Avoiding Research in Inpatient Peds

[sunflower18]

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Hello! I know I am only pre-med, but I am a major planner and would like to learn about this sort of thing sooner rather than later.

I have done a lot of shadowing and volunteering in hospitals, and I am fairly certain that I want to be involved with inpatient medicine and that I want to specialize (currently thinking heme/onc or critical care). However, it concerns me that most pediatric specialists spend more of their time researching than practicing clinical medicine. I don't have anything against research, but I want to be strictly clinical when I become an attending.

My question is: how hard will it be to find jobs like that? Is it impossible to find work as a full-time, strictly clinical pediatric intensivist or oncologist? What kind of hospitals will I have to work at? It seems like most children's hospitals are associated with medical schools, and this creates an academic environment with heavy research involvement expected of their clinicians. If I am truly opposed to research, would it be better to go for the adult specialties? I very much want to work with kids, but if it's an either/or (kids or full time clinical responsibilities), it'd be a tough decision.

Any insight would be greatly appreciated! Thanks so much!

 

[McGillGrad]

You can do whatever you like in your career. No one will force you to do research.

 

[sunflower18]

You can do whatever you like in your career. No one will force you to do research.

Really? You're not expected to? That is an exciting prospect..!! Even in academic locations, you can just say that you'd rather work full time and be strictly clinical? (Sorry for the incredulous questions; this is just very promising!)

 

[SurfingDoctor]

It really depends what you are defining as research and in what setting.

In academics (ie a non-profit hospital affiliated with a university or medical school), people are expected to fulfill non-clinical time (ie time not seeing patients) with something productive. Sometimes that involves creating guidelines or looking at patient outcomes or being part of committees involved in hospital policy or creating educational programs. There is a whole host of things that can fill that time. However, in many institutes, that will not be considered research so much as quality improvement or something else. The difference really in quality improvement versus research is whether you have a protocol or a review board approval (like is needed in research) and whether you plan to publish the data you collect in the public domain (like research, though quality improvement can be published, but the lines between research and quality improvement get fuzzy then). In any case, if you stay in academics, about 20 to 40% of your paid time will be seeing patients and the other time is yours to do with as you see fit, but it has be something of value to the institute (otherwise, they shouldn't be paying you for it). Typically full-time in academic centers is consider 50 hours/week.

The other side would be private hospitals (for profit, typically non-university affiliated). Here you work a set schedule (36 hours/week or so on average) with 4 hours administrative. Typically the administrative time can be used for other hospital-based interests, but it can really be whatever you want (ie, you don't have to do anything if you don't want) because the hospital is paying you see patients and really nothing more.

So in academics, yes, you need to do something, whether that's research or quality improvement or whatever. In private practice, no not really (with the caveat that you have to do some quality improvement wherever you are to remain board certified). But I know plenty of people in academic hospitals who don't to formal research, but are involved in projects with teaching or outcomes or guideline development or what have you. Other people can chime in and give examples, but I can't think of a single person that I know who is in an academic setting and works fulltime only seeing patients usually because by working in academics, you are usually expected to perform academics, not just patient care.

 

[SurfingDoctor]

My question is: how hard will it be to find jobs like that? Is it impossible to find work as a full-time, strictly clinical pediatric intensivist or oncologist?

To answer this part specifically, if you want to be at an academic hospital, the answer is yes, it is impossible (as far as I know). You can not work fulltime seeing only patients in an academic hospital.

 

[McGillGrad]

Really? You're not expected to? That is an exciting prospect..!! Even in academic locations, you can just say that you'd rather work full time and be strictly clinical? (Sorry for the incredulous questions; this is just very promising!)

Unfortunately, in order to become a 100% clinical attending, you will need to complete a fellowship and that involves some degree of research (whether it be clinical or bench research).
Once you are an attending, you can easily settle into an university affiliated community hospital and be purely clinical. It won't be at places that require research, but it will be at places where you can opt out of clinical research in lieu of teaching responsibilities.

 

[oldbearprofessor]

However, it concerns me that most pediatric specialists spend more of their time researching than practicing clinical medicine. I don't have anything against research, but I want to be strictly clinical when I become an attending.

You need to get away from Longwood Avenue if you think that most pedi specialists spend more time actually doing research than patient care. This is just not the case at the vast majority of places, both medical school faculty and non-medical school faculty.

