Allergist and Immunologist

What allergists make

The federal wage survey normally hides this specialty inside a broad group called Physicians, All Other, where the median is about $236,000 and the survey stops publishing above $239,200 rather than giving a top figure. The numbers here come from the occupation-specific profile on My Next Move, the Department of Labor's own career site, which lists a median of $265,930 for allergists and immunologists.

While you are a resident

You are a paid hospital employee for those five years. It is real income, but your medical school loans are usually growing at the same time.

Owning the practice

Employed hospital allergists earn less but carry none of the business risk. Academic allergists at universities usually earn the least and do research instead.

What it costs to get there

Bachelor's degree, in-state public

About $11,000 to $15,000 a year in tuition

Medical school

About $40,000 a year in-state public, around $65,000 a year private

Medical College Admission Test (MCAT) and applications

About $345 for the test, plus $3,000 or more in application and interview costs

United States Medical Licensing Examination (USMLE) steps

Roughly $700 for each of the main steps

Roughly, all in

$190,000 to $340,000

Tuition, fees, exams and kit. Not rent, food or travel

The low end is the cheap undergraduate route, community college credits then an in-state public university, followed by an in-state public medical school. The high end is a private medical school at around $65,000 a year in tuition. Both figures include the MCAT (Medical College Admission Test) at about $345 and roughly $3,000 to apply and interview, plus the USMLE (United States Medical Licensing Examination) steps at about $700 each. The residency and allergy fellowship that follow are paid jobs rather than tuition, so those years cost time, not money.

Median debt for medical graduates who borrow is around $200,000. If you work for a nonprofit hospital, Public Service Loan Forgiveness (PSLF) can cancel the remainder after 10 years of qualifying payments.

Benefits

• Malpractice insurance paid

  Employers almost always cover it, and allergy premiums are among the lowest in medicine.

• Signing bonuses

  Common in underserved areas, sometimes with loan repayment attached.

• Predictable hours

  Clinic-based, largely scheduled, with very little overnight call compared with most specialties.

• Retirement and health coverage

  Standard hospital or group practice benefits, usually generous.

The path

The longest route on this site. Thirteen years after high school, minimum.

1. 1

   High school

   Grades 11 and 12

   Top grades in biology, chemistry and math. You need a strong grade point average to be competitive for medical school later.

2. 2

   Bachelor's degree

   4 years

   Any major, but you must finish the pre-medical science courses. Keep your grades high and take the Medical College Admission Test (MCAT).

3. 3

   Medical school

   4 years

   Two years of classroom science, two years of clinical rotations. You graduate as a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).

4. 4

   Residency

   3 years

   Internal medicine or pediatrics. This is where you learn to be a doctor rather than a student. Paid, supervised, and long hours.

5. 5

   Allergy and immunology fellowship

   2 years

   A further subspecialty training program, then the certifying exam from the American Board of Allergy and Immunology.

High school courses that help

• Biology

  The immune system is the whole specialty.

• Chemistry

  Required for every pre-medical track in the country.

• Physics and calculus

  Both appear on the Medical College Admission Test (MCAT).

• Statistics

  Reading research properly is a daily part of medicine.

Time and money, at a glance

Years after high school

13 to 14

How hard to get in

Roughly 52,000 people apply to medical school each year and about 2 in 5 get in somewhere

Total tuition

$200,000 to $350,000 across college and medical school

Paid while training?

Yes, from residency onward

Licensed by your state, certified by a national board

Every state licenses physicians through its own medical board, and you move your license when you move states. The national part is the exam sequence: the United States Medical Licensing Examination (USMLE) for medical doctors, or its osteopathic equivalent. Board certification in allergy and immunology comes from the American Board of Allergy and Immunology, which is run jointly by the internal medicine and pediatrics boards. Certification is technically voluntary but employers and insurers expect it.

Where people study

There are 174 medical schools across the United States and Canada, according to the Association of American Medical Colleges.

• Public medical schools

  Much cheaper if you are a resident of that state. Many strongly prefer in-state applicants.

• Private medical schools

  No residency preference, but tuition is far higher.

• Osteopathic schools

  Award a Doctor of Osteopathic Medicine (DO) degree and train alongside medical doctors in the same residencies.

• Fellowship programs

  Allergy and immunology fellowships are small. Many programs take only one or two people a year.

Ways the job can specialize

• Food allergy and oral immunotherapy

  Slowly feeding patients tiny, increasing doses of the food they react to. One of the fastest-changing areas in the field.

• Primary immunodeficiency

  Patients born with immune systems that do not work properly. Often lifelong relationships.

• Severe asthma

  Managing the patients other doctors could not control, usually with newer biologic drugs.

• Drug allergy evaluation

  Testing whether a recorded penicillin allergy is real. Most are not, and clearing them changes patient care.

Nice-to-haves before medical school

• Research experience

  Immunology research helps a lot when you apply for a fellowship later.

• Clinical volunteering

  Consistency over years beats a single impressive summer.

• Spanish or another language

  Useful everywhere in American clinical practice.

• A rural or underserved background

  Many state medical schools weigh this in admissions.

Academic or private practice

Academic allergists work at university hospitals, see complicated cases, teach fellows and run research. The pay is the lowest in the specialty and the intellectual reward is the highest. Private practice allergists run a clinic, do skin testing and allergy shots, and can earn far more, especially as a partner. A growing middle option is employment by a large hospital system, which pays decently and hands the business headaches to someone else.

A typical day

Clinic from about 8am. A morning of appointments: a child with new asthma, an adult whose hives will not stop, a family deciding whether to start food immunotherapy. Skin testing happens in the room, so you get answers the same visit. Afternoon: more clinic, a stack of results to interpret, prior authorization forms for expensive biologic drugs, and notes. You go home. Emergencies in this field are rare.

The honest trade-offs

Work life

Typical hours

40 to 50 a week, mostly clinic

Remote work

Some video visits, but testing must be in person

Physical demand

Low

Unionized

Rarely, though resident physicians at some hospitals are

Similar paths

• PediatricianThe family doctor for children, from newborn checkups to teenagers. Eleven years of training, and the lowest pay of any doctor on this list.
• Internal Medicine DoctorThe adult body, all of it, and the complicated patients nobody else can sort out. Eleven years of training.
• DermatologistA doctor for skin, hair and nails. Very well paid, and one of the hardest residencies to get.

It is a small specialty

The American Academy of Allergy, Asthma and Immunology has more than 7,000 members. Compare that with hundreds of thousands of American physicians overall. Nearly everyone in the field ends up knowing everyone else.

Allergy shots take years

Immunotherapy retrains the immune system by injecting tiny amounts of the thing you react to, increasing slowly. A full course usually runs three to five years, so patients become very familiar faces.

Most penicillin allergies are not real

Large numbers of people carry a penicillin allergy label from childhood that testing later disproves. Clearing that label lets doctors use cheaper, safer antibiotics, and allergists do this work every week.

Childhood food allergy keeps rising

Millions of American children now have a diagnosed food allergy, and the numbers have climbed over recent decades. Researchers still argue about why, which is part of what makes the specialty interesting.