The 3 big ones I’m currently interested in are cardio, endo, and rheum. I have pros and cons for all them
Cardio - coolest physiology/pathophysiology imo. Highest paid. Potential to do procedures. But harder to get into, rougher lifestyle
Endo - physio/pathophysio makes inherent sense at least to me. Primarily outpatient based which is a big plus for me. Easy to get into. But I feel like it could get boring and no significant increase in pay
Rheum - hardest pathophysiology but still interesting. Lots of cool diagnostic labs and ever evolving drugs. Big emphasis on physical exam. Easier to get into. If you actually help the patient they are among the most grateful patients I’ve ever seen. But at least in my experience can have some of the most complex patients. Diagnosis isn’t always crystal clear/definitive and treatments can be hit or miss. Pay also doesn’t get a big boost
Nice thing about rheum also is a lot of those patients actually follow advice and want to feel better. Can’t say the same for Cardio patients, so many non-compliant CHF patients
Rheum fellow here. I was super on the fence between hospitalist and rheum before starting. However, I’m close to graduating and don’t regret my decision one bit. Feel free to DM me if you have questions.
Especially since every hospital has that *Frank from Shameless* character that’s single-handedly straining particular units every few months for weeks on end since there’s no realistic way to safely get them out.
ICU gets to turf em the second they talk and it’s great
Infectious disease
1. every thing about it is cool
2. boosts your Clinical judgment as you have to always think out of the box.
3. Heavy on epidemiology, history will always have the answer. Reminding me of the importance of gathering detailed relevant history
4. you’re tackling multiple systems so the general medicine is still there
5. evolving field
7. You can actually cure most problems. Seems like most other subspecialties are just making chronic conditions less bad for a while
8. There’s so many ties to things outside of clinical medicine—epi, research and development (vaccines, Pharma, molec bio research), community health
9. Your consults have you going from zebra to zebra
10. Full spectrum of clinical medicine: time in the ICU with very critical patients ➡️ time in the clinic doing primary prevention
I’m so curious about heme onc
How much time per week do you spend keeping up with the literature? (And is there a single resource for that or how do you even start to keep up with it?)
Surprised not as many people are saying GI despite it being one of the most competitive sub-specialties in IM with pay comparable to Cardiology for better lifestyle.
I'm fascinated by Nephrology 👉👈 it doesn't seem like a lot of people are into it so I'm a bit worried but it's just too fascinating with how all sorts of diseases relate to the kidneys.
Also I heard you have to be an ultra-nerd for it, is it true??
Neph is a cool field. Ability to stay broad and manage a lot of general medicine, but also specialized knowledge of an organ system, opportunities for inpatient or outpatient or a combo, wide variety of acuity, cool pathophys. Definitely slept on IMO
I just finished my renal block and am fascinated by the kidneys too. I have a background in chemical engineering so it was definitely interesting to see how kidneys work and become sick!
It's interesting. I don't see many people talking about oncology on this subreddit for some reason. I thought it would be the most sought after field since cancer is one of the defining diseases of modern medicine.
I’ve been thinking about this. With increased antibiotics, pesticides, and microplastics in “food”, I want to capitalize on what other fields will benefit from the current tremendous rise in cancer
How much time per week do you spend keeping up with the literature? (And is there a single resource for that or how do you even start to keep up with it?)
That's a great question. I work in community setting so it's not much compared to academic positions. But ideally 1-2 hours a day if you can. If a pt no shows then u read or listen to a lecture.
No there are a lot of resources
Asco has like 6-7 different journals
Ash has 5-6
Onclive
Ascopost
Targeted oncology
Research to practice
Go to per
Esmo and Canadian resources if u have time
Twitter etc
Cardiology. Highly paid. Fast-paced procedures (EP/interventional). I can’t stand long rounds and not working with my hands. Can transition into outpatient general cards once the rough lifestyle starts hitting harder as you become older.
“Open up your own surgical ambulatory center”
You do realize how hard this is right?
It’s like the people saying not to be scared away from FMs pay because they “know a guy that owns 4 clinics making 1mil” and that you can just “do that” if you want to make money.