As has been implied in the responses, the time of a pediatric specialist is not split between "research" and "clinical". It involves a lot of different things including reviewing the medical literature, teaching med students, residents, fellows, involvement in hospital activities/committees, etc. Actually, all of these are also done by NON-specialist pediatricians too. If I serve on the residency selection committee is that research? No, but it's not clinical either. Yet it is a common task (time sink? ) of academic faculty.

During fellowship, you must complete an academic research project. There are very broad ranges for what this can be. It doesn't have to be bench research. After that, you can do whatever you want with your career, you don't have to do any research at all in any pediatric specialty if you don't want to do research. However, you do have to justify and fill up your time usefully.

 

[sunflower18]

It really depends what you are defining as research and in what setting.

In academics (ie a non-profit hospital affiliated with a university or medical school), people are expected to fulfill non-clinical time (ie time not seeing patients) with something productive. Sometimes that involves creating guidelines or looking at patient outcomes or being part of committees involved in hospital policy or creating educational programs. There is a whole host of things that can fill that time. However, in many institutes, that will not be considered research so much as quality improvement or something else. The difference really in quality improvement versus research is whether you have a protocol or a review board approval (like is needed in research) and whether you plan to publish the data you collect in the public domain (like research, though quality improvement can be published, but the lines between research and quality improvement get fuzzy then). In any case, if you stay in academics, about 20 to 40% of your paid time will be seeing patients and the other time is yours to do with as you see fit, but it has be something of value to the institute (otherwise, they shouldn't be paying you for it). Typically full-time in academic centers is consider 50 hours/week.

The other side would be private hospitals (for profit, typically non-university affiliated). Here you work a set schedule (36 hours/week or so on average) with 4 hours administrative. Typically the administrative time can be used for other hospital-based interests, but it can really be whatever you want (ie, you don't have to do anything if you don't want) because the hospital is paying you see patients and really nothing more.

So in academics, yes, you need to do something, whether that's research or quality improvement or whatever. In private practice, no not really (with the caveat that you have to do some quality improvement wherever you are to remain board certified). But I know plenty of people in academic hospitals who don't to formal research, but are involved in projects with teaching or outcomes or guideline development or what have you. Other people can chime in and give examples, but I can't think of a single person that I know who is in an academic setting and works fulltime only seeing patients usually because by working in academics, you are usually expected to perform academics, not just patient care.

The bolded was my biggest fear.. Argh. But the private hospital option is definitely intriguing! Who knows, maybe teaching and administrative duties will become more appealing later on, but it's nice to know that there is the option of having a job without those features. How common are private hospitals? It seems like most children's hospitals are academic, but maybe that's because the non-academic ones aren't very well known on a national level. There is a children's hospital in my hometown (unattached to a medical school) in which the doctors are 100% clinical, so I guess it's out there!

Thank you! This was very informative. I was ignorant in thinking that research was the biggest other aspect that occupied time, so thanks for clarifying that 🙂

To answer this part specifically, if you want to be at an academic hospital, the answer is yes, it is impossible (as far as I know). You can not work fulltime seeing only patients in an academic hospital.

Gotcha. Thanks for being so clear and to the point! 🙂

Unfortunately, in order to become a 100% clinical attending, you will need to complete a fellowship and that involves some degree of research (whether it be clinical or bench research).
Once you are an attending, you can easily settle into an university affiliated community hospital and be purely clinical. It won't be at places that require research, but it will be at places where you can opt out of clinical research in lieu of teaching responsibilities.

That makes sense. I knew about the research required in fellowship, but I just wasn't sure what it's like as an attending. Teaching responsibilities just means being in charge of residents and fellows, right? Overseeing their treatment, teaching them how to do procedures, etc?

Thank you for your response!! I appreciate it!!

You need to get away from Longwood Avenue if you think that most pedi specialists spend more time actually doing research than patient care. This is just not the case at the vast majority of places, both medical school faculty and non-medical school faculty.

As has been implied in the responses, the time of a pediatric specialist is not split between "research" and "clinical". It involves a lot of different things including reviewing the medical literature, teaching med students, residents, fellows, involvement in hospital activities/committees, etc. Actually, all of these are also done by NON-specialist pediatricians too. If I serve on the residency selection committee is that research? No, but it's not clinical either. Yet it is a common task (time sink? ) of academic faculty.

During fellowship, you must complete an academic research project. There are very broad ranges for what this can be. It doesn't have to be bench research. After that, you can do whatever you want with your career, you don't have to do any research at all in any pediatric specialty if you don't want to do research. However, you do have to justify and fill up your time usefully.

