Allergy & Immunology Programs and Positions

Day-to-Day Practice

The typical allergist-immunologist works in an outpatient clinic setting. The majority of patient encounters are scheduled office visits for ongoing management of chronic allergic conditions, immunotherapy administration and monitoring, and evaluation of new referrals. Hospital consultations — for anaphylaxis management, drug desensitisation, or evaluation of suspected immunodeficiency in complex inpatients — are more common in academic practice but constitute a smaller proportion of clinical time than in most other specialties.^[2]

Practice patterns differ meaningfully between academic and private settings. Academic allergists maintain a balanced portfolio of clinical care, research, and teaching. Private practice allergists generally carry higher patient volumes with strong revenue from immunotherapy administration and biologic initiation and monitoring.^[5]

Call burden is low relative to most medical specialties. Outpatient allergy practices rarely carry hospital call obligations, and this contributes to the specialty's reputation for sustainable work-life balance — consistently cited in physician satisfaction surveys as a primary driver of career satisfaction.^[5]

Compensation and Earning Potential

MEDIAN (EMPLOYED)
$298,000 / year
Doximity 2023 [6]

TYPICAL RANGE
$220,000 – $450,000+
By setting, geography & volume

Allergy and immunology offers competitive compensation relative to its training length and lifestyle profile. Revenue drivers include patient volume, immunotherapy panel size, and biologic therapy management. Geographic variation is significant: allergists in underserved suburban and rural markets typically outperform urban academic counterparts on total compensation.[6]

Residency and Fellowship Training

Entry into allergy and immunology fellowship requires completion of a three-year ACGME-accredited residency in either internal medicine or pediatrics. The specialty does not offer PGY-1 positions and cannot be entered directly from medical school. Candidates completing a combined internal medicine/pediatrics residency (four years) are also eligible and are highly competitive.[7]

Fellowship training is two years in length and covers the full scope of adult and pediatric allergy and immunology. Core competencies include the diagnosis and management of asthma, allergic rhinitis, food and drug allergy, primary immunodeficiency, and urticaria/angioedema. Fellows gain supervised experience in skin testing, allergen immunotherapy initiation, pulmonary function interpretation, and oral food challenges. Research output — at minimum one project suitable for presentation or publication — is expected by most programmes.[7]

Applications are submitted through ERAS with a July programme start date. The specialty coordinates through the AAAAI/ACAAI fellowship match rather than the standard NRMP Match — applicants should verify programme-specific deadlines, which differ from the main residency match calendar.

How Competitive Is Matching?

Position fill rate
~93%

Programs requiring Step 1
~74%

Programs requiring COMLEX Level 1 (DOs)
~61%

Allergy and immunology fellowship is moderately competitive. In recent cycles approximately 90–95% of offered positions filled in the first round, with US graduates from internal medicine and pediatrics backgrounds making up the majority of successful applicants.[8] Research experience, letters of recommendation from allergist-immunologists, and dedicated clinical exposure to the specialty are the strongest differentiating factors. Competitive applicants typically present Step 1 scores above 230 and Step 2 CK scores above 245.

Job Market and Demand Outlook

The workforce outlook for allergy and immunology is strongly positive. The AAAAI estimates a significant and growing shortage of practising allergists, particularly in rural and suburban markets where access to specialist care is limited.^[4] Approximately 3,800 board-certified allergist-immunologists are currently active in the United States — a number that falls well short of population demand.

The training pipeline of approximately 150 new fellows per year is insufficient to offset retirements while meeting growing demand. Workforce analyses project the shortage will deepen through the 2030s, making this one of the more reliably undersupplied specialties for early-career physicians.^[4]

Program Signals & Geographic Preferences

Fellowship programmes are concentrated in academic medical centres in the Northeast, Midwest, and California. Programmes in the South and Mountain West regions tend to have lower application volumes and may offer stronger match prospects for candidates who signal genuine interest and fit.

Most programmes strongly favour applicants who completed a clinical rotation or research elective in an allergy/immunology division during residency. Attending the AAAAI annual meeting and presenting research at regional or national meetings meaningfully improve visibility with programme directors.

Is Allergy & Immunology Right for You?

Physicians who thrive in allergy and immunology tend to share a few characteristics: intellectual curiosity about the immune system, patience for chronic disease management, and satisfaction in building long-term relationships with patients followed over years or decades. The specialty rewards clinicians who enjoy procedural work — skin testing, immunotherapy, oral challenges — without the demands of a primarily surgical career. Those seeking predominantly acute or hospital-based practice may find the outpatient focus limiting; for others, it represents an ideal balance of intellectual depth, procedural variety, and lifestyle sustainability.

Resources

Board & Certification

• American Board of Allergy and Immunology (ABAI)

Professional Societies

• American Academy of Allergy, Asthma & Immunology (AAAAI)
• American College of Allergy, Asthma & Immunology (ACAAI)

Training & Accreditation

• ACGME program requirements
• AAAAI fellowship match information

Program Search & Data

• FREIDA program search (AMA)
• NRMP match data & statistics

Frequently Asked Questions

References

1. American Board of Allergy and Immunology. Certification information. Philadelphia: ABAI; 2024. Available from: https://www.abai.org
2. American Academy of Allergy, Asthma & Immunology. Allergy & immunology specialty description. Milwaukee: AAAAI; 2023. Available from: https://www.aaaai.org
3. Burks AW, Calderon MA, Casale T, et al. Update on allergy immunotherapy: AAAAI/EAACI consensus. J Allergy Clin Immunol. 2013;131(5):1288–1296. doi:10.1016/j.jaci.2013.01.049
4. American Academy of Allergy, Asthma & Immunology. Workforce study: the allergist workforce. Milwaukee: AAAAI; 2023. Available from: https://www.aaaai.org
5. Medscape. Allergist/immunologist lifestyle, happiness & burnout report. New York: Medscape; 2023. Available from: https://www.medscape.com
6. Doximity. 2023 physician compensation report. San Francisco: Doximity Inc.; 2023. Available from: https://www.doximity.com/survey
7. Accreditation Council for Graduate Medical Education. Program requirements for graduate medical education in allergy and immunology. Chicago: ACGME; 2023. Available from: https://www.acgme.org