Developmental peds vs child psych

[BabyPsychDoc]

hello again

As said previously, I am a GP resident in the UK. I have done lots of things in my life (in medicine and beyond), and for some time thought that GP/FP would be my best fit as it would allow me to do two things that I enjoyed most: peds and psych. However, I am growing disappointed with the fact that I have to pass the most interesting cases in any specialty to ...well, the specialist. This leaves me managing routine cases that are, well, routine and do not require much intellectual effort on my part. And I like challenge. And I like a certain degree of independence and ability to institute definitive management. So, I am thinking about changing my career (yet again!) when I move to the US. I have thought about trying to get a spot in child psych, but recently found out about developmental peds. I know that training is quite different (4 yr adult psych + 2 yr child psych fellowship vs 3 year peds residency + 3 year dev peds fellowship). So, the emphasis of the programs is obviously very different. My question is: how different is the actual practice of the attending in dev peds from the practice of the attending in child psych? Both seem to deal with the same range of problems (ie, ADHD, autistic spectrum, behavioural problems, etc). Is it the approach that varies? If so, how?

I am not really interested in triple board programs, as I cannot see myself actually practising all three (or even two!) specialties after I graduate from residency.

Any advice, please?

Thank you.

P.S. I have good boards scores (238/99 on Step 1, Step 2 scores awaited), and do not have visa issues, if this has any relevance.

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[BabyPsychDoc]

hello again

As said previously, I am a GP resident in the UK. I have done lots of things in my life (in medicine and beyond), and for some time thought that GP/FP would be my best fit as it would allow me to do two things that I enjoyed most: peds and psych. However, I am growing disappointed with the fact that I have to pass the most interesting cases in any specialty to ...well, the specialist. This leaves me managing routine cases that are, well, routine and do not require much intellectual effort on my part. And I like challenge. And I like a certain degree of independence and ability to institute definitive management. So, I am thinking about changing my career (yet again!) when I move to the US. I have thought about trying to get a spot in child psych, but recently found out about developmental peds. I know that training is quite different (4 yr adult psych + 2 yr child psych fellowship vs 3 year peds residency + 3 year dev peds fellowship). So, the emphasis of the programs is obviously very different. My question is: how different is the actual practice of the attending in dev peds from the practice of the attending in child psych? Both seem to deal with the same range of problems (ie, ADHD, autistic spectrum, behavioural problems, etc). Is it the approach that varies? If so, how?

I am not really interested in triple board programs, as I cannot see myself actually practising all three (or even two!) specialties after I graduate from residency.

Any advice, please?

Thank you.

P.S. I have good boards scores (238/99 on Step 1, Step 2 scores awaited), and do not have visa issues, if this has any relevance.

Ermmm....Bump? Any opinions, please? Anything would be appreciated.

 

[oldbearprofessor]

Ermmm....Bump? Any opinions, please? Anything would be appreciated.

Be patient please. There is a developmental pediatrician who posts here and he'll eventually find your post and reply, but he doesn't check in every day.

My take is that the two fields have some relatively small cross-over but are ultimately pretty different. But, since I don't actually do either one, lets wait for someone who does to answer.

 

[Bernardo_11]

Hello, this question is very similiar to someone I answered in PM. So for starters, I'll just reprint the Q and A and you are more than welcome to follow up with more questions after....

Hi
Heard you were doing developmental peds and have some questions:
I am trying to decide what to apply to next year and am torn between peds neuro, devel peds and child psyc.

It seems as though there is a lot of overlap between the three specialties - especially with the ADD/ADHD, autism and PDD cases.
Wondering if you could clarify who sees who and what their roles are?

Also, in the case of developmental peds and child psyc (since they seem the most similar out of them all...) is there a big difference in income? Also is there a big difference to approach to patient managment?

Thanks for any info.

This is a very common and very good question. You should consider asking this out in the public forum for others to see.

Do you plan on doing pediatric training? Because all three options exist with a general pediatric training. Both peds neuro and DB peds require completion of a general peds residency.

Child psych can be accomplished through a triple board program (usually 2 yrs peds, 1.5 yrs of general psych, and 1.5 yrs of child/adolescent psych). Or you can do the general psych/child psych route which usually entails 3-4 yrs of general psych and 2 yrs of child psych.

There is another "sub" specialty of peds neuro called neurodevelopmental disabilties. It is extremely clinical and at the end of the program you are able to sit for the peds, peds neuro, and neuro dev. disabilities specialties.

Peds neuro, in and of itself used to do a lot of developmental work. But most of the cases they deal with are CP and seizure disorders. They do some work with autism/PDD, as well as managing some ADHD, but I wouldn't consider those their "bread and butter" cases.

Child Psych is a great specialty, but their emphasis is more on mental health rather than developmental disabilities. With children though, developmental levels need to be taken into account when making a psychiatric formulation. So they are well knowledgable in developmental problems, but that is not their forte. I found that most of the child psych fellows did more with adolescent mental health rather than school age child problems ir with developmental disabilities.

Developmental/Behavioral Pediatrics was designed to to help children and families with developmental disabilties. So we've learned to be first hand managers in PDD/autism, as well as ADHD. But more than keeping the scope of care in the office visit, DB pediatricians become knowledgable in working with the community and being a navigator for their patients in hooking them up with various service providers. Things like Early Intervention and Special Education become programs you learn to work with closely.

