Allergy & Immunology — Specialty Profile

Exploratory, not prescriptive. This profile blends hard data (pay, match rates, burnout, demographics — each sourced and dated) with generalizations and synthesized online opinion about culture and "who fits." It's here to help you get curious and go find out for yourself — not to tell you who to become. Numbers marked ⟳ verify change every year; check the linked source before you quote one. Last reviewed: 2026-07-25.

Also called: A&I, allergy, allergy/immunology. Subspecialty fellowship of Internal Medicine or Pediatrics, reached by finishing an IM or Peds residency first and then doing a 2-year fellowship rather than by matching from medical school. Organ systems: the immune system across every organ, covering airways, skin, GI tract, and the immune system itself.

The 30-second version

Allergy & Immunology is the specialty people name when they want proof that a low-burnout, well-paid, essentially call-free career in medicine actually exists. It's almost entirely outpatient: you run a clinic, you follow patients (and often their whole families) for years across every age, and you go home at the end of the day with no hospital rounds and no overnight pager. The clinical substance is deeper than the "sneezes and EpiPens" caricature suggests. Clinical immunology spans drug reactions, primary immunodeficiency, mast-cell disease, eosinophilic disorders, and a fast-moving frontier of biologics and food-allergy immunotherapy. The pay is solid, better than general IM or Peds, and unusually strong on a per-hour basis because the hours are light. The whole catch is on the front end: the fellowship is small and competitive, so the field rewards planning early.

Quick dashboard (details and sources below)
Training after med school IM or Peds residency (3) + A&I fellowship (2) = 5 years
Total from college start ~13 years (4 undergrad + 4 med school + 3 residency + 2 fellowship)
Competitiveness (as a subspecialty fellowship) Competitive — small field, 98.9% fill, 1.36 applicants/position (241 for 177, 2026 appointment year) ⟳
Typical full-time pay ~$310,000–$360,000 total comp (private practice runs higher) ⟳
Pay range (structure) 25th pct ~$310k · median ~$360k · 75th pct ~$390k · 90th ~$450k (SalaryDr panel, n=39) ⟳
Lifestyle Outpatient, ~40–44 hrs/wk, essentially no overnight call — among the best in medicine
Burnout 35% of allergists (Medscape Allergist Lifestyle, Happiness & Burnout Report 2023); no cross-specialty rank is published for the field ⟳
% women ~43% practicing; ~68% of fellows in training ⟳
DO / IMG accessibility Opening up — 21.7% DO and 14.9% IMG of the 175 filled positions in the 2026 appointment year, both up sharply on 2025 ⟳

What they actually do

Allergists/immunologists diagnose and treat disorders of the immune system, which in practice means a lot more than hay fever. The bread-and-butter is allergic rhinitis, asthma, chronic urticaria (hives), eczema/atopic dermatitis, food allergy, and drug allergy. But the specialty's intellectual core is clinical immunology: primary immunodeficiencies, immune dysregulation, mast-cell disease, eosinophilic disorders like eosinophilic esophagitis, and adverse drug reactions. The defining skill is the diagnostic reasoning to sort out why an immune system is over-reacting, under-reacting, or attacking the wrong target, and then to modify the disease rather than just suppress a symptom.

The work is outpatient, continuity-based, and conversation-heavy. You see patients of every age (many allergists care for both adults and children in the same clinic), you build relationships that run for years, and you spend real time listening, because a careful allergy history is often the whole diagnosis. There's just enough hands-on work to keep it from feeling purely cognitive.

Representative procedures: skin-prick and intradermal allergy testing · patch testing (contact dermatitis) · spirometry / pulmonary function testing · oral food challenges · drug challenges and drug desensitization (e.g., penicillin de-labeling) · allergen immunotherapy ("allergy shots") · oral immunotherapy (OIT) for food allergy · administration of biologics (anti-IgE, anti-IL-4/13, anti-IL-5 agents).

A day in the life: A typical clinic day runs roughly 8:30 to 6, four to five clinical days a week, with a day often reserved for administration and no hospital rounds. You see somewhere around 15–22 patients, a mix of new consults (the detective work) and follow-ups (asthma control, immunotherapy progress, food-challenge results). Skin testing, a food challenge, or a drug desensitization punctuates the schedule. Overnight call is minimal to none, even in academic centers, and weekends are largely free. When the clinic day ends, the deliberate norm in much of the field is to leave work at work.

The training path & time to completion

This is a subspecialty fellowship with a two-step entry, and one of the few reachable from two different residencies.

