Rheum vs pulm crit

[bronx43]

Well sure you can post things if you know a few things about the specialty. I posted my anecdotes and told you data isn't complete because there are other websites such as the AAAAI and ACAAI postings jobs, along with monthly posts about academic jobs that fellowship directors distribute. Again, people in the field would know this. I'm giving you anecdotes as someone who is in the field, yet you refuse to accept it. The field is no way in trouble and there are plenty of jobs to go around, to the point where private practices don't post jobs because it is difficult to fill these spots. When our practice was hiring, we emailed the nearby programs directors and it took 2 years to fill a spot.

Ok, first off. I never claimed that AI fellows were going unemployed. In fact, I know of NO physicians in ANY field who is unemployed... even pathologists, who have the worst job market in the industry. So, you're arguing entirely against a red herring.

I simply said that the job market is worse for AI than for the other medicine subspecialties such as GI, rheum, heme onc, etc. Because when people apply to specialties, job market is often an important comparative tool.

Furthermore, the job market encompasses more than just "do people get jobs?" Just as important is "can people move where they want to for whatever reason and STILL get a job close by?" In fields such as GI, you can close your eyes, pick a city and be able to find a gig. Rheum is meh.

Also, AAAAI and ACAAI postings are not unique to your field. EVERY specialty has their own societal job postings. How about you list how many job postings are on these boards? We can do a comparison. We already know that large national recruiting websites like practicelink and doccafe don't contain more than a small handful.

In terms of anecdotes, in my large-ish (2+mil) Midwest city, only one AI fellow in the last 5 years has been able to stay in town, despite several that wanted to. Yes, I know the fellows. Several found jobs in smaller cities, some moved very far away to find a job. In contrast, other specialty fellows were all able to stay in town if they wished.

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[bronx43]

You can absolutely comment on other fields but should not post inaccurate information. When that inaccurate information and personal biases are being posted for years, that person should be called out.

Show me the inaccurate information. Also prove my bias. I have stated over and over again that I wouldn't even recommend my own field, and would recommend other fields.

Any numbers I quote are easily verified on job websites, and NRMP in terms of fellowship spots.

Again, if your argument is that "AI jobs are actually invisible and have to be obtained by networking" then whatever. I accept that. Move on.

 

[sloh]

Coming from PM&R where the job market isn’t nearly as plentiful as something like psychiatry or FM, I’m not sure I would call it a good job market if connections are required to land a job

 

[wamcp]

In terms of anecdotes, in my large-ish (2+mil) Midwest city, only one AI fellow in the last 5 years has been able to stay in town, despite several that wanted to. Yes, I know the fellows. Several found jobs in smaller cities, some moved very far away to find a job. In contrast, other specialty fellows were all able to stay in town if they wished.

My friends who went into AI have the exact same issue today. None could find employment in their desired city and have to uproot their family out of state now. One has a cofellow that managed to get the single desired job that their class + neighboring allergy fellowships all applied/competed for.

in contrast, those who want pcp or hospitalist jobs will by and large get one near their desired location even today in a pandemic world. It is by sheer virtue of a big specialty there will always be turnover to get a job anywhere- although the pay may not be good in a saturated market, you at least can find something to stay in an area with family/friends and not have to uproot

 

[spartymedicine]

Let me clarify. It's not nonsense.. that was hyperbole. What is IT is completely and utterly unknown, and I find it unfulfilling that our diseases are so poorly understood to the point which we can barely define WHAT is our disease? So, instead, we try to diagnose and treat in a very shaman-istic way. And because of this shamanistic approach, it leads to hacks out there who over-diagnose for financial purposes.

Very interesting. Heard from an attending that rheum PP is basically managing chronic pain. He did state that the best IM fellowships to go into were rheum or GI for the lifestyle though. Sounds like you're not so into rheum anymore?

