Bias Against Peds?

[Clairea11]

I'm pretty new to the site, but it seems to me that some members make derogatory comments about med students doing badly and then "going into peds," etc, like Pediatrics is some sort of rejects group. I noticed a few comments like this in The Lounge and some other places. Why is this? I was sort of disturbed by these posts, because I want to go into either pediatric oncology or neonatology.

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[oldbearprofessor]

I'm pretty new to the site, but it seems to me that some members make derogatory comments about med students doing badly and then "going into peds," etc, like Pediatrics is some sort of rejects group. I noticed a few comments like this in The Lounge and some other places. Why is this? I was sort of disturbed by these posts, because I want to go into either pediatric oncology or neonatology.

Some people make derogatory comments about people doing ANYTHING other than what they are doing. Some people make derogatory comments about people looking different than they do. So what? If you believe in what you do, then what difference does it make.

As I've noted before, almost all of these folks stop saying those things when they have a child who is ill and discover what pediatricians and pediatric specialists do and how we do it. Others are fortunate and never need to find out about that and can continue to make fun of us.

And we look stupid in bow ties.😛

 

[DarthNeurology]

I'm pretty new to the site, but it seems to me that some members make derogatory comments about med students doing badly and then "going into peds," etc, like Pediatrics is some sort of rejects group. I noticed a few comments like this in The Lounge and some other places. Why is this? I was sort of disturbed by these posts, because I want to go into either pediatric oncology or neonatology.

People who go into Peds feel a calling to help children and put a lot of value on their work. But it is true that, (and I was very shocked to see this), that a lot of medical students look down (way down) on students who want to go into pediatrics because general peds and peds specialties pay much less than their counterparts in internal medicine. I was told bluntly by classmates not to do pediatrics as you will "never make enough" and will have to see tons of patients in an ambulatory setting. This student knew a pediatrician who was seeing 50+ patients and felt that he couldn't ethically be a good pediatrician and still put bread on his family's table.

Plus there is a lot of evidence based research being done in adult medicine and a lot of this lags behind in the pediatric world which I think makes peds seems less technically oriented in terms of procedures and fascinating diagnosis when in reality the amount of knowledge to be a good pediatrician in terms of rare congenital diseases and all of the developmental info is pretty amazing.

It is assumed to that if you are a male medical student that you will go into OR at least consider internal medicine OR surgery or something like that so I think there is this stereotype or something that if you say you are going into peds it doesn't look very "macho" and classmates think your weird or something.

In reality taking care of children is very important, but the medical school curriculum I think is geared mostly to churn out internists, surgeons and specialists and pediatrics and for different reasons family practice, aren't given as high a status or respect --at least in terms of curriculum and advising. If you go to a big private school with a huge tuition then there may not be a lot of students matching into pediatrics and there might be even more in anesthesiology and urology! I went to such a school and believe me there was *zero* mentoring or support if you wanted to do pediatrics and even if you wanted (gasps fill the room) to work with underserved children and do part time international work even . . . Family practice oriented students get more respect as it is seen as broader and requiring more sacrifice but people in peds get a reputation for having made a "bad choice", or something along those lines.

I knew a lot of people who wanted to do pediatric oncology before medical school (a pretty narrow field anyway), but then decided on ob/gyn or pathology or something else so I think a lot of people want to be pediatricians but then feel that the stress and workload aren't well compensated or not intellectually challenging and go into something else and sort of encourage their pedi-minded classmates to do likewise and look down on pediatrics as it doesn't fit their expectations when they do the third year rotation as some academic pediatricians can very, very mean, especially to student who are inclinded to do pediatrics.

But, yeah, the bias is real and it is out there. . .

 

[BigNavyPedsGuy]

I agree with the previous posts.

Also, in general, pediatrics is less competitive to land a residency spot than your high end specialties. This makes people think that it's a last resort or not a real specialty. I think most of specialists (except IM) by the time they finish their residency have a healthy respect for pediatricians because they have to rotate and work with kids. This makes them realize that they have no idea how to take care of a kid and they're pretty scared of that.

But, whatever, you can't live your life just worrying about perceptions or stereotypes.

 

[Stitch]

Dude, I love my job. Period. I get to see sick children recover from diseases that would kill adults in a matter of days. Plus I get hugs from my patients. Neos like OldBearProf save someone's baby's life (or two or three) every time they're on shift.

