Category Archive: Choosing a Specialty

Spotlight Interview: Matching in Ophthalmology (OSU Resident)

Categories:

How to match in....?, Ophthalmology, The Match

April 4, 2012

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An Ophthalmology Resident’s Perspective:

From an interview with an ophthalmology resident at The Ohio State University

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the ophthalmology match?

Extremely competitive.  For foreign medical graduates (FMG) and second time applicants, chances of match are very slim. The overall match rate for ophthalmology is about 75%.

 

  • What are residencies looking for in a ophthalmology applicant?
They are looking for genuine interest in the field of ophthalmology demonstrated by rotation evaluations, Ophthalmology research, volunteering etc, and a highly competitive applicant. Outstanding applicants with high board scores and numerous class honors do not necessarily have to have as much ophthalmology related extracurricular involvement or research. However, if you are not a stellar applicant, early and evident interest is very important.

 

  • What do you wish you knew before application/interview season?  

I wish I knew which programs I was realistically competitive for. Other than the top 15-20 programs it is difficult to know where a program ranks and how good they are or aren’t without interviewing there.  Ask people who recently applied or find a faculty member who is willing to discuss these types of things.

 

  • What should students look for in a ophthalmology residency?

One of the most important things for me was finding attendings who enjoy teaching and enjoy resident interaction. A program that will help put you in a position to match in your desired fellowship is also very important. Learning about a residency’s job and fellowship placement is very important. Clinical and surgical experience, above all, are something that you must weigh. Surgical numbers should be above the national averages and especially above the minimum required amount.

 

  • What other advice do you have for students applying to ophthalmology residency?

Academic ophthalmology is a small world. A great letter from a prominent ophthalmologist is invaluable.

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Ophthalmology? (OSU Resident)

Categories:

Ophthalmology, Why did you choose....?

April 4, 2012

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An Ophthalmology Resident’s Perspective: From an interview with an ophthalmology resident at The Ohio State University

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Ophthalmology?

The first four things that come to my mind are: 1-The range of care, everything from medical management to surgical intervention. 2-The lifestyle. 3-Patient continuity. 4-Most ophthalmologists thoroughly enjoy going to work every day. 

 

  • Describe a Ophthalmologist’s typical work day?

Office time or clinic time takes up some of the week (usually 3-4 days) and surgery takes up the rest of the week.  You can work an 8-5 day but some choose to see more patients and have longer hours.

 

  • What type of lifestyle can a Ophthalmologist expect?  

The workload is very manageable. Unlike other surgical sub-specialties, the schedule can be flexible and there is opportunity to have a good amount of time off.  Many weekends will be free but there is call and it can be very busy.

 

  • What is the potential salary of a Ophthalmologist?

Starting salary approx $170,000.  At about five years out the salary climbs to somewhere in the mid $200,000 range. A few fellowships can lead to more income (retina especially) but there are fellowships that lead to less income (pediatrics).

 

  • What is the job market like for Ophthalmology?

The market for ophthalmologists in urban areas is quite saturated. There are a few opportunities in desirable suburban areas, but many of these are full as well. Rural areas have openings and usually a higher base pay.

 

  • What are the potential downsides of Ophthalmology that students should be aware of?

Finding a job in a desirable location is not an easy task. You can say this about most specialties in medicine. Also, there is a high cost of practice operation. The overhead for an ophthalmologist is much higher than most specialties. We have lots of toys to play with, but they all cost money.

 

  • What else would you tell medical students who are considering Ophthalmology?

The early match often requires an early commitment to ophthalmology and it is to the applicant’s benefit to submit their application as early as possible because some programs extend interviews on what appears to be a rolling basis. Good luck!

 

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: Matching in Neurology

Categories:

How to match in....?, Neurology

April 4, 2012

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A Neurology Attending’s Perspective:

From an interview with a neurology attending at the University of Michigan, Ann Arbor.

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the neurology match?

