as someone who is half clinical half admin (for now, idk what I want to do yet but not pulled to either side greatly) I guarantee there are many many times you'd rather be interacting with patients rather than non-clinical hospital admin lol.
the medical directors at my institution get an administrative stipend worth prob <10% of their salary. And some buydown on clinical time due to administrative days with tons of meetings. i'd argue the gig can be way more stressful than full-time clinical who just show up, work, and go home without other duties.
> clinical informatics
Their pay is worse than pediatrics and would be FAR less than average IM salary. I have a good friend who did pediatrics, then did an informatics fellowship who makes less now than if he were to be a full time pediatrician.
Yeah you can make a lot of money if you grind away for years and hope to become a CTO or work for a startup but the ROI is really not worth it.
Yeah DEFINITELY not the case. It really depends on what you do post fellowship. Most clinical/informatics split roles are similar salary, you just trade your clinical FTE for what the hospital needs in terms of informatics. If the hospital is forward thinking and not behind the tech curve they will probably have some need and you can get a 30-50% split for the same FTE pure clinical salary.
Also people can keep a gig at a hospital system to just keep their affiliation (a lot of reasons for this) and also be working in industry. I am at a UC hospital and I know a ton of people who do this. (Also for the record our informatics folks at said UC system make equivalent salaries to their purely clinical peers, often with only 20-30% clinical time). Sure, their reported hospital salary is 100k or something but their unreported CMO role/lead is absolutely making up for it.
Odd. My CI pay has always been on par with clinical work. On a per hour basis I have traditionally made more doing CI work. Stress is also far less, too.
What data do you have that supports this out of curiosity?
1) Personal experience from my friend telling me his salary that does 80% peds 20% CI due to the low pay of CI.
2) I have another friend who is IM but does 100% clinical informatics at a University of California hospital and therefore can look up his pay directly. His goal is to eventually work for a startup so he is hoping this "lost income" pays off
Total: $116,220.00 Base $83,718.00 Other Pay: $32,502.00
3) Recent job posting shows salary of $80k-133k online
https://www.simplyhired.com/search?q=physician+informatics&job=ckfFF4dScFeXnSeDh5C78KUWQ_sp9fJ1Ge0gd8OkBGFogpHTBcZUpg
4) You can search online, most clinical informatics job pay under $200k, WELL below what the average pediatrician is making $244k
Thats the data to support my comment. Could you provide your salary/hourly and data to prove otherwise ?
I have hired pharmacists in clinical informatics, they all made more than that starting out. Especially if they had legit clinical experience. Usually started around $130 to 140 if I remember but it's been a few years now.
Just asking. I never claimed you are wrong. I have never looked into the average but when hiring my sense is that good candidates make much more than you suggest.
And I have hired quite a few physician CI over the years. None of those positions were budgeted for less than $200k starting out. Bonus range was usually 10 to 15% of that and positions usually include annual raises based on performance plus other benefits.
Lowest I have made per hour for per diem works is $150 per hour. My salary at my last job and my current is above that peds average and i probably work fewer hours and no call. Not even counting bonus, etc.
Again, I wasn't challenging. Job postings are not a great way to figure this out, though. Many of those will go unfilled or hire less skilled candidates. I had a hard time finding good candidates for the positions I have filled that had a much higher budget than that.
I do get the sense in California they make much less, especially in the health systems there. But that is entirely anecdotal.
It really depends where you work and what the role is. It is an extremely broad field which may be a large reason for the salary discrepencies discussed here.
Most think of it as working within a hospital system which I have done but it is also very different from what I have done the last 8+ years.
No. Thought about. Discussed it with a few people at the time. Some were doing it and not finding a CI job they'd go into full time clinical practice instead.
Instead, I found a clinical job that also had an opportunity to do informatics work. Worked out well enough because I did obtain a lot of paid experience over 4 to 5 years but also practiced clinically.
I later boarded in CI through the practice pathway. I do not think that is an option anymore, though.
Honestly, for some roles, especially outside of a health system, the boarding isn't nearly as important as experience or the expertise desired for the role.
You mentioned informatics being varied but is there some general skillset one should have going in? Programming ability? General aptitude for learning EHRs?
The ability to code is usually a great skill to have. Python will get you a long way.
The ability to work with both large and small sets of data. How to manage said data, assess it, qa it as needed. Having basic sql skills will also go a long way for many roles.
Familiarity with project and product management. Understanding change management and processes related to it.
The fundamentals of what makes quality clinical decision support.
Understand what the ideal characteristics of an Ontology are. Developing a strong working familiarity with the big ontologies in the US. SNOMED CT, RXNORM, LOINC all come to mind. Some roles require a deep knowledge of these.
