Lesser known high paying fields?

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I shadowed a rural FM doc. It was like he was literally printing money.

However, he worked 7 days a week. On the weekends he'd cover the ER. He also covered the local nursing home.

I don't know when he slept.
 
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you can make money in almost any field, except Peds and some IM sub specialties like palliative care, geriatrics, ID. I'm only a medical student still but here's what I've seen from attendings I've rotated with who all make a lot:

Psychiatry -> outpatient psych while taking some inpatient duties easy 300k
Anesthesia -> pain fellowship 400k+
Radiology -> volume volume volume efficiency efficiency efficiency 400k+
Rad Onc -> don't need to explain
Plastic surgery -> cosmetics; just don't do inpatient burn unit
EM -> 36 hours/week = 300k+
PM&R -> plenty of money and relaxation (mix of inpatient + outpatient = 250k+ working <50hr/week)
Neurology -> stroke/ICU easy 400+
ObGyn -> REI clinic or MFM easy 400k
General Surgery -> MIS fellowship = $$$
Orthopedic Surgery, Neurosurgery -> $$$ but work hard
Ophtho -> initially suck up to partners in pp so you can become partner, then $$$
ENT -> outpatient pp group = $$$
Pathology -> 300k+ working <50 hrs/wk as long as you don't work in cities > 200k population
IM -> Cardiology = cath all day if invasive, outpatient pp if noninvasive; both 300k+
IM -> GI = colonoscopy all day; guaranteed 300k+
IM -> Heme/Onc -> pp = guaranteed 300k+
IM -> pulm/cc = guaranteed 300k+ but you work >60hrs/week
IM -> endocrine/rheum = 250k with closer to 40hrs/wk
Family med -> open own practice and don't accept Medicaid/Medicare
Nephrology -> operate your own dialysis center

I think I got majority of specialties. Please correct me if I'm dead wrong about any of the above. Just my observations..


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The field of Nephrology is owned by Davita - conglomerate that has monopolized pretty much all dialysis centers and all docs are just employees. Good luck trying to open a dialysis center. This has decimated the field.
 
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Pathology has similar problems with Quest and Labcorp
 
you can make money in almost any field, except Peds and some IM sub specialties like palliative care, geriatrics, ID. I'm only a medical student still but here's what I've seen from attendings I've rotated with who all make a lot:

Psychiatry -> outpatient psych while taking some inpatient duties easy 300k
Anesthesia -> pain fellowship 400k+
Radiology -> volume volume volume efficiency efficiency efficiency 400k+
Rad Onc -> don't need to explain
Plastic surgery -> cosmetics; just don't do inpatient burn unit
EM -> 36 hours/week = 300k+
PM&R -> plenty of money and relaxation (mix of inpatient + outpatient = 250k+ working <50hr/week)
Neurology -> stroke/ICU easy 400+
ObGyn -> REI clinic or MFM easy 400k
General Surgery -> MIS fellowship = $$$
Orthopedic Surgery, Neurosurgery -> $$$ but work hard
Ophtho -> initially suck up to partners in pp so you can become partner, then $$$
ENT -> outpatient pp group = $$$
Pathology -> 300k+ working <50 hrs/wk as long as you don't work in cities > 200k population
IM -> Cardiology = cath all day if invasive, outpatient pp if noninvasive; both 300k+
IM -> GI = colonoscopy all day; guaranteed 300k+
IM -> Heme/Onc -> pp = guaranteed 300k+
IM -> pulm/cc = guaranteed 300k+ but you work >60hrs/week
IM -> endocrine/rheum = 250k with closer to 40hrs/wk
Family med -> open own practice and don't accept Medicaid/Medicare
Nephrology -> operate your own dialysis center

I think I got majority of specialties. Please correct me if I'm dead wrong about any of the above. Just my observations..


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My peds attending made at least 400k/year, probably more since one of his several daughters had a brand name backpack that costs around $1,800...