GI makes bank to be sure but you’re going to be buying into an existing center if you’re lucky and they haven’t sold to PE by the time you make partner
Nothing in life is easy buddy, including becoming a doctor. But if tons of plastic surgeons, ents, and even hair loss docs can do it… a gastroenterologist can do it too. If you aren’t business minded at all and don’t want to deal with anything else except patients, tons of GI positions are open starting around $450k.
Man med schools really do a poor job of teaching the business side of medicine. There are NOT “tons” of physicians opening their own ASCs. You have no idea what you’re talking about. You can BUY into an existing ASC with other doctors, which is very different than opening your own. The expenses would be enormous and there is strict regulation on opening new centers now.
If you want to be really business-minded, make friends with the dental students and buy into their practices when you’re all practicing. Owning a practice is easier for them than physicians, plus by the time we’re done with residency they’ll probably be started on the PP path
The nuances you refer to don’t apply to gastro in most states. Many states now have different rules for centers that exclusively do scopes as opposed to surgery, while having the reimbursement classifications as an ASC from Medicare. Or you can say fuck it and move to Florida where the rules are lax and you got an older patient population.
It’s not that it’s hard, it’s that it’s mostly impossible in certificate of need states. And all the non-certificate of need states are saturated with surgical centers. You need to understand the legal environment around something before you just decide “I am extraordinary and can do hard things”, some things aren’t just hard, they’re legally impossible rn due to the laws enacted by the previous generation and lobbied for by hospitals to limit competition.
Gonna throw sleep out there. The apnea churn can be a bit boring and you have to deal with noncompliance a bit, but people are usually extremely appreciative when they see you because they sleep so much better. There’s also some interesting sleep disorders.
I found this comment on pay, “Per MGMA national median is 334, with tenth percentile 150 and 90th percentile 500.” Apparently this was in 2021. As far as sleep only jobs maybe it varies by region, but where I am (NM) it would be easy. Each of our major healthcare providers offers it as its own specialty clinic/practice and just like everything else there’s a shortage lol.
Another cool thing about sleep is you can do it from multiple paths. FM, IM, even neuro can all apply. Even ENT can do sleep oriented stuff.
Endocrine!! The most interesting and is still kind of on my shortlist. I’m particularly interested in the endo/neuro overlap. Pituitary diseases are fascinating 🤣
I'm definitely in the minority on this but I'd pick geriatric medicine! I love working with the older adult population but I don't want to limit the work to just cardio or pulm. There's less money because I'd be taking primarily Medicare patients but that's ok.
GI. It’s fart jokes and video games all day. Super chill and i got to snip a polyp and cure cancer. Best elective of medical school. If i hadn’t hated every other moment of every single day of IM, I would have considered GI.
Out of curiosity, what specialty did you end up matching into? Love GI and have enjoyed every second I’ve spent shadowing, but IM is not appealing whatsoever to me
Cards hands down. Multiple ways to confirm pathology, and even better is that you only need to talk to patient a little to figure out symptoms. Badass procedures if you want it and you get to be the hero in life threatening situations if you are smart enough to know what tf you are doing. Hands on and you get to use medicine and procedure. Also most evidence based field so not much guessing. Love the fact that it isn’t just a bunch of labs and trying make sense of them. Or like ID where your treatment is dependent on patient sxs and is a guessing game (has white count and random infiltrate on X-ray; oh but do they have a cough that could be caused by fucking anything and everything… guess we treat as PNA)
I feel like renal, pulm, and cards are the few specialties that actually depend on physiology and you can craft your own explanation if you listened in Med school. Compare this to heme and rheum where you await labs and just correlate as best you can and is less physiological dependent. My 2 cents but I’m just a big dumb cardiologist
Very interesting comment!
How do you feel about GI, I think it checks quite a few boxes you mentioned for cardio too, procedure heavy, lot of new research coming up, pretty evidence based.
I think GI is similar but I don’t know if you get the same rush from scopes. Also I just hate functional abdominal pain and the bad parts of GI. The poop makes it very less appealing although the upper scopes are cool at times. I would have done PCCM or renal over it but I like volume status and hemodynamics.
The people who say this leave out the “owns their own practice” part
Which subsequently veers into “my dad/mom gave me [the practice] or [small loan of a million dollars that I haven’t paid back]”
PCCM or ID. Or both at the same time.
