Best fellowship option after peds residency?

[zeppelinpage4]

PGY-3 pediatric resident. Sorry it’s a long post. TLDR at the end. I had set up electives in these fields but all our electives and activities have been cancelled due to COVID-19. So I’m trying to ask online and get at least some guidance/thoughts on what I could be pursuing after graduation in the fall (I finish late).

Background:

1) I chose pediatrics in med school because I admired my own pediatrician, had great mentors in peds, wanted to do primary care and get to know kids/families over years, valued work/life balance and having a family which many peds folks had, liked toddlers and teens (simple problem list, most kids fully recover and get better, possibility to instill lifestyle changes early when it counts most). I like adult patients too and wanted to see both adults and kids, but didn’t like FM and med-peds was too competitive, so I opted for peds.

2) Fast forward to residency. Although I enjoyed the day to day patient care. I hit many setbacks, couldn’t adjust to residency well and needed to remediate rotations as well as retake step 3, diagnosed with depression and burnout, lost a lot of my passion for peds and medicine in general. My biggest issue was handling high patient volumes and multi-tasking. I do really well with repetition and getting really good or focusing on a few things in detail rather than knowing a little about a lot. I’m also not good at constantly adapting to new situations or having multiple things happening at once. I’m much better now from repetition and practice but I know I need more time to adjust to things.

3) I got a lot of crap from family for picking a specialty that I ended up not liking and not researching things enough to make the right decision. Without my passion for pediatrics, I should have picked something with better pay and hours like an IM or IM subspecialty, psych, PM&R etc. Somewhat regret picking peds now.
They just want to see me either find my passion again in peds or if I can’t do that, then find something I’m not passionate about but at least has better pay/hours than gen peds does. But there’s very few peds fellowships options that result in better pay/hours. Seems IM specialties and even general IM pays much better

Current situation:

I’m still not the strongest resident but have managed to get to the end of my third year now and feel more confident in my knowledge and learned a lot from my mistakes.

What I’m looking for now. As mentioned above 1) Either something I would love doing and have passion for, or 2) something that I can tolerate but with good hours/pay.
Right now gen peds has neither passion, nor good pay/hours. I don’t mind it, but don’t feel excited by clinic, doing well checks or seeing babies. The high volumes due to low reimbursement, conveyer belt appointments, and having to know a wide range of info and possibly missing something in the fast appointments makes it really unappealing for me.

I wanted to do primary care at first but, I just didn’t find it as rewarding as getting to fix a kids asthma or dehydration in the hospital over several days and see patients recover and walk out the door. Between that and the fact that I tend to hyper focus and do better with knowing a lot about a little, I think specializing might be a better option over gen peds. And in terms of specialties, I'm debating between clinical or non-clinical as well. As for my options.

Possible options:

1) Since I struggled with residency. I can get away from clinical medicine and pursue clinical informatics which is an area I found interesting and been told it might be a good fit for me. I can also pair it with any specialty and do a mix of clinical and non-clinical. Better hours and better pay than gen peds and only 2 years training. Chance to be creative and improve the system. I had an elective set up but it is cancelled for now as is the research project I was going to be involved with, so I have little hands on experience as of now. But I would likely do this with gen peds.

2) Pediatric pulmonology. I hadn’t thought about this until recently but I’m finding managing vents, ARDS, and inpatient lung issues pretty rewarding. I actually feel like I can save a life or see the benefit of my effort fast (e.g giving albuterol treatments). Nice mix of procedures like bronchoscopy, outpatient clinic, and inpatient, getting longer appointment times. There’s also some unfilled positions left so I may be able to start right after I finish in the Fall and not need a gap year if accepted. My only issues is that salary may not be much higher than gen peds after 3 extra years of training, higher stress/more call, and I don’t know if I’ll like outpatient Pulm clinic yet due to my elective being cancelled.

