Can you do general/primary stuff after you have subspecialize?

[traxxradiorocks]

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I know that you can be hired to do full-time general peds after you have subspecialize but can you do a little primary stuff on the sides?

You know... for those who are in love with the medicine of the subspecialty yet they cannot give up getting involved in the community, etc.

 

[TexasRose]

I know that you can be hired to do full-time general peds after you have subspecialize but can you do a little primary stuff on the sides?

You know... for those who are in love with the medicine of the subspecialty yet they cannot give up getting involved in the community, etc.

I'm sure it's possible to do that. One way is to volunteer your time at a community clinic or shelter. Some specialists spend part of their time doing gen peds, like a couple of sports medicine docs I know. I suppose it all depends on what specialty you are in and how time consuming your "day job" really is.

 

[lockjaw]

I know that you can be hired to do full-time general peds after you have subspecialize but can you do a little primary stuff on the sides?

You know... for those who are in love with the medicine of the subspecialty yet they cannot give up getting involved in the community, etc.

I know of a pediatrician who does general peds 2 days and week and spends the rest of the time in the PICU. His wife also works in their office 2 days and week and otherwise does peds ID. They both did fellowships and are board certified in their subspecialties. Another member of their practice takes a few weekend shifts in the NICU each month. I don't think she has any formal neonatal fellowship training, but I might be wrong about that. The other 3 members of their practice do full-time general peds. So it's definitely possible, even if it's not common.

 

[traxxradiorocks]

That's quite good to hear. I strongly believe at this point that's what I want do when I grow up (planning on going into either PICU or NICU) yet still get involved in community medicine on the sides.
Thanks!

 

[Stitch]

I know of a pediatrician who does general peds 2 days and week and spends the rest of the time in the PICU. His wife also works in their office 2 days and week and otherwise does peds ID. They both did fellowships and are board certified in their subspecialties. Another member of their practice takes a few weekend shifts in the NICU each month. I don't think she has any formal neonatal fellowship training, but I might be wrong about that. The other 3 members of their practice do full-time general peds. So it's definitely possible, even if it's not common.

I think such a scenario is fairly rare. Most intensivists, both PICU and NICU really aren't that much interested in outpatient stuff. Moreover, especially in PICU there aren't a lot of docs in the first place. A PICU or NICU group may not appreciate having you do both. To manage complex cardiac disease and ventilators it's very difficult to do 'part time' and be great at it.

It's probably more possible to do something like ID, renal, rheum in addition to gen peds. For billing purposes however, you can't consult yourself and get paid for it. And to be honest, most of our peds subspecialists are pretty busy because there aren't enough to go around.

 

[oldbearprofessor]

I think such a scenario is fairly rare.

Definitely rare, but not unheard of throughout the US. However, it is common, and almost standard in much of Latin America. It's the only way the neonatologists can survive economically since they don't get paid much. Actually, what many do is work in the public (or government) sector in the AM, run a tiny private NICU in the PM and then see a handful of general pedi patients in the early evening. So, for the OP, I recommend moving to Bolivia where this is standard!🙂

 

[deleted311769]

It's probably more possible to do something like ID, renal, rheum in addition to gen peds. For billing purposes however, you can't consult yourself and get paid for it. And to be honest, most of our peds subspecialists are pretty busy because there aren't enough to go around.

I know someone who is a specialist and part of a general peds group. His patients alternate throughout the day between general peds and specialty appointments. The others in the group can refer to him, and he gets referrals from other doctors in the city as well. But he does far more general peds than his specialty.

I also know a number of specialists who do international trips to get their general peds fixes (one who goes many many times a year), and a few who volunteer at free clinics.

 

[michigangirl]

As other posters have noted, it's extremely rare (here in U.S.) for picu or nicu trained docs to do some "primary care on the side"-- I think being a specialist in peds specialty that actually does clinic (cardiology, nephrology, basically anything but PICU or NICU) would lend itself better to doing a day or two a week of community peds. The issue with this is that every day you aren't working in our specialty is a day less that you aren't advancing yourself in your specialty-- if you're at an academic center, this can be very important. I think you'll also find that after doing a PICU or NICU fellowship, general peds is the last thing you're interested in doing, and it is VERY hard to balance NICU/PICU schedules/call with a clinic practice. There ARE ways of doing community work without being a general pediatrician part-time. For example, you can volunteer with community initiatives, education in schools, etc. You can also do work abroad in post-op ICU care in developing countries when surgeons and anesthesiologists go abroad to donate their services. As the picu doc on the team you serve as the cardiac ICU attending for children in a developing country who are getting no-cost vital surgery( hearts, cleft palates/lips, etc.).

