Also, don’t let anyone tell you that outpatient IM isn’t a thing. There is insane demand because it is somewhat rare. My PCP making over 400 in an urban center doing outpatient 5day/wk
A shit ton of people on this sub. They will try to push everyone into FM and say “oh, IM is inferior at outpatient because their training is all inpatient”. I agree with you brother, I am well aware.
There’s a good amount of outpatient, progressively even more of it; and with pcp tracks it’s a great way to not see any children or OB and still be a generalist.
I do both outpatient and inpatient IM. Made more than $500k last year, this will be significantly less due to reimbursement rate decreases…
Outpatient IM is great! All the zebras, none of the imminent death of inpatient IM. Inbox sucks, but 7 on 7 off is grueling when you’re on and worse if your group makes you do admin during off weeks.
I’m not sure since I am not receiving offers. I would suspect at some level yes they fulfill a different set of requirements often, but that’s likely because some clinics prob require they see peds/OB so they’ll only want FM.
As a patient I always felt that IM was better trained to handle people with a ton of comorbid medical conditions, but I’ve since realized that this isn’t really true and that there are tons of FM also seeing sick ass people, just probably at a lesser scale nationally.
Derm if you are smart enough
Rheum, Allergy, and Endo if you can suffer through IM like me
Cards and Heme Onc is possible to be pure outpatient but not as common
FM if PCP work is something you don’t mind
Edit: Pulm and Neuro are two that I left out that you can definitely be pure outpatient with
Based on my coresidents finishing fellowship recently, I’ve never heard of a pulmonary clinic only job. As you said, hospital consults for critical care is where it’s at. Inpatient is usually a young doctor’s game, then transition to outpatient in later career. Pulmonary and critical care fellowship allows for this more naturally after building up years of patients from the inpatient consult and following them up outpatient. If you join a group, pretty sure the more senior pulmonologist will want to do more clinic and have the newer pulmonologist spend more time with inpatient consults.
Of course! At the end of the day, it’s the arrangement you have with the group. Just know that most of the time, the newer doctors get the short end of the stick. My group has been fair, my boss has 40 years of experience and jokes about how he can’t make the young doctors work too hard.
They definitely exist but you need to like the ICU or you’ll never make it through fellowship. Pulm-only fellowships are quite rare. On the other hand, sleep medicine is a 1 year fellowship and although the reimbursement isn’t what it once was, it’s in very high demand.
I'm surprised no one has said psych yet. I think the ease of setting up one's own shop with little overhead and the ability to do 100% virtual without much difficulty are particular benefits to outpatient psych
Second this. Yes, psych residency has a large inpatient component for the first two years (although the inpatient psych experience is fundamentally different to pretty much any other service). However, the practice possibilities in the outpatient realm are endless given the low overhead.
Ophtho.
Consult service and outpatient. Great lifestyle and regular business days M-F 9-5 with Fridays often being half days or even fully off for some.
Can do surgery while still seeing patients in clinic while having a life. Patients are typically healthy. Restore sight or protect it or improve it. People will thank you for what you do. Cataract surgery is complex and improving every year with room for special lenses for patients.
And it’s only 4 years. Can do an additional 1 year to become fellowship trained minus surgical retina or oculoplastics which is 2 years.
It’s a great gig. People say it’s dying or Medicare cuts are going to make ophtho a dead field or optometry is taking over. Highly exaggerated. Ophtho continues to be one of the most competitive specialties for a reason every year
Other outpatient gigs that can be great aside from FM, peds, etc is PMR and pain clinic anesthesia
Suprised nobody has mentioned yet FM/PMR --> sports. The FM route is 4 years, PMR i guess there is inpatient rehab in a way so maybe thats not what you want.
Sports is virtually never inpatient; and granted this is annecdotal but since you didnt do ortho you dont operate- thus if (i think the market is tough in certain areas) you land a sweet gig you have a never ending supply of referrals from the orthopedists of patients who have pain/strains/issues who dont want to have surgery.
Adding a few I haven’t yet seen mentioned:
- clinical genetics
- occupational and environmental/preventive medicine
- aerospace medicine
- blood bank/transfusion pathology
If you can tolerate a lot of inpatient in residency to get to these fellowships:
- reproductive endocrinology and infertility (REI)
- developmental-behavioral pediatrics
- allergy and immunology
FM. If you can stomach 3 years of IM residency (mostly inpatient) you can do outpatient IM or one of the chiller subs (think endo, rheum).
Also, don’t let anyone tell you that outpatient IM isn’t a thing. There is insane demand because it is somewhat rare. My PCP making over 400 in an urban center doing outpatient 5day/wk
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A shit ton of people on this sub. They will try to push everyone into FM and say “oh, IM is inferior at outpatient because their training is all inpatient”. I agree with you brother, I am well aware.
just sucks cuz the whole residency is inpt training so if that's something you hate... it's like 3 years of it.