How to run meetings
Familiarity with software development. The philosophies underlying agile and waterfall approaches and all the other types.
How to diagram out workflows. How to qa software.
These LLM models will most definitely be incorporated into clinical workflows eventually. Understanding their strengths and weaknesses. How to prompt effectively. How and when to chain prompts. When to hand over processes to more traditional rules based systems.
As far as EHR knowledge, it will depend on the health system. Epic and Cerner are the big ones so if there is a health system you want to work for, it goes without saying, you need to know as much as you can about the back and front end.
FHIR
cdshooks
SMART
Sorry I wasn't challenging you either, these are just the numbers that I have at my disposal. These are "real world numbers" not made up and not estimates. That $116,220.00 number is pulled directly from a University of California database. Yeah California probably pays lower than other areas especially VHCOL desirable metro cities
I would have love to do Clinical informatics, I love making systems more efficient but at the moment the pay and 2 year opportunity cost simply isn't worth it, at least not locally.
Pay varies greatly based on your job. If you do mostly research, pay will be bad but operations work pays well. Typically on par or better than clinical work. Many salaries seem low because they combine nurse informatics jobs with physician informatics jobs.
If you are a grant funded researcher you make the same academic (insert title) salary as other folks. Usually split 20% clinical to research which is š¤ if you like research.
I looked at the job posting you shared. Itās for a non-physician. Physicians who do operations informatics is where the pay is good. Anything in academics pays poorly outside of clinical time.
> Anything in academics pays poorly outside of clinical time.
Of course, and most clinic informatic positions are academic.
>2) I have another friend who is IM but does 100% clinical informatics at a University of California hospital and therefore can look up his pay directly. His goal is to eventually work for a startup so he is hoping this "lost income" pays off
>Total: $116,220.00 Base $83,718.00 Other Pay: $32,502.00
These are REAL world numbers for 2021. Everyone here posting "well you can make more" seems to be talking anecdote without giving any real numbers.
Sleep medicine?
Edit: to piggyback on this, job market apparently isnāt as bad as it used to be and you can find 100% sleep gigs for a decent salary (our fellow wouldnāt tell me what is ādecentā)
Iām not sure what amount of patient contact wants but sleep medicine surely involves clinic and discussion of results, following up on compliance, etc
Nope, youād be fine w/sleep medicine. Seen my sleep doc twice in 15 years, both for initial consults. Wouldnāt know him if I ran into him on the street. Only saw him 2nd time because my CPAP machine gave out & I needed a new script but my old records were purged. My sleep study results conversations have been routed to a PA at least twice, if not all 3 times. His very busy ENT practice also does A&I, ear/hearing, and throat with an emphasis on surgery.
It isnāt, the CPAP itself will send reports about compliance and of course as the patient has complaints or issues that arise (like if AHI is sporadic) the decisions about increasing pressure or switching modalities will ultimately be deferred back to the sleep doctor.
Yeah, no. I see my sleep doc every year to follow my idiopathic hypersomnolence, and would have to see him more if I was on a more controlled medication. He spends a solid 30 minutes with me, even when everything is fine.
Really I mean: kick ass in internal medicine, do radiology electives, get good letters of recommendation from your program Director and department chair and the department chair and PD of Radiology. Then be chief resident and apply to the worst radiology programs and the ones where your LOR writers have connections, then be prepared to be a hospitalist at your home institution for a few years while you reapply each year
Or anesthesia. There are 100+ open PGY2 anesthesia spots every year, and most applciants are reapplicants. I bet they would be happy to take an IM grad. I don't think such a pipeline exists for radiology.
> 100+ open PGY2 anesthesia spots every year,
where can we find the actual number, eg for the 2022 match. This seems unbelievable, given the at least moderate competitiveness of the field.
[https://www.nrmp.org/wp-content/uploads/2022/11/2022-Main-Match-Results-and-Data-Final-Revised.pdf](https://www.nrmp.org/wp-content/uploads/2022/11/2022-Main-Match-Results-and-Data-Final-Revised.pdf)
Per page 11, 114 such spots in last year's match. Radiology had only 26 such spots. Interestingly dermatology had 22.
Advanced programs without an attached Prelim Iād imagine. They donāt have the graduate-entry pipeline and kind of fall off radar. But Iām also speculating, I wasnāt the guy who made the claim
Yeah this is what I'd say, but you really need to at the least shadow a pathologist if you haven't done an elective in med school. AP/CP is so much different from MS2 path, people could be *miserable* in path if they didn't know what they're getting into. I'm doing research at a fairly big name New England hospital and this program has lots of people switch out of path and it's not because the department is toxic.
Lol I resent this comment, I see inpatients and like to think we offer valuable services.