 

[Redpancreas]

Hi all,

I’m an IM resident at a university-affiliated community hospital. I want to apply for fellowship, however, am torn between rheum and pulm crit. I do realize that these are two very different career paths and a lot of people would not be choosing between two of them. On the other hand, I feel that they have a lot in common: multisystem approach and diagnostic challenges.
I like that rheum has seen a lot advances recently. These days monoclonal antibodies targeting certain steps of immune response are very common therapeutic options in many conditions not only in rheum but in other fields.
At the same time, sometimes I feel that rheum may become boring over time, especially, in the outpatient setting.

I like pulm crit because it combines very interesting physiology with rapid application of your skills and assessment of the outcomes of your patients at the bedside. Pulm as a subspecialty is very complex and versatile. But some people argue that crit docs can burn out over time.
Would like to get your opinions on that? Any input from rheum fellows/attendings about the prospects of their field? Would also appreciate the same input from pulm folks..

Thank you

Not interested in Rheum/Pulm Crit and am in neither field, but I can make a few points as a resident. First, every branch of medicine has diagnostic challenges and a multi-system approach or else you wouldn't be required to be board certified in IM prior to applying. At superficial glance, I think you're making a case for pulm/crit for yourself because 1) you like the acuity and think clinic can be boring. 2) it is very common in PCCM to transition to pulm only and do clinic on burn out. Rheumatology is primarily an outpatient field. There are a few inpatient Rheum emergencies like septic joints you may be asked to tap if Ortho isn't around and rarely scleroderma renal crisis if IM recognizes it and calls you, but most of the clinical work is done as an outpatient.

As for where this thread has veered off to in terms of Rheum's sustainability/demand, I am not able to comment on that with any level of authority, but can envision the point bronx43's making as even in academic centers, many of the referrals are just fibro, OA, etc so I can see how much worse it would be in a suburban or rural community. I envision Rheum doctor's try to hold onto their actual SLE/RA, etc. patients, but if I had a relatively less common rheumatological condition, I would seek to establish with a university specialist as opposed to the local rheumatologist.

 

[bronx43]

Very interesting. Heard from an attending that rheum PP is basically managing chronic pain. He did state that the best IM fellowships to go into were rheum or GI for the lifestyle though. Sounds like you're not so into rheum anymore?

PP rheum isn't about managing chronic pain. It's about making money, and chronic pain is simply the easiest and fastest way to get there. It's not just rheum... it's simply PP, whether it's scoping every colon that walks in the door, replacing every knee, or cutting off every basal cell.

I'm an academic, so I don't see pain. Rheum is fine... it's a so-so field, but the world outside of academia can be somewhat of a cesspool with diminishing returns in terms of infusions. Great hours though.

 

[spartymedicine]

PP rheum isn't about managing chronic pain. It's about making money, and chronic pain is simply the easiest and fastest way to get there. It's not just rheum... it's simply PP, whether it's scoping every colon that walks in the door, replacing every knee, or cutting off every basal cell.

I'm an academic, so I don't see pain. Rheum is fine... it's a so-so field, but the world outside of academia can be somewhat of a cesspool with diminishing returns in terms of infusions. Great hours though.

Would you go into rheum again? Or do something like GI or Heme-Onc?

 

[bronx43]

Would you go into rheum again? Or do something like GI or Heme-Onc?

If I HAD to do clinical medicine? Probably heme onc.
If I HAD to do medicine in general? Keep my current situation and hope to do research/accrue non-clinical time.
If I didn't have to do medicine? Wouldn't do medicine.

 

[Euxox]

Kind of off topic, but I find it interesting that multiple people in this thread said they'd do software engineering instead of medicine if they could turn back the clock. I actually went in the opposite direction, and I think this is very much a "grass is greener" situation. This is my take on software engineering:

Hours: Highly variable. Can be anything from 40 to 80 hours a week. Depending on where you work, there may occasionally be nights and weekends when deadlines are near. Pay can be better if you work closer to 80 hours, but usually not by much. Companies may also dangle some stock options at you to get you to work closer to 80, but good luck getting them to vest. As an aside, I think sometimes we take for granted that we have a privilege in medicine where more hours = more RVUs = more income (to varying degrees depending on your specialty and market saturation in your area). But this rule doesn't apply for most jobs, software engineering included.

