Pediatrics

Greetings: We are ready to start a pediatric mentoring thread. I am a neonatologist and faculty at a large Children's Hospital and can answer questions primarily related to specialty pediatrics and the path there. If the questions are outside of my knowledge, I'll try to get the answer for you. Although the mentoring thread is not designed to have PMs sent to mentors, in this case, I am glad to have PMs as I've always had. Career questions very specific to neonatology might best be addressed in the neonatology forum, although I'm glad to answer them here so everyone will see the questions and answers.

In addition, this thread will have a pediatric hospitalist who will be available to answer questions about general pediatrics and hospitalists. She will introduce herself in another post.

Hope we can be of help.

princessbbn said:

Hi oldbearprofessor!

Thanks for taking the time to answer our questions, here on student doctor. I have always been interested in pediatrics, but recently I have also become interested in neurology. Therefore, I was considering pursuing pediatric neurology, which I have heard is a fairly new field. I was wondering if you would be able to provide some information concerning this area of specialty. I have heard that the field of pediatric neurology is a bit more research-based? Also, would you know how competitive it may be? Any information/opinions concerning this area would be greatly appreciated. Thanks in advance for your help and advice!

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Well, this is certainly a challenging issue to start with!
First of all, I have tremendous respect for pediatric neurologists. It's an incredible field and one day about 4 years ago I got to meet the specialty WAY too "up-close and personal" when one of my children (who completely recovered) developed an acute encephalopathy.

There are multiple routes into it, but the usual current path is to do 2 years of pediatric residency and then do your child neurology fellowship. Some details can be found http://www.sfmatch.org/residency/child_neurology/index.htm

but I strongly encourage anyone interested in this to "talk to a pro" about the details of arranging this and also manipulating the general NRMP match for those planning on pedi neuro.

From what I've seen most pediatric neurologists are primarily clinical or conduct clinical research. Many focus on epilepsy and its management. There is a good bit of research involving new therapies for epilepsy as well as long-term neurological impairment. There is some basic science research as well, but I've mostly seen the pedi neurologists doing clinically oriented research. We are badly in need of good clinical research in children in this area - so much of the research on medications for neurological disorders has been focused on adults and not nearly enough on children.

I can't comment on competitiveness but from what I've seen it's a fairly self-selected group of folks with a strong interest in this who find slots. It used to be the biggest problem was getting pedi residencies that would accept someone for only 2 years, but with the SFmatch I think that has gone better lately. I'm open to correction on this from others about competitiveness - we'll see if one of the other mentors has any comments.

Sorry I can't be of much more detailed help - there are occasionally threads on pedi about this, but not often. Regardless, it is a great field and if it's what interests you, I'm sure you'll find a position!

Kfire326 said:

Hi,

I'm going to start medical school this August. I have no particular interest (or disinterest) in pediatrics, but I have a question that others may also find helpful. I guess it might be a sensitive topic, but it's something I've thought about.

I was wondering about the threat of lawsuits involving accusations of verbal and/or even physical misconduct on the part of the doctor (i.e. inappropriate remarks or touching). Whether it actually happens is one thing, but I'd imagine parents are probably hyper-sensitive when it comes to how their child is being treated by their pediatrician. Would you say there are many of these lawsuits that are pretty much baseless? Lawsuits that stem from parents' nervousness? And how does the threat of these lawsuits affect a Pediatricians work?

For example, a woman I work with, a 1st grade teacher, refuses to help her students (regardless of sex) button their pants after going to the bathroom if they cannot do it on their own. She knows she wouldn't do anything inappropriate, but argues that all it takes to ruin her career is one person to think something might be going on.

Thanks.

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Well, as a neonatologist this isn't my issue. However, it is a legitimate question and the type of concern that medical students have that are hard to get people to discuss. I have no idea what the frequency of legal action is against pediatricians for inappropriate behavior with a patient, however, I expect it is extremely rare. Pediatricians usually will exam the genitalia of small children with the parent present but certainly for an older child will have a nurse present in the same way that an "adult" doctor would for an older patient. Most kids don't act up too much around their pediatrician for obvious reasons (they are a bit afraid of us and our needles!).

Pediatricians can and do get sued. However, this type of accusation would be low on our concern list. Other than ensuring that we are cautious about what we say and have a nurse or other person present during some physicals, I wouldn't say it affects much what we do. Parents will readily fire a pediatrician they don't like, but accusing them of assault would be very uncommon. Hopefully my colleague on this board can add more comments.

shoppe said:

Would you mind introduce yourself? When did it dawn on you to be a doctor-a neonatologist? How much schooling did it take? What did you major as an undergrad? How long was your residency? I heard it's typically shorter than other medical professions, like 1 or 2 years?

Here is my scenario: I just got accepted to pharmacy school for Fall 2007. However, I have thought about pediatrics a lot but never have the courage to switch since I always felt like I'm so deep into my career path that I couldn't get out. But when I went to the pharmacy weekend, it dawned on me that this is not where I want to be. I know my parents will kill me with this decision but I think if I don't go for med, I'll regret this forever and I better start now than to waste another year in pharmacy school. So far, I have worked almost a year at an acupuncture clinic and two years at a retail pharmacy. I'll graduate with a BS in biology and chemistry next week. So if I start over now, do you think I would make it in med? My GPA is 3.86 with 94% on PCAT. Someone said I might not be competitive this Nov. and I should wait until 2008 to apply for 2009 instead. I really hope to get in next year but do you think it's possible? That is if I do well on my MCAT and get at least 3 months for clinical experience?