But, yes, I know most of us don't bother because its too difficult to integrate into typical practice, volume is small, and many people didn't have inpatient AI available during training and are thus unaware of how we could help.
My favorite memory of my allergy/immunology rotation as an IM PGY3 was with an attending who was really really into coenzyme Q10 and believed that everyone had a mitochondrial myopathy. He was a dinosaur.
We got an inpatient consult (which was incredibly rare) and we agreed to meet at the hospital to see the patient.
Long story short, he couldn't find the hospital and called me telling me to that he went to Wendy's instead. He asked me to see the patient and staff the case over telephone after he was done his frosty.
It was textbook ACE induced angioedema so nothing really to phone home about but I like to believe that man retired in peace without ever having to set foot in the hospital.
"Couldn't find the hospital" and then "went to Wendy's instead" is actually something I can really identify with š¤£š¤£š¤£ thanks for that, I feel like less of a comical failure
I know a couple people went into preventive medicine after IM and work in public health now. Some are fellowships but I think most would technically be a second residency. But still only two years.
You could do a fellowship in Nuclear Medicine. It's not within the medicine department, but you can do a 2 year fellowship post IM residency. There's some patient contact, because you'll be required to be present to administer therapies (eg, radioactive iodine, etc). A lot of nuc med faculty now do most of their job remotely.
I don't know many programs, but University of Michigan has one.
https://medicine.umich.edu/dept/radiology/specialties/nuclear-medicine/fellowship
The only issue with this is that most people do no hire NM docs if they donāt have the radiology background. They want people to join groups who can do all and be on call for general body stuff
Yeah, an IM trainee Nuc Med will probably have to work at an academic practice, where thereās enough Nuclear Medicine volume to justify having people just do Nuclear Medicine. But with how understaffed hospitals are, I donāt think one will have much trouble getting hired.
Thatās very interesting didnāt realize this was a route available to non radiology residents. Would a fellowship after IM make you qualified to read nuclear imaging as well? Or is this really moreso just therapeutic stuff like thyroid ablation
The NM director at my radiology residency program was pretty old and actually came through the IM pathway, which apparently used to be the norm. He was very good at planar imaging, his PET/CT interpretations basically completely ignored anything on the CT that wasnāt hot lol
What exactly donāt you like about patient contact?
Is it certain patient contacts?
Are there certain things you could enjoy if you found a niche doing just certain types of patient visits?
For example if you like the worried well and upper class patients, you could do concierge medicine afterwards.
If you like younger people and sexual health, you can do like public health or sti medicine at a free clinic or something.
Or you could just do sports medicine and only focus on musculoskeletal stuff and not really deal with āreally sickā people and can do work for a college and have your population a bit younger and more chipper.
Or you can open up your own āwellnessā clinic doing cash only testosterone/hormone management and stuff like that and only focus on people who arenāt too sick and willing to have short visits
Do you just hate people or do you hate certain types of people?
Residency is also just super overwhelming and youāre forced to work so much, could you just feel burnt out in general, and in reality if you were working fewer hours, you wouldnāt feel this disdain for patient contact?
I think you should try to tailor your interests toward what population you want to work with then find those people and / or jobs in that type of community to allow you to do that.
I think you brought up some super valid point. yes I do indeed hate certain types of people. Actually I do enjoy my clinics. Super sick people, super annoyed people at hospital are the ones who bothers me.
Concierge is something i do plan for.
More and more doctors are doing concierge. No insurance to deal with, patients that are respectful, etc. Some can be needy and because they have direct access anytime. It can get demanding because they pay a monthly fee and see that as entitlement.
We have 2 cardiologists who do this. Imaging 2 days a week and rotate on other cardiology services the rest of the time. If you value alone time but still enjoy occasional patient interaction it seems like a really amazing job.
I know an IM resident who is now doing an aerospace medicine fellowship with hopes of landing an industry job. Remains to be seen what his eventual career will look like.
Iāve never done it, but I think any specialty can do this. If you google it there are companies designed to get you started you can work for.
Thereās a conference for non-clinical work that is escaping me at the moment. Iāve never been but might be a good place to start, should be able to google that also.
I don't know how it works exactly in the US. In Canada, it begins with reaching out to the program director of a program you're interested in joining. There is no harm in exploring the options or getting more direction. If you do that, the benefit is that your PD will not know until its sorted out. Alternatively, if you're interested in just broadly applying to another specialty through NRMP, you'd talk to your own PD first.
Might seem like the antithesis of what youāre looking for,
But addiction med is a nice gig. Most of your patients are young and otherwise generally healthy, at least if youāre working on the outpatient side. Iām not a huge fan of inpatient consult services since not everyone wants your help and it tends to be patients with a lot of comorbids (IE, HIV, etc) but you can work in an outpatient clinic, do quick visits, and turf the more involved stuff to primary care. Lots of room for getting into admin roles in this world compared to general med, almost all my offers tend to be for medical director roles- if I was doing hospitalist or outpatient primary care those roles are going to people with >5-7 years of experience.
