Can't decide between FM and pediatrics

[Airbender90]

Hello everyone. I'm new to these forums and was not sure if it was okay to post this here or in allopathic. But, since you're all very familiar with Family Medicine, I felt that I might get better advice here.

I'm an MS4 interested in both pediatrics and family medicine. I thought that I would be certain of which one I wanted to do by this point, but after completing both the peds and FM third year clerkships, as well as a Sub-internship in pediatrics and an elective in family medicine...I still can't decide. I really do LOVE both, and for many of the same reasons. My current plan is to apply to both and decide which individual program is the best fit for me, regardless of specialty. Location and fit matter more to me than anything else, since I know I'll enjoy doing both FM or peds. However, I do think that eventually I will need to pick which one I prefer.

I've had a ton of experience in pediatrics. All of the best moments of my third year involved kids or adolescent patients in some way. I loved my pediatrics Sub-internship as well. I have had a lot of exposure to peds, and I know I like it.
However, despite how much I disliked inpatient IM....I found that I really enjoyed seeing adults outpatients during my FM rotation. So now I'm having doubts about which route to go.

I'm often told that FM docs in the Northeast see very few, if any kids, and that my practice would be mostly adults (I assume >75% adults). I like working with kids a lot, and can't imagine practicing medicine without child patients. Ideally I'd like to settle down somewhere like upstate NY, and have around 50/50 ratio of adult and kid patients, but that may not be possible.

Overall my feelings are
outpatient and inpatient kids = outpatient adults >>>>>>>>>inpatient adults (I did not enjoy my inpatient IM rotation).


FM:
Pros:
-Useful in rural setting, where there may be lack of providers and I can be prepared to handle most things
-can see just about anything and everything
-I don't need to give up seeing adults
-can see multiple generations of families

Cons:
-Most of my patients (>75%) might be adults
-May be difficult to keep up to date on medical knowledge for all ages groups

Pediatrics:
Pros:
-Will get to see lots of kids
-more training in childcare so I can be more comfortable taking care of kids
-able to work with parents/family members as caregivers
-More options if I ever decided I might want to specialize down the road

Cons:
-Can't continue seeing kids after they turn 18
-can't see their parents or grandparents as patients

Pros shared by both FM and Peds:
-I like outpatient primary care
-I get to work with patient's family members (either as patients, or as parents/caregivers)
-I get to consider social factors, and see the patient more holistically
-Focus on preventative medicine
-Patient continuity

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[SansaStarkMD]

Sounds like you didn't like inpatient. If outpatient is your goal, FM might be the better route for the undecided.

 

[Airbender90]

Sounds like you didn't like inpatient. If outpatient is your goal, FM might be the better route for the undecided.

Thanks! That's a good point. I definitely preferred outpatient care throughout third year. The only thing that made me question it, was that during my subinternship in peds, I was placed on the pediatric inpatient unit and surprisingly enjoyed it. So I wonder if it might just be adult inpatient that I didn't like.

 

[LUCPM]

.

 

[teacherman84]

So i grew up in new England and never saw a pediatrician growing up, we always went to a family doc. I don't think you can make those general assumptions. It's prob easier in a smaller town though.

Some of my most rewarding and favorite patients are my families and as much as I'm not a fan of OB, i love seeing the kids I delivered grow up, now I take care of mom, dad and all the siblings as well.

It's awful for my efficiency but it's awesome to be able to see a 2 year old for a well visit, hear mom hacking up a lung and be able to give her care then and there so she's not waiting for the appt she booked 2 days from now.

I would say for you specialization would be the decidig factor...if any of the peds specialties are a maybe then you should lean the peds way.

 

[SansaStarkMD]

Med peds then. Adult clinic and peds hospital.

 

[FrustratedFamDoc]

If you couldn't live without seeing kids go peds. If you couldn't live without seeing adults go FM. If you go FM and end up in an area with a high density of pediatricians, the vast majority of your day will be adult medicine, especially as a new grad.

 

[BigRedBeta]

What patient population can you not live without for the rest of your career?