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Hi - There is a thread in pedi that has a good bit about neonatology
http://forums.studentdoctor.net/showthread.php?t=132715

as well as the private forum you are welcome to join. I decided to become a neonatologist during my last year of medical school when I did a sub-internship in a neonatal intensive care unit. Most people don't make a decision, or at least finalize it, as to a pediatric specialty until their second year of pediatric residency. I was an engineering undergrad but decided that I wasn't cut-out to be an engineer and that I liked the interpersonal aspects of medicine more. I have always felt close to babies and small children - even as a teenager. In medical school, I was certain of going into pediatrics early on in my education. Others however, don't decide until later.

Essentially all pediatric specialties require 3 years of general pediatric training followed by 3 years of fellowship. There are some exceptions including a "fast-track" that can allow to shorten this by one year in some cases. Most people do all 6 years.

Only you can decide what career path is best for you. As a parent of 3 teenagers, I can assure you that you wouldn't be the first young adult to do something that wasn't what their parents wished. Talk with them honestly about your feelings and go from there. I'll leave it to the premed advisers to determine whether you should go for a 2008 or 2009 admission. My general sense is that you'd be better delaying and getting more traditional shadowing experience before applying. There is no rush and you'll need to assure the admissions committee of your commitment to a medical education and explain the change from pharmacy.

good luck!

pigglewiggle said:

Hi! I am just wrapping up my first year and I love pediatrics and am 100% sure that is what I want to do. I have struggled a bit this year with grades and have a few low passes (which are internal) but no fails. I keep hearing that 1st and 2nd year grades are not very important in the grand scheme of things, but I am worried that I am hurting my chances at getting a good residency spot. No matter how hard I work I probably won't be first in my class in medical school, but I was wondering if you had any suggestions on how someone in my position could stand out in other ways? Research? Volunteer work? Is there something in particular you look for? Thanks so much!

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First of all, I'm not sure about the "good residency spot" you're looking for. Pediatrics has some great programs that are not at the 10 largest Children's Hospitals in the US. Undoubtedly, there are some programs that are not strong, especially in specialty areas, but even then, you can get reasonable experience in the field. So, I wouldn't at this phase worry too much about getting a "good" spot. Second, I can assure you that your preclinical grades really are not important in the grand or small scheme of things. So, do your best and enjoy your life.

As far as research and volunteering - as always, follow your passion. If you are interested in underserved populations - see if your med school runs a clinic that you can work at even if it's just doing intake histories and vital signs. Advocacy work in the community, education, etc are all worthwhile. Do these things because they interest you and you believe in them, not becasue of what you think you need to do to match. Save that for the ....... folks.

kissachka said:

I'm so happy I found this thread. Firstly, I appreciate you taking the time out of your schedule to answer all these questions. Secondly, I have one of my own. I will be starting medical school this August and was at first interested in general pediatrics. After interning at NY Presbyterian (neonatal unit) for a year my interest shifted towards becoming a neonatologist. I read the other forum on SDN about needing a 3 year pediatric residency followed by a 3 year fellowship in order to become a neonatologist. I'm not 100% sure of how fellowships work...but I'm sure I can find that information elsewhere. I was considering working as a neonatologist for a number of years and then possibly switching over to general pediatrics and having a private practice. Is there any sense in that or is it even possible? I suppose it's because I want to do a little of both and this was the best way I could think of making it possible.Thank You!

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In the United States, virtually no one combines neonatology (as in being a board certified neonatologist) with private general pediatric practice. Among other reasons is that the salary is much higher for a neonatologist. In other countries, where public-hospital based neonatology practice is very poorly reimbursed, it is common for neonatologists to spend their afternoon doing general pediatrics which, in a private setting, pays better.

So, some folks will do private practice and then go and do a subspecialty fellowship, but few go the other direction, especially in hospital-based and critical care fields like NICU, PICU, cardiology.

motek42 said:

I am beginging my 4th year at a foreign medical school with connections to Columbia U med school in NY. My USMLE I score is average. We do not get grades (just pass, fail or honors), so I have a few honors in the first 2 years of med school, but only 1 so far (we have not recived all transcripts yet) in 3rd year. I only "passed" my peds rotation in 3rd year (my attending did not give anyone honors, even though I spent much more than 80 hours a week there, told her I want to be a pediatrician, and she said I gave the best presentation she has ever heard on Pediatric Limp). However, she did give me an excellent letter of recommendation (according to her, of course I have not seen it). I have some research experience in pediatrics and will be doing several peds rotations at Columbia University and UCLA this year. I hope to honor those. What pediatric residency programs in NY/NJ area do you think are okay for me to apply to? Especially as an FMG (but a US citizen and native English speaker).
Any advice is sorely needed as our advisors here don't seem to know what they're talking about. Thanks!

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You may get more info about specific NY area programs in the pedi group and if you search under the individual program names you'll find several threads and description of the major NY area programs.