Oh, really? I was basing that vague statistic of most specialists spending less than 50% of their time clinically on things like the bolded part of the first reply (which said at a lot of academic places, physicians spend 20-30% of their time caring for patients). Which places work like that, and which places have a more even or patient-care dominating balance?

That makes sense. Maybe I'll change my mind, but I really forsee wanting to not fill up my time with a lot of things other than taking care of patients. Maybe the non-academic route is the way to go for me then 👍 Thanks OBP! I really appreciate it!!

 

[SurfingDoctor]

The "private hospital" options are actually a dime a dozen. Specifically with regards to inpatient medicine. Neonatalogy, Hospitalist and Critical Care Medicine have a lot of opportunities to practice inpatient, clinical-only medicine and can geographically be found anywhere. The further upside is that typically private practitioners are given higher pay per year. This is offset by typically a lower number of practitioners in a given speciality per hospital or group and with it, more clinical work hours. I can't speak really more into that model because I've never been at a place like that. With regards to Hem/Onc, I don't know of a pediatric Hem/Onc practioner that is strictly private and non-academics based. Maybe it exists, but I have no idea.

Also the 20 to 40% clinical time (20% is actually too low) can vary greatly depending again on the number of practitioners in that speciality at a given hospital and the type of speciality. It typically holds true for large academic hospitals for inpatient only specialities. Once you go into a speciality that sees clinic patients, the amount of time devoted to clinical responsibilites usually increases.

(Hmm, I don't typically write the word "typically" so much...sorry)

 

[SurfingDoctor]

Also teaching responsibilities go beyond supervision of residents and students. That part is required and not considered non-clinical time teaching. Non-clinical time teaching involves giving presentations or lectures to students, residents or even faculty about a specific topic. This can be done formally with didactitics (as practitioners at university-based hospital have faculty appointments at the university), bedside teaching to students or residents outside of your clinical time, stimulation training, development of education programs (in service training to nurses or doctors) and anything else you can think of that involves you teaching something to someone else. However, like I mentioned, it needs to be during non-clinical time and you need to show a record of you performing the education you provided and that it was peer reviewed (usually through feedback). Again, I'm not on a education track so someone can probably provide more insight, but it is what you make of it.

 

[sunflower18]

The "private hospital" options are actually a dime a dozen. Specifically with regards to inpatient medicine. Neonatalogy, Hospitalist and Critical Care Medicine have a lot of opportunities to practice inpatient, clinical-only medicine and can geographically be found anywhere. The further upside is that typically private practitioners are given higher pay per year. This is offset by typically a lower number of practitioners in a given speciality per hospital or group and with it, more clinical work hours. I can't speak really more into that model because I've never been at a place like that. With regards to Hem/Onc, I don't know of a pediatric Hem/Onc practioner that is strictly private and non-academics based. Maybe it exists, but I have no idea.

Also the 20 to 40% clinical time (20% is actually too low) can vary greatly depending again on the number of practitioners in that speciality at a given hospital and the type of speciality. It typically holds true for large academic hospitals for inpatient only specialities. Once you go into a speciality that sees clinic patients, the amount of time devoted to clinical responsibilites usually increases.

(Hmm, I don't typically write the word "typically" so much...sorry)

Also teaching responsibilities go beyond supervision of residents and students. That part is required and not considered non-clinical time teaching. Non-clinical time teaching involves giving presentations or lectures to students, residents or even faculty about a specific topic. This can be done formally with didactitics (as practitioners at university-based hospital have faculty appointments at the university), bedside teaching to students or residents outside of your clinical time, stimulation training, development of education programs (in service training to nurses or doctors) and anything else you can think of that involves you teaching something to someone else. However, like I mentioned, it needs to be during non-clinical time and you need to show a record of you performing the education you provided and that it was peer reviewed (usually through feedback). Again, I'm not on a education track so someone can probably provide more insight, but it is what you make of it.

Okay, that makes sense!! The hospital near me does have peds heme/onc physicians who are strictly clinical, but I am starting to understand how rare of a case that is. I appreciate your insight into the private hospital route! That definitely makes sense. Private hospitals would not have residents then, correct? Or if they did, they'd be few and far between?

I didn't realize that physicians who see patients in outpatient clinic had more clinical responsibilities, but I suppose that makes sense! Continuity of care and appointment times and all that.

I just don't understand how a physician could work less than half of the time on clinical duties. It seems like they'd get rusty and lose exposure and sacrifice their skills as clinicians. I'm sure that's not the case for everybody, of course, but it seems like some people would lose their abilities pretty quickly if they only worked clinically 20 weeks a year.

