Besides anti-vaxxers/parents, what are cons to primary care peds?

[Dr. Brightside]

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[libertyyne]

Some of the things you have listed are cons for me:

dealing with parents
wellness checks
Jack of all trades master of none
outpatient medicine , mostly seeing worried well.
patients cant tell you whats wrong
churning through many patients a day
low pay comparatively
no /little procedures
long tail liability if you miss something

 

[DrSnips]

I asked many pediatricians I know but they are all happy people with no complaints compared to other physicians I know who often have long lists of cons for their field.

Selection bias. They're happy because they are the sort of people who belong in peds. Take someone who belongs in surgery, put them in peds, and you will have yourself an unhappy pediatrician. Your exposure to various specialties in med school isn't just so you'll learn some medicine; it's also to find out what specialty speaks to your interests and needs. Wait until clerkships to see what you think.

By the way, you won't entirely get away from dealing with parents in adult specialties. Extended adolescence has me dealing with the 50 year-old parents of 30 year-old patients. One of them once chided me for leaving him unattended near a vial of lidocaine, claiming he "was just a baby" and "could have killed himself". Never mind that he is already a father.

 

[themoonman2]

To like primary care peds, you must enjoy well-child visits and talking about developmental milestones with parents. This is not what makes most medical students excited

 

[doc05]

The pay is very poor.

 

[Oso]

Here are things that some people really enjoy: outpatient setting, normal work hours (minimal weekend coverage, if any), majority well visits, longitudinal care, managing some chronic things (ex. asthma, eczema), you can manage some acute things in the office as well (mild asthma exacerbation, croup, bronchiolitis), often being the first person to pick up on stuff (I've seen PCP's catch cancer and all kinds of things, even if they didn't know exactly what was going on they were worried enough to send them to the ED). Some primary pediatricians also spend a bit of their time in a newborn nursery.

The pay is actually pretty good, especially if you're looking at places that need more pediatricians. They also make more than a lot of peds subspecialties (ex. ID, endo, renal, etc.). There's a lot of flexibility as well. I know lot's of people working 50 or 75% full time. Overall I'd say most outpatient pediatricians feel well compensated and satisfied.

I think if you enjoy it then it can be a great career with overall good compensation, minimal training time (3 years), and lots of job opportunities and flexibility.

I wish I was more into it, but alas, it's just not for me. The cons for me are that I do not enjoy outpatient medicine and especially do not enjoy well visits or viral URI/gastro/OM/step pharyngitis visits. I also do not particularly value continuity of care.

 

[mvenus929]

Having to cram a bunch of anticipatory guidance in a 15 minute visit while discussing all the parent’s concerns. The pressure to see 20-30 kids in a day.

It’s hardest just out of residency when you’re still learning and getting to know your patients.

 

[Tenk]

You have to watch kids die. During residency you will watch kids die. In your practice, some of your patients will die.

It ****ing sucks. I’d rather code a thousand 80 year olds than one 8 year old.

 

[mrbreakfast]

All the pediatricians I worked with - outpatient and hospitalists - universally complained about low pay. They didn't think it was fair how much less they were paid than their adult colleagues. All also complained about "bad" parents who don't take good care of their kids.

Outpatient pediatrician wished the work was more intellectually stimulating. Inpatient pediatricians noted watching kids die was awful.

 

[Perrotfish]

All the pediatricians I worked with - outpatient and hospitalists - universally complained about low pay.

Outpatient Peds doesn't actually make much less than FM. Hospitalist Peds makes less than IM hospitalist, and Peds subspecialties make WAY less than IM subspecialties, but most of the outpatient pediatricians I know are doing pretty well considering the length of training and hours worked.
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Sometimes I think pediatricians have internalized the narrative that pediatrics pays poorly rather than actually looking at their take home pay.

 

[Perrotfish]

I'm just an M1 but based on my time scribing, shadowing, research, etc I'm super interested in primary care pediatrics. Besides dealing with anti-vaxxers, what are some significant negatives to this field (besides personal preferences)? I asked many pediatricians I know but they are all happy people with no complaints compared to other physicians I know who often have long lists of cons for their field. You've got a non-competitive, happy environment, working with families, following milestones, broad and sometimes unusual/interesting pathology while primarily being low-stress cases, decent hours, enough money to live comfortably. I'm just wondering if I'm missing anything.

