Top 5 Most Competitive Internal Medicine Specialties

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The field of internal medicine is one of the most sought out fields after completing medical school. Now, we’re going to cover the top 5 most competitive internal medicine specialties.

Even after completing internal medicine residency, physicians often choose to apply for multiple fellowships.  These fellowship specialties can be super competitive and require tons of work to get into while being busy as a brand new doctor.

Now, to understand the competitiveness of these specialties, we’re going to break it into three categories.

The first one is going to be the average match rate, essentially assessing for how many people don’t get in when you apply for that specific fellowship program.

The second is the length of training. And the last one is salary and lifestyle.

So let’s get into it!

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Top 5: Rheumatology

Coming in at number five is the field of rheumatology.

Rheumatologists are physicians who specialize in both musculoskeletal as well as autoimmune diseases such as lupus, rheumatoid arthritis, normal osteoarthritis, as well as things like vasculitis.

Average Match Rate

In terms of competitiveness, the match rate for rheumatology is right at 74%. So about one out of every four applicants won’t match into the field when they apply.

Length Of Training

In terms of length of training, most rheumatology fellowships will be anywhere from two to three years, and if there is a third year, most of that will be spent doing research.

Salary And Lifestyle

Now, breaking down the lifestyle and salary for rheumatology, the average salary goes about $289,000. So definitely less than the salary of our hematology and oncology colleagues, but it comes with a nice perk.

As a rheumatologist, it’s very uncommon for you to work nights. And often, if you have to work on a weekend, you’re just covering within your group or your colleagues and it’s not that bad.

So in terms of work life balance, I would say it’s good to great depending on the practice you’re in.

If you’re dealing with just one part of rheumatology, you tend to have calmer clinic days. But if you’re more of a general rheumatologist and you see a wider range of cases, then you might have a busier and more hectic clinic life.

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Top 4: Hematology/Oncology

Top 4 on our list is the field of hematology and oncology.

In my personal experience, this happens to be the most attractive field for people who are very young and early in their training. Maybe they’re someone in college or in medical school who says they would love to be a doctor who takes care of patients with cancer.

And because of that initial attraction, or perhaps even having personal experiences with cancer within their families, many people continue to pursue the field of hematology and oncology.

Average Match Rate

The average match rate for hematology/oncology is right at 75%, very similar to our field of rheumatology.

Length Of Training

In terms of length of training, the average fellowship for hematology/oncology is three years after completing internal medicine residency.

There are a few options available; for instance, if you opt to specialize solely as a board-certified oncologist or hematologist, rather than both, you may complete a two-year fellowship and start working immediately. But that varies depending on the institution. 

Salary And Lifestyle

Now, let’s talk about salary and lifestyle. The average salary for a hematologist oncologist is about $411,000. Keep in mind this is geographically variable. It also depends on which side of the field you go to.

For example, you can choose to just practice hematology and deal with blood disorders, or you can choose to deal with cancer and oncology.

Depending on the specific practice setting within each of these categories, salaries can vary significantly.

However, the lifestyle can be quite similar between the two specialties, as both are predominantly clinic-centric. You’ll regularly interact with patients, providing follow-up care for their cancer, blood disorders, or anemias. This often involves recurring appointments, and you may also have responsibilities for hospital-based patient consultations.

Now, in terms of work-life balance compared to other fields in internal medicine, hematology/oncology has a very good to fair work-life balance.

One disclaimer though is that your work-life balance and mental wellness can definitely be affected if you choose to go in a very advanced route.

For instance, if you’re an oncologist specializing in pancreatic or lung cancer, you’ll inevitably encounter patients who are diagnosed at an advanced stage. This presents significant challenges as treatment options are often limited, and unfortunately, many patients may not respond well to available treatments.

So, managing the emotional toll of caring for patients who receive a terminal diagnosis, along with supporting their families and addressing the impact on their lifestyles, can be incredibly challenging.

Knowing that despite your best efforts, there’s a good chance the treatments may not succeed, can certainly take a toll, especially within the field of oncology.

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Top 3: Pulmonology and Critical Care Medicine

Top 3 on our list is the field of pulmonary and critical care medicine.

Prior to starting medical school, I thought these were two separate things. I had no idea that people usually are trained in both pulmonary and critical care medicine under the same fellowship.

But in terms of competitiveness, pulmonary and critical care medicine attracts some of the smartest individuals as well as those who love working with their hands and dealing with emergencies.

Average Match Rate

It has an average match rate of only 67.8%, so that means that there are a lot of applicants every single year, and many are not able to get a spot.