3) Allergy/Immunology. Loved this initially and enjoyed my elective. Just 2 years of training, huge salary boost/good compensation, good hours, would allow me to see kids and adults which I missed. Only issues is that I don’t think I really loved it, but I liked it enough and the other aspects of the field make it very appealing. The second issue is that due to my poor residency record, matching into this field would be very tough or almost impossible.

4) Sports medicine. Similar to allergy, it would also allow me to see both adults and kids. And I always wanted to see the full spectrum of ages. Pay is either similar or better than gen peds but I get mixed data online. Only a 1 year fellowship. Seems like better lifestyle/pay than gen peds. Like allergy, I like the topic but I don’t love it. More doing for better hours/pay if possible.

5) Suck it up and do gen peds, maybe it’s better as an attending? But salary will always be limited and learning to be an attending will be its own big adjustment.

I’ve ruled out PICU, NICU, cardio, GI just based on competitiveness even though I know those pay well. I’m open to other ideas if there’s a better option than the above.

TLDR: Burned out and lost interest in gen peds/primary care. Want to switch to a specialty with either better hours/pay that I may not love but like enough (allergy/immunology, sports med or any other specialty I might be missing), or something I might love and would suit my professional goals well in which case pay/hours matter less (peds Pulm) and considering non-clinical fields and moving away from medicine all together (clinical informatics). Or just sticking to gen peds and hoping I’ll like it more as an attending. I’m not a competitive applicant but would like to know which option might be best.

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[Oso]

I think a mostly outpatient field would suit you - allergy/immunology or sports medicine, which you mentioned, but also perhaps endocrinology or rheumatology. Pulm is good too, though you will see sicker patients and will have to consult in the hospital (better hours than being the primary team, though).

If you DO want to make seeing adults part of your practice, then I would say go with allergy/immuno or sports med. Yes, some people love everything about their fields and have a "passion" for it and live and breathe for it....... but for a lot of people, a job is a job. If you think you could have a mostly enjoyable career with one of these fields where you feel you're making some kind of impact and don't hate the bread and butter, all while making decent pay and having relatively good hours/lifestyle, then I say go with that.

You could always do gen peds for a year or two and see if you like it as an attending and then decide to apply to fellowship after if it's truly what you want to do. This would also give you some time to try to get involved in some research.

Good luck!

 

[90sportsfan]

I'm only a medical student, but it has been my impression reading these boards and talking to others, that allergy/immunology is very competitive (research needed, strong residency evals). I believe you have to also compete with IM residents since I believe it's a shared fellowship. Not that, that should dissuade you, but it may be worth researching if you are a good candidate.

I never knew that Pediatrics had a sports medicine fellowship option (always thought this was only an option through Family Medicine, in addition to obviously a PM&R residency). On paper, that seems like it would be the least stressful, although given that PM&R would seem to cover a lot of that domain; I wonder if there are many job opportunities post-fellowship really out there or if most do general peds and then just add sports medicine as niche/interest to their practice? It may be worth understanding the post-fellowship landscape if it's something you're interested in full-time.

 

[mvenus929]

If your focus is on pay, you're very much gonna be SOL compared to gen peds. The only specialties that consistently pay better are ones that are competitive and have you work harder (PICU, NICU, Cards, ED). AI is also very competitive because you're also competing against IM residents, so if you don't think you're competitive for the peds competition, you're not for AI either.

If your focus is on passion, then you're gonna need to research the other specialties some. I love endocrine, but it pays less than gen peds because it's a cerebral specialty and we do a lot of work that is unreimbursed (and we tend to be focused in academics, which pays less overall).

 

[mossleaves]

i read somewhere that NICU programs had like a 25% unmatchd rate

if you want to know a lot about a little (im the same way) then youve gotta do fellowship

 

[DarkHorizon]

PGY-3 pediatric resident. Sorry it’s a long post. TLDR at the end. I had set up electives in these fields but all our electives and activities have been cancelled due to COVID-19. So I’m trying to ask online and get at least some guidance/thoughts on what I could be pursuing after graduation in the fall (I finish late).