Medical school (4 yrs) → Internal Medicine or Pediatrics residency (3 yrs) → A&I fellowship (2 yrs) → board-eligible with ABAI.12

Two-step entry note: you do not match into A&I out of medical school. You first complete a full residency in either Internal Medicine (adult focus) or Pediatrics (pediatric focus) and become board-certified by that parent board, then you apply to A&I fellowship through a separate, later match. The upside of that structure: your residency itself is a complete, stable career, so your fallback if A&I doesn't work out is already a good one (see the FLI angle).

  • Dual entry (IM or Peds): Both routes feed the same ACGME-accredited A&I fellowships and the same board exam, and all fellows are trained to care for both adults and children regardless of which residency they came from. IM and Peds applicants compete against each other in a single combined match, applying to the same programs and building the same rank lists.1
  • Fellowship length: a minimum of 24 consecutive months of ACGME-accredited training; most programs are 2 years, and research-track programs may run 3.12 ⟳
  • The fellowship match: A&I fills through the NRMP Medicine and Pediatric Specialties Match (the "December match" run by the Specialties Matching Service), the same cycle as other IM and Peds subspecialties, and separate from the medical-school Main Match.3
  • The board is a conjoint one: the American Board of Allergy and Immunology (ABAI) is jointly sponsored by the American Board of Internal Medicine (ABIM) and the American Board of Pediatrics (ABP). You must first be certified by ABIM and/or ABP before you can sit the ABAI exam, which is exactly why either residency route qualifies you for the identical A&I credential.45
  • Total from the start of college: ~13 years (4 undergrad + 4 med school + 3 residency + 2 fellowship).

How competitive is it? (as a subspecialty fellowship)

A&I is a small and genuinely competitive fellowship, and the competition looks different from a med-school-Match specialty because the applicant pool is already filtered (everyone applying has finished an IM or Peds residency), and the number of seats nationally is tiny.

The most recent cycle is the 2026 appointment year, matched in December 2025 and published in NRMP's Results and Data: Specialties Matching Service 2026:6 ⟳

  • 177 positions across 101 programs and 175 filled, a 98.9% fill rate, with only 2 programs left with an open spot.
  • 241 applicants ranked A&I for those 177 positions, an applicant-to-position ratio of 1.36:1 — looser than 2025's 1.47:1, and the field's fill rate held anyway.
  • Small footprint overall: FREIDA counts 92 ACGME-accredited programs and ~345 active fellows on duty nationally.2 ⟳ (NRMP's 102 vs. FREIDA's 92 reflects NRMP counting participating program tracks; both are cited.)

The honest read: nearly every seat fills and a meaningful share of applicants go unmatched, so it is genuinely competitive, though not at the extreme, near-impossible level of dermatology-type fellowships. The binding constraint is the small number of seats, not a brutal ratio. Because the field is a well-known lifestyle destination, strong applicants self-select in, which is what keeps fill rates near 99%. The practical takeaway for a trainee: this is a spot you build toward from early in residency rather than drift into late (see the FLI angle).

Compensation — the robust version

A&I pay is unusually spread out and unusually misread by the headline surveys, for one structural reason that comes before any single number: much of A&I's economics runs on outpatient ancillary revenue that RVU-based employment models barely credit: allergy shots, in-office testing, and buy-and-bill biologics. Physicians who own that revenue (private practice, partners) earn dramatically more than the RVU-only employed median. So the surveys disagree mostly because they're measuring different practice models. Treat Medscape as the anchor for the employed/broad-survey magnitude and SalaryDr / Physician Side Gigs as the window into private-practice reality, while noting those latter samples are small and self-reported — SalaryDr's allergy panel is 39 physicians.789

National number. Depending on source and definition, A&I lands anywhere from ~$255,000 (FastRVU's employed/RVU planning median, the aggregator's own model rather than a licensed MGMA table) to ~$360,000 (SalaryDr median, private-practice-skewed). Medscape's broad survey puts it at ~$319,000 (2025 report) falling to ~$310,000 (2026 report, −3% YoY), ranking A&I roughly 22nd of 29 specialties, the lower-middle of the pay spectrum.7810 A defensible "typical full-time" figure for 2025–26 is ~$310,000–$360,000 total compensation, with private-practice owners running well above that.79 ⟳

The spread (structure, from SalaryDr 2026, a small self-reported sample that skews private practice): 10th pct $290k · 25th $310k · median $360k · 75th $390k · 90th $450k.9 ⟳ Realized outliers on the high end reach $500k+ for owner/partners with heavy immunotherapy and biologics volume; the low end (early-career, low-volume employed) can sit near $210k on MGMA/RVU benchmarks.91112 ⟳