Because developmental disabilities makes a child prone to developming behavioral and mental health problems, we do become learned in some of those conditions. But as supposed to child psych, our emphasis is more on deveopmental disabilties rather than mental health.

As far as pay is concerned, it really depends on your scope of practice. Many of the DB pediatricians I know are academics. So their pay is reliant on doing resident teaching and research projects. Those that have private practices usually do a lot of general peds as well to be a valued part of a pediatric group. But from what I've seen, most of the salaries between run of the mill DB pediatricians is comparable to that of a busy general pediatrician.

I can't say much for child psych. I know there is a significant need for child mental health specialist anywhere you go, but I'm not entirely sure how well they're reimbursed.

Hope this helps.

Nardo.

 

[DarthNeurology]

hello again

As said previously, I am a GP resident in the UK. I have done lots of things in my life (in medicine and beyond), and for some time thought that GP/FP would be my best fit as it would allow me to do two things that I enjoyed most: peds and psych. However, I am growing disappointed with the fact that I have to pass the most interesting cases in any specialty to ...well, the specialist. This leaves me managing routine cases that are, well, routine and do not require much intellectual effort on my part. And I like challenge. And I like a certain degree of independence and ability to institute definitive management. So, I am thinking about changing my career (yet again!) when I move to the US. I have thought about trying to get a spot in child psych, but recently found out about developmental peds. I know that training is quite different (4 yr adult psych + 2 yr child psych fellowship vs 3 year peds residency + 3 year dev peds fellowship). So, the emphasis of the programs is obviously very different. My question is: how different is the actual practice of the attending in dev peds from the practice of the attending in child psych? Both seem to deal with the same range of problems (ie, ADHD, autistic spectrum, behavioural problems, etc). Is it the approach that varies? If so, how?

I am not really interested in triple board programs, as I cannot see myself actually practising all three (or even two!) specialties after I graduate from residency.

Any advice, please?

Thank you.

P.S. I have good boards scores (238/99 on Step 1, Step 2 scores awaited), and do not have visa issues, if this has any relevance.

I think child psychiatry would prepare one to mostly see children/teenagers who have major psychiatric illness problems such as Bipolar disorders, Schizophrenia, Depression (kids get this too), and kids who have been sexually abused too, . . . Developmental pediatrics I think deals more with the developmental disorders versus purely psychiatric disorders such as PDD/Autism, developmental delay etc . . . ADHD I think either could easily treat.

Obviously if you want to treat psychiatrically impaired children this takes double care as 1. These are children and 2. Psychiatric disorders, i.e. you don't want to treat a complicated adult schizophrenic on your own as a family practice person, you refer to a psychiatrist. I would go with Child Psych based on if you liked your psychiatry rotation and want to see child psych patients. If you like more academics and complex developmental disorders like autism, and don't want to see and be responsible for children who have serious psychiatric conditions then go developmental peds . . .
there are not a whole lot of developmental peds programs so you will be very restricted in where you go, . . . child psych I'm pretty sure has more programs.

 

[abc doc]

hello again

As said previously, I am a GP resident in the UK. I have done lots of things in my life (in medicine and beyond), and for some time thought that GP/FP would be my best fit as it would allow me to do two things that I enjoyed most: peds and psych. However, I am growing disappointed with the fact that I have to pass the most interesting cases in any specialty to ...well, the specialist. This leaves me managing routine cases that are, well, routine and do not require much intellectual effort on my part. And I like challenge. And I like a certain degree of independence and ability to institute definitive management. So, I am thinking about changing my career (yet again!) when I move to the US. I have thought about trying to get a spot in child psych, but recently found out about developmental peds. I know that training is quite different (4 yr adult psych + 2 yr child psych fellowship vs 3 year peds residency + 3 year dev peds fellowship). So, the emphasis of the programs is obviously very different. My question is: how different is the actual practice of the attending in dev peds from the practice of the attending in child psych? Both seem to deal with the same range of problems (ie, ADHD, autistic spectrum, behavioural problems, etc). Is it the approach that varies? If so, how?

I am not really interested in triple board programs, as I cannot see myself actually practising all three (or even two!) specialties after I graduate from residency.

Any advice, please?

Thank you.

P.S. I have good boards scores (238/99 on Step 1, Step 2 scores awaited), and do not have visa issues, if this has any relevance.

As a dbp fellow, I can say that I work closely with CAPs and we consult eachother all the time. Dbp sees more infant to toddler age ranges and we do a physical exam. We are trained more extensively in both ordering and analyzing genetic testing and metabolic workups than CAP. Since we see children so young, we are like detectives looking for syndromes that present at a young age. We diagnose a lot of nf-1, TS, FAS, Rett syndrome, anxiety, depression, adhd, cognitive disability, etc. We lead the downs, nicu follow-up, myelo/spinabifida, fragile x, and autism clinics.

We also attend cbt training, ados testing, behavioral family management training, and a multitude of neuropsych training. In my program we are trained how to manage antipsychotics, ssris, stimulants, alpha agonists, and mood stabilizers/neuroleptics. We refer to psych if they need inpatient admission of we feel uncomfortable with complex medical management.

It's a very young and interesting field. Advantages are that we do not admit patients. Even though our salary is at the lower end of the pediatric specialties, our demand is very high so we can virtually go anywhere and there is no inpatient responsibility. We charge consultation fees and insurance has been more accepting of our billing codes. If you like detective work, neurology without the seizure management, and psychiatry without the inpatient admissions this might be the specialty for you!