However, he rotated at 2 hospitals every day and was the medical physician for 2 child psych hospitals, all of which he would go to everyday (rotated at hospital in the morning before clinic, went to psych hospitals in afternoon during lunch) along with working in his group's private clinic. He worked 12 hours+ 6 days a week (started rotating at hospitals between 4 and 5am and clinic "closed" between 4-6 depending on the day) and would rotate at all the hospitals on sundays (so 6-8 hours). Lucky for us he didn't make us go to the hospitals every day and we got Sundays off, but for a peds rotations it was a nightmare.

Point is you can make bank in pretty much any medical field if you're willing to work yourself to the bone.
 
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My peds attending made at least 400k/year, probably more since one of his several daughters had a brand name backpack that costs around $1,800...

However, he rotated at 2 hospitals every day and was the medical physician for 2 child psych hospitals, all of which he would go to everyday (rotated at hospital in the morning before clinic, went to psych hospitals in afternoon during lunch) along with working in his group's private clinic. He worked 12 hours+ 6 days a week (started rotating at hospitals between 4 and 5am and clinic "closed" between 4-6 depending on the day) and would rotate at all the hospitals on sundays (so 6-8 hours). Lucky for us he didn't make us go to the hospitals every day and we got Sundays off, but for a peds rotations it was a nightmare.

Point is you can make bank in pretty much any field if you're willing to work yourself to the bone.

I mean if those silly poor single moms just worked 4 jobs they could support their kids just fine too
 
Can fellowships still be done during research years?
Yes. Most can, at least. Peds needs to be done post-residency, and not every program has fellowships in every field (you can apply to be taken as a fellow at another program, however, if your program will allow you to leave for a year).

EDIT (I asked a fellow): Neurosurgical endovascular fellowships are 2 years: you can either do them both post-residency, or 1 post-residency year if you've done 1 year enfolded. Most other neurosurg fellowships are 1 year and can be done enfolded. I know some people who have done an enfolded in one field followed by a post-residency fellowship in a different field (skull base and endovascular, onc-peds, etc.).
 
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Psych. I know some one who works 80 hour weeks & makes over 700k.
You could make 700k working 80 hours a week in a lot of fields. Hospitalist work can pay 200 an hour or more in rural spots, put in 80 hours and you're making 800k. Hell, if you get an ER job making 300/hour (which is more than doable in a lot of rural southern areas), you can pull $1.2 million a year.
 
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Anyone who works 80 hours a week deserves that kind of $$. You'd have to be crazy to aim to work 80 hrs a week, but to each their own.
 
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You could make 700k working 80 hours a week in a lot of fields. Hospitalist work can pay 200 an hour or more in rural spots, put in 80 hours and you're making 800k. Hell, if you get an ER job making 300/hour (which is more than doable in a lot of rural southern areas), you can pull $1.2 million a year.

Yeah but I was under the impression that EM had monthly work hour restrictions. I think its its 160 or 180 hrs/month.

Correct me if I am wrong please.
 
Yeah but I was under the impression that EM had monthly work hour restrictions. I think its its 160 or 180 hrs/month.

Correct me if I am wrong please.
There are no work hour restrictions when you're an attending lol. What, you think the government is going to make you take a seat or something lol? No, as a resident you're limited to 60 hours a week (just over 240 hours a month on average), but as an attending you can do whatever the **** you want. You'll burn out quick though.
 
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Yeah but I was under the impression that EM had monthly work hour restrictions. I think its its 160 or 180 hrs/month.

Correct me if I am wrong please.

Nope, like Mad Jack said, only restrictions are in residency. One of my buddies had an EM doc as a mentor he told me about. The guy worked insane hours for 4-5 years to pay off their debt and build up a solid starting nest egg and then proceeded to work 25-30 hour weeks for the next X years. Idk exactly how many hours/wk or month he was working, but apparently he was making 600k+/yr. Basically, he spent 4-5 years in his early 30's killing himself so he could spend the rest of his career working 3 days a week making 150k+ and let his investments accumulate for retirement.
 
