Specialties that are 40 hours a week and pay well

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Well, to be fair, I meant specialties as a whole :rofl: , but yeah, that sounds very much up there. I'd think close seconds are Mohs and Retina.
Mohs has a listed 75th of >1 million/yr. Wild.
 
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Mohs has a listed 75th of >1 million/yr. Wild.
What source? I figured most surveys wouldn't have enough data points for either Mohs or Retina. Especially when they have such a low response rate.
 
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Psychiatry has a pretty high ceiling and it's not just limited to high-end cash practices or working insane hours.

*Steeples fingers together* Tell me more.
 
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*Steeples fingers together* Tell me more.
PP in general (not just wealthy patients) with reasonable business sense, locums work, forensics, IMEs, working outside of major metro areas (I currently have one such offer for an inpatient position with a population I enjoying working with, starting at $420K, good benefits, government pension, qualifies for state and federal loan foregiveness programs beyond PSLF if I stay for at least 4 years, ~40hrs/week, home call q10), etc. Plus you can mix and match those to your liking. It's also possible to arrange multiple inpatient gigs and hit the upper 6 figure lower 7 figure range, but that comes at the cost of working >40-50hrs/week and, more importantly, quality of the work you're providing.
 
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Nice numbers. Are you in a private group? And where are you practicing geographically?
Hospital employed, SC.

First of all, congrats on the great income! Next - how many years have you been in practice with how many raises? Are you academic as well? Sorry, just trying to understand the full picture. ^_^ Congrats again.
I'm paid on production (with quality bonuses that are also based on that productivity) so my only "raises" are because I've been seeing more patients as time goes on. I was just barely meeting my salary guarantee until one of my partners retired August 1. I've doubled my numbers since then.

I've been in my current location for 2 years this Memorial Day. I occasionally have students from the local DO school rotate with me but that's 1 month every 2-3 so most of the year its just me.

To get into the nitty gritty, every single thing we do in medicine has what's called a CPT code. Its a 5 digit number that tells insurance companies what we did to a given patient. For example, a lap chole with cholangiogram is 47563, 58300 is for inserting an IUD, 20611 is for a knee injection. You also have codes for office visits/hospital visits/ED visits. Every single CPT code has what's called a wRVU attached to it (that stands for work relative value units). The wRVU value is related to the complexity of the code. The lap chole is worth 11.47 wRVU, the IUD 1.01, and the knee injection 1.10. If you are employed and paid on production, you will have a dollar value per wRVU. The national average for family medicine is around $40/wRVU. So if I do a knee injection, I get paid $44.

So every month the hospital calculates how many wRVUs I've earned, multiples that by the wRVU multiplier to determine what I've earned that month. They compare that to what they paid me that month. If I earned more than they paid, they pay me the difference. If I earned less, they pay me less the next month.
 
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I think highest hourly goes to nighthawk DR, you can be partnered and make the same as the day guys while working only 120 shifts/year.
Shhhh...they are going to hear you. Let's keep that rads match rate >95% for the best paying field in medicine...
 
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Shhhh...they are going to hear you. Let's keep that rads match rate >95% for the best paying field in medicine...
Rads paying really well isn't a secret. It's just that many things matter more than the pay.
 
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Rads has already been cut to high heaven in the last 20 yrs, which is why all the salty old rads tell people it sucks. the problem is that other fields suck in medicine soooo much more that even if rads are working 5x harder for half the money, its still better than most other specialties
 
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Rads has already been cut to high heaven in the last 20 yrs, which is why all the salty old rads tell people it sucks. the problem is that other fields suck in medicine soooo much more that even if rads are working 5x harder for half the money, its still better than most other specialties
"suck" is relative.
 
Rads has already been cut to high heaven in the last 20 yrs, which is why all the salty old rads tell people it sucks. the problem is that other fields suck in medicine soooo much more that even if rads are working 5x harder for half the money, its still better than most other specialties
The thing with these old salty docs who complain about how much money they used to make is that while they are typing that comment on SDN with one hand, they are signing away their practice to a venture capital firm with the other hand.
 
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The thing with these old salty docs who complain about how much money they used to make is that while they are typing that comment on SDN with one hand, they are signing away their practice to a venture capital firm with the other hand.
A lot of the time, there is still plenty of money to be made. These older docs are just set in their ways and unwilling to try new things.
 
Yeah rads is awesome but lets not let SDN overhype it and possibly contribute to a future crash like in radonc

/s but maybe srs?
It's too awesome...

500k/yr, 10 wks vacation and most importantly, no patient contact...
 
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Rads cuts out the emotional burden of direct patient care almost entirely along with a lot of the busy work and scut associated with it. That makes up for a lot.
 