Seniority helps, but ownership is the real lever. SalaryDr's progression runs entry-level (0–2 yrs) ~$340k → mid-career ~$353k → experienced (11–15 yrs) ~$440k.9 But the biggest jump isn't tenure. It's buying into a practice, which converts you from a wage-earner into an owner of the immunotherapy/testing/biologics revenue stream. Practice owners derive ~44.7% of comp from productivity vs. 22.3% for employees.13 ⟳

Academic vs. private practice is A&I's defining split. Because owners capture ancillary revenue, private practice pays far more than academia here:

  • Group private practice (independent + PE-backed): avg ~$342,000, up to ~$500,000.12
  • Academic hospitals: ~$236,000. The lowest setting, skewed toward research/protected time.12
  • The academic-to-private gap in A&I can be $100k–$250k+, one of the widest setting-based spreads of any outpatient specialty.1211 ⟳

Geography (SalaryDr 2026 metro averages, small sample): Los Angeles ~$380k · Boston ~$370k · Miami ~$360k · Chicago $350k · Houston $340k; top states by median include California and Iowa ($360k) and Massachusetts ($350k).9 High-cost metros command higher nominal pay; competitive-wage states include Texas, Florida, New York, and California.11 ⟳

Urban vs. rural. Directionally, rural/underserved areas can offer a scarcity premium (few allergists), but A&I revenue depends on patient density to sustain immunotherapy and biologics volume, so many rural markets can't support a full A&I practice, which blunts the usual rural-pays-more pattern. No survey publishes a clean A&I-specific urban-vs-rural dollar gap.11 ⟳

The trend that colors all of it: the biologics boom. The single biggest upward driver of A&I income in the 2020s is the rapid expansion of biologic indications (severe asthma, atopic dermatitis, chronic urticaria, eosinophilic esophagitis, and now food allergy). Practices that buy and administer these high-cost drugs capture the margin, a windfall that flows to owners rather than to RVU-employed physicians. At the same time, the industry-wide drift toward RVU-productivity pay actively "devalues compensation from allergen immunotherapy," squeezing employed allergists and pushing income-maximizers toward ownership. Private-equity roll-ups of A&I groups are now consolidating that ancillary revenue at scale.1310 ⟳

Starting-package extras (Physician Side Gigs, 2023–25): sign-on bonus (28% received, avg $18k), relocation (26% received, avg $12k), CME stipend (67% received, avg $2.6k), ~22 vacation days; average student-loan debt at graduation ~$193k.12 ⟳

Lifestyle & the outpatient bargain

The single most-cited pro of A&I: it is, by most measures, the closest thing medicine has to a controllable-lifestyle-and-high-happiness combination. It's outpatient and clinic-based (office hours typically ~8-to-5 or 8:30-to-6), essentially no overnight call even in academic centers, predictable hours (self-reports cluster around ~40–44 hrs/week), and weekends largely free.1415 Schedule control is excellent, especially in private practice, where you set your own clinic template. Part-time or tapered arrangements are unusually feasible.

The trade-off is the mirror image of that comfort, and it is about content rather than hours. This is not a procedure-heavy or OR-based life; the "procedures" are testing, challenges, and injections. Bread-and-butter clinic (rhinitis, urticaria, asthma follow-ups) can feel repetitive to someone who craves acuity or the variety of a crisis. And the field's one hard structural catch sits before you ever start practicing: the small, competitive fellowship. But once you're in, the lifestyle is the whole point, and it largely delivers.

Lifestyle rating: 5/5. High on both predictability and control: defined outpatient hours, minimal call, and real say over your own schedule, especially as an owner.

Wellbeing — the part that's genuinely a strength

Unusually for these profiles, the wellbeing section here is good news.

Burnout: 35% of allergists, in the one report that measures the field directly. That is Medscape's Allergist Lifestyle, Happiness & Burnout Report 2023, relayed by Healthgrades. The published cross-specialty tables carry no allergy row to set beside it, so this page gives no cross-specialty rank.16 ⟳ The structural reasons to expect a favorable number are the outpatient, low-acuity, no-call shape of the work. (The general pattern in the cross-specialty data: emergency medicine, OB/GYN, and primary care highest; the low-acuity outpatient/lifestyle fields lowest.)