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You could make 700k working 80 hours a week in a lot of fields. Hospitalist work can pay 200 an hour or more in rural spots, put in 80 hours and you're making 800k. Hell, if you get an ER job making 300/hour (which is more than doable in a lot of rural southern areas), you can pull $1.2 million a year.

What does a 80 hour week schedule look like? 12 hour shifts? 24 hour shifts (including on-call?)? is that over 5, 6 or 7 days? I'm genuinely curious and have always wondered
 
I know ER doctors who easily cleared 750-800k by picking up shifts all over the Midwest ...
 
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What does a 80 hour week schedule look like? 12 hour shifts? 24 hour shifts (including on-call?)? is that over 5, 6 or 7 days? I'm genuinely curious and have always wondered
Depends on what you want. ED work is shift work, so if you were looking to do 80 hours, best way to do it would be 4 12 hour shifts and 2 16 hour shifts per week. In residency it's usually 6 12-16 hour shifts all in a row with a day off on an 80 hour rotation like IM, but some places have you do 30 hour shifts once a week then fill in the rest with 12s and 16s to give you a couple days off a week on occasion.
 
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Maybe don't give such specific numbers guys. Radiologists posting their salaries online was referenced as justification for slashing their pay a few years back.
 
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I've had attending tell me directly. Some to brag, and others to educate. I had no idea rural ER can pay 900k.

That's 375/hr at 200 hrs per month. I doubt anyone is able to string that kind of time and money together...
 
Maybe don't give such specific numbers guys. Radiologists posting their salaries online was referenced as justification for slashing their pay a few years back.
I'm using numbers that are available from various salary sites. The big exception to this in the thread is likely the outlier psychiatrists- they're typically cash-only private practice types, pretty hard to slash the salary of a guy who doesn't take insurance and charges patients directly lol.
 
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That's 375/hr at 200 hrs per month. I doubt anyone is able to string that kind of time and money together...

That does sound pretty outrageous at a flat rate. However, if a person does 10 nights of call in a month at 3k/night (something I've heard of in several locations), that's an extra 30k/mo or 360k/year. If the guy had a set-up like that, it drops down to 225/hr at 200 hrs per month (to put them at 540k/yr, totaling 900k with call), which seems a lot more realistic. Either way sounds like a pretty crazy set up, but if that were really the case it's probably part of why he chose another job that paid 1/3 the salary...
 
That does sound pretty outrageous at a flat rate. However, if a person does 10 nights of call in a month at 3k/night (something I've heard of in several locations), that's an extra 30k/mo or 360k/year. If the guy had a set-up like that, it drops down to 225/hr at 200 hrs per month (to put them at 540k/yr, totaling 900k with call), which seems a lot more realistic. Either way sounds like a pretty crazy set up, but if that were really the case it's probably part of why he chose another job that paid 1/3 the salary...

What part of call are you talking about? It's impossible as an ED provider to work 280+ hours/month as you have described. If he has a base gig at 225/hr and is working 200 hrs/mo he is the hardest working doc in his group. Most groups are not doing 12's, meaning that he's likely doing a mix of 8's and 10's to get to 200 hours/mo which is 20+ shifts at his home institution. You can't pile on an additional 10 nights of moonlighting b/c you would essentially work every single day of the month for 1 year straight.

My point is that most ED docs are not making 375/hr or working 200 hours/mo. If he's like hard working partner doing 160 hours/mo at a "partner rate" then he would have to have a rate of $470/hour to make 900k/year which doesn't happen. Can it happen on a locum-level for a few shifts? Sure it can... but it's not going to be something that is sustained for very long as the CEO's won't let it.
 
