Academic Medicine and Pediatric Subspecialties

[Gleevec]

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Hi everyone,
I'm several years off from making any firm decision on my specialty, but I was wondering if anyone had any information on some of the pediatric subspecialties and whether its likely I would be able to get a job at a university hospital. Im really interested in peds heme/onc, peds cards, and peds ER and was wondering what the lifestyle, pay, and competitiveness for these specialties would be in an academic setting? Has anyone done any rotations in these and found them to be especially interesting or boring?

Just idle curiosity at this point, thanks for any info you can provide. I appreciate it!

Thanks,
Gleevec

 

[SunnyS81]

I'm sure you'll get more responses soon.

Last week a group of peds specialists gave us a talk and there wer a few interesting things:

1) THere is a huge shortage of peds specialists.
2) In many programs they have loan payback programs.
3) I think Cards is the only really hard one. I forget if anything else is.
4) You pretty much need to be at an academic hospital. There aren't that many childrens hospitals in the US, and most are affiliated with universities. WIthout the pull of a childrens hospital, it is unlikely you'll have the patient base neccessary to maintain a practice.

 

[Gleevec]

Originally posted by SunnyS81
I'm sure you'll get more responses soon.

Last week a group of peds specialists gave us a talk and there wer a few interesting things:

1) THere is a huge shortage of peds specialists.
2) In many programs they have loan payback programs.
3) I think Cards is the only really hard one. I forget if anything else is.
4) You pretty much need to be at an academic hospital. There aren't that many childrens hospitals in the US, and most are affiliated with universities. WIthout the pull of a childrens hospital, it is unlikely you'll have the patient base neccessary to maintain a practice.

Hey Sunny,
Thanks for your reply, it was really helpful. I didnt know there was a shortage of peds subspecialists. It seems as if the number of sick babies doesnt change as much (ie.. a much larger baby boom population is about to hit geriatrics, cardiologists, etc) so I was pleasantly surprised to hear about the need for peds subspecialists. Im really looking forward to working in academic hospital as well.

Just another question for everyone, in addition to my curiosity regarding the competitiveness of different subspecialties (as Sunny said, peds cards seems to be quite competitive), is research a requirement as it is in competitive IM or surgery specialties? Im interested in doing research in med school as it is, but if its required, it will just further my desire to stick around med school an extra year (for free) for research.

 

[wub]

Originally posted by Gleevec
Hey Sunny,
Thanks for your reply, it was really helpful. I didnt know there was a shortage of peds subspecialists. It seems as if the number of sick babies doesnt change as much (ie.. a much larger baby boom population is about to hit geriatrics, cardiologists, etc) so I was pleasantly surprised to hear about the need for peds subspecialists. Im really looking forward to working in academic hospital as well.

Just another question for everyone, in addition to my curiosity regarding the competitiveness of different subspecialties (as Sunny said, peds cards seems to be quite competitive), is research a requirement as it is in competitive IM or surgery specialties? Im interested in doing research in med school as it is, but if its required, it will just further my desire to stick around med school an extra year (for free) for research.

There is a shortage in peds subspecialists because no one wants to do it, not because there is an increase in pediatric population. Most people going into peds plan on doing general peds, therefore, programs are having a hard time filling their fellow spots. An attending told me that there are about 80 pediatric nephrologists in the whole COUNTRY. That's how short the supply, thus how high the demand, is right now for peds subspecialists.

As for the competitiveness, it is not competitive at all. Even for the relatively harder ones like cards or heme/onc, it is still much easier when compared to IM fellowhips. At the very least, anyone should be able to stay at his/her own institution for fellowship in any field. "Back-dooring" into fellowship spots at one's own hospital is extremely common and easy to do, even at high-end, presitigious programs. Therefore, doing research for an extra year solely for the purpose of matching into a peds fellowship program is not necessary.

 

[doc05]

peds heme/onc is perhaps the most sickening, depressing specialty. why would anyone ever choose this field?

 

[amdap]

From what I understand (which is not much), the shortage of peds subspecialists is also due to:

Salaries - - - specialists in peds don't make too much more money than regular pediatricians. It is not as lucrative as specializing in adult medicine.

Also, time - - - 3 more years is a long time when you have loans to pay back in a speciality that is the lowest-paid to begin with.

That is just what I heard - anyone in agreement?

 

[rustybruce]

"peds heme/onc is perhaps the most sickening, depressing specialty. why would anyone ever choose this field?"



Doc05

I suspect that some people are dedicated to certain sick patient populations that many others would find dreadful. I know many oncologists who love what they do and would never do EM, Gas, Ortho, IM, etc because those patient populations aren't ideal to them either.

I would not, however, refer to peds heme/onc as "sickening". True it is sad and perhaps depressing, but if a suffering child (in whom many others see life and hope) is sickening, you should stick to Path. Of course, I don't know you so you may be kidding. Maybe you do Peds Heme/Onc

 

[bumd]

throw peds critical care into the mix. the vast majority of the time you'll be working at an academic medical center. you'll get a nice mix of cards, trauma, post-op, and bread-and-butter peds gone bad. i didn't even think about it before 3rd year, now i'm planning on doing it.