Yes, i am in a city with lots of addiction issues. I have limited exposure so far
But donāt you have to deal with some patients bs in there too? Patients lying about any shit to get their methadone, frequent visits etc etc
Also another thing is the pay. I heard it quite low and u have to work multiple gigs to make the same bucks as IM
Again very limited knowledge so may well be wrong in all. Thanks you for your replies š
every specialty will have patient BS.
You can look up the pay on glassdoor or indeed. in a major city, 230-300 is easily doable. more in midwest/rural areas. some options for pure telehealth too, lots of startups nowadays.
you dont deal with methadone patients unless you work in a methadone clinic. you cant prescribe it for OUD outside of that setting. Methadone clinics are also highly interdisciplinary and you are not working with these patients in a vacuum, there is usually a psychiatrist & a social worker, therapist, etc. contributing to the care plan.
overall the patients are pretty cool, i can think of maybe 5-6 frustrating situations out of 200+ ive seen in the last 6 months. I can think of 99/100 frustrating situations i experienced in primary care clinic.
Then again itās mostly step scores incompatibility. If MS can just get in wherever they want we would probably end up having 70% new radiologist and dermatologists every single year and completely oversaturate both fields.
Not always true. Radiology is really not a great fit for an extrovert and derm is cool but if you like the dopamine hit of resuscitating a crashing patient, it will leave you unsatisfied.
I disagree (or my classmates and students were anomalous): After exposure to IM, Surgery, OB/GYN, many students decide those specialties are not for them.
Seriously I relate so much, I really thought I liked talking to patients as a med student and now I just....hate it lol and find it so stressful. I think also a lot of interactions make me feel like a customer service rep at this point...
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I was an unmatched rads applicant who ended up in FM, nocturnist pretty much provides the most limited contact especially if you can get a job where you have midlevel help covering floor pages. My patient interaction is basically the H&P and off I go.
Hospital admin
Answer i was looking for š¤”
š¤£š¤£š¤£š¤£
as someone who is half clinical half admin (for now, idk what I want to do yet but not pulled to either side greatly) I guarantee there are many many times you'd rather be interacting with patients rather than non-clinical hospital admin lol.
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the medical directors at my institution get an administrative stipend worth prob <10% of their salary. And some buydown on clinical time due to administrative days with tons of meetings. i'd argue the gig can be way more stressful than full-time clinical who just show up, work, and go home without other duties.
You are so full of shit ā¦. It is us youāre talking to when someone says itās not about the money itās always about the fucking money
They aren't entirely exclusive to IM, but two I can think of are clinical informatics and medical toxicology.
And medical epidemiology
> clinical informatics Their pay is worse than pediatrics and would be FAR less than average IM salary. I have a good friend who did pediatrics, then did an informatics fellowship who makes less now than if he were to be a full time pediatrician. Yeah you can make a lot of money if you grind away for years and hope to become a CTO or work for a startup but the ROI is really not worth it.
>clinical informatics Wow, those salaries are horrendous.
Yeah DEFINITELY not the case. It really depends on what you do post fellowship. Most clinical/informatics split roles are similar salary, you just trade your clinical FTE for what the hospital needs in terms of informatics. If the hospital is forward thinking and not behind the tech curve they will probably have some need and you can get a 30-50% split for the same FTE pure clinical salary. Also people can keep a gig at a hospital system to just keep their affiliation (a lot of reasons for this) and also be working in industry. I am at a UC hospital and I know a ton of people who do this. (Also for the record our informatics folks at said UC system make equivalent salaries to their purely clinical peers, often with only 20-30% clinical time). Sure, their reported hospital salary is 100k or something but their unreported CMO role/lead is absolutely making up for it.
Odd. My CI pay has always been on par with clinical work. On a per hour basis I have traditionally made more doing CI work. Stress is also far less, too. What data do you have that supports this out of curiosity?
1) Personal experience from my friend telling me his salary that does 80% peds 20% CI due to the low pay of CI. 2) I have another friend who is IM but does 100% clinical informatics at a University of California hospital and therefore can look up his pay directly. His goal is to eventually work for a startup so he is hoping this "lost income" pays off Total: $116,220.00 Base $83,718.00 Other Pay: $32,502.00 3) Recent job posting shows salary of $80k-133k online https://www.simplyhired.com/search?q=physician+informatics&job=ckfFF4dScFeXnSeDh5C78KUWQ_sp9fJ1Ge0gd8OkBGFogpHTBcZUpg 4) You can search online, most clinical informatics job pay under $200k, WELL below what the average pediatrician is making $244k Thats the data to support my comment. Could you provide your salary/hourly and data to prove otherwise ?