Thanks!

I don't think you are missing anything, but then again I went into Peds. I think the key positives and negatives about the field both stem from a lack of cynicism. You are dealing with a patient population you 100% believe in and want to do your best for. On the one hand that is very motiving, and you will see almost none of the eye rolling and deep sighs so common in the world of adult medicine. On the other hand that means that you can end up getting much more worked up about non-compliance than you would for an adult, and of course when you can't actually fix the problem you're dealing with its nightmarish.

 

[VA Hopeful Dr]

Outpatient Peds doesn't actually make much less than FM. Hospitalist Peds makes less than IM hospitalist, and Peds subspecialties make WAY less than IM subspecialties, but most of the outpatient pediatricians I know are doing pretty well considering the length of training and hours worked.
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Sometimes I think pediatricians have internalized the narrative that pediatrics pays poorly rather than actually looking at their take home pay.

This.

If we look at the 2018 Medscape report (since I am not going to pay for the MGMA).

IM is 231
FM is 219
Peds is 212

So 7k/year less than FM. That's damned near a rounding error.

The basically 20k less than IM isn't great, but if you're choosing a field based on 20k/year in medicine you're doing it wrong.

 

[Perrotfish]

This.

If we look at the 2018 Medscape report (since I am not going to pay for the MGMA).

IM is 231
FM is 219
Peds is 212

So 7k/year less than FM. That's damned near a rounding error.

The basically 20k less than IM isn't great, but if you're choosing a field based on 20k/year in medicine you're doing it wrong.

And I wonder how much of even that difference is inpatient Peds dragging the average down.

 

[VA Hopeful Dr]

And I wonder how much of even that difference is inpatient Peds dragging the average down.

That and maybe more pediatricians work part time?

 

[AsianPersuasion]

I think in another life if I were to choose outpatients, it would be peds. Kids are cute and I don't get tired of taking care of them like I do with adults sometimes.

 

[SurfingDoctor]

You practice based on other people’s schedule, not your own. That was the only thing I disliked about outpatient medicine.

 

[VA Hopeful Dr]

You practice based on other people’s schedule, not your own. That was the only thing I disliked about outpatient medicine.

Huh?

 

[SurfingDoctor]

Huh?

Just my experience as a resident. Patients show up 2 hours late, you still see them. Obviously solo practice is likely different, but it left a bad taste in my mouth.

 

[VA Hopeful Dr]

Just my experience as a resident. Patients show up 2 hours late, you still see them. Obviously solo practice is likely different, but it left a bad taste in my mouth.

Ah, yeah that's totally a resident clinic thing. Once in the real world 99% of us have full control over our schedules. My late policy is if you're 15 minutes late that's a no show. If I have any openings, they can still be seen that day during that time.

 

[SurfingDoctor]

Ah, yeah that's totally a resident clinic thing. Once in the real world 99% of us have full control over our schedules. My late policy is if you're 15 minutes late that's a no show. If I have any openings, they can still be seen that day during that time.

I still prefer shift work and rounding on my own time. But if I ever get tired of critical care, I’d probably go back to primary pediatrics. I never gave up my general pediatrics board for that reason.

 

[GuzzyRon]

By the way, you won't entirely get away from dealing with parents in adult specialties. Extended adolescence has me dealing with the 50 year-old parents of 30 year-old patients. One of them once chided me for leaving him unattended near a vial of lidocaine, claiming he "was just a baby" and "could have killed himself". Never mind that he is already a father.

 

[deleted645092]

The major cons from my peds rotation is that it is just B.O.R.I.N.G.

Tons of viral URIs that end up getting antibiotics no matter what cause the parents bring them back 1-2 days later because they “just aren’t getting better”.

Tons of diarrhea.

Tons of bellyaches.

Tons of kids faking sick to get out of school.

Plus have you ever tried to get a good look in a kid’s ear, sick or not? It’s the hardest thing I’ve had to do on rotations.

Pediatricians love their jobs though and they’re the most pleasant docs to work with. I don’t think I’ve ever seen on in a hurry or stressed out, except once when a snowstorm was going to make my preceptor late to a concert because she couldn’t cut her clinic time short to make up for the extra travel time.

 

[raiderette]

I had 4 sexual abuse cases on my rotation. I spent 7 years working with teenage and adult victims at PP and with a rape counseling volunteer, but this broke me a bit.