 

[kungfufishing]

I have a close friend who is a PICU doc and it was the only specialty I considered other than EM, where Im going to end up. He has a fairly ideal set up, in that he gets to participate in clinical research, adjuncts for a medical school, and still practices in a private setting. Although peds for the most part doesnt pay well, and the money certainly isnt the reason to do it, the guy I know makes well over 300/year (PICU has lots of procedures and technology). Tends to work 72 on/96 off. Of course, there is the whole "dying children" aspect but at the same time they get to go home and have a life when they get better. In the end I just didnt love it, but it is a pretty sweet gig if you set it up right.

 

[Homunculus]

Originally posted by kungfufishing
I have a close friend who is a PICU doc and it was the only specialty I considered other than EM, where Im going to end up. He has a fairly ideal set up, in that he gets to participate in clinical research, adjuncts for a medical school, and still practices in a private setting. Although peds for the most part doesnt pay well, and the money certainly isnt the reason to do it, the guy I know makes well over 300/year (PICU has lots of procedures and technology). Tends to work 72 on/96 off. Of course, there is the whole "dying children" aspect but at the same time they get to go home and have a life when they get better. In the end I just didnt love it, but it is a pretty sweet gig if you set it up right.

i have to agree. the PICU has the same complexity of medical cases as the adult ICU with, IMO, more variety. not to mention the fact that the majority of the kids that end up there aren't there because of their own doing. they aren't overweight uncontrolled diabetic smokers with CHF and COPD.

as for the lack of specialists-- i think that many of the gung-ho "gimme a procedure and someone near death so i can save them" types aren't into peds. these personalities usually go into IM, ER, surgery, etc. peds tends to draw its people from a different crowd. not that it's a bad thing, it's just that most people don't go into pediatrics to get their hard core medicine on. for me, i wanted to do hard-core medicine, but wanted to do it on a patient population i cared for. adults annoy me.

 

[Homunculus]

Originally posted by kungfufishing
I have a close friend who is a PICU doc and it was the only specialty I considered other than EM, where Im going to end up. He has a fairly ideal set up, in that he gets to participate in clinical research, adjuncts for a medical school, and still practices in a private setting. Although peds for the most part doesnt pay well, and the money certainly isnt the reason to do it, the guy I know makes well over 300/year (PICU has lots of procedures and technology). Tends to work 72 on/96 off. Of course, there is the whole "dying children" aspect but at the same time they get to go home and have a life when they get better. In the end I just didnt love it, but it is a pretty sweet gig if you set it up right.

that's weird-- i have a close friend who is a close friend of a PICU doc and he is trying to do ER, too. except this guy is all crazy about camping out in the wilderness wrestling bears and giardia while doing first aid on a stranded hiker that has been bitten by a rabid woodchuck. he's an odd guy to say the least.

 

[frog4brooke]

Don't forget that PEDs ER you can do EM or Peds, then Peds EM fellowship or a combined Peds/EM residency (there are not many of these).

F4B

 

[Kalel]

Peds/ER is competetive because there are only a few programs in the nation that offer this combined program. For the peds fellowships, a pediatrician told me that they are very non-competetive. Most people who go into peds don't go in with the plan of doing a fellowship afterwards. According to him, the criteria that most peds fellowships (including ones like cards or GI) use to evaluate applicants is just a commitment to actually completing the program. Apparently, drop-out rates are fairly high for peds fellowships from people who go into them but then find the workload too difficult for their stage of their life. In general, the peds specialties earn less then the medical subspecialties too. Society has an expectation that all kids should receive medical care, but no one really wants to have to pay for it. It's sad when kids can't afford medical care too, because it'stheir parents fault and not theirs; so I think that there is a lot of uncompensated care going on in pediatrics because no one wants to turn down a sick kid. This is just my theory though, I don't know what the actual numbers are. A lot of states are developing programs that insure all kids, but states have horrible budget keeping skills so these programs inevitably end up being decreased in terms of reimbursing hospitals for procedures to make up for legislators unwillingness to raise taxes or cut services.

 

[Pelivar]

Peds Em is very competitive. Their are only 2 combined peds/EM programs in the country with 2 spots each for a grand total of 4 spots. If you do peds and want to do peds EM it is a 3 year fellowship wich is very hard to get into. I know people who gruaduated from residency and have had to apply for fellowship for a few years before matching. If you do EM and want a peds EM fellowship it is 2-3 years depending on the place.

-P

 

[Robz]

Originally posted by doc05
peds heme/onc is perhaps the most sickening, depressing specialty. why would anyone ever choose this field?

I'm interested in this field.....

 

[Gleevec]

So are there any peds subspecialties that are actually popular?

Thanks for all the responses, they've been very useful.