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Sunday, August 3, 2014

Residency Match Competitiveness 2014

An editorial published in this month's Journal of the American College of Radiology updated the competitiveness of the 2014 residency match for the major 21 specialties.  We had previously discussed the authors' data in an earlier publication on the competitiveness of specialties from 2011 to 2013.  They calculate each specialty's competitiveness based on positions per US applicant (PPUSA). According to the new data, Urology is now the most competitive specialty, surpassing Plastic Surgery.  The 5 toughest specialties to match are still all surgical specialties.


Residency Match Competitiveness by Specialty in 2014


Specialty PPUSA


Urology 0.70
Plastic Surgery 0.76


Otolaryngology 0.80
Orthopedic Surgery 0.83
Neurological Surgery 0.87
Dermatology 0.89


Radiation Oncology 0.99
Ophthalmology 1.00


General Surgery 1.18
OBGYN 1.20
Emergency Medicine 1.21
Internal Medicine-Pediatrics 1.29


Pediatrics 1.44
Anesthesiology 1.49
Diagnostic Radiology 1.51


PM&R 1.69
Neurology 1.86


Psychiatry 1.98
Internal Medicine 2.01


Family Medicine 2.26
Pathology 2.29


Source:  Journal of the American College of Radiology

Thursday, June 19, 2014

2014 - 2015 Residency Application Guide

Choose, apply, match.

Disclaimer:  these are only my opinion and you ultimately influence and determine your match success.

This post will be updated throughout 2014.


Choose

Tuesday, June 3, 2014

Can I Afford to Buy a Home During Residency?

Residency is a difficult financial period for most graduates.  The relatively low salaries, high cost of living in cities, and student loan repayments all put a heavy burden on our pockets.  A lot of residents rent an apartment but some choose to buy a home.  This could be quite economical in areas where monthly rent prices are not that much different than mortgage payments.  Residents in longer training programs can further benefit by living in their home for an extended period without ever paying someone else rent.  Purchasing a home is very costly and requires you to maintain a certain income to afford mortgage payments.  HSH.com has calculated the income needed to own a home based on principal, interest, taxes, and insurance.  The monthly payments and salary needed to buy are calculated from average 30-year fixed rate mortgages on median-priced homes in 27 different cities.  I have included the average PGY1 salary for the corresponding cities.

City Median Price Monthly Payment Salary Required Average Salary

Cleveland

$102,100

$695

$29,800

$49,600
Pittsburgh $120,000 $704 $30,200 $49,600
St. Louis $120,500 $730 $31,300 $50,000
Cincinnati $121,700 $743 $31,900 $50,000
Detroit $110,750 $753 $32,300 $48,200
Atlanta $141,900 $798 $34,200 $50,700
Tampa $145,000 $850 $36,400 $47,400
Phoenix $194,300 $964 $41,300 $50,100
Orlando $178,000 $1,009 $43,200 $48,700
San Antonio $169,300 $1,038 $44,500 $51,100
Minneapolis $188,200 $1,067 $45,700 $49,500
Dallas $174,800 $1,113 $47,700 $52,600
Houston $184,600 $1,144 $49,000 $48,200
Philadelphia $201,800 $1,179 $50,500 $51,000
Chicago $176,900 $1,234 $52,900 $48,800
Baltimore $224,500 $1,239 $53,100 $49,000
Sacramento $255,800 $1,356 $58,100 $51,300
Miami $259,000 $1,394 $59,700 $49,700
Denver $288,400 $1,397 $59,900 $51,100
Portland $271,900 $1,407 $60,300 $52,100
Seattle $339,900 $1,723 $73,900 $50,600
Washington, DC $358,900 $1,832 $78,500 $50,800
Boston $363,200 $1,862 $79,800 $55,700
Los Angeles $406,200 $2,006 $86,000 $51,300
New York City $388,900 $2,095 $89,800 $58,000
San Diego $483,000 $2,299 $98,500 $51,100
San Francisco $679,800 $3,200 $137,100 $52,900

Home Price and Mortgage Source:  The salary you must earn to buy a home in 27 metros
PGY1 Salary Source:  FREIDA


I have highlighted in green the cities where PGY1 salary is greater than the salary required to own a median-priced home.  This is assuming that the resident salary is the only source of household income and there aren't any other major payments such as student loans.  If you get a bigger return on the interest by quickly paying into student loans, then you can think of that as a good investment.  Otherwise, if you live in an affordable city, think about owning a home to avoid paying someone else rent every month.