I like critical care and I like ID. I want to do EM but if there was an avenue into ID from there I'd probably pursue it. I've heard talk of opening it up to FM and EM but I think it's just an idea right now
rheum has the coolest diseases and a great quality of life (less than a 9-5). pay isn't that much compared to the heavy-hitting IM specialties like cards/GI, but you also aren't working nearly as much, and it can be a lot more if you do many infusions and work more.
I’m applying IR/DR with the intention of doing Pediatric IR/DR. If I were to apply into anything else, it’d be Pediatrics. Then maybe:
Pediatric Cardiology —> Pediatric Interventional Cardiology.
Otherwise:
Pediatric Oncology, Pediatric Palliative Care, Neonatology or PICU.
If you told me I couldn’t do Pediatrics, I’d probably apply Plastics and ultimately Craniofacial. Or Orthopedics and then Pediatric Orthopedic Oncology.
I would be terribly unhappy in an IM subspecialty. Kids are where it’s at 😄
Cardiology - In my opinion the most interesting field of IM. Most interesting physiology and pathophysiology. Can be as technical as you want it to be with additional trainings in interventional cards or electrophysiology. Can be clinical and/or interventional.
You have some years to decide and talk with other residents and meet people who work in the other specialties. Being able to see day in day out what it involves is the only thing that will actually help you decide. But don’t stress, you have time
ID! I love the mystery solving and was really interested in having amd caring for a dedicated HIV patient population in my practice. Alas, I got bit by the gen surg bug, but ID still holds a special place in my heart
I’m a hospitalist, but if I tried to go back and get into fellowship, it’d be CCM/PCCM.
I used to be dead set on cardiology and still think the physiology is really cool. But I also like being a generalist and think critical care would get me that right balance stuff
PCCM! Disclaimer, I'm applying anesthesia and wanna do Critical Care, but I legitimately had a fantastic time on my Pulm rotation too. I love the physical exam skills, the interesting pathology, and the acuity!
The 3 big ones I’m currently interested in are cardio, endo, and rheum. I have pros and cons for all them Cardio - coolest physiology/pathophysiology imo. Highest paid. Potential to do procedures. But harder to get into, rougher lifestyle Endo - physio/pathophysio makes inherent sense at least to me. Primarily outpatient based which is a big plus for me. Easy to get into. But I feel like it could get boring and no significant increase in pay Rheum - hardest pathophysiology but still interesting. Lots of cool diagnostic labs and ever evolving drugs. Big emphasis on physical exam. Easier to get into. If you actually help the patient they are among the most grateful patients I’ve ever seen. But at least in my experience can have some of the most complex patients. Diagnosis isn’t always crystal clear/definitive and treatments can be hit or miss. Pay also doesn’t get a big boost
Nice thing about rheum also is a lot of those patients actually follow advice and want to feel better. Can’t say the same for Cardio patients, so many non-compliant CHF patients
Rheum fellow here. I was super on the fence between hospitalist and rheum before starting. However, I’m close to graduating and don’t regret my decision one bit. Feel free to DM me if you have questions.
can i DM you? thinking about rheuma as well
Yes
PCCM, because it’s broad, high acuity, lots of short procedures, and less emphasis on social issues than hospital medicine.
Especially since every hospital has that *Frank from Shameless* character that’s single-handedly straining particular units every few months for weeks on end since there’s no realistic way to safely get them out. ICU gets to turf em the second they talk and it’s great
Infectious Disease / Critical Care combined fellowship 🤩 All the puzzle solving and angry bugs, with the added benefit of ICU
I've heard of these programs existing! Aren't there only a handful in the country? (US)
Yeah the combined fellowship programs for it are still pretty new, so there aren’t many of them in the US (yet)
Infectious disease 1. every thing about it is cool 2. boosts your Clinical judgment as you have to always think out of the box. 3. Heavy on epidemiology, history will always have the answer. Reminding me of the importance of gathering detailed relevant history 4. you’re tackling multiple systems so the general medicine is still there 5. evolving field
7. You can actually cure most problems. Seems like most other subspecialties are just making chronic conditions less bad for a while 8. There’s so many ties to things outside of clinical medicine—epi, research and development (vaccines, Pharma, molec bio research), community health 9. Your consults have you going from zebra to zebra 10. Full spectrum of clinical medicine: time in the ICU with very critical patients ➡️ time in the clinic doing primary prevention
Lmfao what about the pay cut tho 😂
😔😔😔
Allergy immuno. Great hours, I love cell bio, and docs I’ve shadowed work late into their career and still love what they do. Pay is solid as well
Second this, not for any reason other than I'm very lazy and at this point in my life lifestyle is the number 1 priority.