Fairly competitive for the top programs, but there are enough good programs that most good students should match well.  Average programs and lower tend to fill with foreign medical graduates, so overall the competition is probably below average.

 

  • What are residencies looking for in a neurology applicant?
Despite the reputation for being a less-competitive match, Neuro residents literally have patients lives put in their hands fairly frequently, and often when nobody else in the hospital has a clue what to do.  Thus, it is imperative that the residents be extremely responsible and capable of learning how to handle things like acute stroke, status epilepticus, and other neurological crises.  Oftentimes other physicians will completely miss the diagnosis and it is YOUR job to save the person’s life.  A potential resident must be able to handle that.

 

  • What do you wish you knew before application/interview season?  

Even though it is less-competitive overall, it IS competitive for the top programs, so don’t be cocky.  And remember—ALL residencies just want someone who really, really REALLY wants to learn and take care of patients.

 

  • What should students look for in a neurology residency?

There MUST be an ICU experience of some sort, where you take care of neurological emergencies.  There must be a mix of strong outpatient clinics,neurological consults, and inpatient neurology.  I cannot imagine how you can become a neurologist in a place that only does consults, and not have your own patients.

 

  • What other advice do you have for students applying to neurology residency?

To be completely honest, a lot of people make fun of neurology…right up until the point that they need you.  And you know what?  Everybody always eventually needs you.  Then they call you and are scared to death and you walk in like a hotshot and have all the answers.  Patient’s seizing?  Big deal.  Acute stroke?  tPA and let’s go.  Mental status changes in a 85 y/o demented man with sepsis?  Uh… sure, I’ll do that consult ( in like 3 MINUTES!!)   Unexplained progressive weakness?  Oh yeah, this is the fun part.

Neuro’s awesome.

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Neurology?

Categories:

Neurology, Neurology Rotation, Why did you choose....?

March 31, 2012

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A Neurology Attending's Perspective: From an interview with a neurology attending at the University of Michigan, in Ann Arbor

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to neurology?

The subject matter was, and still remains, the most interesting part of medicine to me.  I love figuring out where the problem is—the “localize the lesion” question that is the heart of neurology.  But perhaps the most important is that I enjoy the day-to-day interactions with patients:  the types of questions they have, the exams I have to do, the problems we have to deal with…  I saw what it was like in med school, and realized this was my favorite by far.

 

  • Describe a neurologist's typical work day?

A clinic day is 8-5, with fairly long visits for each patient.  I get 30 minutes for a follow up and 60 for a new.  Most of the visit is getting the history.  In the hospital (teaching hospital with residents), rounds are usually mid-morning, consults in the afternoon.

 

  • What type of lifestyle can a neurologist expect?  

There are a few neurological emergencies, which are uncommon but usually end up going to an ICU right away.  You can pick a subspecialty that has minimal emergencies.  Most private jobs I see have call q 4-6.  However, call is usually from home, answering questions.  The biggest determinant of lifestyle is reimbursement.  If you have a billable procedure like EMG, botox, EEG, sleep studies, you can pay your salary quite easily and have a very relaxed schedule—probably 50 hours a week at most.  Without a procedure, much more time is necessary, as the visits can last a long time so you may have long clinic hours.  60 hours or so.  Call may be q4-6 but I rarely see attending neurologists in the hospital after 9 PM or before 7 AM.  Usually call is handled from home.

 

  • What is the potential salary of a neurologist?

A private neurologist will start at about $200-250K.  They will need some procedure (EEG, EMG, sleep studies, botox, etc) to be able to maintain that without a terrible clinic schedule.

 

  • What is the job market like for neurology?

I get advertisements for neurology positions all over the country, all the time.

 

  • What are the potential downsides of neurology that students should be aware of?

Seeing patients in clinic takes longer than most specialties but bills the same, which can hurt the reimbursement a lot. Most neurologists need some sub-specialty training to get a procedure like EMG or EEG.  In a private hospital, you stand the risk of being consulted on every mental status change, which is rarely neurologic.  They are easy consults, but could make call very annoying.  Most neurologists just tell the consulting team to get a bunch of tests that night and then see the patient in the AM.