Monday, June 2, 2014

Best States to Practice Medicine 2014

Medscape updated its list of best and worst places to practice medicine based on lifestyle, practice conditions, climate, and amenities.


Best States to Practice (in no particular order)
Washington
Wyoming
Texas
Indiana
Minnesota
Massachusetts
New Hampshire
North Carolina
Virginia
Tennessee
Georgia

Worst States to Practice (in no particular order)
California
New Mexico
Michigan
Rhode Island
Florida

Source:  Best & Worst Places to Practice 2014


The Mercatus Center at George Mason University ranks the overall freedom in the 50 states based on fiscal, regulatory, and personal freedom.


Fiscal Freedom:  taxes, government employment, spending, debt, and fiscal decentralization.

Best States to Practice
2. Tennessee
6. New Hampshire
10. Texas
12. Virginia
14. Georgia
19. Washington
25. North Carolina
29. Massachusetts
38. Indiana
40. Minnesota
45. Wyoming

Worst States to Practice
11. Florida
18. New Mexico
39. Michigan
42. Rhode Island
44. California


Regulatory Freedom:  liability system, property rights, health insurance, and the labor market.

Best States to Practice
1. Indiana
9. Virginia
11. Wyoming
12. Tennessee
14. North Carolina
16. Georgia
18. Minnesota
24. Texas
27. New Hampshire
36. Massachusetts
37. Washington

Worst States to Practice
19. Michigan
32. Florida
39. New Mexico
43. Rhode Island
50. California


Personal Freedom:  victimless crimes, guns, tobacco, and education.

Best States to Practice
5. New Hampshire
7. Indiana
10. Massachusetts
12. Georgia
14. North Carolina
16. Washington
21. Wyoming
24. Tennessee
25. Minnesota
31. Texas
38. Virginia

Worst States to Practice
4. New Mexico
33. Rhode Island
36. Florida
41. Michigan
47. California


Overall Freedom:  35.3% fiscal freedom + 32.0% regulatory freedom + 32.7% personal freedom

Best States to Practice
3. Tennessee
4. New Hampshire
8. Virginia
9. Georgia
14. Texas
16. Indiana
24. North Carolina
29. Washington
30. Massachusetts
34. Minnesota
36. Wyoming

Worst States to Practice
21. New Mexico
23. Florida
35. Michigan
46. Rhode Island
49. California

Source:  Freedom in the 50 States


Medscape's best states to practice generally perform better in fiscal, regulatory, and personal freedom than its worst states but there is considerable overlap.

Sunday, June 1, 2014

Residency Match Competitiveness by Specialty

A paper published in the Journal of the American College of Radiology in May 2014 evaluated the competitiveness of the match for the major residency specialties.  Instead of using USMLE Scores as a marker for competitiveness, the authors utilized supply and demand factors.  They used positions per US applicant (PPUSA) as their value for difficulty in the match.  A lower value of the PPUSA represented a more competitive specialty.  They argued that "board scores and other variables traditionally used to gauge competitiveness can be confounded when there is a mismatch created by an overabundance of available positions."  This could be another way of looking at specialty competitiveness.  


Residency Match Competitiveness by Specialty from 2011 to 2013


Specialty PPUSA
Plastic Surgery 0.74
Urology 0.82
Orthopedic Surgery 0.83
Otolaryngology 0.84
Neurological Surgery 0.93
Radiation Oncology 0.93
Dermatology 0.95
Ophthalmology 1.01
General Surgery 1.10
Emergency Medicine 1.15
Internal Medicine-Pediatrics 1.16
OBGYN 1.24
Diagnostic Radiology 1.29
Anesthesiology 1.31
Pediatrics 1.42
Neurology 1.76
Psychiatry 1.77
PM&R 1.79
Internal Medicine 1.80
Pathology 1.98
Family Medicine 2.13


Some fields have similar competitiveness and are grouped together.

Friday, May 16, 2014

Non-US IMG USMLE Scores in the Match

Previously we showed the USMLE scores of US IMGs in the 2013 Match.  Please click on the link for definitions of US and non-US IMG.  In 2013, 5100 US IMG and 7600 non-US IMG applied for residency.  The following tables are for non-US IMGs in the 2013 Match.