Background:

1) I chose pediatrics in med school because I admired my own pediatrician, had great mentors in peds, wanted to do primary care and get to know kids/families over years, valued work/life balance and having a family which many peds folks had, liked toddlers and teens (simple problem list, most kids fully recover and get better, possibility to instill lifestyle changes early when it counts most). I like adult patients too and wanted to see both adults and kids, but didn’t like FM and med-peds was too competitive, so I opted for peds.

2) Fast forward to residency. Although I enjoyed the day to day patient care. I hit many setbacks, couldn’t adjust to residency well and needed to remediate rotations as well as retake step 3, diagnosed with depression and burnout, lost a lot of my passion for peds and medicine in general. My biggest issue was handling high patient volumes and multi-tasking. I do really well with repetition and getting really good or focusing on a few things in detail rather than knowing a little about a lot. I’m also not good at constantly adapting to new situations or having multiple things happening at once. I’m much better now from repetition and practice but I know I need more time to adjust to things.

3) I got a lot of crap from family for picking a specialty that I ended up not liking and not researching things enough to make the right decision. Without my passion for pediatrics, I should have picked something with better pay and hours like an IM or IM subspecialty, psych, PM&R etc. Somewhat regret picking peds now.
They just want to see me either find my passion again in peds or if I can’t do that, then find something I’m not passionate about but at least has better pay/hours than gen peds does. But there’s very few peds fellowships options that result in better pay/hours. Seems IM specialties and even general IM pays much better

Current situation:

I’m still not the strongest resident but have managed to get to the end of my third year now and feel more confident in my knowledge and learned a lot from my mistakes.

What I’m looking for now. As mentioned above 1) Either something I would love doing and have passion for, or 2) something that I can tolerate but with good hours/pay.
Right now gen peds has neither passion, nor good pay/hours. I don’t mind it, but don’t feel excited by clinic, doing well checks or seeing babies. The high volumes due to low reimbursement, conveyer belt appointments, and having to know a wide range of info and possibly missing something in the fast appointments makes it really unappealing for me.

I wanted to do primary care at first but, I just didn’t find it as rewarding as getting to fix a kids asthma or dehydration in the hospital over several days and see patients recover and walk out the door. Between that and the fact that I tend to hyper focus and do better with knowing a lot about a little, I think specializing might be a better option over gen peds. And in terms of specialties, I'm debating between clinical or non-clinical as well. As for my options.

Possible options:

1) Since I struggled with residency. I can get away from clinical medicine and pursue clinical informatics which is an area I found interesting and been told it might be a good fit for me. I can also pair it with any specialty and do a mix of clinical and non-clinical. Better hours and better pay than gen peds and only 2 years training. Chance to be creative and improve the system. I had an elective set up but it is cancelled for now as is the research project I was going to be involved with, so I have little hands on experience as of now. But I would likely do this with gen peds.

2) Pediatric pulmonology. I hadn’t thought about this until recently but I’m finding managing vents, ARDS, and inpatient lung issues pretty rewarding. I actually feel like I can save a life or see the benefit of my effort fast (e.g giving albuterol treatments). Nice mix of procedures like bronchoscopy, outpatient clinic, and inpatient, getting longer appointment times. There’s also some unfilled positions left so I may be able to start right after I finish in the Fall and not need a gap year if accepted. My only issues is that salary may not be much higher than gen peds after 3 extra years of training, higher stress/more call, and I don’t know if I’ll like outpatient Pulm clinic yet due to my elective being cancelled.

3) Allergy/Immunology. Loved this initially and enjoyed my elective. Just 2 years of training, huge salary boost/good compensation, good hours, would allow me to see kids and adults which I missed. Only issues is that I don’t think I really loved it, but I liked it enough and the other aspects of the field make it very appealing. The second issue is that due to my poor residency record, matching into this field would be very tough or almost impossible.