Happiness & satisfaction: In the 2025 Healthgrades/Medscape read, allergists/immunologists ranked highest for happiness, with about 94% agreeing happiness in the specialty is possible, the top of that measure.1718 ⟳ Read that for what it asks: whether the field permits a good life. Self-reported satisfaction runs around 4.0/5 on a self-selected aggregator panel.19 Whether allergists would choose the specialty again is a separate question, and no survey publisher has released a by-specialty answer since roughly 2019, so this page gives no figure for it.19 ⟳ A candid caveat on volatility: A&I had a sharp reported dip in work-life balance in the 2022 Medscape cycle, so year-to-year survey swings are real. What is favorable is the multi-year trend rather than any single data point.20 ⟳

Career longevity is a real feature. The low physical toll and strong schedule control mean allergists tend to practice long, often shifting to part-time rather than fully retiring. Where many specialties treat their subspecialties as burnout off-ramps, A&I is closer to being the off-ramp other physicians envy.

Who's in the field (demographics)

  • Women: ~43% of active practicing allergists (up from ~30% in 2010), and a clear majority of the pipeline: ~68% of A&I fellows in training, ~54% of faculty, and ~55% of program directors are women. One of the more female-represented physician subspecialties, and rapidly shifting.21 ⟳
  • DO: 21.7% of the 175 filled fellowship positions in the 2026 appointment year (38 of 175), up from 15.0% of positions offered in 2025 — the largest single-cycle move in the field's five-year trend, and a real widening of the door.6 ⟳
  • IMG: 14.9% of filled positions (10 US-citizen IMGs at 5.7% plus 16 non-US IMGs at 9.1%); US MD graduates take 62.9%, down from 71.9% of positions offered a year earlier. One Canadian graduate matched, 0.6%.6 ⟳
  • URiM: NRMP, ACGME, and AAAAI do not publish an underrepresented-in-medicine breakdown at this subspecialty granularity, so there is no A&I-specific figure to give.6

Culture, personality & the online stereotypes

The real pattern, said plainly and attributed to the field's reputation and the online read, not stated as fact and not a verdict on any individual. Plenty of allergists don't fit it.

Who gravitates here: cerebral immunology lovers who want a genuinely controllable life without leaving medicine's intellectual deep end. The archetype is someone who found immunology fascinating in med school, liked clinic more than the wards, enjoys long and probing patient conversations, and consciously prioritized life outside work, but still wanted enough of a hands-on element (skin testing, food and drug challenges, immunotherapy) to not feel purely cognitive. As one allergist quoted by the AMA puts it: if immunotherapy strikes you as genuinely cool, you'll probably love the field. As always, plenty of people in the field do not fit any single mold.22

The stereotypes. Community caricatures rather than facts, each with an unfair edge:

  • "It's just sneezes and EpiPens." The most persistent one, and the one people in the field push back on hardest. Reality: clinical immunology (immunodeficiency, mast-cell disease, drug reactions, eosinophilic disorders) is one of the most intellectually demanding, fastest-advancing corners of medicine.
  • "The lifestyle specialty for people who don't want to work hard." Reality: the fellowship is competitive precisely because the lifestyle is real and known. You have to work hard to get in, and the immunology is genuinely difficult.
  • "Chill and well-paid, but impossible to get into." Reality: it's competitive, but the constraint is the small number of seats rather than a dermatology-level ratio. Plannable, not hopeless.
  • "Not real doctors / no acuity." Reframes the field's actual value, which is disease-modifying outpatient care and complex immunology, as if hospital acuity were the only real medicine.

What people say online (synthesized and paraphrased, not quotes): Across trainee and physician forums, allergists come across as some of the happiest, least-burned-out physicians on the forums. Residents eyeing lifestyle repeatedly float A&I, and then discover that the constraint is landing a spot rather than the work, because programs are few and applicant pools strong. There's a recurring debate over whether the pay "should" be higher given the training length, usually balanced against near-universal agreement that the quality of life more than makes up for it. And there's a steady undercurrent of correcting the "it's just allergies" stereotype by pointing to the immunology depth and the biologics/food-allergy revolution. The consistent through-line: people who match into A&I rarely regret it.