 

  • Every specialty has a reputation, how do you respond to the reputation of neurologists?

There are two.  The first reputation is that neuro cannot fix anything, only diagnose it.  This is now an archaic idea, since we now can treat almost every disease to some degree: we have acute stroke treatments (tPA), many MS treatments, and neurological diseases are one of the top areas of drug research in all companies.  The second is a reverse reputation (one that we notice ourselves about other physicians):  most physicians are terrified of Neurology, and would often much rather consult us than do a neuro exam.  This is a shame, and leads to some disappointing situations.  But it also generates a bit of an “outsider” image between us and all other specialties, somewhat similar to the disconnection between medicine and surgery.

 

  • What else would you tell medical students who are considering neurology?

If you like figuring out problems like a medical detective, and if you are a very observant person who likes little details,neurology should be at the top of your list.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: Matching in Dermatology

Categories:

Dermatology, How to match in....?, The Match

March 31, 2012

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A Dermatology Resident’s Perspective:

From an interview with a dermatology resident at Wayne State University in Detroit, Michigan

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

  • How competitive is the dermatology match?

Very. There are not a lot of training programs as compared to otherspecialties. On top of that, each program may only have 2-3 spots yearly. As you can imagine, this creates a competitive atmosphere in the Dermatology match.

 

  • What are residencies looking for in a dermatology applicant?
There are rumors about Dermatology i.e. You must do research, you must have 250+ on Step 1, etc. Although these will help in the match, each applicant has their own characteristics that may impress a program (i.e leadership,Clinical experiences). In general, a well-rounded student will be very competitive. Honors in third year clerkships will be very helpful. Dermatology programs particularly look at the Internal Medicine clerkship as a strong indicator. 

 

  • What do you wish you knew before application/interview season?  

Since Dermatology is competitive, it is important to apply broadly across the country. The application and travel expenses can be costly so prepare wisely.

 

  • What should students look for in a dermatology residency?

Important aspects of Dermatology training include a diverse patient population, wide variety of training in all Dermatology subspecialties (Pathology, Pediatrics, Procedural, Mohs and Cosmetics) and learning environment (clinic vs. inpatient; large program vs small program)

 

  • What other advice do you have for students applying to dermatology residency?

It is important to immerse yourself in the field of Dermatology. Performing well in a Dermatology clerkship will be very helpful. Away rotations are helpful to show a program how well you can fit in at that program AND will give you the opportunity to get a strong letter of recommendation from  Program director at your away rotation.

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why Did You Choose Dermatology?

Categories:

Choosing a Specialty, Dermatology, Why did you choose....?

March 31, 2012

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A Dermatology Resident’s Perspective: From an interview with a dermatology resident at Wayne State University in Detroit, Michigan

Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

 

  • What attracted you to Dermatology?

The variety of pathology seen in the field of Dermatology initially attracted me. The field allows your to be a clinician, a surgeon and a pathologist all in one day. This kind of variety seems to allow me to be entertained for the next 20+ years.

 

  • Describe a Dermatologist’s typical work day?

The majority of Dermatologist spend there days seeing patients in clinic. Common things are common so most days consist of diagnosis and treatment of skin cancer, acne, benign skin conditions, warts, etc. Some Dermatologists mix their day up with procedures such as benign or cancer excisions, aesthetic procedures, laser surgeries, etc. dermatopathologist spend their days viewing pathology slides to lead to the diagnosis of various skin conditions. Mohs micrographic surgeons use a special surgical technique to treat skin cancer at the microscopic level. Procedural and Cosmetic Dermatologists uses injections, chemicals, lasers and surgical techniques to improve the aesthetic appearance of their patients.

 

  • What type of lifestyle can a Dermatologist expect?  