It sounds like you're early in your career-- I would be wary of mentioning on interviews for residency/fellowship etc. that your main goal is to be an intensivist who does some general peds on the side. These are traditionally on opposite ends of the spectrum and for someone who doesn't know you may be a red flag for lack of focus. focus on talking about an interest in community health and service, volunteer work.

Being a general pediatrician takes a lot of practice. The best general pediatricians, as with any profession, do it day in and day out and they are the best pediatricians out there because they do it all the time. Same goes for PICU/NICU-- diluting one job with another completely different one makes it harder to become an expert in that field. Besides, you will have plenty of family members and friends who hit you up for general pediatric advice all the time-- and you'll realize if you're an intensivist a lot of the time you don't know the answer about this vaccine or that oral antibiotic because that's just not your expertise anymore.

long post, hope this helps- great intentions..just food for thought. good luck!

 

[Stitch]

I know someone who is a specialist and part of a general peds group. His patients alternate throughout the day between general peds and specialty appointments. The others in the group can refer to him, and he gets referrals from other doctors in the city as well. But he does far more general peds than his specialty.

I also know a number of specialists who do international trips to get their general peds fixes (one who goes many many times a year), and a few who volunteer at free clinics.

I'm curious how that group does its billing then because in general, you can't double bill. There's also competition clauses near a lot of children's hospitals. For example one of our subspecialists decided to leave the hospital and join a local general practice. He was not allowed to practice his subspecialty in private practice because there was a non compete clause to protect his former partners. He also got dinged for consulting as a specialist on his own general patients. Most insurance will pay for one type of visit but not two by the same person or group, but this may vary and I don't have a lot of experience looking into the specific mechanics.

 

[Stitch]

In general I think the era of being able to be a 'jack of all trades' is coming to an end. Partly because of the in depth knowledge/clinical exposure/training required and partly because of the legal climate. FP is probably going to have to restruture in order to provide adequte training (few have good peds exposure anymore), and even peds/IM hospitalists may split off and have a different track from those wanting to do general peds. There are already a few handfuls of hospitalist fellowships out there; outpatient is very different from inpatient management. With reduced work/training hours, I expect these sorts of issues will multiply.

Even within PICU many institutions are separating off their cardiac intensivists from the main med/surge PICU attendings and units. Eventually you'll probably have to do an extra year in critical care in order to take care of the congenital heart repairs because it really is that complicated and different. If you were to do PICU with some gen peds on the side, you're (eventually) unlikely to be taking care of hearts as well.

 

[JMMH]

I know a few subspecialists who moonlight at community hospitals to cover deliveries and the nursery every so often on the weekend.

 

[ComradeDoktor]

I also know a number of specialists who do international trips to get their general peds fixes (one who goes many many times a year), and a few who volunteer at free clinics.

Naive college student question, but is that safe? If someone spends 50 weeks a year in a specialty practice in the States and two weeks a year doing general pediatrics abroad, I'd imagine they would forget a lot of what they learned in residency. Is that kind of person going to have enough general knowledge left safely do medicine in a third world country?

 

[oldbearprofessor]

Naive college student question, but is that safe? If someone spends 50 weeks a year in a specialty practice in the States and two weeks a year doing general pediatrics abroad, I'd imagine they would forget a lot of what they learned in residency. Is that kind of person going to have enough general knowledge left safely do medicine in a third world country?

Well, it beats having premeds doing it.😛

In general, most of those trips involve very basic care issues that can be handled without too much problem. After 20+ years NOT doing primary care, I'd say I would feel a bit uncomfortable at first, but wouldn't feel like I couldn't pick it up quickly. However, I prefer to stick to neonatology for the most part when I travel internationally. Most folks who do this do it once or more annually and have gotten used to it and retained those skills.

Of course, one can face some tropical diseases that aren't in our usual guidelines and then need to get some consultation, but in general, I don't think having a boarded pediatrician who is a subspecialist doing primary care annually in a developing country is very problematic from a knowledge perspective.