Voices from the field. Paraphrased from public writing, with links to the originals:

  • Dr. Burcin Fraser, in the AMA's "Shadowing" series, describes most of her patients as healthy, the work centered on prevention and disease-modifying care for food allergy, rhinitis, and asthma. She notes that moving to private practice sharply reduced the burnout she'd felt in hospital settings.22
  • Dr. Alnoor Malick, also via the AMA, says he chose A&I for its all-ages patient mix and its blend of acute and chronic disease, and describes his life as exactly what he wanted: clinical medicine with minimal after-hours call and protected family time.23
  • The AAAAI's "A Rewarding Career in Allergy/Immunology" frames the draw as lifelong patient relationships across all ages plus a rapidly advancing science base spanning food allergy, drug allergy, immunodeficiency, and eosinophilic/mast-cell disease.24

Why people choose it / why people leave

Why choose it: best-in-medicine work-life balance (outpatient, no overnight call, predictable clinic hours, real schedule control) · very low burnout, and the highest share in medicine agreeing the field allows a happy, balanced life · intellectually rich, since clinical immunology is deep and moving fast (biologics, oral immunotherapy) · long-term continuity with patients of all ages, often whole families · solid pay with strong per-hour economics and private-practice/entrepreneurial upside · excellent career longevity (taper rather than retire) · reachable from either an IM or Peds residency.

Why leave or avoid it: if you want a procedure-heavy or OR-based career, this isn't it, because the "procedures" are testing, challenges, and injections · compensation trails surgical and high-procedure fields, so it's the wrong pick if maximizing income is the top priority · bread-and-butter clinic can feel repetitive to someone who craves acuity or variety-of-crisis · the fellowship is small and competitive, so access is a front-loaded cost you can't coast through · employed/RVU roles are structurally underpaid relative to owners, so the best economics require taking on ownership.

Best fit if: you genuinely enjoyed immunology and like long, probing patient conversations · you want a controllable, family-compatible life without leaving medicine's intellectual deep end · you're comfortable in a mostly-outpatient, continuity-based practice · you're patient and a good listener, because the field rewards taking the extra five minutes.

Not for you if: you need the OR, high procedural volume, or adrenaline/acuity to stay engaged · you're optimizing purely for maximum salary · you dislike outpatient clinic and long-term patient management · you don't actually find the immunology interesting (the "it's just allergies" version gets old fast if the science doesn't grab you).

The FLI angle — Allergy & Immunology for first-gen, low-income & immigrant students

A&I is one of the strongest lifestyle-to-effort trades a first-gen or low-income student can aim for, if you plan the runway early. The kind realism here: the destination is excellent and the on-ramp is unusually forgiving, but the door is narrow and it closes if you wait.

Where A&I fits FLI realities well:

  • The route is accessible, and the fallback is a real career. You don't need a hyper-competitive residency first. A&I opens off a standard internal medicine or pediatrics residency, both broadly attainable (and both among the more IMG- and DO-friendly fields). That matters enormously without a financial safety net: if A&I fellowship doesn't work out, staying a general internist or pediatrician is already a good, stable, well-paying career. Low downside risk is a genuine advantage of this path.
  • The payoff fits FLI priorities. Excellent, predictable lifestyle + solid pay (~$310k–$360k, more with ownership) + low burnout + long career longevity = exactly the stability and quality-of-life profile that's valuable when you're the first in your family in medicine and possibly supporting others. And unlike hourly/shift fields, the earning comes without a permanent nights-and-weekends toll.
  • Ownership is a real wealth lever, if you can access it. The private-practice immunotherapy/testing/biologics revenue stream is where the money is. For a first-gen physician, buying into a practice is a wealth-building path, though it takes capital and know-how that FLI trainees are less likely to arrive with, so the business side is worth learning early.

Risks to name honestly:

  • The bottleneck is access, and it's front-loaded. The fellowship is small and competitive: few programs, few spots, strong applicant pools. This is the one place you can't coast. Translate that into concrete early moves during residency: get involved in A&I research or QI, find A&I mentors and letter-writers, do an away/elective rotation, and start networking with programs well before application season. The bottleneck is access, so front-load the effort.
  • The extra 2 years is real time and deferred income. A subspecialty means fellowship pay (resident-level wages) for two more years before the attending jump, a longer runway than fields you enter straight from med school. Weigh that if you need to start earning fast; the flip side is that IM/Peds attending income is available if you don't pursue the fellowship.
  • Employed roles underpay the specialty. Much of A&I's earning power lives in ownership. If you land in an RVU-based employed job without the capital or opportunity to buy in, your pay can sit well below the private-practice figures, a gap that hits hardest for those starting with no family financial cushion.

Bottom line: a reachable on-ramp, a safe fallback, and a top-tier destination for lifestyle and longevity, with the single firm condition that you treat fellowship applications as a deliberate, early project rather than an afterthought.