Specialty Matched
Internal Medicine 1690
Family Medicine 293
Pediatrics 278
Psychiatry 163
Surgery-General 158
Pathology 151
Neurology 148
Anesthesiology 78
Radiology-Diagnostic 66
OBGYN 62
Emergency Medicine 31
PM&R 21



A vast majority of non-US IMGs matched into Internal Medicine in 2013.  Let us break it down by scores.


Specialty Mean STEP 1
Surgery-General 233
Radiology-Diagnostic 232
Internal Medicine 231
Neurology 230
Average 227
Anesthesiology 226
Emergency Medicine 226
OBGYN 226
Pathology 226
Pediatrics 223
PM&R 220
Psychiatry 214
Family Medicine 213


Specialty Mean STEP 2
Surgery-General 240
Radiology-Diagnostic 238
Internal Medicine 236
Neurology 236
Anesthesiology 234
OBGYN 234
Average 233
Emergency Medicine 231
Pediatrics 231
Pathology 228
PM&R 225
Family Medicine 219
Psychiatry 219



The average scores of matched non-US IMGs in 2013 were similar to those of US seniors who matched  in 2011 (although it is inaccurate to compare because USMLE scores tend to increase every year).  However, USMLE scores are just one component of the residency application evaluation.  I have worked with incredibly talented American graduate, US IMG, and non-US IMG co-residents.  Let's hope we continue to invite the best and the brightest into the profession.


Related:

Thursday, May 15, 2014

US IMG USMLE Scores in the Match

The Educational Commission for Foreign Medical Graduates (ECFMG) defines international medical graduates (IMG) as physicians who graduated from a medical school located outside the United States and Canada.  The location of the school, not the citizenship, determines whether a physician applying to residency is an IMG.  Depending on citizenship, these applicants can be classified as US IMGs or non-US IMGs.  Today, we will look at the match statistics of US IMGs in the 2013 Match, published by the NRMP in Charting Outcomes in the Match, International Medical Graduates.


Specialty Matched
Internal Medicine 841
Family Medicine 531
Psychiatry 203
Pediatrics 196
Surgery-General 119
Anesthesiology 95
OBGYN 78
Neurology 59
Radiology-Diagnostic 55
Emergency Medicine 53
Pathology 46
PM&R 40

Source:  Charting Outcomes in the Match, International Medical Graduates


The number of applicants matched to each field will depend on the size of the specialty.  Internal Medicine is by far the largest specialty in all of medicine and therefore will receive a large percentage of graduates from all categories of applicants.  The above data also designates the sample size for the following tables.


Specialty Mean STEP 1
Radiology-Diagnostic 237
Anesthesiology 234
Surgery-General 227
Emergency Medicine 225
Pathology 224
PM&R 223
Internal Medicine 221
OBGYN 221
Average 217
Neurology 216
Pediatrics 216
Family Medicine 206
Psychiatry 205


Specialty Mean STEP 2
Radiology-Diagnostic 241
Anesthesiology 239
Emergency Medicine 235
Surgery-General 234
OBGYN 232
PM&R 231
Internal Medicine 228
Pathology 226
Average 224
Pediatrics 224
Neurology 222
Family Medicine 213
Psychiatry 211



The two tables above list the mean USMLE STEP 1 and STEP 2 CK scores for US IMGs who matched into their specialties in 2013.  The average scores for those who matched were 217 and 224, respectively.  Radiology, Anesthesiology, Emergency Medicine, and General Surgery applicants who matched had the highest average scores.  Tomorrow we will discuss USMLE scores for non-US IMG applicants.


Related:

Non-US IMG USMLE Scores in the Match

Monday, May 12, 2014

Physician Lifestyle: Overall Satisfaction 2014

Medscape calculated overall career satisfaction for each specialty by averaging percentage who would choose medicine again, percentage who would choose their specialty again, and percentage satisfied with their income.  This method does give equal weighting to all three factors which can make the final results arbitrary.  Once again, Dermatology takes the #1 spot by a large margin.