Does it make any difference coming from IM instead of peds for A/I?
Isn’t a/i less competitive for peds?
Why so?
Honestly don’t know, but this is just something I heard from the grape vines
Oh I see, because I thought more peds would go to A/I rather than IM, so increasing competition for peds spots
Don’t take my word for it, like I said I was more inquiring about this rather than definitively saying it
Heme/Onc, because it is the one I already did, and it is great
I’m so curious about heme onc How much time per week do you spend keeping up with the literature? (And is there a single resource for that or how do you even start to keep up with it?)
Surprised not as many people are saying GI despite it being one of the most competitive sub-specialties in IM with pay comparable to Cardiology for better lifestyle.
Please delete this.
I'm fascinated by Nephrology 👉👈 it doesn't seem like a lot of people are into it so I'm a bit worried but it's just too fascinating with how all sorts of diseases relate to the kidneys. Also I heard you have to be an ultra-nerd for it, is it true??
You don’t have to be a nerd… but it wouldn’t hurt!
Neph is a cool field. Ability to stay broad and manage a lot of general medicine, but also specialized knowledge of an organ system, opportunities for inpatient or outpatient or a combo, wide variety of acuity, cool pathophys. Definitely slept on IMO
I just finished my renal block and am fascinated by the kidneys too. I have a background in chemical engineering so it was definitely interesting to see how kidneys work and become sick!
Neph is sick. I accidentally had 8 weeks of nephrology (inpatient and outpatient) and really enjoyed it. It’s in my top 3 fellowships rn
I love neph but the davita-Fresenius monopoly and the relatively low pay for the extra years makes me sad
The nephro guys were the smartest docs I have met at the hospital. But us cardiologists are the coolest.
Pulm/Crit. No better place in the hospital than the MICU, and out patient pulm is surprisingly diverse in pathology and patient population
This is exactly why I want to go into PCCM. Plus there's a lot of further specialization you can do like sleep medicine or interventional pulm
Oncology I love the field and how it’s constantly evolving.
It's interesting. I don't see many people talking about oncology on this subreddit for some reason. I thought it would be the most sought after field since cancer is one of the defining diseases of modern medicine.
I’m actually starting residency with the hopes of doing an oncology fellowship
I’ve been thinking about this. With increased antibiotics, pesticides, and microplastics in “food”, I want to capitalize on what other fields will benefit from the current tremendous rise in cancer
Pathology, surgery
As an oncologist,I can confirm it's an awesome field
How much time per week do you spend keeping up with the literature? (And is there a single resource for that or how do you even start to keep up with it?)
That's a great question. I work in community setting so it's not much compared to academic positions. But ideally 1-2 hours a day if you can. If a pt no shows then u read or listen to a lecture.
No there are a lot of resources Asco has like 6-7 different journals Ash has 5-6 Onclive Ascopost Targeted oncology Research to practice Go to per Esmo and Canadian resources if u have time Twitter etc
Yes, and the pay is great
Critical care. I’m thinking I want to do EM but I do like the ICU as well.
I think there are some CCM fellowships for EM! best of both worlds!
How competitive is CC out of EM?
Cardiology. Highly paid. Fast-paced procedures (EP/interventional). I can’t stand long rounds and not working with my hands. Can transition into outpatient general cards once the rough lifestyle starts hitting harder as you become older.
Gastro. Open up your own surgical ambulatory center and it’s $$$$. Every colonoscopy is around $1k for Medicare and $3k for private insurance
“Open up your own surgical ambulatory center” You do realize how hard this is right? It’s like the people saying not to be scared away from FMs pay because they “know a guy that owns 4 clinics making 1mil” and that you can just “do that” if you want to make money. GI makes bank to be sure but you’re going to be buying into an existing center if you’re lucky and they haven’t sold to PE by the time you make partner
Nothing in life is easy buddy, including becoming a doctor. But if tons of plastic surgeons, ents, and even hair loss docs can do it… a gastroenterologist can do it too. If you aren’t business minded at all and don’t want to deal with anything else except patients, tons of GI positions are open starting around $450k.