Subspecialties & focus areas within A&I

Formal fellowships-within-the-fellowship are rare, but practice focus and academic niche vary a lot, and these are the clinical worlds you can lean into:24

  • Food allergy. One of the fastest-moving areas: oral immunotherapy (OIT), food challenges, and now biologics. High patient/family engagement, strong outpatient continuity, big pediatric overlap.
  • Drug allergy. Penicillin/antibiotic de-labeling, drug challenges and desensitizations. Increasingly valued for antibiotic stewardship; intellectually satisfying detective work.
  • Immunodeficiency (clinical immunology). Primary and acquired immune deficiencies and immune dysregulation. The most immunology-heavy and complex corner; often more academic / tertiary-referral in flavor.
  • Eosinophilic & mast-cell disease. Eosinophilic esophagitis and GI disease, hypereosinophilic syndromes, mastocytosis. A growing, biologic-driven niche that overlaps with GI and heme.

Fun facts

  • You can reach one of medicine's best lifestyles through either an internal medicine or a pediatrics residency. A&I is one of the few subspecialties that accepts both paths into the same fellowship and the same board.
  • ABAI is a conjoint board, the only subspecialty board jointly sponsored by both the American Board of Internal Medicine and the American Board of Pediatrics, which is the structural reason the dual entry works.
  • Allergen immunotherapy ("allergy shots") is essentially disease-modifying, one of the few treatments in medicine that retrains the immune system rather than just suppressing symptoms.
  • Oral immunotherapy for food allergy, plus biologics like omalizumab now approved for it, has turned a formerly "avoid-it-and-carry-an-EpiPen" field into an actively therapeutic one.
  • Allergists are among the physicians most likely to keep practicing part-time rather than fully retire, and the low physical toll shows up in career length.
  • The stereotype ("sneezes and EpiPens") and the reality (drug-allergy de-labeling, primary immunodeficiency, mast-cell disease) are almost comically far apart.

Sources

Footnotes

  1. A&I dual entry (IM or Peds), fellowship structure, and combined match. ABAI/National Jewish Health cert-requirements PDF (2024) (https://www.nationaljewish.org/NJH/media/pdf/About-the-American-Board-of-Allergy-and-Immunology.pdf); AMA FREIDA, Allergy & Immunology (2024) (https://freida.ama-assn.org/specialty/allergy-and-immunology). ↩ ↩2 ↩3

  2. Fellowship length (min 24 consecutive months; most 2 yr, research-track up to 3) and program/fellow footprint (92 ACGME programs, ~345 active fellows). AMA FREIDA (2024) (https://freida.ama-assn.org/specialty/allergy-and-immunology); ABAI via National Jewish Health PDF (2024) (https://www.nationaljewish.org/NJH/media/pdf/About-the-American-Board-of-Allergy-and-Immunology.pdf). ↩ ↩2 ↩3

  3. 2025 Medicine & Pediatric Specialties Match (Match Day Dec 3, 2025; 177 positions, 98.9% fill) and the December SMS match cycle. NRMP news release (Dec 2025) (https://www.nrmp.org/about/news/2025/12/nrmp-celebrates-results-for-the-2025-medicine-and-pediatric-specialties-match/). ↩

  4. ABAI as a conjoint board jointly sponsored by ABIM and ABP. ABAI Conjoint Board page (https://www.abai.org/conjboard.asp). ↩

  5. Prerequisite ABIM and/or ABP certification before the ABAI exam. ABAI, Conjoint Board — the ABAI is sponsored by ABIM and ABP jointly (https://www.abai.org/conjboard.asp); ABAI via National Jewish Health PDF (2024) (https://www.nationaljewish.org/NJH/media/pdf/About-the-American-Board-of-Allergy-and-Immunology.pdf). ↩

  6. NRMP, Results and Data: Specialties Matching Service 2026 Appointment Year, February 2026. Table 1A: 241 applicants, 177 positions offered, 101 programs, 175 filled (98.9%), 2 programs left unfilled — an applicant-to-position ratio of 1.36:1. Table 2, applicant type of the 175 filled positions: US MD graduates 110 (62.9%), US DO graduates 38 (21.7%), US IMGs 10 (5.7%), non-US IMGs 16 (9.1%), Canadian graduates 1 (0.6%). Every applicant-type share on this page is a percentage of positions filled. https://www.nrmp.org/wp-content/uploads/2026/02/SMS_Results_and_Data_Report2026.pdf Corrected 2026-08-17: the dashboard, the competitiveness section and all three demographic bullets ran on Results and Data 2025 (167 positions, 165 filled, 246 applicants, 1.47:1, DO 15.2%, IMG ~12.1%, US MD 71.9%) while the page's own competitiveness lede already called the 2026 cycle "the most recent." The 2026 report published in February 2026, five months before this file's review date. The 2025 figures were right for their edition; the edition was stale, and it understated current accessibility in the direction that matters to a reader. On NRMP's five-year trend tables, measured against positions offered rather than filled, the DO share went 17.7% → 15.4% → 17.2% → 15.0% → 21.5%, and US MD 68.7% → 68.6% → 66.9% → 71.9% → 62.1%. Note the column order: SMS 2026 places Canadian graduates last, after non-US IMG, where SMS 2025 places it third, so the two editions cannot be read positionally against each other. Prior edition, for the trend: https://www.nrmp.org/wp-content/uploads/2025/02/SMS_Results_and_Data_2025.pdf ↩ ↩2 ↩3 ↩4