Specialty Percent Satisfied
Dermatology 65%
Psychiatry 58%
Oncology 56%
Infectious Disease 56%
Emergency Medicine 56%
Pediatrics 56%
Ophthalmology 53%
Rheumatology 53%
Cardiology 53%
Pathology 53%
Critical Care 53%
Gastroenterology 52%
Radiology 51%
Orthopedics 51%
Anesthesiology 50%
Urology 50%
Family Medicine 50%
Endocrinology 49%
General Surgery 48%
Nephrology 48%
Obstetrics and Gynecology 48%
Pulmonary Medicine 48%
Internal Medicine 47%
Neurology 47%
Plastic Surgery 45%

Source:  Medscape

Sunday, May 11, 2014

Physician Lifestyle: Choose Specialty Again? 2014

Previously, we looked at what percentage of doctors would choose medicine again as a career.  Today's question is:  if doctors had to do it all over again, what percentage of them would choose their specialty again?


Specialty Choose Again
Dermatology 77%
Orthopedics 64%
Ophthalmology 61%
Cardiology 61%
Gastroenterology 59%
Oncology 58%
Plastic Surgery 57%
Infectious Disease 55%
Urology 54%
Radiology 54%
Psychiatry 54%
Rheumatology 54%
General Surgery 52%
Pediatrics 52%
Pathology 51%
Endocrinology 50%
Critical Care 50%
Anesthesiology 48%
Emergency Medicine 46%
Neurology 45%
Nephrology 43%
Obstetrics and Gynecology 43%
Pulmonary Medicine 40%
Family Medicine 32%
Internal Medicine 27%

Source:  Medscape


Most doctors fall in the 40% to 60% range when it comes to picking their own specialty again.  Dermatology and Orthopedics are on the high end of the spectrum and Family Medicine and Internal Medicine are on the low end.  This pattern looks like the reverse of the one we saw in yesterday's post about choosing medicine again as a career.

Saturday, May 10, 2014

Physician Lifestyle: Choose Medicine Again? 2014

Yesterday, we discussed physician satisfaction with their compensation.  Here is the question for today:  if physicians had to do it all over again, what percentage of them would choose medicine as a career?


Specialty Choose Again
Internal Medicine 68%
Family Medicine 67%
Infectious Disease 67%
Pulmonary Medicine 63%
Pediatrics 63%
Emergency Medicine 61%
Rheumatology 61%
Obstetrics and Gynecology 60%
Psychiatry 60%
Nephrology 59%
Critical Care 58%
Oncology 58%
Endocrinology 57%
Neurology 56%
Ophthalmology 56%
Urology 55%
Cardiology 55%
Dermatology 53%
Gastroenterology 51%
Pathology 50%
General Surgery 48%
Anesthesiology 47%
Radiology 45%
Orthopedics 44%
Plastic Surgery 41%

Source:  Medscape


Interestingly, the higher paying specialties are less likely to go into medicine again.  About two-thirds of primary care physicians would do it again.  Next, we will look at the percentage of physicians who would choose their specialty again.

Friday, May 9, 2014

Physician Lifestyle: Satisfaction with Income 2014

Medscape recently released its 2014 Physician Compensation Report and we calculated the pay per hour for each specialty.  But what percentage of physicians feel fairly compensated?  Fortunately, Medscape also has that answer for us in their survey.


Specialty Percent Satisfied
Dermatology 64%
Emergency Medicine 61%
Psychiatry 59%
Pathology 59%
Pediatrics 54%
Anesthesiology 54%
Radiology 53%
Oncology 52%
Critical Care 51%
Family Medicine 50%
Gastroenterology 47%
Internal Medicine 46%
Infectious Disease 46%
Rheumatology 46%
Orthopedics 45%
Cardiology 44%
General Surgery 43%
Urology 42%
Obstetrics and Gynecology 42%
Ophthalmology 42%
Nephrology 41%
Endocrinology 41%
Neurology 39%
Pulmonary Medicine 39%
Plastic Surgery 37%

Source:  Medscape


Dermatologists are most satisfied with their compensation amongst all specialties and also rank second in our pay per hour calculation.  They work the fewest hours as well.  The surgical specialties usually get paid more than other specialties, but according to the above table their satisfaction with compensation is on the lower end.  They do put in a lot of hours at work and maybe that's part of the reason.

Thursday, May 8, 2014

Internship and Residency Work Hours

The following table shows 2012 average hours per week, days off per week, and hours per day for PGY1 year of the major residency specialties.  Asterisks represent residencies that start in the PGY2 year (advanced) and their hours correspond to PGY2.