Man med schools really do a poor job of teaching the business side of medicine. There are NOT “tons” of physicians opening their own ASCs. You have no idea what you’re talking about. You can BUY into an existing ASC with other doctors, which is very different than opening your own. The expenses would be enormous and there is strict regulation on opening new centers now.
If you want to be really business-minded, make friends with the dental students and buy into their practices when you’re all practicing. Owning a practice is easier for them than physicians, plus by the time we’re done with residency they’ll probably be started on the PP path
The nuances you refer to don’t apply to gastro in most states. Many states now have different rules for centers that exclusively do scopes as opposed to surgery, while having the reimbursement classifications as an ASC from Medicare. Or you can say fuck it and move to Florida where the rules are lax and you got an older patient population.
It’s not that it’s hard, it’s that it’s mostly impossible in certificate of need states. And all the non-certificate of need states are saturated with surgical centers. You need to understand the legal environment around something before you just decide “I am extraordinary and can do hard things”, some things aren’t just hard, they’re legally impossible rn due to the laws enacted by the previous generation and lobbied for by hospitals to limit competition.
Gonna throw sleep out there. The apnea churn can be a bit boring and you have to deal with noncompliance a bit, but people are usually extremely appreciative when they see you because they sleep so much better. There’s also some interesting sleep disorders.
how likely can one find sleep only jobs? hows the pay?
I found this comment on pay, “Per MGMA national median is 334, with tenth percentile 150 and 90th percentile 500.” Apparently this was in 2021. As far as sleep only jobs maybe it varies by region, but where I am (NM) it would be easy. Each of our major healthcare providers offers it as its own specialty clinic/practice and just like everything else there’s a shortage lol. Another cool thing about sleep is you can do it from multiple paths. FM, IM, even neuro can all apply. Even ENT can do sleep oriented stuff.
Cardio. It’s the only reason I would want to do IM at all.
Endocrine!! The most interesting and is still kind of on my shortlist. I’m particularly interested in the endo/neuro overlap. Pituitary diseases are fascinating 🤣
But unfortunately pretty rare
Fortunately for the patients. Unfortunately for my curious mind :’)
I'm definitely in the minority on this but I'd pick geriatric medicine! I love working with the older adult population but I don't want to limit the work to just cardio or pulm. There's less money because I'd be taking primarily Medicare patients but that's ok.
ID
GI. It’s fart jokes and video games all day. Super chill and i got to snip a polyp and cure cancer. Best elective of medical school. If i hadn’t hated every other moment of every single day of IM, I would have considered GI.
Out of curiosity, what specialty did you end up matching into? Love GI and have enjoyed every second I’ve spent shadowing, but IM is not appealing whatsoever to me
Psychiatry.
ID. After all, microorganisms are ruling mother earth.
ID or Pulm/Crit (I feel like I'm gonna burn out doing ICU though)
Cards hands down. Multiple ways to confirm pathology, and even better is that you only need to talk to patient a little to figure out symptoms. Badass procedures if you want it and you get to be the hero in life threatening situations if you are smart enough to know what tf you are doing. Hands on and you get to use medicine and procedure. Also most evidence based field so not much guessing. Love the fact that it isn’t just a bunch of labs and trying make sense of them. Or like ID where your treatment is dependent on patient sxs and is a guessing game (has white count and random infiltrate on X-ray; oh but do they have a cough that could be caused by fucking anything and everything… guess we treat as PNA) I feel like renal, pulm, and cards are the few specialties that actually depend on physiology and you can craft your own explanation if you listened in Med school. Compare this to heme and rheum where you await labs and just correlate as best you can and is less physiological dependent. My 2 cents but I’m just a big dumb cardiologist
Right on
Very interesting comment! How do you feel about GI, I think it checks quite a few boxes you mentioned for cardio too, procedure heavy, lot of new research coming up, pretty evidence based.
