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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?
I agree with the advice thus far regarding a) deciding between surgery and medicine, and b) not picking something based on income. The residencies for these fields (ENT vs IM) are really quite different. While a small number of years in the grand scheme of things, you do have to ask yourself if you want to spend 5 years in a surgical residency vs 3 years in an IM residency (and THEN apply to another fellowship...or two). Perhaps additional rotations or shadowing residents more might help? If you have down time on specialties in your end of third year rotations and can get away to round with or see specific procedures if going late in the day or weekends that not only speaks volumes about your commitment but gives you a better idea of how the specialty operates during the odd hours. Don't sacrifice your 3rd year grades to do so - making AOA is likely more important, for example.
As for ENT and fellowships, I don't know of any data showing declining compensation, and I wouldn't base your decision off one attending complaining about 2015 data. Salaries have been reasonably high (median around the $430k's), but this will vary depending on academic vs private or rural vs city. Ancillary income can be a significant advantage, and there are plenty of ENTs out there making $600k+. A paper came out a few years back that showed that fellowships in ENT didn't confer any economic advantage over being a generalist (provided you trust their assumptions and methods). This has been shown in other fields as well, but not in IM-->Cards or GI I'm guessing.
Also take the 30,000 ft view of healthcare and technology. A lot of what ENT does is quality of life based with endpoints that aren't as easy to measure. GI does a lot of important cancer screening for everyone, and cards has more endpoints that are life or death and involves a disease (atherosclerosis) that is in the crosshairs in terms of disruption and spending. You are less diversified in interventional cards IMO, in terms of diseases providing for your livelihood. Any technological disruption affects you significantly more than in a given field in ENT, for example. The same risks apply for someone who has decided to get a fellowship in ENT, but those disease processes fly under the radar a lot more than the #1 killer in the US.
The biggest threat to income in all these fields, aside from idiosyncratic disruption, is single payer. Which do you think will be affected by cuts (which will be substantial under single payer) or more regulation - the specialty that involves recommended screening for all or #1 healthcare cost expenditure, or one that is primarily based in quality of life concerns with comparatively little economic impact? I'm inherently biased in saying I think ENT is more well protected; however, this is not the reason I chose ENT. I chose ENT because of the diversity of cases, the people, and the interesting disease processes that can manifest in a complex region of the body. Hopefully you have an ah-ha moment. I can't help but think more and more exposure will show you the light. Best of luck!
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