Specialty Hours Per Week Days Off Per Week Hours Per Day
Surgery-General 74.5 1.0 12.4
Neurological Surgery 74.3 1.1 12.6
Plastic Surgery 71.1 1.1 12.1
OBGYN 69.5 1.3 12.2
Orthopaedic Surgery 68.7 1.2 11.8
Otolaryngology 67.8 1.2 11.7
Urology 65.8 1.3 11.5
Neurology 64.5 1.2 11.1
Pediatrics 63.4 1.2 10.9
Internal Medicine 63.1 1.2 10.9
Family Medicine 62.3 1.3 10.9
Anesthesiology* 61.2 1.5 11.1
Transitional Year 60.3 1.3 10.6
Emergency Medicine 56.8 1.5 10.3
Psychiatry 55.1 1.4 9.8
PM&R* 53.7 1.6 9.9
Ophthalmology* 51.8 1.6 9.6
Radiology-Diagnostic* 51.7 1.7 9.8
Pathology 51.4 1.7 9.7
Radiation Oncology* 49.6 1.9 9.7
Dermatology* 45.4 1.9 8.9

Source:  FREIDA

Compared to 2011, residency work hours are slightly down across most specialties.  This is probably due to the new work hour restrictions that were implemented in 2011.  Not surprising, the top seven most worked residency specialties are all surgical.  Dermatology residency is close to banker's hours.

If you are a medical student who plan on matching at an advanced (starting in PGY2) residency program such as the ones marked with an asterisk, then you will also need to match separately at an intern year (PGY1).  Your choices are:  Preliminary Surgery (General Surgery PGY1), Preliminary Medicine (Internal Medicine PGY1), or Transitional Year.

Internship Hours Per Week Days Off Per Week Hours Per Day
Surgery-General 74.5 1.0 12.4
Internal Medicine 63.1 1.2 10.9
Transitional Year 60.3 1.3 10.6

Source:  FREIDA

Preliminary Surgery has the most brutal hours and I generally do not recommend it unless you have a very compelling reason to do it.  Transitional Year is by far the most competitive internship to match.  The best Dermatology, Radiation Oncology, Ophthalmology, Diagnostic Radiology, and Anesthesiology applicants all compete for these limited positions.  Transitional Year programs generally offer more electives than Preliminary Medicine programs but this varies greatly across programs and regions.  As you can see in the above table, the average difference in weekly hours is only 2.8.  A lot of Transitional Year programs are in unpopular locations (rural, fly-over states).  The easiest Transitional Year will beat out the easiest Preliminary Medicine year but Preliminary Medicine at a community hospital can offer you as much flexibility as a Transitional Year program.  Multiple Transitional Year programs require rotations on Surgery, which is worse than Internal Medicine months.  There are also many more Preliminary Medicine programs and their locations tend to be better.  Get a Transitional Year program if you can but remember that your intern year isn't guaranteed to be worse if you match Preliminary Medicine.  The difference is smaller than you think.

Tuesday, April 22, 2014

Imagining the EMR of the Future

A key provision of the American Recovery and Reinvestment Act of 2009 is that all public and private healthcare providers must adopt and demonstrate "meaningful use" of electronic medical records or EMRs.  Since then, we have seen a dramatic adaptation of EMRs by hospitals across the country, which is to be expected.  Now, there's great debate about whether EMRs have improved healthcare at all, but that will not be the focus of this article, mostly because EMRs are here to stay, and because I do believe that their net effect has been positive so far despite the road bumps.

What I mainly want to focus on in this article is what an ideal EMR might look like.  The issue with current EMRs is that they're mostly focused on billing, with the user interface being secondary.  This leads to a lot of inefficiencies in work flow and that has a direct impact on patient care, not to mention monetary outcomes (which are, for better or worse, probably the biggest consideration for those individuals who make decisions regarding purchasing an EMR).  I will admit that there have been a lot of improvements in the EMR interface for users to make it more useful for everyday workflow, but I would argue that these changes are relatively minor, more like band-aids than large scale improvements.  The design of EMRs to maximize workflow is still in its infancy, and I believe there is dramatic potential to improve how we use EMRs to improve communication, workflow, and patient care.