More generally, nothing you've written above suggests any reason not to apply to any program you want to consider going to in the NY/NJ area or for that matter anywhere else in the US (there is life outside of NY I hear ). The most important thing will be the type of letters you get and connections you make in your US rotations this year. Even the "grade" may not matter as much as making contacts and getting good letters.

ambulancedriver said:

i'm paying for school with a primary care scholarship that requires some time commitment after general residency before I can do a fellowship or academic work.

for someone in this situation, how difficult is it to get a fellowship (peds EM lets say) or hospitalist job 2 years out of residency? is it significantly more difficult 4 years out of residency?

thanks for taking the time to provide guidance!

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In general, a period of time, even quite a few years between finishing residency and starting fellowship is not seen as a "negative" in fellowship applications. If anything it is seen as a positive.

GAdoc said:

Hi, I'll be starting medical school in Georgia this fall. Until recently, I had never considered pediatrics. However, there are some factors that are causing me to reconsider. For the sake of argument let me first say that I plan to explore all possibilities before settling on a final career path.

I do have a couple questions, however, related to pediatrics.

1. In general why do you think someone would choose a pediatric field (whether it be surgical or non-surgical) over a field that deals mostly with adults? I know you can't speak for all doctors, but what are some general reasons?

2. How competitive is pediatric cardiology?

3. Would a pediatric cardiologist be able to do invasive procedures or would that require an additional fellowship is invasive cardiology?

4. What is the job market like for pediatric cardiologists?

Thanks for your time.

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The simplest reason is the actual one that most folks choose pediatrics. They like providing care for children. The reasons for THAT can be numerous. It includes an obvious sense of concern for children's health care and a desire to care for a population that generally isn't responsible via lifestyle issues for some of their chronic illnesses. Others simply like the atmosphere in a children's hospital better than in an adult one.

Pediatric specialties are not very competitive although among these pediatric cardiology is one of the few relatively competitive ones.

Pediatric cardiologists are trained to do cardiac catheterizations. In the largest children's hospitals, it is typical that an extra year of training is done at the end of fellowship for those who will make a career out of doing cath procedures.

The job market should be pretty good for pediatric specialists in all areas for the forseeable future as there is a shortage of all of them. Hard to predict details for someone who is at least 10 years away from finishing a fellowship.

If you post some of these questions on the pedi forum, there is a resident planning on pedi cardiology who provides information about it and if you search there have been a few threads about it as well.

moto_za said:

How long is the residency for pediatrics? Well I know it is three years, but I was wondering why a resident told me that after the first year you can just get licensed and stop and work etc. I thought you had to finish a min. of 3 years before you did that?

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A pediatric residency in the United States is 3 years. In some states, it is possible to get a medical license after your first year. Do a search and you'll find this issue has been discussed before on SDN. However, a medical license is of little use by itself (except in some places for moonlighting) and does not make one a pediatrician. So, plan on those 2 wonderful years after internship. Time moves fairly quickly during the second year yand during the third year, you are running inpatient services, teaching interns and medical students and getting ready for your career/job.

Enjoy the ride....

Mandanesss said:

Hello! I wanted to ask you about Pediatric Gastroenterology. I've had Ulcerative Colitis since I was 9 years old and have been interested in this area ever since then. Could you please tell me more about it? Would it be best to get a masters in nutirition, as well? Tell me all you know about this field! Thank you!

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Pediatric gastroenterology combined with nutrition is a subspecialty of pediatrics requiring a 3 year fellowship after 3 years of pediatric residency. Positions are obtained via a matching program similar to the residency match. It is moderately competitive for some of the best known programs.

Training in pediatric gastroenterology requires, like all pediatric specialty some research project. These can be primarily related to gastroenterology or more to nutrition. There are opportunities for basic science as well as clinical research.

There is no particular reason to become a registered dietitian (RD) or obtained a master's in nutrition. If you have a strong interest in clinical nutrition within this field you'll have many opportunities to learn more about it without that.

beautifulbabies said:

I am a 2nd year peds resident looking for some advice on a career in developmental pediatrics. I enjoy the field but I fear that it is in fact too limited...ADHD/Autism/ADHD/Autism. I am interested in academics as well and maybe even research. I am attracted to the pace of it all as well as the psychiatric/psychosocial aspects ( I majored in Psychology in college). I have considered doing a fellowship in this but maintaining a part-time career in general peds. Is this realistic? Maybe it means that I am making the wrong decision? Please reply when you can with any advice, good and bad. Why did you pursue this field? Downsides? Upsides? the future...
Thank you in advance. Really appreicate any advice.

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Developmental peds is a great field with a wide range of opportunities. There is an attending in developmental peds who reads and responds on the pedi forum so I suggest posting a question there or searching under developmental peds. There is a tremendous need for developmental peds at many pediatric centers so I don't think you'd need to do part-time general peds unless you really wanted to.

Farfromtime said:

Just wondering if anyone had suggestions about setting up rotations in a different state than your med school. How should you approach the person/dept in charge? Any suggestions about applying?

I was alarmed to see that some hospitals want an application (just to rotate there) 5 months before the rotation. Is this normal?

Any recommendations for pediatric rotations in NYC? (PM if you feel it's 'advertising.')

Thanks in advance!

