March Madness

Elyas Bakhtiari, for HealthLeaders Media, March 27, 2008
For many medical students, March Madness has nothing to do with basketball. This is the time of year they find out which residency program accepted them, effectively determining the specialty they'll practice for years to come.

This year's "match day" was last Thursday, and medical students weren't the only ones following the results. Facilities concerned about physician shortages look to residency placements for indications about upcoming recruitment challenges and investment opportunities. We hear often of the projected shortage of 200,000 physicians by 2020, but that number doesn't adequately address the nuance of the problem. Some specialties are already experiencing shortages and have been for several years. Others may see significant growth for many years to come.

In the spirit of March Madness, here's a brief ranking of how each specialty will fare between now and 2020. Fill out your brackets accordingly:

(1) Dermatology. Most specialties that offer high salaries also have rigorous schedules with full call, and specialties with flexible schedules that appeal to "lifestyle" physicians often lag behind in compensation. But with median salaries around $400,000, dermatology offers both, and that's what makes this specialty a physician favorite.

(2-3) Plastic surgery/otolaryngology. As this New York Times article notes, medical students with the highest medical-board scores are gravitating toward "appearance-related" specialties, which have everything today's physicians are looking for: high patient demand (thanks to a looks-obsessed culture), high pay, and options for flexible and autonomous scheduling.

(4-5) Radiology/anesthesiology. Though these specialties have seen or will see shortages, they pay fairly well--a factor that is crucial when competing for a limited number of applicants--and are able to use nonphysicians (i.e., CRNAs) and technology (think teleradiology) to treat more patients with fewer physicians.

(6) Ophthalmology. With a median compensation of about $300,000, ophthalmology is in the middle of the pack on "offense" (i.e., salaries), but it makes up for that with a strong defense (i.e., opportunities for work-life balance).

(7) Cardiology. Invasive cardiologists are among the highest-earning specialists. Though hit recently by reimbursement cuts, the specialty is a big revenue generator for hospitals, which will continue to invest in this area. The problem: The aging population is going to send the need for cardiac services soaring, and facilities will need more cardiologists to keep up.

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