So, what might this EMR look like?  Here are a few functionality features that I would like to see implemented in future generations of EMRs (in no particular order).  This is in no way a complete list, and I will likely add or subtract from it in the future.

1) Simplification
Current EMRs are too complex.  There's many ways to customize your settings, and there's often numerous different ways to look at the same data (Ins and Outs, for example, can be found from 2 different tabs).  It might sound nice to be able to customize your own settings, but if an EMR interface is designed correctly, the user SHOULDN'T ever want to change those settings in the first place.  Furthermore, all of the different options lead to variations in how people use EMRs, and also make it difficult for users to find what they're looking for exactly.  There should be ONE interface for one type of user (doctors, nurses, etc) and that interface should be designed in a way to present the information that is most relevant to that user group clearly.  This would decrease variation, improve communication, and increase efficiency.

2) Picture and video integration
They say that a picture is worth a thousand words.  A video is probably at least worth a thousand pictures then.  Written language is just a form of communication, but there's many instances in which a video or a picture is much much much more effective in doing so.  Modern EMRs should have the ability to seamlessly integrate pictures and videos into notes and other documentation, keyword being seamlessly.

3) Visual, picture based interface, for users
When you look at an EMR, it's just words, words, words, and you often have to go to many different parts of the EMR to find all the information you're looking for.  The interface that a user uses should have all the relevant information that the user needs readily available, and that information should be organized in a visual manner.  For example, imagine having a figure of a human being represent the patient.  If you're interested in finding out how many bowel movements he's had or what his current diet order is, you can just hover your mouse over the figure's abdomen, and the information you need would appear.  Might not be the best example, but you probably get the idea.

4) Integration of notes, orders, sign out
I often have to write the same things 3 times.  For example, I have to put in orders, then write what orders I want in my note, and then I have to repeat this on my signout sheet.  I should have to do this just once.  I think notes can be less of a separate entity that you have to type up, and instead be more of a snapshot of what is happening at the moment for the patient, since all of that information is already in the EMR.

5) Improvements in communication
It's almost impossible to reach the person that you want to reach unless you physically find them or page them and this is a tragedy.  There should be the ability to instant message, or chat with other health care providers that you're looking for.  Furthermore, there should be no reason why I can't reach the person that I am trying to contact.  There should be 0% error in this.  Interns who have gone through the experience of calling ten different people to find the right person know what I am talking about here.  Honestly, gchat itself would be a dramatic improvement in the paging/phone system that hospitals currently employ, and it's free too.

6) Discharge coordination
The discharge process for any hospital is a giant mess, but that's another story.  There's a dramatic amount that EMRs could do to improve this process.  For example, the discharge paperwork that patients get is a mess.  It's no wonder that patients sometimes fall through the cracks, because it's so hard to understand anything that's printed out for discharge.  There should be a standardized patient-friendly discharge form to help facilitate patient communication and understanding.

7) Up to date medication lists
Is there any reason why medication lists from pharmacies, etc, aren't automatically updated into the EMR?

8) Medical snapshot and timeline
There is a ton of information on patients who are already in the EMR system.  However, it takes a long time to sort through it all to find the useful information.  It's even harder to have a birds eye view of the patient's health through the years.  There are two options that I can think of to improve on this.  The first is an automated function to search through all the previous notes and summarize important and relevant events and graph these out visually on a timeline to give a more complete picture of a patient's health.  The second is a personalized medical record that patients can carry with them.  For example, every time the patient goes to the hospital or sees his PCP, his "health snapshot" would be updated with relevant events.  This would not just be a list of notes from previous visits, but a succinct, useful, and summary of the patient's overall health that is constantly updated.  This file can be carried in the patient's mobile phone or other devices, and can be scanned every time he comes in contact with the medical field.  This assures that the patient's most up to date medical information is always easily accessible.