  7. Medscape Physician Compensation Report 2025 — A&I ~$319,000, rank 22/29 (survey 10/2024–1/2025). Via Kaplan (https://www.kaptest.com/study/mcat/doctor-salaries-by-specialty/) and Becker's (https://www.beckershospitalreview.com/compensation-issues/29-physician-specialties-ranked-by-pay-2/). ↩ ↩2 ↩3

  8. Medscape Physician Compensation Report 2026 — A&I ~$310,000, −3% YoY, rank 22/29. Via Weatherby (https://weatherbyhealthcare.com/blog/annual-physician-salary-report) and Becker's (https://www.beckershospitalreview.com/compensation-issues/29-physician-specialties-ranked-by-annual-compensation-medscape/). ↩ ↩2

  9. SalaryDr 2026 (n=39, self-reported, private-practice-skewed) — median $360k; percentiles P10 $290k / P25 $310k / P50 $360k / P75 $390k / P90 $450k; experience progression; metro and state figures. https://www.salarydr.com/specialty/allergy-and-immunology ↩ ↩2 ↩3 ↩4 ↩5 ↩6

  10. Biologics boom, buy-and-bill margins, and private-equity roll-ups as the primary upward drivers of A&I practice revenue; employed/RVU planning median ~$255k and early-career ~$210k. FastRVU (https://fastrvu.com/specialties/allergy-immunology); ACAAI EMD (https://college.acaai.org/from-the-desk-of-the-emd-how-are-allergists-paid/). Corrected 2026-08-17: the $255k was labeled "MGMA employed/RVU median" in the body and "MGMA 2026 via FastRVU" here, and the body pointed at the two Medscape notes, neither of which publishes it. FastRVU's own site disclaims the MGMA lineage, stating it does not reproduce restricted benchmark datasets and is not produced by MGMA, AMGA, SullivanCotter, CMS or AMA. The MGMA label is gone, the host is named in the visible sentence, and the body now cites this note. The figures are unchanged. ↩ ↩2

  11. MedContractReview 2026 (settings, geography, urban/rural qualitative, trends; note no clean A&I urban-rural dollar gap published). https://medcontractreview.com/allergy-and-immunology-salary-earnings-growth-and-career-prospects/ ↩ ↩2 ↩3 ↩4

  12. Physician Side Gigs 2023–25 — group private practice avg ~$342k (up to ~$500k), academic ~$236k, non-academic hospital $335k–$514k; sign-on/relocation/CME/vacation and ~$193k student-loan debt. https://www.physiciansidegigs.com/average-allergist-and-immunologist-salary ↩ ↩2 ↩3 ↩4 ↩5

  13. ACAAI "From the Desk of the EMD: How Are Allergists Paid?" — comp structure (owners ~44.7% productivity vs employees ~22.3%), immunotherapy/RVU economics, RVU weighting devaluing immunotherapy. https://college.acaai.org/from-the-desk-of-the-emd-how-are-allergists-paid/ ↩ ↩2

  14. A&I outpatient schedule, hours, and minimal call — AMA "Shadowing" profiles (Fraser: ~4 clinical days, ~15–22 patients/day; Malick: 8:30–6, deliberate no-work-at-home). AMA (https://www.ama-assn.org/medical-students/preparing-residency/what-its-allergy-and-immunology-shadowing-dr-fraser; https://www.ama-assn.org/medical-students/preparing-residency/what-it-s-allergy-immunology-shadowing-dr-malick). ↩

  15. Minimal-to-no overnight call and ~40–44 hr/week estimates. Med School Insiders, "So You Want to Be an Allergist/Immunologist" (https://medschoolinsiders.com/pre-med/so-you-want-to-be-an-allergist-immunologist/); YouSMLE, "Gastroenterology vs. Allergy & Immunology" (https://www.yousmle.com/gastroenterology-vs-allergy-immunology-which-specialty-is-right-for-you/). ↩