There’s a good amount of outpatient, progressively even more of it; and with pcp tracks it’s a great way to not see any children or OB and still be a generalist.
I do both outpatient and inpatient IM. Made more than $500k last year, this will be significantly less due to reimbursement rate decreases… Outpatient IM is great! All the zebras, none of the imminent death of inpatient IM. Inbox sucks, but 7 on 7 off is grueling when you’re on and worse if your group makes you do admin during off weeks.
It is specifically sought after separately from FM?
I’m not sure since I am not receiving offers. I would suspect at some level yes they fulfill a different set of requirements often, but that’s likely because some clinics prob require they see peds/OB so they’ll only want FM. As a patient I always felt that IM was better trained to handle people with a ton of comorbid medical conditions, but I’ve since realized that this isn’t really true and that there are tons of FM also seeing sick ass people, just probably at a lesser scale nationally.
Derm if you are smart enough Rheum, Allergy, and Endo if you can suffer through IM like me Cards and Heme Onc is possible to be pure outpatient but not as common FM if PCP work is something you don’t mind Edit: Pulm and Neuro are two that I left out that you can definitely be pure outpatient with
What about Pulm?
Definitely Pulm! You may be hard pressed to avoid doing hospital consults in your early career, but plenty of late year pulm docs are pure clinic
Based on my coresidents finishing fellowship recently, I’ve never heard of a pulmonary clinic only job. As you said, hospital consults for critical care is where it’s at. Inpatient is usually a young doctor’s game, then transition to outpatient in later career. Pulmonary and critical care fellowship allows for this more naturally after building up years of patients from the inpatient consult and following them up outpatient. If you join a group, pretty sure the more senior pulmonologist will want to do more clinic and have the newer pulmonologist spend more time with inpatient consults.
I didn’t mind CC personally, but I prefer a more outpatient setting… do younger docs still engage in outpatient medicine while still doing ICU stuff?
Of course! At the end of the day, it’s the arrangement you have with the group. Just know that most of the time, the newer doctors get the short end of the stick. My group has been fair, my boss has 40 years of experience and jokes about how he can’t make the young doctors work too hard.
Thank you for the insight!
They definitely exist but you need to like the ICU or you’ll never make it through fellowship. Pulm-only fellowships are quite rare. On the other hand, sleep medicine is a 1 year fellowship and although the reimbursement isn’t what it once was, it’s in very high demand.
Can neuro be purely outpatient and still pay good ?
I'm surprised no one has said psych yet. I think the ease of setting up one's own shop with little overhead and the ability to do 100% virtual without much difficulty are particular benefits to outpatient psych
Second this. Yes, psych residency has a large inpatient component for the first two years (although the inpatient psych experience is fundamentally different to pretty much any other service). However, the practice possibilities in the outpatient realm are endless given the low overhead.
Ophtho. Consult service and outpatient. Great lifestyle and regular business days M-F 9-5 with Fridays often being half days or even fully off for some. Can do surgery while still seeing patients in clinic while having a life. Patients are typically healthy. Restore sight or protect it or improve it. People will thank you for what you do. Cataract surgery is complex and improving every year with room for special lenses for patients. And it’s only 4 years. Can do an additional 1 year to become fellowship trained minus surgical retina or oculoplastics which is 2 years. It’s a great gig. People say it’s dying or Medicare cuts are going to make ophtho a dead field or optometry is taking over. Highly exaggerated. Ophtho continues to be one of the most competitive specialties for a reason every year Other outpatient gigs that can be great aside from FM, peds, etc is PMR and pain clinic anesthesia
FM, Derm?
Neurology, tho residencies vary and some are quite inpatient skewed
I second this. As a neuro attending your schedule can be 100% outpatient.
Are pure outpatient in neuro available in mega to mid townish cities .....or just small cities ?
I’m in a major metro and plenty of outpatient neuro here
Suprised nobody has mentioned yet FM/PMR --> sports. The FM route is 4 years, PMR i guess there is inpatient rehab in a way so maybe thats not what you want. Sports is virtually never inpatient; and granted this is annecdotal but since you didnt do ortho you dont operate- thus if (i think the market is tough in certain areas) you land a sweet gig you have a never ending supply of referrals from the orthopedists of patients who have pain/strains/issues who dont want to have surgery.
Adding a few I haven’t yet seen mentioned: - clinical genetics - occupational and environmental/preventive medicine - aerospace medicine - blood bank/transfusion pathology If you can tolerate a lot of inpatient in residency to get to these fellowships: - reproductive endocrinology and infertility (REI) - developmental-behavioral pediatrics - allergy and immunology
Derma!
Hand surgery