Monday, April 21, 2014

Physician Lifestyle: Highest Pay per Hour 2014

SpecialtyPay per Hour
Orthopaedics$139
Dermatology$130
Gastroenterology$120
Plastic Surgery$119
Cardiology$117
Urology$115
Emergency Medicine$113
Radiology$113
Ophthalmology$110
Anesthesiology$107
Oncology$106
General Surgery$96
Nephrology$83
Neurology$83
Psychiatry$81
Pulmonary Medicine$81
Critical Care$81
OBGYN$81
Rheumatology$77
Pediatrics$74
Endocrinology$73
Internal Medicine$66
Family Medicine$64
Infectious Disease$63


Salary Comparisons:

Internal Medicine and its Subspecialties



Sunday, April 20, 2014

Physician Lifestyle: ROAD Specialties 2014

Last year, we tried to debunk the myth of the so-called ROAD (Radiology, Ophthalmology, Anesthesiology, and Dermatology) specialties.  These 4 fields are supposed to offer the best lifestyle for physicians.  We will try that again this year with new data.  Click here to see last year's survey data for comparison.


Specialty Mean 2013 Salary Weekly Hours Pay per Hour Training Years
Dermatology $308,000 45.4 $130 4
Radiology $340,000 58.0 $113 5 to 6
Ophthalmology $291,000 51.0 $110 4
Anesthesiology $338,000 61.0 $107 4

Salary source:  Medscape
Hours source:  AAMC


As we stated last year, Dermatology is by far the most well-rounded field in all of medicine.  Their pay is in the top third of all physicians and nobody beats their hours.  They rank number 1 in happiness, overall satisfaction, and career choice.  If you have competitive scores and are still undecided, I encourage you to try out Dermatology.  You will likely not regret the decision.  

Radiology has hit a very rough patch in recent years.  It went through Medicare reimbursement cuts in the late 2000s and now the job market is very tight.  It was 1 of 5 specialties that had a decrease in salary compared to the year prior.  Reported salary dropped by 2% in 2013 while inflation was 1.5%.  Radiology residency is still expanding, which will make the job market worse.  There were 1176 positions in the 2014 Match and 81 of them went unfilled.  

Ophthalmology had reimbursement cuts to cataract surgery many years ago.  The field is too dependent on Medicare reimbursements.  Medicare recently released its 2012 reimbursement data and Ophthalmologists received the highest amount per physician.  But this is not how much they get paid; it only represents revenue.  If the release of this data leads to political outcry and more cuts, then the financial aspects of this field will be in trouble.

Anesthesiologists are fighting a losing turf battle against CRNAs.  17 states so far have opted out of Medicare's physician supervision requirement for CRNAs.  If CRNAs come at a fraction of the cost, then hospitals have less financial incentive to staff so many Anesthesiologists.  Like Radiology, Anesthesiology residency also faces an over-expansion problem.  There were 1662 positions in the 2014 Match and 70 of them went unfilled.  They also work a lot of hours now, 61 a week.


It is time to redefine the lifestyle specialties.  ROAD might have applied 10 to 20 years ago but the financial and work landscapes have changed.  In my opinion, the ROA fields no longer qualify.  Only Dermatology withstood the test of time.  To premeds out there, don't go into medicine if you expect to work less than 70 to 80 hours a week as a resident or 50 to 60 hours a week as an attending.  Dermatology might be the answer for some but there were only 414 spots in the 2014 Match out of 29,671 spots offered for all residents.  From now on, just assume the weekly hours for every specialty will rise and there will not be a 40-hour weekly job in the future.  The financial difference between them will lie in the salary and pay per hour.  If you are already in medical school, this is a free society and you are free to maximize your potential.  You are free (as long as you are competitive enough) to choose a specialty for whatever reason and do not have to defend it.  If those reasons are financial (like the majority of working Americans), then I have some recommendations for you.


Just DOG it specialties.  I could have used the acronym in reverse but it is Easter Sunday...

Specialty Mean 2013 Salary Weekly Hours Pay per Hour Training Years
Dermatology $308,000 45.4 $130 4
Orthopaedics $413,000 57.0 $139 5
Gastroenterology $348,000 56.0 $120 6

Salary source:  Medscape
Hours source:  AAMC


As I mentioned previously, Dermatology is the most well-rounded field in medicine.  It offers the lowest weekly work hours.  Orthopaedics and Gastroenterology are procedure-heavy fields and they take a lot of call.  However, they are well compensated on a pay per hour basis.  Keep in mind that Gastroenterology is a fellowship and you do have to go through 3 years of Internal Medicine first.  Listed below are the Match rates for US MD graduates.  The 3 specialties are about equal in competitiveness.

Dermatology:  79%
Orthopaedics:  77%
Internal Medicine/Gastroenterology:  95% x 78% = 74%

The main point is expect to work very hard for your pay.