Pay: It's decent considering that you start straight out of undergrad and don't have med school loans. It's not like you'll be rolling in cash though. Entry level pay isn't that much better than a resident's salary, except in the Bay Area (where it's a necessary adjustment for cost of living). Salary goes up a bit as you gain seniority, but not by much for most people. Most programmers' salaries will level off below $150k. 99th percentile salary is about $300,000, but I wouldn't bet on being one of the superstars who gets there. If money is your primary concern, medicine puts you in a much better place with regard to total lifetime earnings, even with the extra med school debt. We're talking about two million dollars more in lifetime earnings for an internist with $250k in debt at graduation and a modest loan repayment schedule.

Career satisfaction: Programming can be intellectually stimulating, but it's a very different sort of intellectual stimulation than medicine. I think a lot of smart physicians would actually find programming to be boring and occasionally frustrating. I personally love programming and love computer science, but the problem is that most real world programming problems (i.e. ones that you will actually be paid to work on) are very simple and boil down either to making buttons that let non-programmers modify data in a database or to doing mundane data conversion back and forth between different formats. Most of this stuff has already been done a million times before.

Interesting work that requires advanced knowledge of algorithms and data structures is quite rare. You can really throw away most of what you learn in a four year degree and do very well just based on what you learn in three or four classes in the two semesters, plus some practice/repetition. That's a big part of why so many non-computer science trained people are getting software engineering jobs these days.

You want to work on something cool/fun? Sure, those jobs exist... but...

...If you want to do something fun like video game programming or virtual reality, be prepared to be geographically limited and to slave away with very long work hours and below average pay.

...If you want to do something intellectual like artificial intelligence or robotics, you generally need a PhD. Jobs in industry are geographically limited (mostly Bay Area) and highly competitive due to the small number of positions. If you want to go the academic route, pay isn't great considering all the extra training time you put in as a PhD and a postdoc, and you have to deal with the tenure track BS and everything that comes with it. The "get grants or get out" environment is absolutely worse than it is in academic medicine because computer science profs aren't making $$$ for their university by bringing in RVUs.

There are some jobs (like compiler development, systems programming, etc.) that generally don't require PhDs, but do let you apply advanced computer science concepts. The problem is that if you go into these subfields, you are getting very niche and this affects how easy it is to find a job. Mozilla recently laid off an entire department that was working on an experimental next generation browser engine. Super smart people, but Google and Microsoft aren't interested in this particular technology, so those programmers are straight out of luck.

So similar issues to as medicine: Money, lifestyle, interesting work, geographic location. It's usually not to hard to get two or three out of four. Very difficult to get all four. You have to pick what makes you happiest.

All said, I think medicine wins. More autonomy. More prestige. Better pay. And most importantly the work is not just rewarding intellectually, but also in the direct and very tangible impact you have on your patients. You'll never find yourself working on a problem that is so abstracted from actual humans that you wake up one morning and ask yourself what the hell you've actually been doing for the past five years. That's why I jumped ship from software engineering and why I'm sure as hell not looking back.

 

[wamcp]

Kind of off topic, but I find it interesting that multiple people in this thread said they'd do software engineering instead of medicine if they could turn back the clock. I actually went in the opposite direction, and I think this is very much a "grass is greener" situation. This is my take on software engineering:

Hours: Highly variable. Can be anything from 40 to 80 hours a week. Pay isn't much different whether you are working 40 or working 80. As an aside, I think sometimes we take for granted that we have a privilege in medicine where more hours = more RVUs = more income (to varying degrees depending on your specialty and market saturation in your area). But this rule doesn't apply for most jobs, software engineering included.

