Family Medicine Vs. Pediatrics?

[Dancer1986]

Hello, I am a relatively new third year medical student and have been sure I wanted to be a pediatrician since long before I even started medical school. I have always just loved kids, and I want to do outpatient Primary Care. However, my first rotation, Family Medicine, is almost over, and I have just loved it! The two specialties seem somewhat similiar because with both you get to know the whole family, watch and help kids grow up, and build relationships over time, except for the fact that many of the patients are adults also. My attendings have told me I can choose to focus more on children when Im in practice as well if I do FM. So now I am a bit confused. I know I have to wait until my pediatrics rotation to be sure, but I have already did a one year preceptorship in a pediatrics office last year, and just loved that as well! Did anyone else have difficulty with choosing between these 2 specialties as well? What helped you decide? Thanks so much for your advice!

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[deleted87716]

Never even considered peds. Not even for a second. I prefer patients I can talk to.

But, that's just me.

I have friends who are pediatricians. Honestly, their job sounds really boring. Well-baby checks all day, every day?* No, thanks. I like having a few kids in the practice to keep things interesting, but I'll take real disease over worried Moms any day.

*I should clarify that this is hyperbole. I am not saying that I actually think pediatricians spend 100% of their time performing well-child exams, any more than I actually think that IM is "all old people, all the time." Still, they do more of it than I want to.

 

[lowbudget]

I'm the opposite. I enjoy being a kid's doctor. I really struggled with deciding between peds & FM. My Pulm/CC attending said it best in an attempt to sway me: "If you like kids so much, go have some of your own" which really made me rethink why I liked peds. I had to separate myself, where I was at that moment in time, from what I viewed as a lifelong career. My FM attending said that in practice, your practice will grow with you. So, I always questioned whether I would enjoy kids as much as I grew old. I picked FM over peds because I liked the versatility & how my day is broken up by lots of variety. My gen peds attending was an old guy who mostly gave out parenting advice, most of which, in his words, were not evidence-based (scientifically) so he preached parenting skills out of the Bible during most of his WCE just because it's just "as good if not better than any other" non-evidence-based sources. Interesting nevertheless, but I couldn't see myself doing that into his age (mid-60's).

Anyways, I have a good amount of kids in my practice. Enough to break up my day, challenge my skills, but not get burned out seeing just kids or just adults. I capture a lot of kids who have "outgrown" their pediatrician or whose families I see. Pretty cool.

Oh... and, disagree with BD. Some of these kids have real pathologies. And, I'll take a worried Mom any day over a Mom who didn't care.

 

[deleted87716]

Some of these kids have real pathologies.

A few. Most of those will get turfed to the nearest childrens' hospital/specialty clinic.

And, I'll take a worried Mom any day over a Mom who didn't care.

Chances are, you'll encounter plenty of both.

I capture a lot of kids who have "outgrown" their pediatrician or whose families I see. Pretty cool.

Agreed.

 

[oldbearprofessor]

Well-baby checks all day, every day? No, thanks. I like having a few kids in the practice to keep things interesting, but I'll take real disease over worried Moms any day.

22% of an average pediatrician's contacts are for well child (which includes) babies care. (Pediatrics, July 2004)

About 15% of children have special health care needs and many (most in my experience, but I don't think there are reliable data about the exact percent) of these have their care coordinated by a pediatrician.(AAP)

It is possible to advocate FM over pedi for many reasons without overstating the negatives of pediatrics.

OBP out....further discussion of pedi as a career belongs in the pedi forum.

 

[michaelrack]

A few. Most of those will get turfed to the nearest childrens' hospital/specialty clinic.

.

Blue Dog, I am surprised at you, making a comment like that. Some people (not me) would make similar comments about Family docs doing the same thing for their patients (of all ages).

 

[EdibleEgg]

I was torn between peds/EM/FM. I chose FM because of the breadth and flexibility. I didn't want to give up seeing adults. Otherwise there is a lot of similarity between Peds and FM, both in personality and practice. My practice is in no means a representative of the average, but around 15% of my office practice is pediatrics. I don't see children under 2 (I would have to take unassigned call for pediatrics and that would double my call if I did). I may be able to see a larger portion if I really marketed myself that way, but I have too many other battles to fight.

Peds is definitely more than a series of well child checks, no more than FM is a series of hypertension follow ups. However, most of the pediatricians here are very eager to get acutely sick kids out to a tertiary care center. A child dying, even with appropriate management, is devastating to everyone involved. That doesn't mean that pathology isn't managed here, just not much approaching acute illness.

It's a tough call between the two. Again, they are very similar. You can see a lot of kids as a Family Physician, but you have to make an extra effort to tailor your practice that way. Many of things that make FM great can also be found in Peds, but some flexibility and breadth are sacrificed. Most people that are happy in FM would be happy in Peds and vice versa.

 

[Stitch]

Never even considered peds. Not even for a second. I prefer patients I can talk to.

But, that's just me.

I have friends who are pediatricians. Honestly, their job sounds really boring. Well-baby checks all day, every day? No, thanks. I like having a few kids in the practice to keep things interesting, but I'll take real disease over worried Moms any day.

I think there are several attitudes you could take here. Honestly I don't get why you'd do FP if you aren't interested in children, but there seem to be a lot of FPs who feel this way. Why not just do IM instead then?

Now I have a few friends who do a great job as FPs taking care of peds patients but they are very aware of when they need to refer to a pediatrician for help. Because the fact is children can get sick and can do so in a subtle way. In short, sick kids look like well kids until they're in a lot of trouble, and it's no easy task to sort out which is which.

