General Pediatric FAQ: How to become a pediatrician

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Stitch

Stitch

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Discussion here should focus on how to become a general pediatrician or how to go into one of the various pediatric sub specialties.

Old Bear Prof started us off in a previous thread:

oldbearprofessor said:
A pediatric residency is a 3 year residency after medical school. Upon completion of these three years, one may do go into general practice of pediatrics or do a subspecialty fellowship. Virtually all of these fellowships are 3 additional years and include a research component. I won't list them all, it's easy to look them up.

Now then, it gets more complex from here....

Pediatric surgical specialties such as pediatric surgery, pediatric ENT, etc, etc follow a surgical, not a medical training path and one does not do a general pediatric residency.

There are certain paths that allow for completing pediatric residency in two years as part of a combined program.
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This may not have been mentioned, but after completing a pediatric residency (3 years), you have a few options for work without doing a subspecialty.

One is general private practice. This would be the pediatrician you probably remember from childhood. Where you went every year for a school check up, shots, and for sick visits when you weren't feeling well. People go into private practice for many reasons, but most really enjoy having a close relationship with children and their families. You basically get to watch children grow up, help them through school and be involved long term.

General practice is focusing more on coordination of care with various subspecialists. Think of a former premie infant with multiple medical issues including seizures, chronic lung disease, eye problems. They are in desperate need a medical home, someone who can put it all together and insure that the patient gets to appropriate specialty care. Recognizing normal development is essential, as general peds people are often the first to suspect heart disease, malignancies or other abnormalities, and have to refer those patients appropriately for treatment. It's often very challenging to pick out the needle in the haystack and find that child who is sick, and that challenge is part of why people do it.

Some primary care pediatricians also round on their patients when/if they are admitted to the hospital, and are involved with their sicker patients in that manner. Others do only outpatient. It's very practice dependent, and if it's something you like or don't like, you should be able to find a practice that does or doesn't do it.

Don't forget that general practice is also dealing with ADHD, learning disability diagnosis, autistic children, and even some psychiatric issues such as bipolar and depression. General peds guys are having to pick up this area because of the dearth of pediatric mental health providers.
 
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Hospitalist work is also available after residency. It works much like the internal medicine hospitalists, but is a bit newer in pediatrics.

Rather than do outpatient primary care, you can focus only on inpatient care. There are hospitalists who only work in nurseries, and there are some that do it all. It's becoming more and more common to have a hospitalist take care of admitted children in the hospital rather than the child's PCP. So anything from an asthma exacerbation to cellulitis, the hospitalist will coordinate in patient care only, and then allow the patient to follow up with the PCP once discharged.

Some hospitalists are fellowship trained, however. At this point in time, fellowship training is not a requirement, but it does allow you to get into academic research, and often academic centers/universities will want that on your resume. I don't think there's a board exam or standardized fellowship criteria yet, but that may happen in the future.
 
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In terms of subspecialties, here is an AAP link to pediatric subspecialty listings.

In general, fellowship (sub specialty training) is 3 years and involves 1.5-2 years of research, requiring some sort of publication or paper write up. More on this later.

As OBP pointed out, the surgical fields do not go through a pediatrics residency. So if you wanted to be a peds surgeon, then you need to do a surgical residency and not a pediatrics residency. Same for anesthesia or ENT.

The medical subspealities all go through pediatrics first.
 
A common question is when people decide to do a pediatric specialty and whether it is possible (or common) to work as a general pediatrician and then go on to fellowship after a few years.

There are some articles about specialty choice in the literature, but basically, most people will come into residency with an idea of whether they want to do general or a specialty. Plenty change their minds both ways or change which specialty they want to do. Mostly, the decision is made by about the middle of the second year of residency, but it is certainly possible to make it later and do a "chief resident year" or work for a year (clinical or research) and then do fellowship. Occasionally there are positions for fellows that open up late outside the specialty matches as well.

There are folks who will work as a general pediatrician for a few years and then go and do a fellowship. It is not necessarily hard to land a fellowship, but it can be hard to give up an "attending" lifestyle and salary and go back to a salary and call schedule like a resident. Some do it, but with each year it can be a bit harder. Military docs are special cases here and some of them are on this forum and can comment about that pathway.
 
oldbearprofessor said:
A common question is when people decide to do a pediatric specialty and whether it is possible (or common) to work as a general pediatrician and then go on to fellowship after a few years.