I mean honestly, which patients will leave a void in your professional soul if you could never see them again? Not just "oh I really enjoyed seeing that one little old lady in clinic" or that "I have fun doing 4 and 6 month old well child checks, it'd be great to keep doing them". Very few people on the Peds/FM/Med/peds continuum can actually say that they feel equal about both patient populations and one falls into the have to have, and the other is a "just nice to have".

If kids are your need and adult "just nice to have", then go into pediatrics, you'll be much happier. If it's the opposite, then FM makes more sense but only if you really are going to small town in your future. Specialization in big cities is absolutely going limit the number of kids you see in FM.

 

[akilysa]

One thing to consider is that Peds residency is a ton of inpatient, and a lot of pediatricians these days end up either going one way or the other after residency despite heavy inpatient training in residency (e.g. many end up doing only outpatient after residency, or otherwise they become hospitalists or specialists). It sounds like you like inpatient pediatrics though so that shouldn't be an issue for you.

Another thing to consider for FM is that in some residencies there is a significant amount of OB and inpatient adult medicine (but by no means a majority--you would just want to narrow down which ones you apply to). I have some friends who went into FM who were mainly interested in Peds and so chose to apply to and rank highly FM residencies which had a reputation for being strong in Peds and had good inpatient Peds training (not all FM residencies have strong inpatient Peds training so that's something you'd want to make sure you research).

At my FM residency I feel like we get good peds training (have a lot of peds clinic patients, strong peds didactics, get strong peds inpatient training and follow our peds patients into the ICU, etc.)

Having said all of this, if at some point you decide you for sure want to do inpatient peds, I think I would go into peds, not FM.

 

[witzelsucht]

Med peds is only one extra year and you get to be known as the smartest doc around, rather than some dude who failed step 1 (I respect FM, but other people don't, and M-P gives you extra skillset for managing sick adults with congenital childhood diseases like CF)

 

[SansaStarkMD]

Med peds is only one extra year and you get to be known as the smartest doc around, rather than some dude who failed step 1 (I respect FM, but other people don't, and M-P gives you extra skillset for managing sick adults with congenital childhood diseases like CF)

I was going to go into family medicine, but I don't want you to think I'm dumb. Please tell me... what should I do with my life random stranger? I really don't want to round for the rest of my life, but if you will think I'm smart I guess I can do it! I have a delicate ego after all. Someone please help me sort out my daddy issues before I make the wrong choice!

 

[witzelsucht]

I was going to go into family medicine, but I don't want you to think I'm dumb. Please tell me... what should I do with my life random stranger? I really don't want to round for the rest of my life, but if you will think I'm smart I guess I can do it! I have a delicate ego after all. Someone please help me sort out my daddy issues before I make the wrong choice!

"Pediatrics:
Pros:
-Will get to see lots of kids
-more training in childcare so I can be more comfortable taking care of kids
-able to work with parents/family members as caregivers
-More options if I ever decided I might want to specialize down the road

Cons:
-Can't continue seeing kids after they turn 18
-can't see their parents or grandparents as patients"


Hm....so my solution includes all his pros of peds, and fixes his cons of peds. If you are too lazy to do an extra year of residency, that's fine, but maybe OP wants to be able to manage sick sick kids and not just do well baby exams and give out amoxicillin to every fussy kid like its going out of style

 

[SansaStarkMD]

Or maybe OP wants to be a pediatric neurosurgeon on mars and not just take care of simple earthlings

... you peasant.

 

[cabinbuilder]

The thing I couldn't stand about peds was the parents. Entitled, on Medicaid, food stamps, with their coach bags, mega tattoos, and a better phone than me. What an Rx for Tylenol and advil because, "they can't afford it". Hmmmm how's that?

 

[deleted87716]

I dunno...from what I've seen, most general pediatricians freak out when they encounter actual disease and immediately refer.

If I had to do well-child exams all day, I'd shoot myself. But that's just me.

 

[Airbender90]

Wow, thank you for the replies everyone! Sorry for not getting back sooner. I finally had a pediatric and family interview and was able to get a better sense of what the programs are like. Not surprisingly I loved both but I had one big realization during the family interview.