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Sorry, you're question has been sitting here as I was waiting to see if someone else who knew more about NYC would answer that part. It has become increasingly common for hospitals to ask for applications for rotations. Don't take it personally. As far as approaching folks, most programs will have an office that handles those applications. I nice email to the person in charge with a copy of your CV is a reasonable start.

GradTX said:

I'm applying to MSTP programs this cycle, and right now I'm interested in going into one of the pediatric subspecialties. Is is a good idea to go to a medical school associated with a large, free-standing children's hopsital? I need some way to narrow down my list!

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It really isn't necessary to do this. Pick the program for the best overall experience and MSTP training in your area. If you have a strong interest in pedi, it would be nice to be somewhere that has the ability to schedule electives in pedi and to see some "specialty" things like congenital heart surgery. Even in these, it would be possible to schedule electives on the outside to pick up a couple months of pedi specialties.

If you have a strong interest in pedi rheum, pedi renal, pedi cardiology or pedi critical care, you'll not find much of these in the smaller programs, but most of the rest of the specialties will have some coverage. On the other hand, all of this advice won't help you too much in limiting schools for application since most MSTP programs are associated with med schools with substantial pedi programs.

Lifeguard2003 said:

I just finished my 3rd year and will be starting the application process for a pediatric residency in the next month. I am slightly overwhelmed with deciding where I want to end up for the next 3 years. I was just curious if you could shed some light on deciding between large vs small programs. I would also like to know how many programs I should consider applying to. My ultimate goal is to pursue a pediatric hematology-oncology fellowship so I am looking at a lot of the "top" hospitals. I know everyone tells you that you should just feel out the programs and go where you "fit" best, but alot of people that matched in peds this year said they liked all the places they interviewed at.

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At this point, I would apply to a range of programs to see how you respond to the descriptions they provide. You'll get an idea out on the interview trail if you like big programs or small ones. In general, those going into something like heme-onc will usually prefer a larger, more academic program, but that isn't a hard and fast rule.

It isn't uncommon not to like all the places you visit. After all, when interviewing you, they are trying to sell the place, and pediatrics isn't a tough sell. . Still, you'll pick up differences in how residents fit into the program and what the program director is like.

Consider whether you'd like to do some research while a resident. Consider the city and the family or other support you'll have. Then pick a range of programs of different sizes and see what you feel comfortable with - it's a bit like college when you had to pick between a big and small one. Both are fine, just different styles are best for different folks.

montessori2md said:

How do staff (I mean both physicians, as well as everyone else in the unit) prepare for all the emotional and ethical aspects of peds, particularly in neonatal, where so much effort can be necessary to keep a child alive who may or may not ever recover? Are staff required to participate in training to help them to interact with parents appropriately? Or is it basically a self-selected group of people who find themselves able to do so? Is burn-out more of an issue on some services than others (I refer here to primarily to nursing staff)?

Also interested in your impression of overall quality of life in the various peds specialities, or what the factors are as far as call schedule, time off, etc. Does it depend on the hospital, the specialty, the region?

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There is very little formal staff training in grief counseling or dealing with one's own reaction to these situations. Nursing staff may get a bit of orientation, but not much. Medical school curriculums certainly have a bit of this in it, but it doesn't really help [much]. If anything, making medical students try to practice "grief counseling" may make them more cynical. There is no way to practice this. You can give people ideas of the "right" and "wrong" things to say, but that isn't much help.

I don't think pediatricians or pediatric specialists who deal with death commonly (pedi ICU, neo ICU, pedi cardiology, pedi heme/onc as well as those who deal with special populations such as kids with cystic fibrosis) are in any way a self-selected group that deals with these things better or worse than any other group.

So, what is the answer? I'm afraid it comes down to experience and observation. With time and the chance to see how it is done, pediatric residents and especially fellows in these specialties learn both how to approach and deal with families and how to deal with their own reactions. It is common for the physician-in-training to be upset the first few times but gradually learn to accept what happens and be helpful. Obviously, some do this better than others. By observation, trainees see what they do and don't like about how others handle the situation. It's easy to quickly learn that some doctors don't like to be around what a patient is dying and how that impacts a family.

One thing that is very helpful is that with time, both the doctors and the nurses who are caring for these children recognize that the death of their patient is often both unavoidable, and something that ends a lot of suffering for which there is no real chance of a good outcome. That doesn't make it less sad, but allows for us to accept what our role is. Also, with time, we become more used to being around families and what to say in this circumstance, making it a bit easier.

There is some burnout of NICU/PICU, etc nurses, but it's really more related to the high-paced, relatively high stress of hanging lots of IV drips, managing the patient, etc than related to the outcome of the patient or dealing with death. Some like it, some don't, but I don't think that the stress of dealing with death is a primary reason for NICU/PICU, etc nurses to leave.

The quality of life question is probably best addressed in the pedi forum where you'll get a broader range of answers.

2BAnIDrNoMore said:

Hello:

Can you shed a little light on pursuing Peds EM? How long is residency? What's your view on the combo (Peds/EM) residency? I read the following on SDN:

There are three options when it comes to Peds EM:
1: Peds residency then EM fellowship
2: EM residency then Peds fellowship
3: Combined Peds/EM residency


*There's a disadvantage if you do Peds first then an EM fellowship; it takes a full 6 years to complete. It only takes 5 years if you go with either of the other 2 options. Also, if EM is what you are interested in and peds is a big interest but you don't see yourself spending the rest of your life in a peds setting, just do EM; you'll have a lot of peds patients.