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What part of call are you talking about? It's impossible as an ED provider to work 280+ hours/month as you have described. If he has a base gig at 225/hr and is working 200 hrs/mo he is the hardest working doc in his group. Most groups are not doing 12's, meaning that he's likely doing a mix of 8's and 10's to get to 200 hours/mo which is 20+ shifts at his home institution. You can't pile on an additional 10 nights of moonlighting b/c you would essentially work every single day of the month for 1 year straight.

My point is that most ED docs are not making 375/hr or working 200 hours/mo. If he's like hard working partner doing 160 hours/mo at a "partner rate" then he would have to have a rate of $470/hour to make 900k/year which doesn't happen. Can it happen on a locum-level for a few shifts? Sure it can... but it's not going to be something that is sustained for very long as the CEO's won't let it.

I was just giving an alternative payment contract as to how one might arrive at that $900k mark. I also forgot we were talking about ED docs with this though. I've met surgeons in private practice that do 8-10 call nights/mo at the rate I stated and also work their regular schedules on weekdays. The call nights were at rural/outer suburban locations where most of the time they wouldn't even get called in, they'd collect their extra paycheck just for taking the pager home with them. I guess I was working off the idea of 10 call shifts (~80 hrs) + 20ish 8-10 hour days/month (the weekdays) which is your 160-200hrs/mo, for a total of 240-280hrs (depending on what their weekday schedule looks like). Doing that you'd have to make ~280/hr on your normal non-call shifts to end up at 900k. Still really high, but not as outrageous as $470/hr.

It's still a crazy schedule, and I'm not saying that's what would happen. I was just trying to give other ideas as to how to arrive at that 900k other than straight hourly pay.
 
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Psych. I know some one who works 80 hour weeks & makes over 700k.
I would be curious to hear what this 80 hr week looked like. Inpatient? outpatient? Pp? Location (can be vague to keep amininmity).
 
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Psych has huge earning potential. Do child psych in an area where there isn't one. You will make good money. Only two child psychs in the area I did my clinicals and they made 500 to 600k including their rvus
 
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I would be curious to hear what this 80 hr week looked like. Inpatient? outpatient? Pp? Location (can be vague to keep amininmity).

This person is obsesssed with money, they go home about once every 3-4 days. They work days at a child psych PP, Inpatient night shifts, and another outpatient PP. And these are all within 2-3/hrs from a major NE city.

Not a good way to live imo. I do think 3-400k might be doable in a PP setting for around 50hrs a week. Another person I know works 4hrs/day 5 days/wk at a midwest city and pulls in 260k.
 
What I've taken away from this thread is: You can make a lot of money in literally any specialty.
 
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What I've taken away from this thread is: You can make a lot of money in literally any specialty.

What is missing in this discussion is that the ease with which one can make X varies.

The starting salary for many dermatologists for a 4 day work week (which is often considered "full time" for derm) can be twice than of a pediatrician working 5 days a week. An orthopedic surgeon with a full schedule will make more hour-per-hour than an outpatient primary care doc with a full schedule.

Yes, a degree of business acumen and the right payer mix can shift the scales, but there are major differences in remuneration across specialties.

Let us not forget that due to a graduated federal tax system (and often a graduated state tax system, too), each extra dollar earned after certain tax theresholds are taxed at a higher rate. Is it really worth busting your butt to earn 500k instead of 400k if that extra 100k has a tax rate of at least 40%?
 
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Not to digress to the ER physician making 900k, but there are areas in the rural Midwest that certainly present these opportunities. The gigs may or may not be hard to come by, but a hospital I'm very familiar with was paying one EM boarded locum physician (filling most of the weekdays with midlevels) upward of 12k a weekend. Which comes out to a reasonable 250/hr. The midlevels were making ~5k. I knew him well enough to talk money with him and he basically said it's worth it to fly in about 3 weekends each month and work less than half time during the week at his regular job. Granted, he was doing 48 hour in-house (very non-doctorlike) shifts in a low volume ED. So sometimes it really really sucked. Sometimes it was really pretty good. He's one of two ER docs I knew that flew in from other parts of the country to work in their "off" time. I wasn't close enough with the other one to talk about money, but she did very well for herself.