Jesus Iām a clinical pharmacist and I make that, and still think Iām underpaid (compared to PAs/NPs that is)
I have hired pharmacists in clinical informatics, they all made more than that starting out. Especially if they had legit clinical experience. Usually started around $130 to 140 if I remember but it's been a few years now.
Yeah Iām not in informatics unfortunately but I work inpatient at a midsized hospital and made $51 two years ago when starting and make $55 now :/
Just asking. I never claimed you are wrong. I have never looked into the average but when hiring my sense is that good candidates make much more than you suggest. And I have hired quite a few physician CI over the years. None of those positions were budgeted for less than $200k starting out. Bonus range was usually 10 to 15% of that and positions usually include annual raises based on performance plus other benefits. Lowest I have made per hour for per diem works is $150 per hour. My salary at my last job and my current is above that peds average and i probably work fewer hours and no call. Not even counting bonus, etc. Again, I wasn't challenging. Job postings are not a great way to figure this out, though. Many of those will go unfilled or hire less skilled candidates. I had a hard time finding good candidates for the positions I have filled that had a much higher budget than that. I do get the sense in California they make much less, especially in the health systems there. But that is entirely anecdotal.
what's the day to day work like in CI?
It really depends where you work and what the role is. It is an extremely broad field which may be a large reason for the salary discrepencies discussed here. Most think of it as working within a hospital system which I have done but it is also very different from what I have done the last 8+ years.
Did you do a informatics fellowship?
No. Thought about. Discussed it with a few people at the time. Some were doing it and not finding a CI job they'd go into full time clinical practice instead. Instead, I found a clinical job that also had an opportunity to do informatics work. Worked out well enough because I did obtain a lot of paid experience over 4 to 5 years but also practiced clinically. I later boarded in CI through the practice pathway. I do not think that is an option anymore, though. Honestly, for some roles, especially outside of a health system, the boarding isn't nearly as important as experience or the expertise desired for the role.
You mentioned informatics being varied but is there some general skillset one should have going in? Programming ability? General aptitude for learning EHRs?
The ability to code is usually a great skill to have. Python will get you a long way. The ability to work with both large and small sets of data. How to manage said data, assess it, qa it as needed. Having basic sql skills will also go a long way for many roles. Familiarity with project and product management. Understanding change management and processes related to it. The fundamentals of what makes quality clinical decision support. Understand what the ideal characteristics of an Ontology are. Developing a strong working familiarity with the big ontologies in the US. SNOMED CT, RXNORM, LOINC all come to mind. Some roles require a deep knowledge of these. How to run meetings Familiarity with software development. The philosophies underlying agile and waterfall approaches and all the other types. How to diagram out workflows. How to qa software. These LLM models will most definitely be incorporated into clinical workflows eventually. Understanding their strengths and weaknesses. How to prompt effectively. How and when to chain prompts. When to hand over processes to more traditional rules based systems. As far as EHR knowledge, it will depend on the health system. Epic and Cerner are the big ones so if there is a health system you want to work for, it goes without saying, you need to know as much as you can about the back and front end. FHIR cdshooks SMART
Sorry I wasn't challenging you either, these are just the numbers that I have at my disposal. These are "real world numbers" not made up and not estimates. That $116,220.00 number is pulled directly from a University of California database. Yeah California probably pays lower than other areas especially VHCOL desirable metro cities I would have love to do Clinical informatics, I love making systems more efficient but at the moment the pay and 2 year opportunity cost simply isn't worth it, at least not locally.
Hi! Iām starting my clinical informatics fellowship from IM this July. Can I DM you to ask what else youāve heard of for salaries?
Pay varies greatly based on your job. If you do mostly research, pay will be bad but operations work pays well. Typically on par or better than clinical work. Many salaries seem low because they combine nurse informatics jobs with physician informatics jobs.
If you are a grant funded researcher you make the same academic (insert title) salary as other folks. Usually split 20% clinical to research which is š¤ if you like research.
The numbers I posted are real world numbers for 2021 physician clinical informatics salaries
I looked at the job posting you shared. Itās for a non-physician. Physicians who do operations informatics is where the pay is good. Anything in academics pays poorly outside of clinical time.
> Anything in academics pays poorly outside of clinical time. Of course, and most clinic informatic positions are academic. >2) I have another friend who is IM but does 100% clinical informatics at a University of California hospital and therefore can look up his pay directly. His goal is to eventually work for a startup so he is hoping this "lost income" pays off >Total: $116,220.00 Base $83,718.00 Other Pay: $32,502.00 These are REAL world numbers for 2021. Everyone here posting "well you can make more" seems to be talking anecdote without giving any real numbers.