I spend a fair amount of my time cleaning up the mess from FPs who believe otherwise, and I'm not talking about premie babies or medically complex kids. If you want to take care of kids, do so with a genuine interest and not just 'on the side' or 'here and there.'

If you want to do FP and take care of kids, make sure the residency gives you good peds exposure with pediatricians as well as FPs. People on this forum can probably help you find good programs. You may also want to consider med/peds. Although there are fewer programs out there, I've found their graduates to be very well trained (not a ding against FP, just throwing out other options)

 

[MedicineDoc]

I really like kids and it's nice to see a few but, I find on my peds rotations that runny noses all day long is really boring and draining of all energy even with the kids being entertaining at times.

 

[smq123]

Did anyone else have difficulty with choosing between these 2 specialties as well? What helped you decide? Thanks so much for your advice!

I really like OB/gyn, and you don't get a lot of that in peds. I won't say you get NONE (having had to do pelvic exams on both peds and in the peds ED), but you certainly don't have as much in peds as you do in FP. And some people are perfectly okay with never having to do another pap smear again in their lives - you may be one of those people.

 

[deleted87716]

Some of you need to remember that we're all just giving our opinions here.

I don't think that a neonatologist or a sleep medicine specialist is any better qualified than I am to render an opinion about my personal aptitude for a career in general pediatrics. Quote stats all you want. It is what it is.

I intentionally qualified my comments with "that's just me." I think that's all I need to say, frankly.

 

[oldbearprofessor]

Some of you need to remember that we're all just giving our opinions here.

I don't think that a neonatologist or a sleep medicine specialist is any better qualified than I am to render an opinion about my personal aptitude for a career in general pediatrics. Quote stats all you want. It is what it is.

I intentionally qualified my comments with "that's just me." I think that's all I need to say, frankly.

No idea in the world what you are talking about. I didn't comment about your aptitude for anything.

And never ever let data get in the way of personal bias. You can frankly say whatever you want. I just responded with data.

 

[deleted87716]

No idea in the world what you are talking about. I didn't comment about your aptitude for anything.

And never ever let data get in the way of personal bias. You can frankly say whatever you want. I just responded with data.

You accused me of "overstating the negatives of pediatrics." I didn't OVERstate them, I stated them, from my perspective.

Just as you and others did here: http://forums.studentdoctor.net/showthread.php?t=747985

 

[michaelrack]

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[smq123]

Boy, I bet the OP didn't expect THIS response. FPs and pediatricians - the two specialties with the stereotype of being the "nicest," duking it out.

OP - I think that both fields have their pluses and minuses. Sure, a large portion of peds is well child checks, but a large portion of FP is routine annual physicals. You have annoyingly anxious parents in one, and annoyingly anxious patients in the other. ("But doctor, I read on the internet that a lack of fever, non-productive cough, and runny nose can be a sign of drug resistant TB....")

Basically, it comes down to - do you mind not seeing adults? Some people really don't care, and I've met some pediatricians who don't even particularly like seeing teenagers. (Although, having taken care of those teenagers, too, I can't say that I blame them. ) And how do you feel about routine OB/gyn? What kind of psych issues would you rather see? - behavioral ones (ADHD, conduct disorder, ODD, etc.) or mental ones (anxiety, depression, "I'm lonely and just need someone to talk to," schizophrenia, and a little "adult onset" ADHD for good measure).

Since you are starting 3rd year, I also think you should go through and keep an open mind. While you say that you'd like to do outpatient primary care, perhaps your cardiology rotation will spark your interest. Or your pulm rotation. Or some other subspecialty that you will have to do a peds residency first in order to do.

They're both great fields. You can't really go wrong either way.

 

[Dharma]

Bump! @Dancer1986 what did you end up going with?

 

[deleted87716]

Bump! @Dancer1986 what did you end up going with?

The OP hasn't been online since November, 2011.

 

[Dharma]

The OP hasn't been online since November, 2011.

Can't hurt to give it a try! At the very least it bumps up a question a decent number of med students have.

 

[samcutchn]

family med is more likely to be a generic field where pediatrics are only for kids..

 

[deleted87716]

family med is more likely to be a generic field where pediatrics are only for kids..

Hardly. The majority of my patients are between 18-65 years old. Not exactly "geriatric."

 

[MerickManual]

Hardly. The majority of my patients are between 18-65 years old. Not exactly "geriatric."

I believe he said generic not geriatric. But true point nevertheless.

 

[deleted87716]

I believe he said generic not geriatric. But true point nevertheless.

Whoops. Well, it ain't "generic," either.

 

[the_drunken_doctor]

Actually, I've heard that one can go into FM, but focus on pediatrics.

Any truth to this?

 

[styphon]

Actually, I've heard that one can go into FM, but focus on pediatrics.

Any truth to this?

Yes, there is nothing to stop you from doing only pediatrics. I have been offered jobs where I would only see <18 y/o, and at one point I was offered a job seeing only nursery pts + newborns at clinic.

Two points:
1. Question is -- why do it this way? Family medicine residency will train you in OB/adult/peds - if you only want to do peds, why not do a pediatric residency?
2. You can't specialize much - you could do a fellowship in adolescent medicine - but Peds has tons of fellowships that are not available to FM. If you want to work NICU/PICU you most likely would have to be Pediatric trained, if you wanted to be a hospitalist in a large hospital that treats peds - (regional childrens hospital) you usually have to have pediatric residency training..