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Rads cuts out the emotional burden of direct patient care almost entirely along with a lot of the busy work and scut associated with it. That makes up for a lot.
Idk about you guys but half the reason many of us went into medicine in the first place was for direct patient care
 
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Idk about you guys but half the reason many of us went into medicine in the first place was for direct patient care

It appears overrated when you are admitting the same individual for a 3rd time within a month for decompensated HF...
 
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It appears overrated when you are admitting the same individual for a 3rd time within a month for decompensated HF...
To each their own. There’s a bunch more great stories of patient contact too. Yes there’s downsides to everything for different people but I would go bat**** crazy staring at a screen all damn day in the dark. Maybe that’s why not everyone is flying to rads?
 
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To each their own. There’s a bunch more great stories of patient contact too. Yes there’s downsides to everything for different people but I would go bat**** crazy staring at a screen all damn day in the dark. Maybe that’s why not everyone is flying to rads?
That’s the logical reason that more people don’t apply to rads. The illogical one is AI. Put those two together and rads is a lot less competitive than derm while being higher paying per hour🤯
 
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That’s the logical reason that more people don’t apply to rads. The illogical one is AI. Put those two together and rads is a lot less competitive than derm while being higher paying per hour🤯
? The average Radiologist works a lot more hours than the average Dermatologist with very similar pay. The pay per hour is not higher.
 
Maybe they mean nocturnist Rads?
That’s a subset of Radiology, not Radiology in general. By that logic, compare it to Mohs or Retina. Both have a very similar $/h to nocturnist Rads.

I’d think most med students are straying from nocturnist rads because they don’t want to be nocturnal.
 
I dont think you can compare dermatologist working 4 days a week to a nighthawk rad... what percentage of rads even do nighthawk exclusively? my understanding is its moreso just crap you have to deal with rather than a preferred type of job
 
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I dont think you can compare dermatologist working 4 days a week to a nighthawk rad... what percentage of rads even do nighthawk exclusively? my understanding is its moreso just crap you have to deal with rather than a preferred type of job
Exactly. You have to compare apples to apples.
 
That’s a subset of Radiology, not Radiology in general. By that logic, compare it to Mohs or Retina. Both have a very similar $/h to nocturnist Rads.

I’d think most med students are straying from nocturnist rads because they don’t want to be nocturnal.
That’s not exactly the fairest comparison because Mohs and retina require a specific, competitive fellowship to get their insane pay. Night rads doesn’t need a specific fellowship, any fellowship will do and most aren’t competitive at all. You don’t even technically need a fellowship, but it’s kinda like ortho these days where everyone does one. Regardless, you can do night rads for more $$$/hr and switch back to days if you hate it. I guess you could go back to general derm or ophtho if you hated Mohs or retina but that switch isn't exactly common.
 
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I dont think you can compare dermatologist working 4 days a week to a nighthawk rad... what percentage of rads even do nighthawk exclusively? my understanding is its moreso just crap you have to deal with rather than a preferred type of job
Well you can’t mention derm working 4 days a week and not mention night rads only working 1/3rd of the year. Yes it’s nights, but it’s also 1 week on 2 weeks off for $400k which is insane even for the ability to do that for a few years.
 
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That’s not exactly the fairest comparison because Mohs and retina require a specific, competitive fellowship to get their insane pay. Night rads doesn’t need a specific fellowship, any fellowship will do and most aren’t competitive at all. You don’t even technically need a fellowship, but it’s kinda like ortho these days where everyone does one. Regardless, you can do night rads for more $$$/hr and switch back to days if you hate it. I guess you could go back to general derm or ophtho if you hated Mohs or retina but that switch isn't exactly common.

For nighthawks are you talking about doing nights only at a PP as either an associate or a partner? if the former, usually dont make as much as the latter. and if the latter, I'm not sure how common it is to be a partner who only does nights.

also it was my understanding that nighthawks are often contracted out through teleradiology companies who pay you peanuts/rvu in comparison to a regular pp rad
 
Well you can’t mention derm working 4 days a week and not mention night rads only working 1/3rd of the year. Yes it’s nights, but it’s also 1 week on 2 weeks off for $400k which is insane even for the ability to do that for a few years.