Length Of Training

In terms of the length of training, most pulmonary fellowships span three years, incorporating a combination of critical care and pulmonary electives and rotations, each with their own specific focus, throughout each year of the fellowship.

How much you’re trained on both the pulmonary versus the critical care side would really depend on the institution that you’re working with.

Salary And Lifestyle

Now, let’s break down the salary and lifestyle for a pulmonary-critical care doctor. It varies significantly because typically, you’ll specialize in one or the other.

During your fellowship in pulmonary or critical care, most doctors will choose to focus on either field. You might work in the intensive care unit (ICU) as a critical care doctor, which becomes your primary lifestyle, or you may opt for a clinic setting as a pulmonologist, with occasional patient visits in the hospital.

The average salary is about $369,000. And keep in mind, there’s a wide spectrum.

On one end, if you’re a critical care doctor working in an institution that bills based on the complexity of the patients you treat—given the inherently complex nature of critical care patients—you’ll naturally bill higher.

This is because critical care doctors often deal with patients facing terminal illnesses, which adds to the complexity of their work.

Consequently, critical care doctors, especially those in private hospitals, tend to earn more.

On the flip side, pulmonary doctors typically follow a more standard clinical schedule, similar to other medical fields, with weekday clinics, occasional consults, and possibly weekend responsibilities. Their earnings tend to hover around the $350,000 to $360,000 range, though this can vary depending on the specific institution and arrangements.

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Top 2: Cardiology

Top 2 on our list is the field of cardiology.

Now, I’m particularly biased and attracted towards this field because I’m about to start my cardiology fellowship in just a few months as of the making of this article.

In addition to oncology, as we discussed earlier, cardiology happens to be another field in medicine that people are often drawn to early on in their medical journey.

Average Match Rate

When you think about someone in medicine, you often envision either a heart doctor or a cancer doctor. Consequently, cardiology ranks among the most competitive fields to apply to, with an average match rate of just 69.7%.

Later, we’ll talk about other factors that help applicants be competitive in case you’re interested in any of these fields.

But particularly in the field of cardiology, research is super important, thus making it more competitive. Many applicants are tasked with balancing three years of residency while also engaging in research during that period.

Length Of Training

In terms of length of training, the field of cardiology typically involves a three-year program. Often, the final year is dedicated to extensive research or elective rotations, allowing fellows to tailor their training to their specific interests within the field of cardiology.

Salary And Lifestyle

Let’s get into salary, lifestyle, and the overall enjoyment of the job.

Firstly, I must acknowledge my bias, as I’ll be starting my cardiology fellowship in just a few months. Therefore, take all my insights with a grain of salt.

Beginning with salary, the average income for a cardiologist is approximately $490,000. However, it’s important to note a significant caveat, which applies to all the specialties we’ll discuss today.

This is crucial because the reported salary is often inflated by those cardiologists who perform a higher volume of invasive procedures.

Those who perform stents, catheterizations, or electrophysiology procedures, as well as those involved in valve repairs, are technically still considered cardiologists. However, they tend to earn significantly more due to billing for more complex and lucrative procedures.

On the other hand, general cardiologists, who primarily see patients in clinic settings for issues like heart attacks, lipid evaluations, or echocardiograms, may earn slightly less.

So while the average salary in cardiology hovers around $490,000, there’s a considerable range. Some cardiologists earn substantially more due to their involvement in invasive procedures, while others may earn closer to the $350,000 to $400,000 range. Nonetheless, all these figures represent excellent salaries within the medical field.

Now, when it comes to lifestyle, the field of cardiology spans a wide spectrum. Some cardiologists opt for a more general practice, working in clinics Monday through Friday, with occasional weekend responsibilities. This setup tends to offer a favorable lifestyle compared to more intense procedural specialties.

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Top 1: Gastroenterology

And finally, we arrive at top 1: the field of gastroenterology.

Now, I must admit my bias, as this happens to be my least favorite field within medicine.

However, it’s undeniable that gastroenterology offers the best combination for doctors who are interested in both clinical medicine and performing hands-on procedures as a significant part of their practice.

It’s quite common for gastroenterologists to have a diverse practice. They often see patients in their clinics, provide consultations in hospitals, and perform various procedures such as EGDs (Esophagogastroduodenoscopies) or colonoscopies.

These procedures are crucial for evaluating conditions like polyps, sources of bleeding, or causes of malnutrition and malabsorption.