Is all of the above correct?

I also read that Peds EM jobs are scarce and it would be better to do EM; is this true? This may be a silly question but does Peds EM limit you to children's hospitals? (<--based on the fact that SDN posts say we should just do EM)

Thanks in advance!

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This debate is one of the occasional ones on SDN and in general tends to find its way to the EM forums more than the pedi ones. There is no "best" or "one" way to a career in pediEM. Certainly, one can do an EM residency and then have a career in which one sees a lot of pedi patients. How best to arrange that would be best discussed by the EM folks. If one does 3 years pedi and then 3 years pedi EM fellowship, then it is likely that ones career will be spent in a children's hospital EM setting. That only makes sense because you'll have spent 3 years doing research into issues related to pedi EM. I don't know about the job prospects, but as always, it is impossible to readily predict for a premed what the job prospects in any area will be when they finish fellowship 10-12 years later.

From my perspective, the student has to decide whether their primary interest is pediatric care or emergency care and how they feel about taking care of adult patients. I have seen many folks start in pedi with a strong interest in EM and end up doing a completely different fellowship. So, if you, like me, don't want adult patients virtually ever and are focused on pedi, then do a pedi residency and decide if you want EM fellowship or not. On the other hand, if you prefer kids, don't mind adults, and have your greatest interest in EM, then do EM residency and then decide if you want additional pedi-EM training. I can't comment about the combined residency. I don't understand that one well, so someone who has done it should comment.

WiscDoc said:

Oldbearprofessor,

Thanks for starting this thread. Your advice is very well appreciated.

So I am just starting med school this year (I started in May) and I know that I would like to work with a relatively younger population (maybe younger than 50) and i think I would enjoy working with kids the most (under 18). I have many younger siblings and cousins and i know that I love dealing with kids.

I know I don't want to general pediatric, because I am the type that likes to master something, and my understanding is that specializing in an area by definition means that you master that one area. Furthermore, my BS was in biomedical-mechanical engieering, and most of our applciations were in orthopedic related stuff, so I have an interest in ortho too. I know everything is in the air and a lot can change during 3rd year.

My question is this: Which of the following do I do:

1- Do I go for a peds residency and then do a followship in a certain are (cardio, ortho, oncology or any other that I am currently interested in)

OR

2-Do I apply for a residency in one of the areas that I am interested in (obviously THE ONE that i discover I have a passion for over the next couple of years) and then do a fellowship in peds?

Or

3-Do I specialize in something and then just work at a children's hospital?

Thanks in advance.

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Hi - the good news is that you have about 3 years to decide what really interests you. Basically, however, you must decide when applying to residency if you wish to do a medical specialty (pediatrics) or a surgical specialty. For example, if you wish to do pediatric surgery, pediatric orthopedics, pediatric ophthalmology, etc, these are specialties within surgery and your training will follow a surgical route, then you will apply for a fellowship in the pediatric aspect of it. For example, to become a pediatric surgeon, one completes a full 5 year surgical residency, then does a pediatric surgical fellowship. Some of these are competitive (pediatric surgery - often one needs to do 2 yrs of research as well), others less so.

If you want to do a pediatric medical specialty, which roughly parallel the adult ones (heme/onc, endocrine, infectious diseases, etc) with a few exceptions (we have neonatology, they have geriatrics...), then you do a general pediatric residency and apply towards the end of that (end of the second yr usually) for a fellowship. Pediatric fellowships range from totally non-competitive to moderately competitive for some of the best know programs in certain fields.

Hope this helps, it'll become clearer as you work your way through the first couple of years and meet up with folks in these areas. Meanwhile, feel free to post further questions on the pedi forum.

red453 said:

What are the opportunities to work part-time beside private practice? Can it be done as a hospitalist or neonatology (two of my interests)

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Well, my colleague is a hospitalist so she should comment on that. In terms of subspecialties, including neonatology, it certainly is possible to do that and work shifts or other forms of part-time schedules. In academics, it is often important to try to establish a research or educational career and part-time is a challenge with that. But it is done and can be arranged. Fellowships are generally full-time though, so any part-time work for subspecialists would usually be after becoming an attending. People needing extra time during fellowships will usually take a leave of absence rather than work part-time during fellowship training.

veenut said:

Hi Docs,

Thanks for taking the time to answer our questions! I'm an M2 who's still pretty unsure of what to specialize in, but I've always enjoyed spending time with kids and have a bit of a soft spot for pediatrics. What worries me is the massive amount of debt I'll have incurred over the course of school - between 160-200k. Most of the figures I've seen indicate that pediatricians generally earn at at the lower end of the spectrum of physician salaries. I don't expect you to be my financial planners, but do you think it's even feasible to pay off that amount of debt on a primary care salary? To offset the lower salaries, do hospitals/group practices offer loan-repayment programs to help relieve the debt? I don't particularly like the idea of being limited in my choice of specialty by money matters, but I suppose it's unrealistic to expect otherwise. Thanks for any advice you can offer!