One of the residents was discussing their OB training, and as much as I love the idea of being able to do everything...it seemed overwhelming. I remember my ob/gyn rotation and to be honest, I don't know if I want to go through those long nights doing C-section and deliveries again.

I loved both the pediatrics and family programs I've seen. I really felt I could be happy at both. However, even though I LOVE the idea of being a doctor for the entire family...the reality of going through months of OB is making me second guess that. On the plus side, the family program I went to had very strong pediatrics training (mostly outpatient, with some inpatient exposure as well.) So, I'm confident I would come out comfortable with seeing kids outpatient.

Also to those who mentioned med-peds, I was seriously looking at it for a long time...but it seemed to be very inpatient heavy. Right now my interests are in outpatient primary care...so FM would make more sense over med-peds for me.

So i grew up in new England and never saw a pediatrician growing up, we always went to a family doc. I don't think you can make those general assumptions. It's prob easier in a smaller town though.

Some of my most rewarding and favorite patients are my families and as much as I'm not a fan of OB, i love seeing the kids I delivered grow up, now I take care of mom, dad and all the siblings as well.

It's awful for my efficiency but it's awesome to be able to see a 2 year old for a well visit, hear mom hacking up a lung and be able to give her care then and there so she's not waiting for the appt she booked 2 days from now.

I would say for you specialization would be the decidig factor...if any of the peds specialties are a maybe then you should lean the peds way.

Thank you so much for your post. This is exactly why I don't want to let go of family medicine...I just love the idea of seeing an entire family as a whole.

Right now I am 95% sure I don't want to specialize. If I did, it would be in something like palliative care or extra pysch related training.
Of course, I know people can change their mind in residency, and that 5% chance of me falling in love with a specialty could happen. So pediatrics leaves that door open.

If you couldn't live without seeing kids go peds. If you couldn't live without seeing adults go FM. If you go FM and end up in an area with a high density of pediatricians, the vast majority of your day will be adult medicine, especially as a new grad.

I couldn't live without seeing kids. I know if I had to choose between just seeing adults, or just seeing children...I would absolutely want to see children. All through third year, my favorite patient experiences happened when seeing kids.

What patient population can you not live without for the rest of your career?

I mean honestly, which patients will leave a void in your professional soul if you could never see them again? Not just "oh I really enjoyed seeing that one little old lady in clinic" or that "I have fun doing 4 and 6 month old well child checks, it'd be great to keep doing them". Very few people on the Peds/FM/Med/peds continuum can actually say that they feel equal about both patient populations and one falls into the have to have, and the other is a "just nice to have".

If kids are your need and adult "just nice to have", then go into pediatrics, you'll be much happier. If it's the opposite, then FM makes more sense but only if you really are going to small town in your future. Specialization in big cities is absolutely going limit the number of kids you see in FM.

Thanks for framing that so well for me. I hadn't even thought about it in this regard.

If I'm being honest with myself, kids are my need. I like seeing adults and the idea of getting to see the whole family, but for me adults are more of a "just nice to have" I think.

One thing to consider is that Peds residency is a ton of inpatient, and a lot of pediatricians these days end up either going one way or the other after residency despite heavy inpatient training in residency (e.g. many end up doing only outpatient after residency, or otherwise they become hospitalists or specialists). It sounds like you like inpatient pediatrics though so that shouldn't be an issue for you.

Another thing to consider for FM is that in some residencies there is a significant amount of OB and inpatient adult medicine (but by no means a majority--you would just want to narrow down which ones you apply to). I have some friends who went into FM who were mainly interested in Peds and so chose to apply to and rank highly FM residencies which had a reputation for being strong in Peds and had good inpatient Peds training (not all FM residencies have strong inpatient Peds training so that's something you'd want to make sure you research).

At my FM residency I feel like we get good peds training (have a lot of peds clinic patients, strong peds didactics, get strong peds inpatient training and follow our peds patients into the ICU, etc.

Having said all of this, if at some point you decide you for sure want to do inpatient peds, I think I would go into peds, not FM.

Thank you, I really like this idea. The family program I visited had a stronger focus on pediatrics than others, and so it won me over. The only issue is that there is still a fair share of obstetrics which intimidates me a lot.
I enjoyed my ob/gyn rotation...but I don't know if I want to go through that again as a resident. It was very intense.