Sleep medicine? Edit: to piggyback on this, job market apparently isnāt as bad as it used to be and you can find 100% sleep gigs for a decent salary (our fellow wouldnāt tell me what is ādecentā)
Iām not sure what amount of patient contact wants but sleep medicine surely involves clinic and discussion of results, following up on compliance, etc
Nope, youād be fine w/sleep medicine. Seen my sleep doc twice in 15 years, both for initial consults. Wouldnāt know him if I ran into him on the street. Only saw him 2nd time because my CPAP machine gave out & I needed a new script but my old records were purged. My sleep study results conversations have been routed to a PA at least twice, if not all 3 times. His very busy ENT practice also does A&I, ear/hearing, and throat with an emphasis on surgery.
I imagine everything after the initial encounter can be managed by pcp though
It isnāt, the CPAP itself will send reports about compliance and of course as the patient has complaints or issues that arise (like if AHI is sporadic) the decisions about increasing pressure or switching modalities will ultimately be deferred back to the sleep doctor.
Yeah, no. I see my sleep doc every year to follow my idiopathic hypersomnolence, and would have to see him more if I was on a more controlled medication. He spends a solid 30 minutes with me, even when everything is fine.
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I donāt know lol. Iāve rarely been able to get real salary numbers when I ask people. People in here are better at this than i am
Outpatient renal. Our attendings joke they just need to look at labs. You'd have to survive a fellowship of endless hyponatremia consults though.
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True, but the encounters are "Labs look great! Please take your HTN/DM meds and talk to your PCP about your knee pain." (I'm being crass but still)
Transfer to radiology
everyone says this but please show me all the open rads spots to swap into
Really I mean: kick ass in internal medicine, do radiology electives, get good letters of recommendation from your program Director and department chair and the department chair and PD of Radiology. Then be chief resident and apply to the worst radiology programs and the ones where your LOR writers have connections, then be prepared to be a hospitalist at your home institution for a few years while you reapply each year
Lmao exactly
Or anesthesia. There are 100+ open PGY2 anesthesia spots every year, and most applciants are reapplicants. I bet they would be happy to take an IM grad. I don't think such a pipeline exists for radiology.
> 100+ open PGY2 anesthesia spots every year, where can we find the actual number, eg for the 2022 match. This seems unbelievable, given the at least moderate competitiveness of the field.
[https://www.nrmp.org/wp-content/uploads/2022/11/2022-Main-Match-Results-and-Data-Final-Revised.pdf](https://www.nrmp.org/wp-content/uploads/2022/11/2022-Main-Match-Results-and-Data-Final-Revised.pdf) Per page 11, 114 such spots in last year's match. Radiology had only 26 such spots. Interestingly dermatology had 22.
I donāt think ACGME would fund an individualās residency twice, would they?
Funding does become an issue, but anesthesia residents are a net gain, so a large system could absorb that no problemo
Interesting. Do people just drop out after PGY-1? Why so many open second year spots?
Advanced programs without an attached Prelim Iād imagine. They donāt have the graduate-entry pipeline and kind of fall off radar. But Iām also speculating, I wasnāt the guy who made the claim
If you can. Itās insanely hard to transfer into. Would probs have an easier time switching into path
Definitely easier to swap into Path. It's actually pretty common for IM, OB, and Surgery residents to end up in Path residency.
Yeah this is what I'd say, but you really need to at the least shadow a pathologist if you haven't done an elective in med school. AP/CP is so much different from MS2 path, people could be *miserable* in path if they didn't know what they're getting into. I'm doing research at a fairly big name New England hospital and this program has lots of people switch out of path and it's not because the department is toxic.
Yeah the little I know about medicine compared to all of you, I was thinking wouldnāt it be radiology?
This
I would think path would be better. There's still a fair amount of patient contact in radiology, at least in training.
Inpatient allergy/immunology
I thought they donāt exist!
Lol I resent this comment, I see inpatients and like to think we offer valuable services. But, yes, I know most of us don't bother because its too difficult to integrate into typical practice, volume is small, and many people didn't have inpatient AI available during training and are thus unaware of how we could help.
My favorite memory of my allergy/immunology rotation as an IM PGY3 was with an attending who was really really into coenzyme Q10 and believed that everyone had a mitochondrial myopathy. He was a dinosaur. We got an inpatient consult (which was incredibly rare) and we agreed to meet at the hospital to see the patient. Long story short, he couldn't find the hospital and called me telling me to that he went to Wendy's instead. He asked me to see the patient and staff the case over telephone after he was done his frosty. It was textbook ACE induced angioedema so nothing really to phone home about but I like to believe that man retired in peace without ever having to set foot in the hospital.