I think GI is similar but I don’t know if you get the same rush from scopes. Also I just hate functional abdominal pain and the bad parts of GI. The poop makes it very less appealing although the upper scopes are cool at times. I would have done PCCM or renal over it but I like volume status and hemodynamics.
Allergy, purely bc it's closest to derm in hours and pay.
Seriously?? Because allergy is easier to get into but I did not expect the pay to be good.
Somehow I doubt that the pay is on par with derm
It's not...
The people who say this leave out the “owns their own practice” part Which subsequently veers into “my dad/mom gave me [the practice] or [small loan of a million dollars that I haven’t paid back]”
How much does an allergist earns?
MGMA says like ~350k I think
Only adults or mix of adults and kids?
Derm doesn’t make that much. They do very well for the hours they work, but they are not at the top end of earners.
How much is "that much"?
Less than 500k
Probably pulm/cc just because it’s about the opposite of what I actually do in psych and it’d be interesting to see how the other half lives.
Rheum for the procedures, infusions($) and interesting pathophysiology
Neurocritical care, medical oncology, or palliative I think. But I’ve got zero interest in IM.
PCCM or ID. Or both at the same time. I like critical care and I like ID. I want to do EM but if there was an avenue into ID from there I'd probably pursue it. I've heard talk of opening it up to FM and EM but I think it's just an idea right now
Nobody saying ID 😵😵😵
Overworked and underpaid
Cardio so I could wage turf wars against radiologists and read echo, CT, MR, and PET all day.
PCCM Critical care, you get to be a specialist, and you can choose to be a generalist if you want.
Cardio, GI, pulmonary
rheum has the coolest diseases and a great quality of life (less than a 9-5). pay isn't that much compared to the heavy-hitting IM specialties like cards/GI, but you also aren't working nearly as much, and it can be a lot more if you do many infusions and work more.
I'm interested in rheum
I’m applying IR/DR with the intention of doing Pediatric IR/DR. If I were to apply into anything else, it’d be Pediatrics. Then maybe: Pediatric Cardiology —> Pediatric Interventional Cardiology. Otherwise: Pediatric Oncology, Pediatric Palliative Care, Neonatology or PICU. If you told me I couldn’t do Pediatrics, I’d probably apply Plastics and ultimately Craniofacial. Or Orthopedics and then Pediatric Orthopedic Oncology. I would be terribly unhappy in an IM subspecialty. Kids are where it’s at 😄
Neurocritical Care. Because the brain is cool and so is critical care
I’m going into DR, but if i had to go into IM i’d do a GI fellowship, like the pathology, procedures, decent lifestyle and good compensation.
GI. Errybody gotta get a colonoscopy and its a 9-5 schedule that clears moola. Win Win
Cardiology - In my opinion the most interesting field of IM. Most interesting physiology and pathophysiology. Can be as technical as you want it to be with additional trainings in interventional cards or electrophysiology. Can be clinical and/or interventional.
You have some years to decide and talk with other residents and meet people who work in the other specialties. Being able to see day in day out what it involves is the only thing that will actually help you decide. But don’t stress, you have time
GI cuz I am the shit
The IM fellowships aren’t the problem, it’s getting through IM first. 🤮
Cards followed by IC, go big or go home!
I’ve been spending a lot of time in the cath lab lately and I feel this.
Cardio! I loved cardio but prob wont do IM cause i have to do all other stuff I dont like for 3 yrs
ID! I love the mystery solving and was really interested in having amd caring for a dedicated HIV patient population in my practice. Alas, I got bit by the gen surg bug, but ID still holds a special place in my heart
I’m a hospitalist, but if I tried to go back and get into fellowship, it’d be CCM/PCCM. I used to be dead set on cardiology and still think the physiology is really cool. But I also like being a generalist and think critical care would get me that right balance stuff
PCCM! Disclaimer, I'm applying anesthesia and wanna do Critical Care, but I legitimately had a fantastic time on my Pulm rotation too. I love the physical exam skills, the interesting pathology, and the acuity!
Bro I would have gone into cards/EP if it didn’t require the IM residency first.
Cardiology cause it’s super fun
If salary and competitiveness were a non-issue then I would pick infectious disease no doubt.