I am posting this in the Attending forum hoping for some real world insight into the business side of pediatric subspecialty practice. I hope to be able to give some useful guidance to my daughter who is currently a medical student. She is considering going into a peds cardiology or heme onc, anong other possibilities.

Looking at the published salary surveys, it is shocking how much lower the peds specialties are compared to the same in the adult world. Some reasons that pop to mind are that perhaps a much larger percentage of the peds practice in an academic or hospital employed setting. I suppose they would not see any revenue from the infusion business of a an oncology practice. Are there many private practice peds oncologists out there? As far as cardiology goes, I would think the peds would do a bunch of ultrasounds but of course they would not be doing much nuclear cardiology. I don't see why a pediatric interventionalist would make half as much as the adult version, though.

Any insights are greatly appreciated.

In EM (Peds EM) it's because of the way coding/billing works. The Peds EM guys see a much higher percentage of patients that bill out at lower levels. Seeing 20 sore throats and URIs does not bill as high as seeing 20 60 yo diabetic chest pains. It's not really fair because in all honesty trying to figure out if a 1 yo is septic or not is often much more difficult than seeing and admitting a chest pain which is a no brainer.

As for the peds sub specialties like GI and cards I have heard that they see fewer patients, ie, have to spend more time with patients, than their adult counterparts. I don't really know on that one. I suppose there may be some billing issues there as well.

I do not believe SDN has any currently practicing pediatric heme/onc docs or attending pediatric cardiologists so I will briefly respond that all of the reasons you suspect are part of it. We have a greater academic proportion of docs, fewer procedures (including interventional cards), longer time spent per patient and a long-standing history of taking a high proportion of minimally paying patients. Half is actually a generous estimate of the relative salary in some fields compared to adult counterparts.

On the other hand, pediatric subspecialists are in demand throughout the country, have an incredibly and well-documented high job satisfaction rate and will never lack for work. The opportunities for research from the most basic science to clinical trials are numerous. Our patients are great and they make it, for me at least, a joy to come to work.

link: http://pediatrics.aappublications.org/cgi/content/full/116/5/1192

On the other hand, pediatric subspecialists are in demand throughout the country, have an incredibly and well-documented high job satisfaction rate and will never lack for work.

That's a good point. If you're a Peds EM doc you can have a job with my group right now and we're not hiring adult EPs. We have 2 people who have used their peds credentials to get in the door and now work both Peds and Adult shifts.

Thanks for the responses. My hat is off to all those who do the important but unfortunately under-compensated work of taking care of sick kids