4) Sports medicine. Similar to allergy, it would also allow me to see both adults and kids. And I always wanted to see the full spectrum of ages. Pay is either similar or better than gen peds but I get mixed data online. Only a 1 year fellowship. Seems like better lifestyle/pay than gen peds. Like allergy, I like the topic but I don’t love it. More doing for better hours/pay if possible.

5) Suck it up and do gen peds, maybe it’s better as an attending? But salary will always be limited and learning to be an attending will be its own big adjustment.

I’ve ruled out PICU, NICU, cardio, GI just based on competitiveness even though I know those pay well. I’m open to other ideas if there’s a better option than the above.

TLDR: Burned out and lost interest in gen peds/primary care. Want to switch to a specialty with either better hours/pay that I may not love but like enough (allergy/immunology, sports med or any other specialty I might be missing), or something I might love and would suit my professional goals well in which case pay/hours matter less (peds Pulm) and considering non-clinical fields and moving away from medicine all together (clinical informatics). Or just sticking to gen peds and hoping I’ll like it more as an attending. I’m not a competitive applicant but would like to know which option might be best.

I’m an orthopod, so I’m a little biased, but I think you should do sports medicine. It’s by far the least stressful option with great lifestyle. The challenge will be to find a job with pure sports medicine, but you can be the niche guy since you are peds trained (very few primary care sports med are peds trained). We have a peds trained sports med guy in our practice, he sees a lot of peds non op fractures, scoliosis that he braces, a lot of peds growing pains. He also sees adults, any thing remotely challenging where a surgical decision has to be made, he just refers it to one of the surgeons. Works 7-3, 4.5 days a week. It’s really low stress, any stressful case or decision can be turfed to the surgeon, pay is a little higher than pure FM and pure peds, but I know some guys doing as high as $350k. You should seriously consider it.

Also, you mentioned you like repetition, it’s a lot of knee/shoulder/hip pain, other than your usual non op peds frsctures.

 

[zeppelinpage4]

I think a mostly outpatient field would suit you - allergy/immunology or sports medicine, which you mentioned, but also perhaps endocrinology or rheumatology. Pulm is good too, though you will see sicker patients and will have to consult in the hospital (better hours than being the primary team, though).

If you DO want to make seeing adults part of your practice, then I would say go with allergy/immuno or sports med. Yes, some people love everything about their fields and have a "passion" for it and live and breathe for it....... but for a lot of people, a job is a job. If you think you could have a mostly enjoyable career with one of these fields where you feel you're making some kind of impact and don't hate the bread and butter, all while making decent pay and having relatively good hours/lifestyle, then I say go with that.

You could always do gen peds for a year or two and see if you like it as an attending and then decide to apply to fellowship after if it's truly what you want to do. This would also give you some time to try to get involved in some research.

Good luck!

Thank you, that's actually very reassuring the hear. I've felt a lot of pressure, especially from others to find a "passion" and if I can't find that, then I made a mistake in my career decisions. However, what you said makes sense to me. As long as the job is enjoyable and I am doing something positive and feel I've done some good with good compensation for that, I'm content.

I will look into rheumatology as I have not seen much of it in pediatrics. I've done elective in endocrinology, and it seemed to have more difficult schedule due to hospital consults and sicker patients like pulm, but they seemed fairly happy.

And I definitely want to include adults, so I'm going to give sports medicine the most serious look right now. I've spoken to people and accepted that I likely will not match allergy but I may re-consider that as well. But I will definitely look at sports medicine the most seriously right now. Seems it fits much of what I am looking for and I could see myself being very happy with it. The patient population and age ranges of sports medicine seems to fit very close to the patients I find most rewarding to treat, e.g. kids, teenagers, and active older adults whom I can talk to, communicate with, and relate to. It was only the very old geriatric patients with dementia and babies that I did not enjoy working with so much, as I can't speak or interact with them but sports med would minimize my interaction with both populations.

I'm only a medical student, but it has been my impression reading these boards and talking to others, that allergy/immunology is very competitive (research needed, strong residency evals). I believe you have to also compete with IM residents since I believe it's a shared fellowship. Not that, that should dissuade you, but it may be worth researching if you are a good candidate.