I guess the point of this is to illustrate that working shifts outside of the normal length/frequency can really add up. And yeah it can put you in a position to make almost 1M if you really hustle. Most people don't want to work that hard, myself included.
 
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Not to digress to the ER physician making 900k, but there are areas in the rural Midwest that certainly present these opportunities. The gigs may or may not be hard to come by, but a hospital I'm very familiar with was paying one EM boarded locum physician (filling most of the weekdays with midlevels) upward of 12k a weekend. Which comes out to a reasonable 250/hr. The midlevels were making ~5k.

I don't get the logic here. If the hospital is able to manage just fine with midlevels on the weekdays, why would it pay pay an EM doc 2 or 3 times the rate on the weekends instead of just having the midlevels cover the weekend as well? It's not like the hospital can tell its patients to hold off coming for their "complicated" emergencies till the weekend lol.
 
Psych. I know some one who works 80 hour weeks & makes over 700k.

Anyone have info on PP psychiatry market?

Locums. My buddy once made $15,000 in a single shift. Granted it was a last minute deal on a holiday but I routinely made $4,000-5,000 a shift myself back in residency for last minute call ins. Credential yourself out to a large geographical area and just negotiate.

Do they pay for transportation?

I've had attending tell me directly. Some to brag, and others to educate. I had no idea rural ER can pay 900k.

Wut

I would be curious to hear what this 80 hr week looked like. Inpatient? outpatient? Pp? Location (can be vague to keep amininmity).

+1
 
Anyone have info on PP psychiatry market?



Do they pay for transportation?



Wut



+1
Depends on your contract for transportation.

You can make that much in EM but only if you are working nearly every day. Like literally almost every single day. It's not sustainable by a long shot.
 
I don't get the logic here. If the hospital is able to manage just fine with midlevels on the weekdays, why would it pay pay an EM doc 2 or 3 times the rate on the weekends instead of just having the midlevels cover the weekend as well? It's not like the hospital can tell its patients to hold off coming for their "complicated" emergencies till the weekend lol.

I agree, the logic is a bit skewed. But one thing I've noticed having worked for a smaller hospital and a Catholic Wal-Mart style conglomerate is that administration at some (most) places is ridiculous. I remember one conversation where he told me that he thinks it is because during the week they have more medical staff available in other parts of the hospital, so the ER staff doesn't have to go up and do codes, rapid responses, etc. It was better to have a doc on the weekends because they had minimal medical staff in-house to deal with those nondepartmental emergencies. My wife worked with him in the ED some weekends and she said they frequently earned their money.
 
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Depends on your contract for transportation.

You can make that much in EM but only if you are working nearly every day. Like literally almost every single day. It's not sustainable by a long shot.

Tenk what's your specialty? You said as a resident you made 4-5k per shift doing locums, I am very interested. Can you please elaborate a bit
 
Thanks. Is this something that you can do in other fields like IM or Radiology once you're a PGY-2/3? Sounds like a great way to help with loans
Uncortunately I have no idea, I just stumbled in from pre-allo and saw a rare question that I could answer in this forum.
Back to my regularly scheduled confused silence.
 
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Uncortunately I have no idea, I just stumbled in from pre-allo and saw a rare question that I could answer in this forum.
Back to my regularly scheduled confused silence.

Lol no worries, thanks. Will wait to see if residents can chime in
 
Thanks. Is this something that you can do in other fields like IM or Radiology once you're a PGY-2/3? Sounds like a great way to help with loans
IM can moonlight in UC and sometimes hospitalist if small enough. Radiology, technically can do UC but I don't think many would do that, seems dangerous. UC pays far less than ED, like on the magnitude of less than half.
 
Thanks. Is this something that you can do in other fields like IM or Radiology once you're a PGY-2/3? Sounds like a great way to help with loans

I'm FM and most residents in my program start moonlighting as PGY2 in rural EDs for ~$200/hr.