Beware of anyone who thinks that their field is the end all and be all of medicine. They're idiots. All fields of medicine are important; all require hard work and compassion; it's just a matter of finding out how you think and what you like.

 

[DarthNeurology]

I think most of specialists (except IM) by the time they finish their residency have a healthy respect for pediatricians because they have to rotate and work with kids.

Yeah, I have seen that too, IM attendings don't respect some students who choose peds as they think it isn't a specialty or somehow not as complex as IM.

 

[edmadison]

I agree with the above but would emphasize that it's all about the money. I think when other docs look a peditricians who obviously weren't swayed by the money the feel jealousy and self loathing. They feel like sell outs. Thank god we're above that 😛

Anything that lets me be more sanctimonious is a good thing from my perspective.

Ed

 

[BigNavyPedsGuy]

Anything that lets me be more sanctimonious is a good thing from my perspective.

Ed

I'm not petty enough to EVER feel sanctimonious.

 

[oldbearprofessor]

I'm not pretty enough to EVER feel sanctimonious.

Fixed that for ya big guy.😛

 

[Doctor Bagel]

The medical world is really annoying in that people are always looking down on other specialties. If you think peds is bad, try going into psych. 😱 But regardless of what you hear at your school, pediatricians are pretty respected people in the community. No one outside of your medical school bubble will assume you're a pediatrician because you screwed up on Step 1 or couldn't match in derm.

 

[rotatores]

I think most of specialists (except IM) by the time they finish their residency have a healthy respect for pediatricians because they have to rotate and work with kids. This makes them realize that they have no idea how to take care of a kid and they're pretty scared of that.

Well said! One quickly realizes this after getting many calls from the ER folk that go something like,

"Eh, ah, I've got this kid down here."

"Okay, and?"

"Can you come and give me your blessing on him?"

"What's your clinical question?"

"Umm..?"

 

[antihero94]

I'm pretty new to the site, but it seems to me that some members make derogatory comments about med students doing badly and then "going into peds," etc, like Pediatrics is some sort of rejects group. I noticed a few comments like this in The Lounge and some other places. Why is this? I was sort of disturbed by these posts, because I want to go into either pediatric oncology or neonatology.

Pediatrics in general may be somewhat less competitive, but some programs are more competitive than even the most competitive IM residencies. At my program the new intern class had 1380 applicants for 41 spots.

 

[surftheiop]

. If you think peds is bad, try going into psych. 😱

For the last 3 or 4 months ive been reading almost all of the specialties boards and the PEDs and Psych boards seem to be full of the most positive and least deragatory people. Maybe the fact that money doesnt motivate people into these fields means people are more likely to choose for the "right" reasons?

 

[Amgen1]

one of the most frustrating aspects for me is seeing how poorly paid they are. my wife is finishing her pediatric subspecialty fellowship and the salaries are horrible. she is finishing 6yrs of postgraduate training- very difficult training and the salaries are insulting. She was AOA, had stellar board score, and went to a top 5 peds residency. she has other graduate from her top 5 fellowship program start for salaries less than the majority of midlevels.

she loves what she does, and she takes care of some of the sickest kids in the hospital. And I thank God there are people as intelligent as here who want to dedicate their lives to the field

However, it makes me sick that NPs with a 2yrs masters start at salaries higher than most general pediatricians and work half the number of hours and can make demands as to what their work schedule is. The never work nights, they never work weekends, they never work holidays. Sickening

 

[oldbearprofessor]

However, it makes me sick that NPs with a 2yrs masters start at salaries higher than most general pediatricians and work half the number of hours and can make demands as to what their work schedule is. The never work nights, they never work weekends, they never work holidays. Sickening

You are entitled to your opinion, although I do not share your concerns about what other people are earning. The bolded part is factually incorrect. Many NNPs (who are NPs) as well as some other NP specialties of pediatrics routinely work weekends, nights, and holidays. Most if not virtually all large NICUs have 24/7 coverage by NPs and have had this for many years. Many smaller NICUs use NNPs for night/weekend coverage as well.

