comment
-
I generally agree with SValleyMD 's outlook on this. Procedural beats non-procedural. Regarding rads, it doesn't seem that income has declined but I've heard anecdotally it's harder to find a job. So consider both income and the number of job openings.Comment
-
I am going to disagree with this. The government (CMS) can unilaterally and suddenly change (usually drop) reimbursement for specialties and subspecialties, and I have seen numerous examples of this in my post-residency career. The trend toward reimbursement is downward, but who knows who is going to take the next hit?
My subspecialty, IR, was once a cash cow for private practice groups and now is a loss leader. Ophthalmology was once one of the highest paying specialties and now tends to be more middle of the pack (still great lifestyle).
Additionally, the way we do things is constantly upended by technology. If there is a successful breast cancer blood test (which is being actively researched), suddenly half or more of the mammograms will go away. What will happen to all of the subspecialty mammographers? And so forth…
Optho is a good example that I believe fits my argument. Sure they’ve trended down substantially, but they’re still solidly in the top half of compensation. It’s possible this could slide further, but if you started in optho 20-25 years ago when the money was gushing out of patients eyes, you’re still doing well today, probably making double what your shrink and peds neighbors are pulling in. Same if you picked ortho today. It’s definitely going to trail off at some point, but it’ll still be a high paying field.
I don’t believe there has been a top paying specialty that has suddenly found themselves at the bottom of the field. Perhaps deep subspecialties hinged on one or two treatments might come and go but that’s the nature of medicine, and people adapt. However I’d love to know if I’m wrong here.
Ophthalmology compensation has been completely eviscerated and the field should no longer be considered a lucrative specialty (it is still a lifestyle specialty through). I work for a large organization and sit on several committees, including compensation committee. Ophthalmology MGMA wRVU value is the lowest out of all surgical specialties and even lower than primary care in some cases. Cataract reimbursement had declined from almost $4K in the late 80's to around $500 now. Retina and glaucoma procedures have been cut and bundled to the bone. On top of that, hospitals and most large health organizations do not need ophthalmology since we are not big money makers for them, so that alone limits our options. Most hospitals just end up contracting with PP docs and do not hire ophthalmology directly. However, there are some practices (retina or refractive for examples) that are doing well, especially if they have their own surgery center. These are becoming more and more rare every year and getting into a good partnership situation for new grads is becoming nearly impossible in any half-decent area. My advice, is to look at other truly lucrative specialties.Comment
-
You can be sure revenue and lifestyle will fluctuate up and down but typically if one field is lucrative now, it’ll be lucrative later. If something makes a lot now, even if things changed and they trended down for awhile, took a cut, it’d still be higher than many others. Same for the flipside. Even if a low paying specialty is on the upswing, it has a long way to go to surpass the traditionally high paying specialties.
Keep in mind that physician compensation is driven directly by market demand and supply and what the market places value upon. Some of this market value is influenced by 3rd party payors which can change due to policy or things outside of your control. Ultimately it’s all set by what someone is willing to pay, either 3rd party or patient himself.
I am going to disagree with this. The government (CMS) can unilaterally and suddenly change (usually drop) reimbursement for specialties and subspecialties, and I have seen numerous examples of this in my post-residency career. The trend toward reimbursement is downward, but who knows who is going to take the next hit?
My subspecialty, IR, was once a cash cow for private practice groups and now is a loss leader. Ophthalmology was once one of the highest paying specialties and now tends to be more middle of the pack (still great lifestyle).
Additionally, the way we do things is constantly upended by technology. If there is a successful breast cancer blood test (which is being actively researched), suddenly half or more of the mammograms will go away. What will happen to all of the subspecialty mammographers? And so forth…
Agree, physician compensation is not a free market system, concierge medicine aside or cash only. CMS and the RUC have a lot to do with any changes.
Regardless anecdotally agree optho and rads have seen some cuts lately. I understand neurology got some cuts a while back as well. Psych (my specialty) has been trending upwards both in $$ and applicants, perhaps no coincidence. Much of the $$ increase had to do with CPT code changes a few years back. OP I do however agree that dramatic changes are unlikely. I don't see FP overtaking neurosurgery anytime soon..Comment
-
OP: Study.
Then decide what field makes you happy.
If dollars is the only equation -- quit medicine, go into business. --- you'll otherwise have a high burnout risk in whatever you choose. Seriously. The amount of energy plowed into medicine and ROI in the pure dollar sense doesn't cut it.
I don't know a single physician living in destitute--even the ones that lived high on the hog.
Medicine spans the entire spectrum. I'd die if I had to be a pathologist. I would think my fellow pathologists feel the same way in working in outpatient IM.
These things are way to early to decide in MS1.Comment
-
I am going to disagree with this. The government (CMS) can unilaterally and suddenly change (usually drop) reimbursement for specialties and subspecialties, and I have seen numerous examples of this in my post-residency career. The trend toward reimbursement is downward, but who knows who is going to take the next hit?