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I'm not the best one to answer this. I was fortunate to be educated at a time and place when tuition for medical school was nearly zero and I graduated without debt. I am eternally grateful to my parents for their support during my training and it allowed me to pursue three fellowships and really do what I wanted with my career (considerable thanks to my spouse too for that support!).

I believe it is practical to repay this type of debt, but a lot depends on your family situation and where you wish to live. I wouldn't count on loan repayment although it is possible. I think it is very important to talk now to financial experts and get their perspective. I know that many pediatricians do have this type of debt and are successful. Some subspecialties of pedi offer the opportunity for considerably higher salary than general pedi, but at the expense of three years more training and a lower salary during that training. Other subspecialties are not that much better (if at all) paid than general pedi.

Regardless, I'm certain that if pedi is what you want to do that it is worth it to strongly consider doing a pediatric residency. I have loved the field and even residency , and couldn't imagine having made a different choice. If this is how you feel, I'm hopeful you'll be able to make it work out for you and your family.

directdoc said:

Besides private practice, what are the job options open to general pediatricians? How do these differ from the private practice in terms of hours, salary, and lifestyle?

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There are a variety of job opportunities outside of community-based private practice for "general pediatricians", which, for the present we can define as a person who completed a pediatric residency, but did not do any fellowship training. In the pedi forum are a few folks who are doing some of these. The two I would point out are that of "academic general pediatrics" - the practice of pediatrics in an outpatient setting for a medical school, and "hospitalists."

Currently there are fellowships for "academic general pediatrics" and many of these people have MPH or similar training. It's highly variable and hard to predict what opportunities will exist at different places for this. What the job often entails is training residents in out-patient settings as well as a good bit of general teaching.

Increasingly common are varying forms of "hospitalist" positions. Others can speak to the range of opportunities here, but they are increasing. It can include covering in-patient general services, night-call in Level 2 neonatal units and night-call covering the delivery room or nursery at small hospitals. The future of this area and how many will do this with and without some type of additional training are uncertain to me, but I think it is a real opportunity.

nvshelat said:

Could you describe for me the typical day for a ped heme/onc?

Thanks!

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As with most pediatric specialty services, pedi heme/onc has the following usual clinical responsibilities:

1. In-patient service - these will be patients admitted to their service for primary management. Many or most of these will be oncology patients being treated under varying protocols. There may be a separate bone marrow transplant service.
2. In-patient consult service - usually in pedi these are primarily non-oncological problems that heme/onc has been askede to advise on. This would include things like thrombosis management, evaluation of bleeding disorders, etc. The heme/onc folks may get asked to see former oncology patients admitted for other unrelated problems as well, just to "watch."
3. Out-patient clinics - covering the whole range from f/u chemotherapy to f/u of heme disorders such as hemophilia.

How these responsibilities are covered by the clinical team will depend on the size of the team and number of patients. In some hospitals only a few attendings will cover all of these, doing morning rounds on all in-patients (on-service and consult) and seeing clinic patients later in the day.

Bigger hospitals will usually split these tasks so that one month an attending (and fellow if they have them) will do in-patients (or consults) and others will handle clinic. They may have cross-over responsibilities as well. Hem/onc folks tend to be pretty bonded to their own patients for obvious reasons. So, they will often follow them in the outpatient clinic themselves after hospital discharge even if they are still working on an in-patient service. Similarly, even if not on the in-patient service, they may look in on admitted patients.

On top of all of these responsibilities are the usual academic responsibilities if they are in an academic program (as are most heme/onc docs in pedi, but I don't know the %) such as teaching and research as well. Some pedi heme/onc docs have laboratories and devote 6-10 months/year to research, others are strictly clinical. Virtually all are involved if they are in an academic institution in teaching.

avemar01 said:

Hi Dr. OldBearProfessor! I'm an IMG and I want to get into a Pediatrics Residency Program. I had the "calling" on wanting to be a Pediatrician during my Internship training. But the thing is, my Pediatrics academic grades are not really high even during clerkship and intership. But my academic grades as a whole is fine. I ranked 4th on graduation year. Hmmm. I was also skimming thru the training hospitals and I was kind of disheartened with the other training institutions because it seems like they're not really considering IMGs. I would want to get a really good training. And I'm torn now between getting a Neurology fellowship and Neonatology. Hmmm... oh well. Please give me some enlightenment. Please. I thought of getting into the 3 yr Pediatrics residency first then maybe I'll figure out where I'll be headed next. Thanks so much in advance. Eagerly waiting for your advice.

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Hi - I'm not entirely sure I understand what you're asking me. If you've just completed an internship in a foreign country and want to continue your training in the US in pediatrics, I would certainly recommend doing a full pediatric residency here. Ultimately, if your goal is to practice in the US, you will need to do 2 years residency in the US to become board eligible in a specialty even if you've done a full residency overseas (I believe this is the current rule - used to be fellowship and one year, but now I believe it is at least 2 years for pediatricians trained overseas). Regardless, this will provide you the most options to choose your area.

As far as getting a pediatric spot here, I'm no expert on that as I am not a program director. There are certainly a number of programs that accept many foreign medical graduates and this information is not too hard to find on the internet. Letters of recommendation are very important.