 

[oldbearprofessor]

I just don't understand how a physician could work less than half of the time on clinical duties. It seems like they'd get rusty and lose exposure and sacrifice their skills as clinicians. I'm sure that's not the case for everybody, of course, but it seems like some people would lose their abilities pretty quickly if they only worked clinically 20 weeks a year.

Intubation is like riding a bicycle....

What you're not quite getting is that many academic docs only work full-time doing rounds 20-30% of the time (e.g. 2-4 months/year), but they are taking night and weekend call throughout the year and if they are in a specialty with clinics, seeing patients in clinic one or two half-days/week throughout the year. They are going to clinical conferences weekly, etc.

 

[michigangirl]

Intubation is like riding a bicycle....

What you're not quite getting is that many academic docs only work full-time doing rounds 20-30% of the time (e.g. 2-4 months/year), but they are taking night and weekend call throughout the year and if they are in a specialty with clinics, seeing patients in clinic one or two half-days/week throughout the year. They are going to clinical conferences weekly, etc.

This is exactly the take home message.

 

[oldbearprofessor]

Okay, that makes sense!! The hospital near me does have peds heme/onc physicians who are strictly clinical, but I am starting to understand how rare of a case that is. I appreciate your insight into the private hospital route! That definitely makes sense. Private hospitals would not have residents then, correct? Or if they did, they'd be few and far between?

You are confusing the concepts of "private", meaning "non-public" funded hospital and "non-academic" meaning not having a primary med school affiliation. Even then, many hospitals with strong academic affiliations have many specialists who work there without being on the med school faculty. Pediatric and other residents exist at all types of hospitals, although there are a few non-academic children's hospitals that do not have pediatric residents.

There are more than a few non medical school faculty pedi heme/onc docs. It is true that generally, heme/onc, endo, ID and a few others trend towards academic faculty compared to neonatology and a few other pedi specialties.

 

[michigangirl]

Hello! I know I am only pre-med, but I am a major planner and would like to learn about this sort of thing sooner rather than later.

I have done a lot of shadowing and volunteering in hospitals, and I am fairly certain that I want to be involved with inpatient medicine and that I want to specialize (currently thinking heme/onc or critical care). However, it concerns me that most pediatric specialists spend more of their time researching than practicing clinical medicine. I don't have anything against research, but I want to be strictly clinical when I become an attending.

My question is: how hard will it be to find jobs like that? Is it impossible to find work as a full-time, strictly clinical pediatric intensivist or oncologist? What kind of hospitals will I have to work at? It seems like most children's hospitals are associated with medical schools, and this creates an academic environment with heavy research involvement expected of their clinicians. If I am truly opposed to research, would it be better to go for the adult specialties? I very much want to work with kids, but if it's an either/or (kids or full time clinical responsibilities), it'd be a tough decision.

Any insight would be greatly appreciated! Thanks so much!

Also, it is likely that you have not seen the full gamut of research opportunities available to pediatricians and pediatric subspecialists. I felt the same way when I was a pre-med. Even when I was a resident and most of fellowship. But in PICU fellowship I came upon a burning clinical question that I wanted to get answered-- and now I am one of those research focused clinicians. I don't enjoy lab work, so I only work with patients, doing human subjects (clinical) research. I formulated enough of a knowledge base to actually create a hypothesis driven question that had not been answered, and needs to be. So hence everything changed.

 

[pinarello]

Also, it is likely that you have not seen the full gamut of research opportunities available to pediatricians and pediatric subspecialists. I felt the same way when I was a pre-med. Even when I was a resident and most of fellowship. But in PICU fellowship I came upon a burning clinical question that I wanted to get answered-- and now I am one of those research focused clinicians. I don't enjoy lab work, so I only work with patients, doing human subjects (clinical) research. I formulated enough of a knowledge base to actually create a hypothesis driven question that had not been answered, and needs to be. So hence everything changed.

Just to echo what Michigangirl eluded to in her post, don't knock research until you've tried it. I used to HATE the idea of research because I just didn't find it interesting. Part of the lack of interest was more a sense of fear because I didn't know what I was doing. I didn't have the "tools" (whatever that may entail) to approach a research question and attempt to answer it.

Research isn't glamorous nor do you get any sort of instant gratification. In fact, it's quite an arduous and tedious at times. However, it is quite satisfying when you are able to come to a conclusion and potentially contribute to the well-being of others. Medicine (and science in general) wouldn't be where it is today if it wasn't for researchers.

With all that said, if you simply do not like research, don't do it. Life's too short to be doing something you're not interested in.