 

[Amgen1]

I stand corrected. those that do work nights do so on a shift work basis, working 3 or 4 12hr shifts per week. In all systems that I have seen, if the midlevels can't or won't work a shift, then it is dropped on the residents/ fellows without any reciprocation

I don't think it is fair to say that people should have no concern for what others around them make. If the hospital/university pays someone who has 1/10 of the training you do and 1/10 of the knowledge base and has 1/10 of the responsibility that you have as an attending the same salary then you should be concerned.

healthcare is currently 18% of the GDP. that is not sustainable. it is not efficient or fair to pay someone who is underqualified/ underworked such a large piece of the pie

 

[BigNavyPedsGuy]

healthcare is currently 18% of the GDP. that is not sustainable. it is not efficient or fair to pay someone who is underqualified/ underworked such a large piece of the pie

That's an interesting point . . . . I have nothing to add. I just wanted to give you credit to making a new point in a discussion about a VERY well discussed issue.

 

[surftheiop]

healthcare is currently 18% of the GDP. that is not sustainable. it is not efficient or fair to pay someone who is underqualified/ underworked such a large piece of the pie

Alot of economists would say its much more sustainible to have someone with 3(?) years of post-grad training deal with routine cases as opposed to a pediatrician with > 7 years of postgrad training.

Yes there would be more mistakes, but from a purely economic perspective many economists would say its worth it. (They can calculate the dollar value people put on their own lives/their children's lives based on the levels of risk they are willing to accept for different salaries, driving to the cheaper store thats farther away, buying a cheaper/less safe car, etc.)

 

[lowbudget]

Alot of economists would say its much more sustainible to have someone with 3(?) years of post-grad training deal with routine cases as opposed to a pediatrician with > 7 years of postgrad training.

Ha! Yea, and those same economists will take their kids to see pediatricians.

I do think that when you're considering pediatrics during medical school (just like any other decision) that you really take a hard look at yourself.

One advice that I got was to ask: Do I want to do pediatrics because I want to be a *doctor* for children? Or is it because I simply want kids? It can be hard to make that distinction, given that we're all mostly in our 20's & 30's, around the time when we are expected to have children of our own, seeing others outside of medicine start their families.

I think we can all agree that kids are a joy to take care of because they're cute, vulnerable, and undeserving of suffering. But when they become ugly, difficult, violent, ill, disabled, and everyone walks away from them, will you be the last one standing to take care of them? To be their doctor? And devote time & energy into learning how to take care of them?

 

[Amgen1]

Alot of economists would say its much more sustainible to have someone with 3(?) years of post-grad training deal with routine cases as opposed to a pediatrician with > 7 years of postgrad training.

Yes there would be more mistakes, but from a purely economic perspective many economists would say its worth it. (They can calculate the dollar value people put on their own lives/their children's lives based on the levels of risk they are willing to accept for different salaries, driving to the cheaper store thats farther away, buying a cheaper/less safe car, etc.)

I disagree. Midlevels will order more unnecessary tests, utilize expensive specialist for consults much more heavily, and in general chew up more resources.

In addition, while in training residents/ fellows are cheap labor for the system. They decrease cost, not increase costs. That is why people are estimating that if the IOMs 60 hr work week is put into place it will cost the system 1B$ +. Because one resident does the work of 2-3 midlevels

 

[umass rower]

I went to a school that has a pretty strong focus on the primary care specialties, so I've never really noticed any bias with regards to my decision to go into peds. And now that I'm in a peds residency, I wouldn't see much of the people who hold those opinions anyway.

I think that most people who don't have a proper respect for pediatricians think that way because they don't really understand what we do. I blame the way medical training goes, because there's a lot of time spent learning about how to manage adult diseases, and very little learning about childhood ones. As a result, a lot of adult-oriented students/physicians don't fully appreciate the work involved in managing a child with only one or two problems. In reality, we generally substitute the complexity of adults for increased potential for rapid change and sometimes more subtle or obscure diagnoses.

 

[Stitch]

I think that most people who don't have a proper respect for pediatricians think that way because they don't really understand what we do. I blame the way medical training goes, because there's a lot of time spent learning about how to manage adult diseases, and very little learning about childhood ones. As a result, a lot of adult-oriented students/physicians don't fully appreciate the work involved in managing a child with only one or two problems. In reality, we generally substitute the complexity of adults for increased potential for rapid change and sometimes more subtle or obscure diagnoses.

I partially agree. Look at the former 24 week premie who is on 12 different medicines and has chronic special needs. That's no 'easier' than the 90 year old GOMER on tons of meds coming in for a bleed, then awaiting nursing home placement. Most adult ERs are terrified when that kid comes in, and gets them to a peds center right away. We definitely see our fair share of medically complex kids, and those same kids need a real medical home. Those kids often need a pediatrician, not a midlevel.