Most Dermatologist work 5-6 days weekly. The majority of patients are seen between 8am and 5 pm. Dermatologist who are affiliated with hospitals may seen Dermatology consults throughout the day and occasionally on weekends. There are only a few Dermatological emergencies. Therefore, your evening and weekends are used to enjoy family or personal interest. Although the hours of a Dermatologist may be limited to 40-50 hours per week, most Dermatologist will tell you they spend a large amount of time reading new literature and review old text as the field is very vast. A good trained Dermatologist must stay up with current recommendations.

 

  • What is the earning potential of a Dermatologist?

Typically, a Dermatologist may earn roughly between $200,000 and $400,000. This depends on the setting of your practice (Academic vs. Private), location of your practice (Urban vs. Rural) and Volume of patients. With any specialty, there are always outliers. Dermatologist who see large volumes of patients, perform cosmetic or surgical procedures, may earn more income.

 

  • What is the job market like for Dermatology?

There is currently a shortage of trained Dermatologist across the United States. Therefore, the job market is pretty good.

 

  • What are the potential downsides of Dermatology that students should be aware of?

Many people (especially other physicians) comment about the awesome lifestyle of Dermatologist. Although generally dermatologist have great lifestyles, they work very hard for this lifestyle. If you are looking for a field that is “easy,” Dermatology is not for you. The training is an intense 3 years filled with countless hours of clinic and reading…Lots of reading. Life as an attending may be seen as glamorous but your earning potential is based on how hard you work. Due to the shortage of Dermatologist, many physicians have to “stretch themselves thin” in order to accommodate their patient population. Many Dermatologist work beyond normal business hours and even weekends to accommodate the patients they serve.

 

  • What else would you tell medical students who are considering Dermatology?

It will be very helpful to get a full Dermatology experience during your medical school training. The more you see, the better you will understand the field and if it is a good choice for you.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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U.S. Residency Programs Under Probation

Categories:

Residency, Choosing a Specialty, Specialties, The Match

November 15, 2011

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The ACGME is incharge of accrediting U.S. medical and surgical residencies. There are three decisions that can be made: Accreditation, probationary accreditation, or withdrawl of accreditation. The ACGME compiles an up-to-date list of residency programs under probation or with withdrawn accreditation in all specialties. I had previously reported on the list for 2012, but many of these programs have either dissolved or have been able to regain good standing with the ACGME. Rather than list all the current institutions on probation, a list which is always in flux, it is best to search the database yourself. You can search for all specialies, or by a single specialty. This is probably a very good thing to do when deciding where to apply.

Click here to search for programs under ACGME probationary accreditation 

Click here to search for programs whose accreditation has been withdrawn

 

 

 

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Which doctors get sued the most?

Categories:

General, Choosing a Specialty, General Surgery, Neurosurgery, Pediatrics, Psychiatry

September 23, 2011

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Have you ever wondered which physician specialties deal with the most malpractice lawsuits? While I was in medical school I often heard physicians discuss the rising costs of malpractice insurance and the lack of tort reform.  I knew that OB/GYN doctors had to deal with a lot of lawsuits, but I had no knowledge of which other specialties faced frequent lawsuits.  The New England Journal of Medicine recently published a great paper identifying which medical specialties are sued the most frequently.  The paper can be freely accessed by anyone (click here to see the full article).

The most interesting results can be summarized by the graph below, which demonstrates the percentage of physicians sued in a calendar year, separated by specialty. As you can see, neurosurgeons and cardio-thoracic surgeons lead the list with nearly 20% of all physicians in these specialties sued each year.  Wow, that seems excessive!  On the other side of the graph, only about 3% of psychiatry and pediatric physicians deal with lawsuits each year.

Taken from NEJM, click the link below to see the full article

See the full article here

The article also presents data that demonstrate the cumulative probability of being sued during your career.  They find that by the time physicians in ‘high risk’ malpractice fields, such as general surgery and neurosurgery, reach 55 years of age nearly every singly physician has been sued at least once (95-99%).