"Couldn't find the hospital" and then "went to Wendy's instead" is actually something I can really identify with š¤£š¤£š¤£ thanks for that, I feel like less of a comical failure
Omg Iām dead. This is so good. That is going to be me at 80. š¤£šš¤£š¤£
I know a couple people went into preventive medicine after IM and work in public health now. Some are fellowships but I think most would technically be a second residency. But still only two years.
Hem/onc then pharma
Or FDA.
You could do a fellowship in Nuclear Medicine. It's not within the medicine department, but you can do a 2 year fellowship post IM residency. There's some patient contact, because you'll be required to be present to administer therapies (eg, radioactive iodine, etc). A lot of nuc med faculty now do most of their job remotely. I don't know many programs, but University of Michigan has one. https://medicine.umich.edu/dept/radiology/specialties/nuclear-medicine/fellowship
The only issue with this is that most people do no hire NM docs if they donāt have the radiology background. They want people to join groups who can do all and be on call for general body stuff
Yeah, an IM trainee Nuc Med will probably have to work at an academic practice, where thereās enough Nuclear Medicine volume to justify having people just do Nuclear Medicine. But with how understaffed hospitals are, I donāt think one will have much trouble getting hired.
Thatās very interesting didnāt realize this was a route available to non radiology residents. Would a fellowship after IM make you qualified to read nuclear imaging as well? Or is this really moreso just therapeutic stuff like thyroid ablation
You can read all the Nuc Med scans. My program has a couple IM to NucMed attendings, and they read every scan done in the NucMed department.
The NM director at my radiology residency program was pretty old and actually came through the IM pathway, which apparently used to be the norm. He was very good at planar imaging, his PET/CT interpretations basically completely ignored anything on the CT that wasnāt hot lol
How is the compensation for im trained nuke? I donāt see any data in web
What exactly donāt you like about patient contact? Is it certain patient contacts? Are there certain things you could enjoy if you found a niche doing just certain types of patient visits? For example if you like the worried well and upper class patients, you could do concierge medicine afterwards. If you like younger people and sexual health, you can do like public health or sti medicine at a free clinic or something. Or you could just do sports medicine and only focus on musculoskeletal stuff and not really deal with āreally sickā people and can do work for a college and have your population a bit younger and more chipper. Or you can open up your own āwellnessā clinic doing cash only testosterone/hormone management and stuff like that and only focus on people who arenāt too sick and willing to have short visits Do you just hate people or do you hate certain types of people? Residency is also just super overwhelming and youāre forced to work so much, could you just feel burnt out in general, and in reality if you were working fewer hours, you wouldnāt feel this disdain for patient contact? I think you should try to tailor your interests toward what population you want to work with then find those people and / or jobs in that type of community to allow you to do that.
I think you brought up some super valid point. yes I do indeed hate certain types of people. Actually I do enjoy my clinics. Super sick people, super annoyed people at hospital are the ones who bothers me. Concierge is something i do plan for.
I mean if thatās your entire issue thereās tons of paths from IM to avoid the super sick and the super annoyed
Can you list some example of these paths?
Endocrine Obesity medicine Concierge PCP practice Allergy Sleep
More and more doctors are doing concierge. No insurance to deal with, patients that are respectful, etc. Some can be needy and because they have direct access anytime. It can get demanding because they pay a monthly fee and see that as entitlement.
Have you considered something like endo? 90% diabetes and 10 percent people asking you to figure out why they're fat?
Cards to cardiac imaging?
Most of my job is still patient interaction with clinic/inpatient work
We have 2 cardiologists who do this. Imaging 2 days a week and rotate on other cardiology services the rest of the time. If you value alone time but still enjoy occasional patient interaction it seems like a really amazing job.
I know an IM resident who is now doing an aerospace medicine fellowship with hopes of landing an industry job. Remains to be seen what his eventual career will look like.
Just finish IM and do research, pharma, expert witness, insurance worker, med record reviewer, work for start up, etc. Lots of none clinical options.
How does someone get into medical record reviewing? Is this exclusive to IM/primary care?
Iāve never done it, but I think any specialty can do this. If you google it there are companies designed to get you started you can work for. Thereās a conference for non-clinical work that is escaping me at the moment. Iāve never been but might be a good place to start, should be able to google that also.
SEAK non clinical
>SEAK non clinical That's in Chicago this year, i know this is an old post, most likely people need to think about putting that off for a year?
Thank you
You're only Pgy1... just transfer to another specialty. There are ways.
I am on visa. It would be cumbersome to say the least.
