Competitiveness of GI and Cardiology

[automaton]

Most people know that GI and Cardiology are "competitive." But for medical students who are thinking of IM mainly as a gateway for fellowships, it might be useful if people can comment on the relative competitiveness of these fellowships. Is it just as difficult as matching into Radiology or Dermatology? Perhaps comparable to matching into EM? Can anyone provide a ballpark estimate of exactly how bad the competition is for these spots? It would suck if some people go into IM thinking they can get a fellowship if it turns out being very difficult.

PS: How about Nephrology? I know it is less competitive than GI, Cards, and Allergy, but again, a ballpark idea would be useful.

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[Handsome88]

Most people know that GI and Cardiology are "competitive." But for medical students who are thinking of IM mainly as a gateway for fellowships, it might be useful if people can comment on the relative competitiveness of these fellowships. Is it just as difficult as matching into Radiology or Dermatology? Perhaps comparable to matching into EM? Can anyone provide a ballpark estimate of exactly how bad the competition is for these spots? It would suck if some people go into IM thinking they can get a fellowship if it turns out being very difficult.

PS: How about Nephrology? I know it is less competitive than GI, Cards, and Allergy, but again, a ballpark idea would be useful.

6 yr bump. How come nobody replied?

 

[panipuri]

in terms of competitiveness

GI> Cards> Heme onc> Pulm Critic= Endo > Rheum > ID> Nephro

allergy immunology has very few spots so its competitive too but i wont put it in this rank order...

ID and Nephro are least competitive...if you do residency from university u can match anywhere with a moderate cv consisting of any case report...i knw many matched without any research or case report..

Cards, GI and heme onc- your best chances will be in house fellowship...coming from community prog chances get slimmer...need research +/- abstract for sure...

this year atleast from few prog i know....endo and pulm critical care is getting more competitive...
even in my prog there are atleast 5 residents each applying in above specialties...
cards 2 and gi only 1 resident....

if you are IMG and require visa....especially H1 then aim for ID and Nephro...otherwise J1 is avaialbe in other subspecialties..

 

[Handsome88]

in terms of competitiveness

GI> Cards> Heme onc> Pulm Critic= Endo > Rheum > ID> Nephro

allergy immunology has very few spots so its competitive too but i wont put it in this rank order...

ID and Nephro are least competitive...if you do residency from university u can match anywhere with a moderate cv consisting of any case report...i knw many matched without any research or case report..

Cards, GI and heme onc- your best chances will be in house fellowship...coming from community prog chances get slimmer...need research +/- abstract for sure...

this year atleast from few prog i know....endo and pulm critical care is getting more competitive...
even in my prog there are atleast 5 residents each applying in above specialties...
cards 2 and gi only 1 resident....

if you are IMG and require visa....especially H1 then aim for ID and Nephro...otherwise J1 is avaialbe in other subspecialties..

Thanks. But the OP was asking about what is considered as competitive for Cards/GI or Hem onc. For example if my choice was between EM and Cards, would it be easier to just go for EM than going from IM to Cards? Some people are just using IM as a gateway for these specialties, but end up not matching in a subspecialty and wishing they had tried matching EM instead from the beginning.
Maybe a percentage of applicants to Cards that match compared to people who match to EM.

 

[panipuri]

oh i didnt read the whole question.
yes than EM is better...

but see what matters for cards is
- your residency prog- community vs university
- in house fellowship
- your patience and readiness to spend time for research during residency...
- amg vs img status..
- willingness to relocate anywhere in usa for fellowship...

but to be honest...go wherever u like to go...dont take EM just because its easier to get into or viceversa....
U hv to spend your whole life practicing a particular specialty...
"Do what u love, love what u do"

 

[digitlnoize]

I'd like to point out that no one knows what the future may hold, and if we see a big drop in procedural reimbursement, you may find cards/GI salaries barely higher than hospitalists'. If this happens, less people would want to spend the extra years in fellowship and will instead opt to go into practice, making subspecialties easier to match. Either way, the current reimbursement system is unsustainable and has to change, the question is how it changes...

 

[pntgrd]

Cards reimbursement are getting big hits, and I predict GI will become way less competitive in the next 5 to 10 years as their bread and butter money maker, colonoscopy, will be replaced by highly sensitive fecal tests for cancer which are in development.

 

[nope80]

How about endocrinology? How competitive to get into the top programs? How much research do people typically do before they apply?

 

[Moozy]

The reimbursements for heme/onc and Cards have gone down which still leaves GI as the most competitive specialty. I hear that reimbursements for Renal have also gone down a lot; whereas CC has increased by 20% and Pulmby 14%.

In comparison to 2008; the number of Pulm/CC applicants for fellowships has increased by 30-40% and Renal has gone down dramatically. The post fellowship market for Renal/ID and Cardiology is not good either especially if you need visa.

I'd like to point out that no one knows what the future may hold, and if we see a big drop in procedural reimbursement, you may find cards/GI salaries barely higher than hospitalists'. If this happens, less people would want to spend the extra years in fellowship and will instead opt to go into practice, making subspecialties easier to match. Either way, the current reimbursement system is unsustainable and has to change, the question is how it changes...

 

[Handsome88]

The reimbursements for heme/onc and Cards have gone down which still leaves GI as the most competitive specialty. I hear that reimbursements for Renal have also gone down a lot; whereas CC has increased by 20% and Pulmby 14%.