Malpractice lawsuits are an important topic, especially when choosing a medical specialty during medical school.  Students need to know what problems the every-day doctors face so that we can make informed decisions.  If someone went into neurosurgery without knowing that nearly 100% of all neurosurgeons will be sued by the age of 55, this might result in a very unhappy professional life.  On the other hand, if you love neurosurgery and you are informed about this problem, you will be able to weigh all the pros and the cons of the specialty before making your decision.  When you know what you are getting into, you always have a higher chance of success.

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Average Physician Salary

Categories:

General, Choosing a Specialty, Compensation, eResources

August 4, 2011

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In this article I will highlight some of the best online resources for researching physician salaries by specialty. I will explain why each site is good and why each site is less than idea. I do not print out any of the salary information. I recently wrote another article where all the salary information from these sites is printed. “The Ultimate Guide to Physician Salaries” is a complete analysis of all physician salary data online. You no longer have to google ‘physician salary’ to find all the best information, the Ultimate Guide to Physician Salary has it all laid out in one place.

The longer you are a medical student, the more you will think about this question. In most academic medicine circles, it is taboo to discuss salaries and earnings.  However, this is an important question and one that SHOULD NOT make you feel guilty.  The information is important in planning your life, budgeting your money and loan dollars, and in choosing a specialty.

 

There are a number of ways to research physician salaries, none of which is perfect.  When conducting this research you must remember that most private physicians own their own practice, are not employed, and therefore do not have an easy reportable income.  In this article we will review the best online resources to research physician salaries, and the pros and cons of each resource.  You should remember that most of these numbers come from email or snail mail surveys with small response rates, so the numbers will vary.  If the data you find online do not come from large physician surveys, they are probably not reliable.  Below I outline four very reliable sources.

 

#1  Medscape Physician Compensation Report

Each year Medscape conducts an enormous survey of physicians of every specialty (see my dedicated article about the newest report).  To access the results of the survey you must be a member of Medscape/Web MD.  This is a free service that I would suggest to all medical students even if you do not access their survey results (membership also provides free access to the best ipod/ipad/iphone apps for medical school which I discuss here).

Access to the site allows you to view the data for all specialties of medicine.  Medscape publishes one conglomerate presentation where they compare compensation among all specialties, all practice settings (private vs. multi specialty group vs. academic), and all locations (urban vs. rural).  In addition, they publish a presentation for each sub-specialty where they explore gender effects, time spent with patients, patient visits in a week, geographical sector (east coast vs. west coast vs. south vs. mid-west), and other factors affecting compensation.

http://www.medscape.com/features/slideshow/compensation/2011/
(login needed)

PROS:
Represents responses from over 15,000 physicians, the largest report of its kind.
Neat display and graphics
Tons of extra information about location, practice setting, etc
Updated yearly
They report the changes to compensation from year to year
Access to their site provides many other benefits (apps)

CONS:
You must have a login, which is free and non-intrusive

 

#2 Careers in Medicine website 

As I discussed in a previous article, the Careers in Medicine (CiM) website is a fantastic resource for all medical students.  The site provides tools to understand personality traits, which specialties you might enjoy the most, and ample information about each specialty in medicine.  One of the best parts about the website is the unbiased salary information they provide about each specialty and some sub-specialties.

Once you are logged on (medical school email address required) you will have to find the links to specialty pages, and then find the compensation tab.  These information reported is survey information and is updated periodically.  They offer the unique ability to compare academic salaries to those of private practitioners in each specialty and sub-specialty.  In addition, they report the salary information broken up into “First three years of career” and “Late career” to compare how compensation might change as your practice gets settled.

https://www.aamc.org/students/medstudents/cim/

PROS:
Unbiased information available only to medical students
Compare compensation of academic to private practice physicians
Part of a great web resource for all medical students
Includes ample information about each specialty

CONS:
You must have a login, which is free for all medical students
There is not compensation information about smaller sub-specialties

 

 #3 Merritt Hawkins

Merritt Hawkins is another web-based survey company that conducts an annual physician compensation survey.  Their data, however, is a little different than the other companies.  The report the results of salary and incentives offered to physicians through head-huThe results of their survey are open to the public.  They conduct a number of great analyses including identifying the most recruited specialties, where to find probono medical work, and their salary information.