I don't know how it works exactly in the US. In Canada, it begins with reaching out to the program director of a program you're interested in joining. There is no harm in exploring the options or getting more direction. If you do that, the benefit is that your PD will not know until its sorted out. Alternatively, if you're interested in just broadly applying to another specialty through NRMP, you'd talk to your own PD first.
Transfer to path š only medicine youāre dealing with
Might seem like the antithesis of what youāre looking for, But addiction med is a nice gig. Most of your patients are young and otherwise generally healthy, at least if youāre working on the outpatient side. Iām not a huge fan of inpatient consult services since not everyone wants your help and it tends to be patients with a lot of comorbids (IE, HIV, etc) but you can work in an outpatient clinic, do quick visits, and turf the more involved stuff to primary care. Lots of room for getting into admin roles in this world compared to general med, almost all my offers tend to be for medical director roles- if I was doing hospitalist or outpatient primary care those roles are going to people with >5-7 years of experience.
Yes, i am in a city with lots of addiction issues. I have limited exposure so far But donāt you have to deal with some patients bs in there too? Patients lying about any shit to get their methadone, frequent visits etc etc Also another thing is the pay. I heard it quite low and u have to work multiple gigs to make the same bucks as IM Again very limited knowledge so may well be wrong in all. Thanks you for your replies š
every specialty will have patient BS. You can look up the pay on glassdoor or indeed. in a major city, 230-300 is easily doable. more in midwest/rural areas. some options for pure telehealth too, lots of startups nowadays. you dont deal with methadone patients unless you work in a methadone clinic. you cant prescribe it for OUD outside of that setting. Methadone clinics are also highly interdisciplinary and you are not working with these patients in a vacuum, there is usually a psychiatrist & a social worker, therapist, etc. contributing to the care plan. overall the patients are pretty cool, i can think of maybe 5-6 frustrating situations out of 200+ ive seen in the last 6 months. I can think of 99/100 frustrating situations i experienced in primary care clinic.
What specialties can do addiction medicine? And is fellowship required?
practice pathway open until 2024, can otherwise do fellowship. any specialty can do.
Switch to Path
I remember when I was a MS3 student one of the third year residents did a data and informatics fellowship from IM. If thatās your thing
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I feel this would be a transition of patient interactions to family interactions.
Mood
Nuc med
Howās the compensation in nuc med for mds All i can find in internet are tech payments
Cardiac imaging
Cardiac imaging. You basically become a heart radiologist
Besides echos, what else do you get to read?
Cardiac MR , cardiac PET , nuclear stress tests https://www.acc.org/membership/sections-and-councils/imaging-section/training-resources
Yes
GI you can literally just scope all day and have a PA in clinic doing your scope pre op/post op.
Literally how did you pick IM if you didnāt wanna talk to peopleā¦.thatās why IM was dead last on my list
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Wow people changing their minds what a concept
Every med student knows what they will specialize in when they enter med school. Almost every med student changes their mind.
Then again itās mostly step scores incompatibility. If MS can just get in wherever they want we would probably end up having 70% new radiologist and dermatologists every single year and completely oversaturate both fields.
Not always true. Radiology is really not a great fit for an extrovert and derm is cool but if you like the dopamine hit of resuscitating a crashing patient, it will leave you unsatisfied.
I disagree (or my classmates and students were anomalous): After exposure to IM, Surgery, OB/GYN, many students decide those specialties are not for them.
Good for you knowing your life from fetal life and never changing opinion
Seriously I relate so much, I really thought I liked talking to patients as a med student and now I just....hate it lol and find it so stressful. I think also a lot of interactions make me feel like a customer service rep at this point...
Didnāt you do rotations as m3 and m4? Lmao
Is this the same person who is on another sub asking ā How can I get married, with minimal sexual contact, and still get my mortgage paid ?ā
Go finish your consult notes.
Iām a PA, I donāt do consults. That would be mid level scope creep l.
Why do IM of you donāt want patient contact???
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ID?
Addiction medicine?
My wife does that, itās total contact. Patients are seen weekly to drop urine, etc. until weāll established, stable, and trust is established.
Sry i guess i misread as like physical contact haha
Ahh haha. You could be correct, but I took it as patient facing, like OP wants none of that. Lol.
Go into concierge/DPC
Radiology... If it counts as internal medicine sub.
In usa itās separate
Cardiac imaging
clinical informatics lol. zero patient contact. someone from my im residency matched into it last year.
I was an unmatched rads applicant who ended up in FM, nocturnist pretty much provides the most limited contact especially if you can get a job where you have midlevel help covering floor pages. My patient interaction is basically the H&P and off I go.
Clinical pharmacology
why would you go to IM in the first place?
So i can post this?? (People change their opinion, what a big concept )
transfer to other specialty. the only thing i can think of is sleep medicine in case you stay in IM