I'd love to see some statistics on the percentage of radiologists who do exclusively nights. Because if its a vanishingly small number, you have to ask yourself why thats the case and if its a sustainable career. On the other hand, how many dermatologists work 4 days a week? a bunch. so it seems to me like I can look at the average 4/day derm salary as a legitimate starting point, but looking at a 1 week on 2 weeks off nighthawk rad position as a weird cherrypicked job that is not really indicative of radiology pay/hour
 
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I'd love to see some statistics on the percentage of radiologists who do exclusively nights. Because if its a vanishingly small number, you have to ask yourself why thats the case and if its a sustainable career. On the other hand, how many dermatologists work 4 days a week? a bunch. so it seems to me like I can look at the average 4/day derm salary as a legitimate starting point, but looking at a 1 week on 2 weeks off nighthawk rad position as a weird cherrypicked job that is not really indicative of radiology pay/hour
I looked and I couldn’t find anything on Auntminnie or Google but you make a good point. Maybe someone from the dark side will enlighten us if they are lurking. And probably smack some sense into me about how much night rads sucks :’(

In regards to practice settings, I have heard of internal night jobs as a partner or associate, either way you get paid a big premium compared to days. And I have read about teleradiology “2 peanuts per RVU” jobs but that’s a little misleading, because a lot of them are salary. You aren’t there to make rake in RVUs, you are there to cover for the practice that contracts with the hospital during the day, because any hospital with an ED needs some kind of rads coverage 24/7.

anyways, I agree average derm makes more than average rads per hour, but the ability to do night rads increases your rate if you are really chasing the $$$/hr AND, more importantly in my eyes, rads is very attainable for the “average” med student at an “average” school. My school does not match anyone in derm some years. And I got to a middle of the road MD state school, not an online Caribbean NP diploma mill.
 
Yeah, nights is definitely part of a regular job (for better or worse), I think it's just that most of the job will be normal days for more normal pay. Still great pay though! Also agree that rads is far more attainable which is very sweet for anyone who wants to have a (relatively) cushier job in medicine
 
I'd love to see some statistics on the percentage of radiologists who do exclusively nights. Because if its a vanishingly small number, you have to ask yourself why thats the case and if its a sustainable career. On the other hand, how many dermatologists work 4 days a week? a bunch. so it seems to me like I can look at the average 4/day derm salary as a legitimate starting point, but looking at a 1 week on 2 weeks off nighthawk rad position as a weird cherrypicked job that is not really indicative of radiology pay/hour
I mean do you consider hospitalist pay to be fake news because they work 1 on:1 off? Very few MDs are IM nocturnists, but that's also a thing. ED docs work weird hours all the time and even alternate day/night, and can make great hourly $$$. There's even locums ED guys, who are moving all over the place and working weird hours, which sounds a lot worse than nighthawking to me.

I bet there's more nighthawk radiologists than mohs surgeons. Lots of groups make use of night coverage so they don't have to rotate call themselves, it's not some tiny niche of 20 people.
 
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I mean do you consider hospitalist pay to be fake news because they work 1 on:1 off? Very few MDs are IM nocturnists, but that's also a thing. ED docs work weird hours all the time and even alternate day/night, and can make great hourly $$$. There's even locums ED guys, who are moving all over the place and working weird hours, which sounds a lot worse than nighthawking to me.

I bet there's more nighthawk radiologists than mohs surgeons. Lots of groups make use of night coverage so they don't have to rotate call themselves, it's not some tiny niche of 20 people.

No, I wouldn't call it fake news since I assume that these hospitalist jobs are not all nights right? Yes ED docs work weird hours but they should also be working normal hours since I'd imagine most ED docs will tell you it's pretty difficult to make a career of only nights so it wouldn't be wise to bank on that salary/hours.

I'm not sure how the number of mohs relative to number of nighthawks is relevant. Regarding "legit" salaries I'm going off percentages. If 90+% of mohs work 4 days a week and make 700k (no clue the real number) that's a very fair number to use imo. But with rads, if less than 5% of jobs (guessing) are these nighthawk jobs with crazy salary/hour ratio... maybe not the best number to use for comparison.
 
The truth of the matter is, for the most part, physicians have it good here. ED doc I worked with when I was a PGY2 doing my 1-month ED. 'I love my gig. I work 8-8 hr shift per month and make over 200k + benefits'.

How many freaking jobs out there that provide this kind of flexibility and salary?
 
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Not sure if this is still available but 5 yrs ago, some friend ED full timers were working 8, 12 hr shifts/mo or 24hrs/wk making 400K+ plus benefits only doing day shifts b/c they paid a stipend for overnight shifts. Some of these guys would work 16 shifts a month, take a month off to travel, then rinse/repeat.

I used to remember there were no specialty that could match this for the short 3 yr residency/flexibility
 
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Not sure if this is still available but 5 yrs ago, some friend ED full timers were working 8, 12 hr shifts/mo or 24hrs/wk making 400K+ plus benefits only doing day shifts b/c they paid a stipend for overnight shifts. Some of these guys would work 16 shifts a month, take a month off to travel, then rinse/repeat.