I never knew that Pediatrics had a sports medicine fellowship option (always thought this was only an option through Family Medicine, in addition to obviously a PM&R residency). On paper, that seems like it would be the least stressful, although given that PM&R would seem to cover a lot of that domain; I wonder if there are many job opportunities post-fellowship really out there or if most do general peds and then just add sports medicine as niche/interest to their practice? It may be worth understanding the post-fellowship landscape if it's something you're interested in full-time.

Yes, I have researched. Hence in my OP I wrote that it is highly unlikely I would be successful if I tried to match as I currently am but it is an option I can pursue if really worth it. There's usually some unfilled spots, so with good amount of research, networking, and applying all over the country I might be able to get a spot somewhere in the country but I've mostly let go of the idea for now unless it turns out to be worth the extra effort and chances of not matching.

Yup, I initially thought I could only do peds sports medicine but was excited to hear I could see adults and kids. I'll need to speak to more sports med doctors about job landscape but what I've found online seems to indicate you can do a sports medicine clinic with kids and/or adults. Not sure if I'd still do gen peds with it, but I'm sure some doctors do both. Again, if I could do electives now or meet with some it would help a lot but I'm stuck to researching online for now. My program doesn't have a sports medicine department.

If your focus is on pay, you're very much gonna be SOL compared to gen peds. The only specialties that consistently pay better are ones that are competitive and have you work harder (PICU, NICU, Cards, ED). AI is also very competitive because you're also competing against IM residents, so if you don't think you're competitive for the peds competition, you're not for AI either.

If your focus is on passion, then you're gonna need to research the other specialties some. I love endocrine, but it pays less than gen peds because it's a cerebral specialty and we do a lot of work that is unreimbursed (and we tend to be focused in academics, which pays less overall).

Yes, I think you've hit the nail on the head for AI and the other competitive ones. I seriously thought about endocrine, the fellows I know seem very happy. They get more time with each patient, have a mix of inpatient and outpatient, and seem to have good work life balance. I did not love my elective in it, but this was a long time ago and I am thinking of looking at it again more seriously. The only thing I was uncertain about was the pay. I heard it was less than gen peds, but then some website list higher salaries than gen peds and I know a fellow who got some job offers offering >200,000K in a seemingly populated desirable area. Is endo generally always lower than gen peds, or does it vary a lot by location? Does it pay about the same as pulmonology?

i read somewhere that NICU programs had like a 25% unmatchd rate

if you want to know a lot about a little (im the same way) then youve gotta do fellowship

Thanks for the insight, I absolutely am of that mind set. Seems like fellowship is the right choice for me if I can find one that is a good fit.

I’m an orthopod, so I’m a little biased, but I think you should do sports medicine. It’s by far the least stressful option with great lifestyle. The challenge will be to find a job with pure sports medicine, but you can be the niche guy since you are peds trained (very few primary care sports med are peds trained). We have a peds trained sports med guy in our practice, he sees a lot of peds non op fractures, scoliosis that he braces, a lot of peds growing pains. He also sees adults, any thing remotely challenging where a surgical decision has to be made, he just refers it to one of the surgeons. Works 7-3, 4.5 days a week. It’s really low stress, any stressful case or decision can be turfed to the surgeon, pay is a little higher than pure FM and pure peds, but I know some guys doing as high as $350k. You should seriously consider it.

Also, you mentioned you like repetition, it’s a lot of knee/shoulder/hip pain, other than your usual non op peds frsctures.

Wow, thank you for that post! We don't have a sport medicine department at my residency and I have heard so little about it until recently when I began researching, that it helps getting info. from someone in the field.
What you described sounds perfect, like almost exactly what I am looking for in terms of hours, pay, workflow and repetition with low stress and ability to refer if needed. I'd be very happy in the type of job you described. Are most sports med jobs like the above? How's the job market in general (e.g. in demand vs. saturated market)

And is sports medicine very competitive? With electives, and research cancelled until COVID-19 passes. Would it be worth it for me to put in a fellowship application this summer without any prior experience and then getting the elective and research time in afterwards in the late summer or Fall during interview time?