I dunno...from what I've seen, most general pediatricians freak out when they encounter actual disease and immediately refer.

If I had to do well-child exams all day, I'd shoot myself. But that's just me.

In this case, if my goal is to do outpatient pediatrics....looks like a peds heavy FM program, or a regular peds program could both get me to that goal. Just with the FM med route I could continue seeing those kids and their parents.

Thanks again for all the input. I definitely won't be considering any FM programs that don't give strong experience in pediatrics.

So I guess it comes down to whether or not I should go with a pediatrics heavy FM program (I get to see the entire family, but need to go through ob/gyn again and close doors to some of the big specialties if I ever have a change of heart)

...OR a straight pediatric program (have all doors open to specialize if I'd like, while seeing the main patient population I enjoy, but give up adults completely)
Any thoughts?

 

[SansaStarkMD]

Will FM you can do everything you want. With peds you can't. Think long term. Don't worry about residency.

 

[BigRedBeta]

So I guess it comes down to whether or not I should go with a pediatrics heavy FM program (I get to see the entire family, but need to go through ob/gyn again and close doors to some of the big specialties if I ever have a change of heart)

...OR a straight pediatric program (have all doors open to specialize if I'd like, while seeing the main patient population I enjoy, but give up adults completely)
Any thoughts?

Based on what you said, it seems highly, highly likely that you'll be happy as a pediatrician.

The thing I worry about it for someone who really enjoys peds but goes into FM is that there are a lot more adult patients in outpatient medicine. That "nice to have" is going to be a MAJOR portion of your training and future proportion. Even in a "peds heavy" residency, I have to wonder what that really means? Maybe others can answer but what can you reasonably expect to max out with kids? 33%, 40%, 50% in your residency? What about after? What percentage of your patients are really going to be the "whole family"? Legitimately I think these are real considerations and to change your career trajectory for 5% of your patient panel doesn't make sense to me.

On a different level, and I'll probably get some flack for this, but if you really want to take care of kids in the best possible way, you should be a pediatrician. Your training for pediatric patients in a FM residency just isn't the same, not that it should be a surprise...it simply can't be, an FM residency has to pull you in so many different directions. Plus, I'm a strong believer in that inpatient medicine makes you better as an outpatient doctor. Here's why - think hard about what really scares you about taking care of patients - probably the sick ones, right? Well that's what inpatient medicine teaches you, particularly for kids because they're generally so healthy. It may sound strange, but as a PICU attending, outpatient pediatrics scares me, because you have to sort through all the viral URI kids to find the one in 500 who is coming down with viral myocarditis. If you've done a majority of outpatient medicine and not much ICU or ED, you don't get that exposure, and it's even less likely if you're spending more time learning about managing adult diabetes and lipid profiles.

 

[Airbender90]

Will FM you can do everything you want. With peds you can't. Think long term. Don't worry about residency.

Thanks, that is very true. I won't let the residency affect my overall career decision.

Do you think it's harder to keep up with the growing medical knowledge as FM doc, since you're needing to stay up to date on peds, and adults?
I expect to feel comfortable with both kids and adults coming out of residency, but unless I see a good volume of both, I'm afraid I might get rusty with one group more than the others.
I'd have to be sure to find a practice that deals with all ages, which I'm hoping isn't too uncommon.

Based on what you said, it seems highly, highly likely that you'll be happy as a pediatrician.

The thing I worry about it for someone who really enjoys peds but goes into FM is that there are a lot more adult patients in outpatient medicine. That "nice to have" is going to be a MAJOR portion of your training and future proportion. Even in a "peds heavy" residency, I have to wonder what that really means? Maybe others can answer but what can you reasonably expect to max out with kids? 33%, 40%, 50% in your residency? What about after? What percentage of your patients are really going to be the "whole family"? Legitimately I think these are real considerations and to change your career trajectory for 5% of your patient panel doesn't make sense to me.