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What I've taken away from this thread is: You can make a lot of money in literally any specialty.

That is correct and you are only scratching the surface. Most MDs accept their fate when it comes to their career trajectory thanks to the current business model employed in medicine, a business model that isn't all that old. It is telling that we who bust our rumps to earn the right to be called Doctor, would be willing to simply lay on the ground and let medical business leaders (e.g. hospital admins, executives at 3rd party payers, bureaucrats at CMS, politicians, etc) roll over us. This is especially striking when it is MDs who literally drive the business. Every single individual in the medical sector gets to do what they do because a physician orders something. And the voyeurs in this scenario have their hands waiting to collect "their fair share" of what the physician is doing.

With an MD in your back pocket you can literally make as much as you want in spite of the current business model. Think outside the box. Don't settle for the current business model to which you limit yourself. Assess your skillsets (only you know them), prioritize your top 5 goals in life, marry them to your MD Degree, and work accordingly towards those fives goals with your known skillsets. Some recent examples of people who refused to play the game of Third Party Payers, CMS and medical groups:

Atul Gawande, MD, MPH
Stefan Larsson, MD, PhD
Abraham Verghese, MD (a Foreign Medical Graduate who practices in USA)
Siddhartha Mukhrejee, MD, DPhil

Each of these physicians gave TED Talks on how they see medicine today, and how physicians should lead. Dr Mukhrejee's short book, "The Laws of Medicine" is brilliant and it provides much fertile ground for this topic on business options for physicians. Dr Verghese has written and spoken at length on this topic as well.

all of these physicians are outliers. All of them come from ethnic/minority backgrounds. They also make very good incomes.

Each has tapped their own skillsets, matched them to their MD training, and created their own path.

Get to know your skillsets, prioritize your top 5 goals in life, and kiss 3rd party payers, medical groups, and CMS goodbye.
 
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Gawande is arguably the worst shyster in all of medicine. It's definitely between him and 'ol Ezekiel Emanuel. At my school we had one of those useless interprofessionalism lectures in which the speaker (not an MD of course) was waxing poetic about the glory of Atul Gawande. My eyes rolled so far back into my head that I blacked out and had a seizure. Damned Gawande turned me into an epileptic from a distance, that's the sort of "doctor" he is.
 
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You can make a pretty high salary in just about any field. The key things that determine your pay are 1) your practice environment (i.e., inpatient vs. outpatient, private practice vs. academics vs. public sector) and 2) how much you're willing to work. You can make a killing working 60-80 hours in just about any specialty. Even in psych - typically considered "low paying" - a private psych hospital in my area offers new residency grads $300k for 40 hours/week of ER shift work. Granted, the shifts are timed randomly - which obviously sucks - but you can't argue with the pay.

The problem is that people expect to work 9-5, 5 days/week and make an insane amount of money. Those opportunities are rarer and more specialty-specific (i.e., fields that are mostly procedure-driven). But if you're willing to work outside of those assumptions and have some degree of business acumen, most specialties can be quite lucrative.
 
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Gawande is arguably the worst shyster in all of medicine. It's definitely between him and 'ol Ezekiel Emanuel. At my school we had one of those useless interprofessionalism lectures in which the speaker (not an MD of course) was waxing poetic about the glory of Atul Gawande. My eyes rolled so far back into my head that I blacked out and had a seizure. Damned Gawande turned me into an epileptic from a distance, that's the sort of "doctor" he is.

Care to elaborate?
 
.....the likes of Mehmet Oz and Deepak Chopra in quackery is quite the indictment.

Quackery is one of Orac's favorite themes that he develops on his website Respectful Insolence. Orac (aka David H. Gorski, MD, PhD, Surgical Oncologist) is long winded but he definitely calls out the quacks. Great writer.

NaturopathQuack-590x360.jpg
 
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