Their main site provides links to all the above information

http://merritthawkins.com/

Their most recent salary information (2010) is available at the link below.

http://www.merritthawkins.com/uploadedFiles/MerrittHawkings/Surveys/mha2010incentivesurvPDF.pdf

PROS:
PDF format with ample information
Compare the results of the last 4 years’ surveys in the same pdf
Very large survey providing reliable results

CONS:
Not all specialties (ophthalmology) are included
No ditinction between practice situation and location

 

 #4 CEJKA Search

This is a little known resource that provides great information.  The AMGA Medical Group Compensation and Financial Survey is a  company that has been following physician salaries for 30 years.  They report the results of their analysis for free on their website.  There is no nonsense to their data, they simply list the median salary for all specialties in medicine.  They also provide compensation information for physician executives and for mid-level providers (PA, CNP, CRNA, Podiatrist, Optometrist, etc.)

 

http://www.cejkasearch.com/view-compensation-data/

PROS:
Clean format, easy to access
Easy to compare, all information on one webpage

CONS:
Fewer respondants than other surveys
Private company

#5 Allied Physicians Survey

The Allied Physicians survey is one of the most readily available tools to research physician salary information.  The organization has been collecting salary information since 2003.  It is unclear if they are still updating the information on their website as it posts “2006” as the most recent update.  The great part about this survey, however, is the ability to quickly compare all the specialties of medicine. They are reported in one webpage, side by side, so you do not have to click one hundred times to see all the information

http://www.alliedphysicians.com/salary-surveys/physicians/

PROS:
Clean format, easy to access
Easy to compare specialties
Demonstrates three compensation tiers (starting, 1-3 years, >3 years)

CONS:
Unclear if the survey is still being updated

 

#6 Public Record Information

As I mentioned in a previous post, many states have now made public university salary information open to the public.  This means that the salaries of many physicians who work at public academic medical centers are now widely accessible.  You can simply google “salary information” and the university you are interested in researching to find the data.  Or, you can go to the website below which has compiled all the information for you.

http://www.collegiatetimes.com/databases/salaries

PROS:
-Learn about real salary information of academic physicians
-Salary data for chairmen, deans, CEOs are all public record

CONS:
-Not all states represented
-Many universities have incentive structures built into salary information, so the numbers you see reported may not be the actual salary brought home by the physician.

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Freedom of Information Acts and Physician Salaries

Categories:

General, Choosing a Specialty, Compensation

July 28, 2011

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Many states have passed freedom of information acts that force public universities to publish the salary data for all of their employees. Whether you agree or disagree with this form of legislation, you should all know what information these acts provide you.  There are now a large number of academic medical centers whose salary information is available to you and the public.  A quick Google search will find the university you are interested and the department, specialty, or physician you would like to learn about.

If you are interested in working in academics, estimating your future salary was next to impossible before this information was made public.  We all know that academic docs usually make less money than private docs, but the taboo issue is never discussed.  Many sites provide survey information on how much physicians make in different specialties, but these rarely distinguish between private and academic physicians.  Now, thanks to the Freedom of Information Acts, you can know.

Because this information is public record, you can just search for it on the web.  I have found that the Collegiate Times website is very well organized and lets you search by University, Department, or Name.

http://www.collegiatetimes.com/databases/salaries

One last caveat.  You will see some information that is surely inaccurate.  Many physicians’ income in an academic center comes from a number of different sources (multiple departments, multiple hospitals, bonuses for productivity etc).  So, if you see an orthopedic surgeon making $60,000 don’t get an aneurysm, there is something else going on.

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