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Best field for having own private practice in the future (8+ years from now)

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  • Best field for having own private practice in the future (8+ years from now)

    I am a second year US MD student, as the title says I am wondering which of the following fields would be the best (highest demand, best financial decision/reimbursement) to have my own private practice in. The fields I am interested in perusing are GI, heme/onc, and interventional pain. Ill be graduating med school with ~170k in debt. Also, so far in my experience I think I would be happy practicing in almost all fields of medicine, but I have a keen interest in the three listed above and am just trying to field more financial advice on each one, as I would eventually like to focus my research on one of those three fields as the fellowships are competitive.

  • #2
    dermatology

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    • #3
      My guess- Pain (fellowship after anesthesia or neuro)

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      • #4
        If you read on sdn about pain fellowship, most the guys there hate their patients

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        • #5
          As private practice continues to decline it creates more competition among employers. So you can probably find an employed job that fits your idea of control/schedule/style ect... Many employed jobs payed by RVU allow you to have more control similar to private practice. Work less make less. It has better guaranteed stable income (not necessarily more though) since insurance/billing often doesn't matter, but unfortunately it is without all the tax benefits.

          The 3 specialties you listed are not the most ideal private practice specialties.

          If private practice is most important to you I would be more flexible in where you are willing to practice rather than your specialty. Certain cities/states are more private practice friendly.

          To answer your question: Any specialty that has cosmetics to off set billing or is very office procedure focused (derm, plastics). Or a specialty where you can charge cash or charge monthly prescription. Think family practice/direct primary care where one charges monthly fee.

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          • #6
            Wasn't there a recent similar thread, can anyone remember?
            But yeah, dermatology

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            • #7
              It may not be the most lucrative, but the "easiest" in my opinion would be outpatient cash psych.

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              • #8
                ”So you can probably find an employed job that fits your idea of control/schedule/style ect... Many employed jobs payed by RVU allow you to have more control similar to private practice.”

                Couldn’t disagree more. If they own you, they own you and more importantly when they own the staff you own nothing..

                My vote is psych.

                I like your thinking OP. If I were to do it again I would pick a specialty that didn’t kiss the ring either.

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                • #9
                  I mean cash-only psych is great, but depends where you live whether feasible. Gonna be hard to do that full time most places. Clearly also, not the most lucrative.

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                  • #10
                    You want to own where procedures are done, if you can. No matter how they cut the pro fees, they still have to pay the facility fees. And keep patients out of hospitals for procedures as much as possible. Think about specialties where you can have ASC ownership. GI, ortho, other surgical sub-specialties etc.

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                    • #11
                      Originally posted by Sundance View Post
                      ”So you can probably find an employed job that fits your idea of control/schedule/style ect... Many employed jobs payed by RVU allow you to have more control similar to private practice.”

                      Couldn’t disagree more. If they own you, they own you and more importantly when they own the staff you own nothing..

                      My vote is psych.

                      I like your thinking OP. If I were to do it again I would pick a specialty that didn’t kiss the ring either.
                      There are plenty of good/great employed jobs where you can have good control of your schedule and get paid well to work more. But, yes, a great private practice job is virtually always better than a great employed job.

                      All of the surgical specialties are great for private practice.

                      Also, what private practice will look like in 8 years should have basically zero effect on your decision making for you choosing your specialty.

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                      • #12
                        Not anything hospital based- EM, hospitalist, ICU, radiology, anesthesia, pathology etc.
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                        • #13
                          Interventional pain management seems pretty hot, and I don't see a reason it would get less hot as the boomers age and life expectancy increases. Fellowships are competitive as you say; if this is what you really want, get a residency with a good fellowship program in the same institution. Programs are much more likely to take an in-house resident into a fellowship.

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                          • #14
                            Originally posted by pysibal View Post
                            Interventional pain management seems pretty hot, and I don't see a reason it would get less hot as the boomers age and life expectancy increases. Fellowships are competitive as you say; if this is what you really want, get a residency with a good fellowship program in the same institution. Programs are much more likely to take an in-house resident into a fellowship.
                            In the competitive specialties, there are advantages of trying to fellowship in the same location as residency. However, there is a numbers game and other disadvantages. Specifically location. Solo vs a group in private practice play into the risk/opportunity/ramp up.
                            Compensation surveys (with their flaws) give you a better flavor of relative comp levels.

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                            • #15
                              Another vote for derm, though of the options you listed GI if you don't mind procedures.

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