After doing your pediatric residency you'll have time as a PL-2 to choose a fellowship area if that is your goal. Again, a lot depends on whether your ultimate plan is to practice in the US.

Good luck.

mmcnam said:

Hi everyone and thanks for contributing to this great thread! I'm applying to med schools now and I'm definitely going to pursue a pediatric field. I come from a large family and I've always been caring for kids, so pediatrics seems like the ideal career for me. I've been wondering, however, about how pediatricians who practice family medicine manage to make ends meet in their first few years. Med school debt is enormous and pediatricians are making less and less every day. It seems most attractive for me to consider a specialty where salaries are higher, but I'd hate to get boxed into a particular career path because of money. However, practicing family medicine nowadays and providing quality care for uninsured kids is a really noble career path. Any thoughts on this?

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Hi - I'm not convinced that pediatricians are making less and less every day, but those debates are best for elsewhere on SDN. Also, I'm not sure what you mean by "pediatricians who practice family medicine", but I think you are referring to pediatricians in community general practice as opposed to specialists or hospital-based pediatricians. Family medicine is a separate field and includes the care of adults and children.

Regardless, although there are many motivations to becoming a pediatrician, I think that enjoyment of caring for children is one of the most important. As you head into choosing a specialty, you'll get a good sense of the financial options in pursuing primary care fields and you might find they are not nearly as bad as you might otherwise be led to believe. If pediatrics is your passion, I hope you'll look at the various options and make the choices that will lead to career satisfaction and happiness for you. Good luck.

tbpap said:

Hi! I have a huge interest in being a neonatologist and had some questions about it. First, is it competitive and hard to become a neonatologist? I'm pre-med and have been considering applying to DO schools as well as MD...are there many DO neonatologists? Also, I'm not sure how the residency works...do you apply for a neonatology residency, or do you become a pediatrician first, then get into a neonatology residency? As a neonatologist, what are the hours? I have heard they work shifts in the NICU. Sorry for all the questions!

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http://forums.studentdoctor.net/showthread.php?t=132715

and

http://forums.studentdoctor.net/showthread.php?t=376406

will help you and give you information and a link to the neonatology forum.

However, briefly:

1. Yes there are lots of DO neonatologists.
2. To become a neonatologist you must first complete a pediatric residency - you apply during your second year of training.
3. Neonatology is "moderately" competitive - if you want it, you can have it. Some of the better known programs are competitive (as with any pedi specialty), the less well-known ones may be non-competitive (ditto).
4. Babies like to be born and be sick at nights. You will likely work nights your entire career or at least until you give up most or all hands-on procedural care. The hours are too variable to generalize. Some places do shift work, others don't

pedshopeful2009 said:

HI,

I'm currently a third year med student and I'm almost 100% sure I'll be going into pediatrics. However, for years advisors and physicians in other fields have been trying to convince me NOT to go into peds. So many people are telling me that I'll never pay off my debt. Currently, I owe $115,000- this includes college and med school loans. Realistically, would I have a lot of problems paying this off as a pediatrician in the Cleveland area (I'm not sure if I want to be a hospitalist or join a practice)? Thanks.

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Hi: first of all, there is no way I can tell you about paying off your loans as I don't know the type of loans, rate, your lifestyle and family issues, etc. So, even if I could predict what salaries would be in Cleveland 4+ years from now, which I can't, I couldn't answer it. Also, you might decide to specialize and this could substantially affect your repayment.

SDN and many other sites offer many descriptions of starting and mean salary both for general pediatricians and specialists. Certainly, your loan amount is not atypical for many pediatricians starting practice and I'm sure many pediatric residents and recent grads can tell you their strategy for loan repayment.

Bottom line is that you should look to do the specialty that will give you the most satisfaction and that you want to do. You'll repay the load and be happier in the process. Meanwhile, I'd recommend getting advice about pediatric careers from pediatricians in your area and school, not people in "other fields."

good luck

redcheeks said:

THank you so much for your time and effort! I'm applying to residency programs with a view to working in general practice afterwards. In applying for jobs in private practice, do you think it would make a big difference whether I went to a big name residency program, ie Johns Hopkins, or a small, less well known program that specialises in training primary care paediatricians ie Brody School of Medicine/ East Carolina Medical school (Greenville, NC)?

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Well, I don't do general pediatrics, but my sense it that it makes extremely little difference in obtaining a job.

BTW, before coming to the US for residency, remember that we write pediatrician, not paediatrician!

nidhi said:

Dear oldbearprofessor,

I am a second yr Pediatric Resident in NYC, and wish to apply for Pediatric gastroenterology. I took some time to figure this out, and thus, didn't apply for the 2009 match last yr.
Also, i an IMG and on H1 visa, so, there are some issues there as well.
However, since i like the subject so much, i can consider going for some Research job for an year, after my residency is over, and then, apply for the fellowship..
I am still in a fix, as i fail to understand whether i should really do a research job to get some paper pub's or just go ahead and apply.. as GI is quite difficult to get thru.
All the places need you to be an American Citizen or a GC holder, neither of which i am!

So, its the battle between giving a sureshot hit or just keep trying every year!?
Some of fellows told me that its probably not a good idea to apply, get rejected and apply again, as the PD's kinda remember you from last yr... i find it difficult to assimilate.. what do you have to say on this?