My subspecialty, IR, was once a cash cow for private practice groups and now is a loss leader. Ophthalmology was once one of the highest paying specialties and now tends to be more middle of the pack (still great lifestyle).
Additionally, the way we do things is constantly upended by technology. If there is a successful breast cancer blood test (which is being actively researched), suddenly half or more of the mammograms will go away. What will happen to all of the subspecialty mammographers? And so forth…
Optho is a good example that I believe fits my argument. Sure they’ve trended down substantially, but they’re still solidly in the top half of compensation. It’s possible this could slide further, but if you started in optho 20-25 years ago when the money was gushing out of patients eyes, you’re still doing well today, probably making double what your shrink and peds neighbors are pulling in. Same if you picked ortho today. It’s definitely going to trail off at some point, but it’ll still be a high paying field.
I don’t believe there has been a top paying specialty that has suddenly found themselves at the bottom of the field. Perhaps deep subspecialties hinged on one or two treatments might come and go but that’s the nature of medicine, and people adapt. However I’d love to know if I’m wrong here.
Ophthalmology compensation has been completely eviscerated and the field should no longer be considered a lucrative specialty (it is still a lifestyle specialty through)...
I am sorry to hear, but this is what I had heard from colleagues. No one is starving, for sure, but it ain't what it once was. Nothing is.Comment
-
Whatever the answer today, things will change by the time you are ready to look for a real job. Do well in school and on step 1, and you'll have options. As a general rule, surgical/procedural specialties are more lucrative than non-procedural, but the intra-specialty variation in earning potential is far more than most people realize. During my job search 5 years ago there was >$300k/year difference between the least and most lucrative offers as an example.Comment
-
Peds is still not lucrative.
Having patients that can't vote or lobby probably doesn't help.
An alt-brown look at medicine, money, faith, & family
www.RogueDadMD.comComment
-
Highly doubtful peds or FM trend way up at any point. Especially as more physician extenders (PAs and NPs) trend up. As pay for quality becomes the norm in full force, fields where you can do small procedures but it's still easy to make patients happy (like Derm) likely have the easiest road. I tell every med student, if you can tolerate looking at moles and warts every day, the rest of your life will be terrific.Comment
-
I think there is lots of change in compensation since I have been in medicine. I really don't think derm was a high paying speciality when I was training. People did it for the lifestyle. All of this info on salaries and earnings I do not remember reading about this either. I think people generally knew that surgical specialities paid better but the absolute numbers were not available. Maybe these medscape salary surveys are not such a good thing. You really need to figure out what you like to do and not totally base it on money.Comment
-
You really need to figure out what you like to do and not totally base it on money.
+1. While your occupation doesn't have to define who you are, and certain specialties may allow you to not work as much or as long, you're still talking about over 100,000 hours of your waking life. Most people's jobs do not give the opportunity to make face-to-face meaningful impact in people's lives. It doesn't mean expected compensation should not be a factor in your decision -- I'm just saying don't go into ER if seeing a snotty kid with a temp of 100 followed by pill-seeking back pain at 3 am is going to turn you into a hateful person after a few years.
The thought of waking up and going to a clinic to talk about skin all day is my nightmare. I'm sure many derms would feel the same about an overnight shift in the ICU. Personally, there are day-to-day differences about some specialties that would have a much larger impact on quality of life than just compensation.
For better or worse, a strong step score should be the #1 priority for you to maximize your options later on.Comment
-
Derm pays well because most of us see a TON of pts. To make money doing cosmetics, you need high volume - the overhead is actually quite high, not to mention the high maintenance patients. So I rarely do cosmetics.
It's a bad sign when derms are feeling burned out, and yes we are. Prior auths, insurance denials, and high maintenance patients....Comment
-
Derm pays well because most of us see a TON of pts. To make money doing cosmetics, you need high volume – the overhead is actually quite high, not to mention the high maintenance patients. So I rarely do cosmetics.
It’s a bad sign when derms are feeling burned out, and yes we are. Prior auths, insurance denials, and high maintenance patients….
One of my best friends from med school is a dermatologist (working for Kaiser), and he is soooo burned out (worse than me
), literally counting the days until retirement.
The notion that you can do well on a test or two and then money rains down on you is far from the reality of practicing medicine today. In most cases, you really do earn your money. Those who have done well financially have often either moved to a low cost of living area and made some personal sacrifices to do so or invested in a business (i.e. Surgery center, imaging center, medical spa, etc.) and took some financial risk to do so.
When you are simply working as a physician wage slave for The Man, you are going to earn your keep.Comment
-
I briefly worked for TPMG about 10 years ago and even back then they were rolling out tele-dermatology. They had their derms sit at home one day per week and look at rashes from remote area FM clinics. I thought it was kind of cool doing work in your pajamas.Comment
Comment