 

[GoSpursGo]

So I have a little trouble figuring out exactly what you're looking for, as the specialties that you selected seem like an odd grab bag that have little to do with each other. You identify peds pulm because you like managing vents/ARDS which obviously deals with very sick kids, but then you're also looking at AI and sports med because they have a better work/life balance. And obviously clinical informatics is its own thing entirely. Clearly, having those electives would have been helpful to narrow the field, but it's a little hard to advise you when I'm not really sure what you're looking for.

I'm kind of offended that the whole pediatric hospitalist medicine fellowship is even a thing, but that might not be a terrible option for you. Whether you like the hours all depends on your perspective--some people like being on for a week then off for a week to have big blocks of time off, others would hate being constantly on for a week or two in a row when you're on service. But if you really think you're interested in clinical informatics, that actually is the setting where I can most easily see you creating an academic niche for yourself in that realm. And worst case scenario, that keeps you connected in academics, continues giving you broad exposure, maybe helps you figure out what you actually want to do among those other specialties.

If you're pretty sure that you want outpatient 9-5, then of the options you listed I agree that sports medicine sounds like a decent option.

 

[togaedere]

Sleep medicine is kind of getting a lot of talk around my residency these days. Don’t know much about it myself cus I’m about to start outpatient career (I’m pgy4 med peds) but it’s a short fellowship, good lifestyle and pay. I can’t give you any more info except just the idea, but if it sounds intriguing you could look into it.

 

[Splenda88]

OP might want to look into doing an FM residency... Might be able to start as a PGY2.

 

[mvenus929]

Yes, I think you've hit the nail on the head for AI and the other competitive ones. I seriously thought about endocrine, the fellows I know seem very happy. They get more time with each patient, have a mix of inpatient and outpatient, and seem to have good work life balance. I did not love my elective in it, but this was a long time ago and I am thinking of looking at it again more seriously. The only thing I was uncertain about was the pay. I heard it was less than gen peds, but then some website list higher salaries than gen peds and I know a fellow who got some job offers offering >200,000K in a seemingly populated desirable area. Is endo generally always lower than gen peds, or does it vary a lot by location? Does it pay about the same as pulmonology?

I can give you more details in about a year--I have very limited experience in salary discussions. My hospital reportedly pays about $160K as a program in the midwest, seeing patients 3 days per week with 1-2 weeks of inpatient per year and a handful of night calls each month (staffed by a fellow first). I imagine there are places where you spend more time seeing patients that will pay better (reportedly, the more clinical position adjacent to our hospital is 180K). That said, I'm also intentionally looking for academic positions because I want to build a career around teaching, and the money doesn't bother me because it's more than anyone in my family has ever made. I also have the bonus of qualifying for PSLF if I do an academic position and will already have 7 years towards it when I graduate fellowship.

 

[ThoracicGuy]

I can give you more details in about a year--I have very limited experience in salary discussions. My hospital reportedly pays about $160K as a program in the midwest, seeing patients 3 days per week with 1-2 weeks of inpatient per year and a handful of night calls each month (staffed by a fellow first). I imagine there are places where you spend more time seeing patients that will pay better (reportedly, the more clinical position adjacent to our hospital is 180K). That said, I'm also intentionally looking for academic positions because I want to build a career around teaching, and the money doesn't bother me because it's more than anyone in my family has ever made. I also have the bonus of qualifying for PSLF if I do an academic position and will already have 7 years towards it when I graduate fellowship.

Just make sure the physicians aren't organized as a for profit group even if they are academic. That could hinder your ability to qualify for PSLF.

 

[mvenus929]

Just make sure the physicians aren't organized as a for profit group even if they are academic. That could hinder your ability to qualify for PSLF.

