MS3 trying to Decide. ENT, GI, Interventional Cards

[Medstudent1928]

So im at the end of my third year and the specialties that i have liked and enjoyed have been ENT, GI and to a slightly lesser degree interventional cards. Im trying to look at this decision from all standpoints and would love the thoughts of physicians in these fields about the financial future of these fields.

 

specifically.

 

GI docs: People online always say that GI is a one trick pony and that when colonoscopy gets cut it will lead to a huge decrease in salary. GI already makes 500+ according to MGMA am I crazy to think that even if compensation took a hit it wouldn't go down bellow 420ish (a 16% decrease). How do you feel about the financial future overall of the specialty, do you think you well trend down or up?

 

ENT docs? I have heard some attending complain about wage stagnation and MGMA 2015 and one I saw from 2012 seem to say compensation has stayed around 400, any concerns? Overall ENT has so many procedures that people do that it seems like it would be more insulated from cuts? Any fellowships out of ENT worth the extra year as far as compensation?

 

Interventional Cards? How saturated is the job market? My wife is an only child and really wishes to be back closer to her family in LA how bad is the job market around LA, how much of a compensation hit are people taking to be in LA? is it unrealistic to expect 450-500K within an hour of LA/San Diego area?

[Peds]

those are all very different.

[Medstudent1928]

Yes they definitely are, but I like procedures and honestly all of these gave me a good mix of procedures, clinic (less so for IC) and lifestyle (I know Gi and cards aren't "fantastic" life style but the are good enough for me). I really like the anatomy of Head and Neck but scoping is also fun and I enjoyed the odd emergency for GI bleeds that you could fix. IC was my favorite for a bit but not sure how condusive the life style is to my goals.

 

I'm weird maybe but I enjoyed a lot of different things.

[CCM]

I'm a CCM fellow currently. Honestly, if I liked all 3 of those equally - I would go for ENT. It's a surgical subspecialty, you will be well respected, low midlevel threat, and shorter training path - especially in comparison to interventional cards.

[Kamban]

Medstudent1928 wrote:

So im at the end of my third year and the specialties that i have liked and enjoyed have been ENT, GI and to a slightly lesser degree interventional cards

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GI and cardiology, let alone interventional cardiology comes after internal medicine. You are thinking way far ahead for these fields and comparing to a totally different field like ENT.

If you want any internal medicine subspeciality then you need to get into a very good internal medicine program and do well enough that you can apply to these fellowships. And remember that is 3 years internal medicine + 3-4 years of fellowship.

Seven years later who knows what the insurance payments will be for these areas and what another internal med subspeciality might pay. And you might like pulmonary or oncology when doing internal medicine rather than GI or cardiology.

[Medstudent1928]

Thats a great point about IM, I've done well to prep myself for both ENT and a competitive IM program so I should when the time comes hopefully be a competitive applicant for good programs in IM that would set me up well for fellowship.

[SValleyMD]

Ic here

Nice thing is you can kind of punt the decision of gi vs cards as u have obviously have a 3 year IM specialty staring at u. So for now it’s ent vs im for now.

Job market remains strong for the most part. I don’t know the so California market extremely well but obviously that’s as competitive it can get. .Though 1 hour from San Diego can really open things up (Temecula) whereas I’m not sure what loosens up an hour from LA.

Median mgma is 650-700k range, so I usually say 1m plus is still doable in low desirable places (though 8-900k more realistic) but saturated city markets I do hear of 400-500k.

Personally None of my buddies or anyone I know is less than 400k right now. Most hover in that 6-7 range.

Lifestyle can vary and can actually be quite good in large groups to outright soul crushing. For example I have a friend in a large 20-25 plus group. He has 12-14 weeks off and does stemi only call q7 or so. Limited clinic. You can see that in these integrated large hospital employed groups with ton of mid level support and guys that only stick to their niche. That can also allow u to be procedure focused. These guys only do 7-9k rvu range.

I’m still old school in q4-5 rural Midwest group so we do ton of call, all general work, clinic, and only about 10-15% ic work with mostly bread and butter. But ironically it’s the churn and burn of general work and call that can really add up the rvus (unless you had a very efficient machine with high referral set up which isn’t super common anymore). We’re 12-15k rvu range

So still a lot of variably at least within cardiology field.

[Medstudent1928]

SValleyMD whats the average hours you guys work and what is the call schedule?

[Panscan]

You should decide surgery or medicine first. If you decide medicine then you have a few more years to pick if you wanna subspecialize. Like why would you need to pick between interventional cards and gi now? Either way you should try to go to a solid medicine program and kick butt

[wa2106]

Financially and schedule-wise you can be fine in any of these fields.

Pick which one you like the best.

[SValleyMD]

Hours are so variable depending on the job. Again you can be q3-4 and be running around with your head cut off or you can see be q15, see 12 pts a day, read a couple echos and be out the door at 3 or 4.

One colleague is week on week off inpatient only with 2-5 caths a day and usually done by 2.

My avg day now is busier than the busiest day I ever had as an Im or cards fellow but you get use to working quicker/more efficiently and that’s a job I chose.

Lots of variability out there. I Echo what others are saying and would luck the one you hate the least

[The White Coat Investor]

CCM wrote:

I’m a CCM fellow currently. Honestly, if I liked all 3 of those equally – I would go for ENT. It’s a surgical subspecialty, you will be well respected, low midlevel threat, and shorter training path – especially in comparison to interventional cards.

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The frequency with which I call these specialities is

1) Cardiology

2) Cardiology

3) Cardiology

4) GI

8) ENT

There are a few ENT emergencies, but they're pretty rare compared to STEMIs and steaks in esophagi. (esophaguses?)

[The White Coat Investor]

SValleyMD wrote:

Ic here

Nice thing is you can kind of punt the decision of gi vs cards as u have obviously have a 3 year IM specialty staring at u. So for now it’s ent vs im for now.

 

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Lots of difference in those two residencies.

[q-school]

if you want to live somewhere popular near LA, all specialties will be relatively saturated.

it's too hard to predict incomes that far out.  some of your questions will probably be largely determined more by CMS and insurance more than by market.

find what you like the best and do that.  the variances in incomes by job are so large that you can't really pick one factor in isolation and expect that to be stable by the time you start work.  why do you like ENT and not ortho?  why not neurosurgery?  interventional radiology?

it's awesome that you have terrific grades!  congratulations.  Doors are wide open for you.

good luck!

 

 

[Bmac]

I would look very closely at WCI’s list above. Lifestyle may not seem like such a big deal now or comparing residencies, but it will matter a lot in 10, 15, 20 years. Of the three I would definitely go for ENT over IC or GI simply from the call standpoint.