There are some articles about specialty choice in the literature, but basically, most people will come into residency with an idea of whether they want to do general or a specialty. Plenty change their minds both ways or change which specialty they want to do. Mostly, the decision is made by about the middle of the second year of residency, but it is certainly possible to make it later and do a "chief resident year" or work for a year (clinical or research) and then do fellowship. Occasionally there are positions for fellows that open up late outside the specialty matches as well.

There are folks who will work as a general pediatrician for a few years and then go and do a fellowship. It is not necessarily hard to land a fellowship, but it can be hard to give up an "attending" lifestyle and salary and go back to a salary and call schedule like a resident. Some do it, but with each year it can be a bit harder. Military docs are special cases here and some of them are on this forum and can comment about that pathway.
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Excellent point OBP. In the military it is more common to do a fellowship after a few years of gen peds b/c we have the option (if selected) of doing a FTOS (funded fellowship) and essentially make the same pay as an attending. Unfortunately we have to go through 2 selections in order to be picked up for a fellowship (military gme selection and civy selection, unless doing a military fellowship).
 
rotatores said:
Excellent point OBP. In the military it is more common to do a fellowship after a few years of gen peds b/c we have the option (if selected) of doing a FTOS (funded fellowship) and essentially make the same pay as an attending. Unfortunately we have to go through 2 selections in order to be picked up for a fellowship (military gme selection and civy selection, unless doing a military fellowship).
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Thanks - can you or one of our others expand on this a bit more explaining the whole pathway, etc and differences amongst the branches (if any). This is a common question.
 
oldbearprofessor said:
Thanks - can you or one of our others expand on this a bit more explaining the whole pathway, etc and differences amongst the branches (if any). This is a common question.
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I can for the Navy (I'll let others expand on their respective branches). After completing med school (either HPSP or USUHS) you get selected into an intership. After a short few months of internship you have to reapply for a residency. Depending on your year, a good number of peds residents will get picked to go straight through, however, some will need to do a GMO (general medical officer) tour for 2-3 years (marines, vs. dive medicine vs flight medicine). After completion of residency you can either do a tour as a general pediatrician or apply for a fellowship. Pediatric fellowships in the Navy are few and far between, however, they have picked up steam as of late. Usually, they are only selecting around 5 fellowships (on average) in all of Navy pediatrics per year. The Navy currently will only train NICU, PICU, Cards, Pulm, Neuro, Endo, Heme/Onc, GI, Devo, Academic felloship (rarely), and A&I (rarely). No genetics, no nephro, and no rheum. Each year is dependent on what the Navy will need in the future. There are different pathways for felloship funding/training. There are a select few military (FTIS)fellowships (Nicu, GI, Endo). With these you don't add additional time as you are paying back time owed but earing extra time at same the pace. You can occasionally get picked up for a FTOS (full time out service) where you gain rank and make the same pay, but you are essentially a civilian. You will add time for this. I believe you can now also do NADDS and FAP (someone else please explain these?). Most of fellowship selection is luck, timing and persistence. Most can get their fellowship of choice, however, it may take multiple attemps at applying.

Hope that helps.
 
Stitch said:
Hospitalist work is also available after residency. It works much like the internal medicine hospitalists, but is a bit newer in pediatrics.

Rather than do outpatient primary care, you can focus only on inpatient care. There are hospitalists who only work in nurseries, and there are some that do it all. It's becoming more and more common to have a hospitalist take care of admitted children in the hospital rather than the child's PCP. So anything from an asthma exacerbation to cellulitis, the hospitalist will coordinate in patient care only, and then allow the patient to follow up with the PCP once discharged.

Some hospitalists are fellowship trained, however. At this point in time, fellowship training is not a requirement, but it does allow you to get into academic research, and often academic centers/universities will want that on your resume. I don't think there's a board exam or standardized fellowship criteria yet, but that may happen in the future.
Click to expand...

This sounds interesting to me... how does one find a job like this and is it common?
 
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