Here are my thoughts of current job market from a senior fellow:
1) Things fluctuate. Just because more available jobs right now in GI, ect, doesn't mean that will be the case in 2 years or 5 years or 10. I do agree that the number of graduating fellows is probably too high and I'm not sure if I agree with the ACC's constant doom and gloom on Cardiologist shortage, but do need to remember when dealing with Cardiology that EP, Interventional, General/Imaging, and even now HF are all basically different subspecialties and can be viewed in that way and it does require more fellows that your basic GI or pulm/cc.
2) EP may have a "job shortage" but every EP guy from my program has found a job in the last 5 years with the vast majority of those guys finding jobs in places they were searching including some competitive areas like Dallas/Houston, ect. From my experience, I haven't seen the "I can't even find a job" talk that I see on the internet and with other specialties. Also, in my area (mid-size metropolitian area) the EP guys in practice still have the "best" jobs and are making 500-800k, no significant call, ect.. It's just that it doesn't take as many EP docs to cover a hospital and most of the ones I know have a good set up and don't want to share right now.
3) If job security is your main concern I think Interventional with broad level II will be the safest bet. STEMI coverage will always be needed especially with every community/regional program wanting 24/7 coverage. The old-timers can only do so much and have to open it up for help more so than General or EP guys. Plus a lot of grandfathered Interventional guys should be coming up on retirement in 5-10 years when they start dropping down in the cath lab. Also, we had a CV-line leader of a local hospital chain talk to us and basically stated that after they get 1-2 General Cards guys that can do advanced imaging (MRI), they have little desire to bring in any more General guys but prefer Interventional guys that are expected to do more General work but also can cover Interventional call and do some Interventional work. So I think even with cath volumes going down that skill set is still needed and will only help in your job search..
4) Even with reimbursements going down, salaries that I've seen are still holding somewhat tight for now and definitely in a decent range IMO. U can't expect the 800k+ salaries but I would be plenty happy to be in the 400-500k range especially if work load isn't as bad. And that range is what I've been seeing with most tentative offers for IC in some decent sized cities in the West (outside of SF, LA, Seattle), Midwest, South, ect.
5) The most important thing IMO is for the Cardiologists in the communities to be more united and leave the dog-eat-dog previous mentality that PP Cards guys used over the years and realize that there is power in numbers. Communities/hospital chains need our skill set. I've seen some great set-ups by groups (usually led by younger guys) that have reasonable and fair contracts and who have very good quality-of-life set ups (4 day work weeks, 6-10 weeks vacation) because the Cardiologist share responsibilities/patients, ect. The times when you had 5-6 docs running around seeing "their patients' at 3-4 local hospitals, doing cath/clinic/inpatient same days, ect should all come to an end. The best group set ups I've seen are those where it's run like a fellowship where someone is on cath for a week, wards for a week, clinic/echo/nuc for a week. No reason why that shouldn't be the case IMO.
6) Cardiologists should demand to get paid for STEMI call and even General Call like Trauma docs get paid for Trauma call, ect... and that should become more the mainstay IMO.
7) I still think the value of being in a specialty that can't be taken over by mid-levels (EP, IC, most General) is of extreme importance... In 5-10 years the influx of midlevels in Hospitalist work will only get worse. I expect midlevels to be more involved in GI/scopes than what we do.
8) There is a reason why the turnover rate is so high with Hospitalists (50%+ in 3-4 years) even with good pay/time off. It's easy for med students or residents to not understand that but until you work as a hospitalist (which I have) vs. specialist than you won't truly understand the picture. Being lowest on the totum pole as a 50 year old Hospitalist who is being forced to admit drunk after drunk or Ortho's hip fracture takes a special personality in order to take that. Personality, can't even do it as a moonlighting fellow.
9) There is always value in having a skill set that is the only skill set that can take care of the hospital's sickest and most profitable (along with Ortho) patients. Again, it requires the specialty to come together to understand that value.