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Pediatric positions, whether they are for residency, fellowship or other positions tend to be less number-oriented and more person-oriented. As such, it's always hard to know how to assess the application from someone that you don't know as I don't know you. I'm not sure that all places require a Green Card for a GI match, I suggest you ask around broadly. Consider whether you are only interested in GI, or would consider other pedi specialties that are more open to H1 holders. Ultimately, consider whether it is worth the time to look for a waiver or other opportunity to get a green card before applying for fellowship if you feel a green card is truly needed.

In general, I would be unenthusiastic about you doing a research year unless it was some area that you were interested in working in throughout your career. I doubt it will affect your application that much, since it won't affect your Visa status and one year of research is unlikely to have a major impact in how you are seen in applying for a pedi fellowship. Consider options that would allow you to practice medicine while you are applying if you have a year between finishing residency and fellowship. These may be most helpful in making the case for your ability to do a good job as a fellow and of course, can help financially.

good luck

toiysruskid said:

I'm a current PGY-2, soon to be PGY-3 in pediatrics with an interest in hospitalist medicine. I have been looking for some answers to a few questions I hope you can help with:

1) I noticed that you decided to pursue academic peds rather than hospitalist peds fellowship. Could you comment on the reason and the differences b/w the two? My understanding is that hospitalist tracks are generally 50% research/clinical whereas academic peds is more like 20-30% clinical.

2) I am not yet clear on the need for additional training to become an academic hospitalist- none of the attendings I work with (in a large completely hospitalist run general peds unit) completed a hospitalist or academic peds fellowship. Do you get a sense that most hospitalists in the future will be graduates of these fellowship programs? Do you think it will be significantly easier to find a job with the additional training?

3) Is there a good resource to compare fellowship training programs?

Thanks for your time.

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Hi - unfortunately our hospitalist mod doesn't come by here much so you might need to post this in the pedi forum to get more answers.

I can say that the role and training of pediatric hospitalists is currently in flux. There are not boards yet, although I've heard this is coming. I think there will be more fellowship trained hospitalists but I suspect that with increasing work hour limitations, there will be plenty of folks doing hospitalist type jobs without the fellowship.

Academic general pediatrics is intended to develop leaders in the field of pediatrics and as such has a strong administrative, education and research component that may not be present in hospitalist training. Academic general is more outpatient oriented and has a strong public health component.

Good luck and feel free to post some further questions in the pedi forum where you should get a range of answers.

LondonNubie said:

I hope this thread is still open. If so, thank you so much for your help. I am quite concerned about applying for Pediatric residencies. I am just beginning my third year in medical school. I did not do amazing during my pre-clinical years and have a subpar step score (a little below 200). I was wondering what types of programs should I look to apply to with hopes of matching. I do not want aim too low, but I want to be realistic. Ideally I would like to be at a free-standing children's hospital that encourages research with the possibility of specializing in Emergency Medicine. If you need to give me a more personal response, please feel free to PM me. Thank you again!

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Sorry for missing this. No one had posted in over a year so I don't check it regularly. The nice thing is that pedi really has less emphasis on Step 1 scores than many other fields. Lots of folks with scores below 200 match at excellent programs and move on to fellowships, even relatively competitive ones like PediEM. You probably have a relatively low chance at the 5 biggest/best known programs but if you have something remarkable in your application, even this isn't impossible.

Mostly I'd target the mid-range Children's hospitals. There are some pretty big ones out there that have great training and aren't as well-known as the biggest 5-10 programs. Think places like Akron, Phoenix, Austin, CHKD, etc, etc.

Make sure to get good letters of rec and do well on sub-Is and electives. Those matter a lot!

Good luck.

PediGal said:

Hi to everyone here! I am finishing up my 3rd year and have intentions of going into pediatrics. I was just wondering if any of the pediatricians, residents or 4th year students who may be here can suggest any rotations other than pediatrics type rotations for 4th year that would be most helpful in my training before intern year.

Of course I'm going to take an array of pediatrics courses--Wards, sub-Is, and a few specialty courses. However, I would like to know if doing something such as radiology, EM or Anesthesia might be helpful in general to gain proficiency in reading radiographs, starting lines, etc. or if that is something I can just expand upon when I hit the wards as an intern?

Thank you!!

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Sorry for missing these - this forum isn't too active.

Radiology, derm and anesthesia would be my choices.
Each of these will teach you some skills and knowledge you won't easily get and will be helpful early on. Anesthesia can be 2 weeks - IV starting and intubations are what you really need.

Don't do EM - you'll get plenty of EM face-time in residency.

Susan Watts said:

I will be starting a IM residency soon but in the back of my mind I kind of still wanted to do Pediatrics, what would be the chance of of going from an IM program after PGY-1 to either a Meds-Peds or straight Peds program given the caveat that I never did any Pedi-electives and just did my core in Pediatrics and only got a Pass in that.

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Med-Peds has problems due to the integrated nature of the training requirements. If this is an interest, let your PD know very early and see what they say.

Actually transferring to pedi? Sure, why not. The electives and the Pass are irrelevant. Just do well in your first few rotations in IM and you'll do fine for most places.