I used to remember there were no specialty that could match this for the short 3 yr residency.
Were they out in the sticks? I'd been hearing the opposite about EM lately, that job market is looking poor
 
It was close to the Houston area but that was 5 yrs ago when it seems like they couldn't find enough EM docs. Market is definitely tightening but I still see decent jobs going for 200/hr. Still alot but when there were 300+/hr jobs around then the old timers will complain how bad EM is.
 
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It was close to the Houston area but that was 5 yrs ago when it seems like they couldn't find enough EM docs. Market is definitely tightening but I still see decent jobs going for 200/hr. Still alot but when there were 300+/hr jobs around then the old timers will complain how bad EM is.
Do you think the recent market squeeze in EM is more to do with COVID, or just a longcoming trend in general?
 
Volume is going back to normal. The threats are private equity, midlevels and all the residencies they are opening up. But most hospital specialities are in the same boat.
 
Not sure if this is still available but 5 yrs ago, some friend ED full timers were working 8, 12 hr shifts/mo or 24hrs/wk making 400K+ plus benefits only doing day shifts b/c they paid a stipend for overnight shifts. Some of these guys would work 16 shifts a month, take a month off to travel, then rinse/repeat.

I used to remember there were no specialty that could match this for the short 3 yr residency/flexibility
It’s almost mean to even mention this to medical students trying to decide on a speciality. By the time we are done with residency, EM will be lucky to be making $180/hr inflation adjusted, let alone the $320/hr you are talking about. Not sure if EM is worth $180-200/hr when your patients will scream, spit, and physically attack you more than any other speciality and you literally can’t turn them away if they show up tomorrow to do the same. You will never have a regular sleep schedule (unless you do only nights), and you spend half your shift on the phone talking to doctors that are mad you called.

EM has some cool aspects too, but telling stories about the golden days of EM is just a sad piece of history about how doctors sold their souls and our future to CMGs after making their own fortune.
 
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Volume is going back to normal. The threats are private equity, midlevels and all the residencies they are opening up. But most hospital specialities are in the same boat.
What's your take on healthcare reform (e.g. public option, single payer, etc...)? Is it the death knell for physician salaries everyone says it is?
 
It’s almost mean to even mention this to medical students trying to decide on a speciality. By the time we are done with residency, EM will be lucky to be making $180/hr inflation adjusted, let alone the $320/hr you are talking about. Not sure if EM is worth $180-200/hr when your patients will scream, spit, and physically attack you more than any other speciality and you literally can’t turn them away if they show up tomorrow to do the same. You will never have a regular sleep schedule (unless you do only nights), and you spend half your shift on the phone talking to doctors that are mad you called.

EM has some cool aspects too, but telling stories about the golden days of EM is just a sad piece of history about how doctors sold their souls and our future to CMGs after making their own fortune.
I think you are reading wayyy to many negative nannies on the EM board. Sure EM is not as good as it was 5+ yrs ago where I would put it up against any specialty when you take into account it is 3 yrs.

You or I have no clue what the market will be in 3-5 yrs, no one does and it is useless to even predict. I heard the same thing 10 yrs ago and the gloom never came true. But you can say this for almost every specialty. You think Radiology is so great- ask them what the market was like 15 yrs ago.

All hospital based specialties complain like there is no tomorrow. Every time they came to the ER, they looked like someone stole their lunch money. Complaints left and right when I called them.

Patients never spit or physically attacked me. Maybe I am smart and stand far away from the dangerous looking one. Patients will scream and yell but its not that hard to walk away. Who cares if a stranger yells at you?

In 20 yrs of doing hospital based EM, I probably did 5 overnight shifts. We always had a nocturnist who we paid more. Even if we didn't have a nocturnist, I could always pay someone to do my nights. It all depends on if money or overnight sleep is more important to you. Did I also mention I never did Thanksgiving, Christmas, Christmas Eve? We just paid more and people picked them up.

To you point of a bad sleep schedule, I had a better sleep schedule than almost all of the specialist. I worked 9 hr shifts, 14 dys a month and avg about 450-500K plus benefits over 20 yrs. As I never did overnight, my latest shift was 1am, home by 130am, sleep by 2am where no one bothers me.

Talk to any OB/Gyn, Gen Surg, cards. Imagine having a full day schedule and taking overnight call. If they were lucky they would not get called in. But when they did and had a big surgery then they were up all night, then another full day clinic schedule the next dy. Miserable.

To your CMG point, almost every specialist is selling their souls. Radiology, Anesthesiology, Orthopedics, Cards, etc... Its rare to actually have an independent practice or small practice. Most are working for large hospital systems, CMGS, private equity and punch the clock just like most EM docs.
 
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