One of the first things I'm asking is who is the employer. So far, the divisions I've spoken with are employed by the hospital/university directly.

 

[zeppelinpage4]

So I have a little trouble figuring out exactly what you're looking for, as the specialties that you selected seem like an odd grab bag that have little to do with each other. You identify peds pulm because you like managing vents/ARDS which obviously deals with very sick kids, but then you're also looking at AI and sports med because they have a better work/life balance. And obviously clinical informatics is its own thing entirely. Clearly, having those electives would have been helpful to narrow the field, but it's a little hard to advise you when I'm not really sure what you're looking for.

I'm kind of offended that the whole pediatric hospitalist medicine fellowship is even a thing, but that might not be a terrible option for you. Whether you like the hours all depends on your perspective--some people like being on for a week then off for a week to have big blocks of time off, others would hate being constantly on for a week or two in a row when you're on service. But if you really think you're interested in clinical informatics, that actually is the setting where I can most easily see you creating an academic niche for yourself in that realm. And worst case scenario, that keeps you connected in academics, continues giving you broad exposure, maybe helps you figure out what you actually want to do among those other specialties.

If you're pretty sure that you want outpatient 9-5, then of the options you listed I agree that sports medicine sounds like a decent option.

No worries, my initial post was a bit all over the place but I was trying to write out all my thoughts but I think it got messy and conflicting. I guess the best way I can explain it is that I want lifestyle and balance, but if I find something very rewarding and interesting (e.g. vent management, ARDS) I would be willing to compromise lifestyle to do something I find worth putting the extra hours for.
Pediatric pulmonology seems very interesting to me as a field, there's mix of procedures, outpatient, and inpatient medicine, and I found that I usually found managing respiratory patients on our floor and ICU more rewarding. As things appear now, I'd be willing to compromise lifestyle if I felt the work was truly rewarding enough to warrant it. However, seeing pulm inpatient as a resident is very different from seeing it as a pulmonologist and without the elective it's very hard to know for sure if I would love this field enough to compromise on future lifestyle and earnings. I was really passionate about doing general pediatrics in med school but in residency I realized I didn't enjoy it as much as I thought. If I pursue pulm and end up not enjoying it as much as I hoped, I'll have lost many years of invested time, lost potential income, and would be working relatively longer hours than sports med or allergy/immunology.
On the other hand, specialties like sports medicine require fewer years of training, offer better salary and better hours. Even if I don't end up loving it, I'll still have the salary and compensation benefits that come with the job. Of course, I still will need to have an interest and liking of it, so I hope to get experience as soon as these COVID restrictions are lifted.
As for informatics, again I will need to do the elective to see if I like it enough. But most informatics doctors practice their main specialty with informatics, so I can pursue it with any of the above options if I really like it.
But yes, having the electives would have helped a lot but as things are with COVID, it won't be an option any time soon. So I'm trying to make decisions from talking to others and researching the fields and their pros/cons online.


Thank you for that advice! Wow, that sounds amazing actually. Would be great to have that type of job in between residency and fellowship. I recently heard that it's possible to work as a hospitalist right out of residency but didn't know how common those jobs were without the hospitalist fellowship. I assumed i would need to do the fellowship but I've seen friends take jobs on inpatient units (usually in ICUs under an attending) fresh out of residency and it seems really cool. At the least, it's a nice alternative to gen peds and might suit my interests better. That's even better if I can incorporate informatics with it. I'll ask at my own institution though I don't think they're hiring. Are there good places online to search out these types of hospitalist and inpatient pediatric jobs?

Sleep medicine is kind of getting a lot of talk around my residency these days. Don’t know much about it myself cus I’m about to start outpatient career (I’m pgy4 med peds) but it’s a short fellowship, good lifestyle and pay. I can’t give you any more info except just the idea, but if it sounds intriguing you could look into it.

Thank you! Will definitely research it. I thought I could only do sleep after pulm, but it seems people can do it after residency too.

OP might want to look into doing an FM residency... Might be able to start as a PGY2.