Pay: It's decent considering that you start straight out of undergrad and don't have med school loans. It's not like you'll be rolling in cash though. Entry level pay isn't that much better than a resident's salary, except in the Bay Area (where it's a necessary adjustment for cost of living). Salary goes up a bit as you gain seniority, but not by much for most people. Most programmers' salaries will level off below $150k. 99th percentile salary is about $300,000, but I wouldn't bet on being one of the superstars who gets there. If money is your primary concern, medicine puts you in a much better place with regard to total lifetime earnings, even with the extra med school debt. We're talking about two million dollars more in lifetime earnings for an internist with $250k in debt at graduation and a modest loan repayment schedule.

Career satisfaction: Programming can be intellectually stimulating, but it's a very different sort of intellectual stimulation than medicine. I think a lot of smart physicians would actually find programming to be boring and occasionally frustrating. I personally love programming and love computer science, but the problem is that most real world programming problems (i.e. ones that you will actually be paid to work on) are very simple and boil down to making buttons for non-programmers to be able to modify data in a mundane data conversion from one format to another in a way that's already been done a million times before. (But the nuts and bolts of the off-the-shelf solution don't fit together in exactly the right way, so you have to redo most of it from scratch.) Interesting work that requires advanced knowledge of algorithms and data structures is quite rate. You can really throw away most of what you learn in a four year degree and do very well just based on what you learn in three or four classes in the two semesters, plus some practice/repetition. That's a big part of why so many non-computer science trained people are getting software engineering jobs these days.

You want to work on something cool/fun? Sure, those jobs exist... but...

...If you want to do something intellectual like artificial intelligence or robotics, you generally need a PhD. Jobs in industry are geographically limited (mostly Bay Area) and highly competitive due to the small number of positions. If you want to go the academic route, pay isn't great considering all the extra training time you put in as a PhD and a postdoc, and you have to deal with the tenure track BS and everything that comes with it. The "get grants or get out" environment is absolutely worse than it is in academic medicine because computer science profs aren't making $$$ for their university by bringing in RVUs.

...If you want to do something fun like video game programming or virtual reality, be prepared to be geographically limited and to slave away with very long work hours and below average pay.

Same as medicine: Money, lifestyle, interesting work, geographic location. It's usually not to hard to get two or three out of four. Very difficult to get all four.

All said, I think medicine wins. More autonomy. More prestige. Better pay. And most importantly the work is not just rewarding intellectually, but also in the direct and very tangible impact you have on your patients. You'll never find yourself working on a problem that is so abstracted from actual humans that you wake up one morning and ask yourself what the hell you've actually been doing for the past five years. That's why I jumped ship from software engineering and why I'm sure as hell not looking back.

Required conferences and meetings are hardly a daily thing for physicians in private practice, in general. And regularly writing up some BS report with a deadline for your supervisor is not either. Both of these things I think most workers heavily detest. Being a physician means you are up there on the totem pole and the staff listens to you, unlike a mere team member in the rest of the workforce with far less autonomy

 

[Crayola227]

Eh, the prestige and autonomy portions not so much. Very degraded as a field from what it once was. Tons and tons of time waste.

 

[Euxox]

Prestige and autonomy are definitely not what they were in the past, but still much more than what you'll get in most other careers.

On the topic of autonomy, here are some things that wont happen in medicine:

• Your boss isn't going to call you into a room and tell you that you're being reassigned to geriatric patients only because management is pivoting the direction of the hospital.
• You aren't going to be told to come in on the weekend and work extra hours off the clock. If you take extra shifts, you'll get paid for extra shifts.
• No one's going to **** on you anonymously in a performance review at the end of the year because they don't agree with the way you dose diuretics when you treat heart failure.

Stuff like this happens all the time in other careers. Honestly, sometimes I feel like we get sucked into such a pity circle about how medicine is falling to pieces that we forget about all the ways that medicine is so great compared to other fields.

 

[VA Hopeful Dr]

Eh, the prestige and autonomy portions not so much. Very degraded as a field from what it once was. Tons and tons of time waste.

The autonomy can be there. PP is still a thing after all. And even employed, it's still better than many jobs (location dependent of course).

I think some of the prestige loss is probably a good thing. Many doctors from 30 years ago were dinguses with a God complex and were allowed to get away with way too much bad behavior.