Therefore, the field of gastroenterology offers numerous opportunities to engage in exciting hands-on procedures while also applying clinical expertise to diagnose and treat patients effectively.

As an aside, while gastroenterology tops our list, it happened to be at the bottom of my list when I was considering fellowships, primarily because I hate poop. But apparently, a lot of people like it.

Average Match Rate

Now, let’s talk about competitiveness.

In addition to the salary, which we’ll discuss shortly, one of the factors contributing to gastroenterology’s status as one of the most competitive specialties is its average match rate of 63.3%.

I can easily attest to the fact that I’ve known many colleagues, friends, and acquaintances who haven’t successfully matched into gastroenterology on their first attempt. This is largely due to its intense competitiveness.

Length Of Training

In terms of length of training, gastroenterology fellowship typically happens to be three years just like our cardiology colleagues.

Salary And Lifestyle

Now, in terms of salary and lifestyle, the average gastroenterologist can expect to earn $450,000 or more annually. However, this figure varies significantly based on the volume of procedures performed.

Most gastroenterologists specialize in conducting procedures such as EGDs and colonoscopies, alongside providing consultations and clinic visits. The frequency with which you perform these procedures will significantly impact your salary.

There are many gastroenterologists who primarily focus on performing procedures and may not see a high volume of patients in clinic. Their preference for procedures often translates into higher salaries due to the increased procedural workload.

In terms of lifestyle, compared to many other medical specialties we’ve discussed, gastroenterology typically offers a fair to good lifestyle.

This is because it provides a nice balance of variety throughout the day. Gastroenterologists get to perform procedures, see patients in clinic, handle consults, and witness the immediate impact of their procedures in diagnosing and managing patients.

So, while I personally hate poop, it’s evident that many individuals find fulfillment in the field of gastroenterology. And I can certainly understand why—it offers a rewarding blend of procedural work and patient care.

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How To Be A Competitive Applicant

Now that we’ve discussed what makes these fields competitive, let’s talk about the factors that can truly make a difference if you’re considering any of these specialties to enhance your competitiveness.

Letters Of Recommendation

Letters of recommendation play a crucial role in the fellowship application process.

As you enter the fellowship pool, the medical community becomes increasingly interconnected, especially in specialties like cardiology where everyone seems to know everyone. Therefore, it’s essential to have strong recommendations from individuals within your institution who can vouch for your skills and qualities at a high level of proficiency.

For me personally, the individuals whose names appeared at the bottom of my recommendation letters were leaders in their respective fields. I was incredibly fortunate to have had the opportunity to work closely with them during my residency program.

When applying for fellowships, having reputable and well-known names endorsing your abilities as a future cardiologist can significantly enhance your application. Seeing esteemed cardiologists speak highly of you carries considerable weight, especially for those evaluating your candidacy from outside your institution.

If you have the chance to work with prominent figures within your institution, I strongly recommend seizing that opportunity—it can greatly bolster your application and chances of success.

Residency Performance Evaluation

Residency Performance Evaluation, or what’s commonly referred to as your dean’s letter or program director letter, holds significant weight as the second factor.

This document compiles evaluations from all your rotations, including both positive feedback and any areas for improvement. It essentially provides a comprehensive overview of your performance throughout your residency.

Regardless of the rotation you’re on, you definitely want to put your best foot forward and try to get the best possible evaluations from your attendings and colleagues. These evaluations contribute to shaping the overall impression of your candidacy for fellowship programs.

Residency Program Reputation

And finally, there is the reputation of your residency program. If you’re in the early stages of medical school and weighing residency options, it’s crucial to consider this aspect.

When evaluating residency programs, especially if you’re eyeing fellowship programs like cardiology, gastroenterology, rheumatology, or surgery, it’s essential to investigate their track record. Have past residents successfully matched into these fields? If not, it’s worth questioning why.

Ideally, your residency program should offer pathways for further training.

Let’s say you wanted to go into cardiology. Ideally, your residency program already has a cardiology program associated with it. But even if it doesn’t, the name and reputation of your residency program does make a big difference.

When I was interviewing for fellowship spots, I rarely had to talk about my clinical competency because people understood that I trained in an institution that trained their residents hard. We were busy and we got to see a lot.

People trusted my residency program as good enough to qualify me as a good enough doctor and a future fellow there.

Those are the things to consider as well as the top five competitive specialties within the field of internal medicine.

Now, I’m sure I’ve missed some things. So if you have any questions, go ahead and drop in the comments section down below. I’m more than happy to answer them.

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Until the next time, my friend…

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