I have thought about a second residency. Would med/peds programs also consider a peds grad and take credit? Fellowship is still preferred as I've heard doing second residency can get complicated with funding and all but it's def an idea to keep in mind.

I can give you more details in about a year--I have very limited experience in salary discussions. My hospital reportedly pays about $160K as a program in the midwest, seeing patients 3 days per week with 1-2 weeks of inpatient per year and a handful of night calls each month (staffed by a fellow first). I imagine there are places where you spend more time seeing patients that will pay better (reportedly, the more clinical position adjacent to our hospital is 180K). That said, I'm also intentionally looking for academic positions because I want to build a career around teaching, and the money doesn't bother me because it's more than anyone in my family has ever made. I also have the bonus of qualifying for PSLF if I do an academic position and will already have 7 years towards it when I graduate fellowship.

Thanks for detailing that out, it's nice to have some idea of the hours and salaries. I too am hoping PSLF comes through for us if I do a fellowship, it's the only way I can financially justify a peds fellowship option right now. Do you think the PSLF has a good chance of working out? It's definitely a factor in my fellowship decision, especially for peds pulm since it's 3 more years without much of an increase in salary.

 

[Splenda88]

@zeppelinpage4

Med-peds is competitive. Chances will be extremely low.

 

[mvenus929]

Thanks for detailing that out, it's nice to have some idea of the hours and salaries. I too am hoping PSLF comes through for us if I do a fellowship, it's the only way I can financially justify a peds fellowship option right now. Do you think the PSLF has a good chance of working out? It's definitely a factor in my fellowship decision, especially for peds pulm since it's 3 more years without much of an increase in salary.

PSLF is already working out for people (including physicians), so I think those of us already working towards it will be fine. New grads, I'm not quite as sure about. There's also a piece of legislation that provides loan repayment for those practicing pediatric subspecialties, because it is less pay and reduced compensation compared to gen peds. It hasn't received any funding, so I'm not sure how successful it will be, but the AAP and others are currently advocating for it to be funded in the next budget, so that may be an option too. There are also more underserved places that will do some loan repayment, though they're less available than in gen peds.

 

[togaedere]

Also I don’t know what it’s like everywhere but our pulm folks are certainly not managing vents. Our pulm folks are almost by and large doing asthma consults with the very occasional bronch thrown in, but in adolescents our adult pulm / critical care team does the Bronchs. Just throwing that out there.

 

[FlowLimited]

It's really unfortunate that your pulmonology elective was cancelled. Is there a local pulmonologist you could talk to/email/video chat? A pulmonologist may spend 20% or less of their time on-call and in the hospital. I would bet that most pulmonologists will tell you it's not their favorite part of the job and not the aspect that sold them on their career. Most pulmonologists are glad they're not the intensivist (and likely vice versa). Pulmonology and PICU are very different fields.

In pulmonology clinic you'll see a wide range of patients. Of course you'll see asthma and cystic fibrosis. You'll also see patients with respiratory muscle weakness, airway clearance impairment, unexplained chronic cough, exertional and non-exertional dyspnea, BPD, recurrent croup, pulmonary aspiration, vocal cord dysfunction, and so on. You will have patients that are easy to treat and some that aren't. You will have CF patients that you see 4 times a year from the week they are born to the time they graduate from college and you will know them far better than their pediatrician. You will have families that you reassure and never see again.

How much acute ventilator management you take part in as a pulmonologist will depend on the institution. You probably won't help much in the PICU. You may help in the NICU with "older" babies who end up with tracheostomies and are still in the hospital while families are being trained. You will do mostly chronic ventilator management and for many kids you'll be charting a course towards eventual decannulation.

Bronchoscopies are also institution and culture dependent. Some PICUs will routinely request bronchoscopy on intubated patients who aren't weaning, plugging/atelectatic, etc. If you're at a lung transplant center you may perform bronchoscopies post-transplant to assess the health of the anastomosis and to obtain transbronchial biopsies.