On a different level, and I'll probably get some flack for this, but if you really want to take care of kids in the best possible way, you should be a pediatrician. Your training for pediatric patients in a FM residency just isn't the same, not that it should be a surprise...it simply can't be, an FM residency has to pull you in so many different directions. Plus, I'm a strong believer in that inpatient medicine makes you better as an outpatient doctor. Here's why - think hard about what really scares you about taking care of patients - probably the sick ones, right? Well that's what inpatient medicine teaches you, particularly for kids because they're generally so healthy. It may sound strange, but as a PICU attending, outpatient pediatrics scares me, because you have to sort through all the viral URI kids to find the one in 500 who is coming down with viral myocarditis. If you've done a majority of outpatient medicine and not much ICU or ED, you don't get that exposure, and it's even less likely if you're spending more time learning about managing adult diabetes and lipid profiles.

Thank you so much BigRed. I honestly hadn't even considered that but you're completely right. It's almost certain that more than half of my patients will be adults if I decide to do family med.
I always thought I wanted to do outpatient adult care, but I just did a two week clerkship doing well adult visits...and it wasn't as fun as I remembered it being several months back as a 3rd year.
Maybe I like the idea of being a family physician, more than the reality of being a family med doctor.
The ideal career I'd like, seeing multiple generations and being the sole physician for a small community might be difficult to find or limit where I can practice. And as you said, I might end up at a practice that mostly deals with adults, or doesn't see kids at all.

It's very immature of me, but the truth is, I just don't seem to want to let go of any patient populations because I want to be able to see everyone. I've spent the last 4 years learning so much, and I don't want to let any of that knowledge go to waste. I always imagined myself as one of those old school doctors that treats and sees everything,. However, the reality is that it's impossible for us as doctors to know and be good at everything.
And if it came down do it, I enjoy seeing kids more than I enjoy seeing adults. I like seeing adults and geriatrics, but kids are definitely my favorite patient population.

I really appreciate your post. It's forced me to ask myself some difficult questions, but the more I think about these questions, the more it seems pediatrics is better suited to me. I just don't like the thought of having to say goodbye to them at 18. Though, I suppose most patients eventually leave for college, or eventually move over time regardless.

 

[VA Hopeful Dr]

OK this is not as hard a decision as you're making it out to be.

Will you be happy if you never have any adult patients? If yes, go peds. If no, either go FM or Med/Peds.

 

[Airbender90]

OK this is not as hard a decision as you're making it out to be.

Will you be happy if you never have any adult patients? If yes, go peds. If no, either go FM or Med/Peds.

Yeah, overthinking it def made this worse.

I def like peds.

As for adults, a few months back during my primary care rotation, I couldn't imagine letting adults go and loved interacting with them. I was sure about family medicine after that.

But, ever since my SubI in peds, I've found myself less excited with adults and I could live without treating adult diseases...especially if it meant being better with seeing kids. I'm just trying to figure out if my prior excitement w/ seeing adults was just a temporary thing or if I would regret not being able to see them in the future. My inpatient IM experience was miserable, but my first outpt IM experience was amazing. And my second outpt IM experience was meh. So I've had mixed experience with adult patients. Wheras I've always had great experiences with kids.

I know I like seeing kids...but I'm uncertain as to whether or not I should let go of adults. I might try to get some more clinic experience with adults...but between interviews and my research elective, I'm pretty busy till December. I'll try to get some more adult care experience in late December or February before making the rank list if I can.

 

[Keona]

I feel like the culture in IM vs FM is different, I despised my IM rotation, in very happy in family medicine. Do you want to practice in a city or somewhere pretty rural? If city you could easily do either one if you want rural fm would be better. Our residency would be considered peds heavy, but I feel comfortable managing kids and knowing when to send them on to a specialist or if they need to go to the ed. Some clinic days I see no kids, other days I see several, I see the most right around school physical time, the summers and early fall. I enjoy the variety and it's nice going back and forth. Some fm residents do not get this same peds exposure that we do though. It's really cool when you get to deliver a baby and take care of the baby and the mom and the dad or the older sibling.

 

[SansaStarkMD]

It will be hard to keep up with any medical field and to do a good job. If you can stomach OB, your peds population will explode.