In comparison to 2008; the number of Pulm/CC applicants for fellowships has increased by 30-40% and Renal has gone down dramatically. The post fellowship market for Renal/ID and Cardiology is not good either especially if you need visa.

Wow big change in only 2 years! Would it be safe to say that in the next 3-5 years that the competitiveness would be as follows:

GI>>>Cards> Pulm/CC > Allergy> Hem/onc >> nephro

 

[Moozy]

I think heme/onc and pulm/cc both share the third spot at this time.I suspect heme/onc will go further down now. Cards is still intriguing due to interventional, but lack of post market fellowship may effect the competition for FMGs. But CC life style may never make it go higher than where it is.

Wow big change in only 2 years! Would it be safe to say that in the next 3-5 years that the competitiveness would be as follows:

GI>>>Cards> Pulm/CC > Allergy> Hem/onc >> nephro

 

[bronx43]

Wow big change in only 2 years! Would it be safe to say that in the next 3-5 years that the competitiveness would be as follows:

GI>>>Cards> Pulm/CC > Allergy> Hem/onc >> nephro

The end result will be parity amongst specialties. Competitiveness now is simply a reflection of the present. If you're applying based on the present, then you'll likely be disappointed when you actually reach your goal 3-4 years later.

 

[AuroraK]

Im hearing a lot of theories, but lets be honest, reimbursement across the board is going to be cut, and there is going to be a lot of parity between specialties as a result. So competitiveness will probably be more related to lifestyle in the future, than reimbursement which it is now. Which probably means Cards and GI will become less competitive, since you have to be available 24-7, compared to HemeOnc/Endo/Rheum which you do not have to be in-house, or Critical Care where you are on shiftwork. I dont really count allergy because it's competitive only because there are no fellowship spots for it, but I would consider it more competitive.

 

[panipuri]

this are my predictions..may be wrong

in next 5 years

More applicants for Pulm, Endo (solely for lifestyle and intellectual, u dont make money in endo)
Pulm/cc is making its way to good lifestyle now..there are intensivist who work for 1 week on and 1 week off - same as hospitalist do...
pulm outpatient is cushy...and with sleep medicine u make money too.
Rheum may go up- coz of reimbursement and many new immunomodulators coming in market which requires infusion set up..
Cards, Gi, heme onc will go down
nephro and ID will be at same what it is now...at the bottom..

 

[Moozy]

Actually Sleep is going down already. The reimbursements have gone down by 21% already as per ACCP Coding 2011. And Sleep is now sought by Neutology, Primary Care as well as Pulm.

Pulm is going up already due to interventional stuff. I think Critical Care is the same and with shift work will become more competetive.

Agree with your assessment on Rheum. Renal for sure is going down fast. ID was never in the business esp. after HAART; and it will not grow further.

Anyways. These are all speculations. At the end what matters is what you like and are content doing. I never liked Cards and still dont.. Have always liked CC/Pulm and am glad I chose it at the times when people always advised otherwise due to life style.. and if it is becoming popular... good for me.. if not.. still good for me.

this are my predictions..may be wrong

in next 5 years

More applicants for Pulm, Endo (solely for lifestyle and intellectual, u dont make money in endo)
Pulm/cc is making its way to good lifestyle now..there are intensivist who work for 1 week on and 1 week off - same as hospitalist do...
pulm outpatient is cushy...and with sleep medicine u make money too.
Rheum may go up- coz of reimbursement and many new immunomodulators coming in market which requires infusion set up..
Cards, Gi, heme onc will go down
nephro and ID will be at same what it is now...at the bottom..

 

[sacrament]

Choosing a career path in medicine based on speculation regarding future compensation and job prospects is like trying to beat the stock market and, with only a few notable exceptions, you'd be a fool to make your decisions based on these hallucinations. Moozy is absolutely right: you have to choose based simply on what you enjoy. It's never more true than in medical training, when you spend years and years getting to a destination and all the while the political and economic terrain is shifting under your feet. There's nothing you can do about that.

 

[Handsome88]

Choosing a career path in medicine based on speculation regarding future compensation and job prospects is like trying to beat the stock market and, with only a few notable exceptions, you'd be a fool to make your decisions based on these hallucinations. Moozy is absolutely right: you have to choose based simply on what you enjoy. It's never more true than in medical training, when you spend years and years getting to a destination and all the while the political and economic terrain is shifting under your feet. There's nothing you can do about that.

Yes you are very right. But people assess what they like by criteria such as (but not limited to) the lifestyle and reimbursements of the specialty (trust me, not THAT many people actually love radiology for the subject, most of them choose it for money and lifestyle). So it is good to know what will happen to these criteria in the future. We are only forecasting, and we could be wrong.

Anyways I got a question. Are ahe reimbursments of all these subspecialties (besides GI/Cards/Pulm) lower than General IM? So residents purely choose them based on lifestyle? I'm not sure how to find accurate numbers...different sources give me different numbers.

 

[lungdocCA]

After a decade in Pulmonary/Critical Care I realize I should have done something else. I have done it all; outpatient Pulmonary, Sleep Disorders, Inpatient Critical Care. Although the field is fascinating the drawbacks are horrible. High liability, frequent lawsuits, relatively poor compensation, bad call, horrible hours and ultimately I find I am "the dumping ground" The best that I found to do is Inpatient Hospitalist work; why do three years of fellowship (plus a year of Sleep Medicine). Just be a Hospitalist - they can do 90% of Critical Care.