  16. Allergist-specific burnout, 35%. Healthgrades Pro, "9 Fast Facts About Burnout Among Allergists" (updated 25 September 2025), relaying Medscape's Allergist Lifestyle, Happiness & Burnout Report 2023 rather than surveying, which is how most Medscape figures reach this site: "35% of allergists reporting burnout," alongside 8% reporting depression and 14% reporting both. https://resources.healthgrades.com/pro/5-fast-facts-about-burnout-among-allergists . Two limitations of the source belong here. Its own opening line says "around 54%," which is not the figure in its body and matches the 54% who said they would consider professional help; 35% is the number it attributes to Medscape. And the same 2023 report placed allergy and immunology fifth-least happy outside work of 29 specialties, at 55% against 79% before the pandemic, so this instrument does not read favorably on every measure it takes. Corrected 2026-08-17: the dashboard and the body previously said "burnout among the lowest of any specialty on Medscape 2024," and this footnote repeated the rank. The cited page carries no rank and no 2024 allergy figure. Medscape 2024's circulated cross-specialty tables print only that survey's highest and lowest ten specialties, and allergy is in neither, and the AMA's 2025 Organizational Biopsy write-up names 15 specialties without allergy or immunology among them, so Medscape remains the instrument for this field. The rank has been dropped rather than re-sourced and the 35% is stated with its own edition. ⟳ ↩

  17. Healthgrades/Medscape "Happiest Physicians by Specialty" (2025) — A&I highest for happiness, ~94% agree happiness is possible. https://resources.healthgrades.com/pro/happiest-physicians-by-specialty ↩

  18. Cross-specialty comparison. Medscape 2025 asked whether doctors in a given specialty can be happy and well-balanced, which is a different question from whether they would choose it again, and ranked allergy & immunology highest at ~94%, ahead of pathology (88%), dermatology (87%), public health (87%) and psychiatry (87%), with emergency medicine and infectious disease lowest at ~63%. Reported by Healthgrades Pro, "Happiest Physicians by Specialty" (https://resources.healthgrades.com/pro/happiest-physicians-by-specialty), the same source as 17. ↩

  19. A&I self-reported satisfaction ~4.0/5, from SalaryDr (https://www.salarydr.com/specialty/allergy-and-immunology), a self-selected aggregator panel with no published n. Its would-choose-again figure is not carried here, and neither is the ~78% overall anchor that used to accompany it: no publisher has released a by-specialty would-choose-again figure since roughly 2019, and the most recent traceable Medscape datapoint of any kind is 68% among physicians under 40 (2022 Young Physician Compensation Report), with no specialty breakdown. SalaryDr panel size: n=39. A self-selected physician panel; the n is disclosed because it is what the figure rests on. Corrected 2026-08-17: the body said flatly that "no one has published a by-specialty answer" while the source cited one sentence earlier for the 4.0/5 satisfaction figure displays a would-choose-again number of 90%. This footnote's "no publisher" was always the intended reading, and the body now says "no survey publisher" and carries the marker, so a reader who clicks through can see why the aggregator's figure is not the answer. ↩ ↩2

  20. Volatility caveat — A&I reported a sharp work-life-balance dip in the 2022 Medscape cycle. Medscape, "Allergists Report Sharp Decline in Work-Life Balance" (2022) (https://www.medscape.com/viewarticle/968729). ↩

  21. A&I sex demographics — fellows in training ~68.3% women (2022), active practicing ~43.1% (up from 30.2% in 2010), faculty ~54%, program directors ~55%. Healio, "Women achieve equity in allergy training, faculty positions" (Jul 2023, reporting AAAAI/JACI:In Practice workforce data) (https://www.healio.com/news/allergy-asthma/20230706/women-achieve-equity-in-allergy-training-faculty-positions); FREIDA (~55% female faculty, 2024). ↩

  22. Dr. Burcin Fraser — AMA "What it's like in allergy & immunology: Shadowing Dr. Fraser." https://www.ama-assn.org/medical-students/preparing-residency/what-its-allergy-and-immunology-shadowing-dr-fraser ↩ ↩2

  23. Dr. Alnoor Malick — AMA "What it's like in allergy & immunology: Shadowing Dr. Malick." https://www.ama-assn.org/medical-students/preparing-residency/what-it-s-allergy-immunology-shadowing-dr-malick ↩

  24. AAAAI, "A Rewarding Career in Allergy/Immunology" — draw of the field, lifelong all-ages relationships, and the focus areas (food/drug allergy, immunodeficiency, eosinophilic/mast-cell disease). https://www.aaaai.org/professional-education/careers-in-a-i ↩ ↩2

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