Career Advice: Pediatrics vs Psychiatry

[Ice Lotus]

Hello! I am a medical student nearing the end of my clinical years. I am interested in pediatric mental health and neurodevelopmental conditions but am struggling to decide between:

• Pediatrics > Developmental-Behavioural Pediatrics
• Pediatrics > Adolescent Medicine
• Psychiatry > Child and Adolescent Psychiatry
• Triple Board

I have enjoyed my clerkships in both pediatrics and psychiatry and currently think I prefer outpatient settings of both. I can’t see myself practicing adult medicine long-term but equally think I would not enjoy clinical practice as much without mental health components.

I know it’s possible to dual apply of course but was hoping to get some perspectives and advice! Thank you in advance


p.s. I’ve posted this to both the pediatrics and psychiatry forums to get perspectives from both sides; it’s my first time posting so please let me know if I should delete one!

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[TexasPhysician]

I don’t recommend triple board.

Do you primarily want to be a psychiatrist or a pediatrician? Either way you can end up focusing on children. If your focus is genetics, autism, and developmental conditions, pediatrics is ideal. If your focus is depression, trauma, adhd, counseling, etc., do psych.

 

[comp1]

Yeah, they're so, so different. I would argue they are even more different than say IM and general adult psychiatry. I'm concerned we can't answer this for you. But do remember, the majority of psychiatry training will be solely on adults. If you're really deadset on only working with kids, it might be better to go with peds. But there's a reason those peds subspecialties exist. Developmental stuff is something psychiatrists try to steer away from because we don't really have meds for it, nor are we trained to manage it in adults or children. As far as adolescents, you might even work with them doing only a general psychiatry residency, so I'm not sure that should really be in the differential, but given that YOU put it in...I'm thinking you're leaning towards peds. Go with your gut and strongly concur, no to the triple board. This is particularly important when you are ambivalent. Figure out what you actually want to do, don't delay that decision with more school.

 

[Merovinge]

Reach out to developmental peds, adolescent med, and peds psych people you know to have this conversation 1:1 is the best possible advice. I briefly considered peds as well and did a peds track PGY-1 year of psych residency (so peds neuro instead of adult neuro, peds wards instead of IM wards).

Briefly, developmental peds is dealing with developmental conditions for which you are often helping to be the medical home for complicated patients (often from a very early age) and ensure they get appropriate care (e.g. speech, OT, PT, audiology, and even PCP needs). You are regularly interfacing with schools to make sure these kids are appropriately cared for in that setting. You will inevitably do some prescribing for things like ADHD a bit less well then a child psychiatrist, but you will much better understand the holistic health needs for kids with significant developmental challenges.

Adolescent medicine deals much more with certain niche areas like eating disorders, reproductive health/development during puberty, and will get you additional mental health training but still less than CAP. You get to be both a specialist for some topics and a generalist which is kind of neat for certain personality types. You will have trained in the NICU for nothing during gen peds, but such is life.

For child/adolescent psychiatry, you do need to be comfortable working largely with adults for 3 years. I was expecting to dislike this, but ended up enjoying adult psychiatry much more than I ever thought possible. If psychotic patients scare you, it would be a very long couple of years of training. I really like working with young adults and medical professionals and I can do those things because I am boarded in adult psychiatry as well as child/adolescent. You will become the terminal expert in child/adolescent mental health issues, for me I had to become a sub-specialist in something to be satisfied. In some ways you get that with all the fellowships above, but I liked my scope of sub-specialty expertise to narrow but not too narrow (i.e. pediatric mental health). CAP is a MUCH larger field than developmental peds or adolescent medicine and for good reason as far more children have mental health needs than severe developmental disabilities and obviously kids +adolescents > adolescents.

Best of luck, this is a relatively answerable question if you can find good mentors and talk it through.

 

[rjs2131]

Hello! I am a medical student nearing the end of my clinical years. I am interested in pediatric mental health and neurodevelopmental conditions but am struggling to decide between:

• Pediatrics > Developmental-Behavioural Pediatrics
• Pediatrics > Adolescent Medicine
• Psychiatry > Child and Adolescent Psychiatry
• Triple Board

I have enjoyed my clerkships in both pediatrics and psychiatry and currently think I prefer outpatient settings of both. I can’t see myself practicing adult medicine long-term but equally think I would not enjoy clinical practice as much without mental health components.

I know it’s possible to dual apply of course but was hoping to get some perspectives and advice! Thank you in advance


p.s. I’ve posted this to both the pediatrics and psychiatry forums to get perspectives from both sides; it’s my first time posting so please let me know if I should delete one!

CAP here - from what I'm aware of, you will have higher demand and generally do better financially as a child psychiatrist vs pediatrician. You also usually have more control (especially outpatient) of how much time you spend with your patients as a psychiatrist vs pediatrician.

If all else is equal, I'd go the child psychiatry route if your intention is to work with kids, have a meaningful impact/relationship with families and do well for yourself financially. Residency/fellowship are also generally less intense vs pediatrics residency, so quality of life is likely better through training. I agree about not doing triple board, as unless you plan to stay in academics, you'll end up being forced to "pick" a specialty and it won't change much financially.

Also - if you want to maintain some of the "medical" aspects of practice you could do C&L or work in academics as a child psychiatrist.

The main reason I would pick peds here is if you don't want to lose the "medicine" aspect of things and enjoy treating all of the common pediatric conditions.

 

[Ice Lotus]

Thank you very much for all the answers! This has been great insight, and I really appreciate it

I'll definitely speak more with my mentors and have a think about all this.

Initial thoughts are that I'm leaning more towards pediatrics, just because I like the idea of being more of being a 'medical home' (to use @Merovinge's phrasing) to a child and their family. That said @rjs2131's point about having more control of how much time I can spend with my patient does resonate, especially since I already am interested in counselling and psychotherapy.

Not going triple board is probably right since I'd moreso just be delaying choosing one. I am leaning towards academic medicine but a competent co-investigator would probably be more useful than trying to juggle both specialties at all times anyway.

Thanks again!

 

[Ice Lotus]

given that YOU put it in...I'm thinking you're leaning towards peds. Go with your gut

this read was so cold yet so true

 

[calvinhobbes]

Hi! Def do psych so you can do child psych. If you’re interested in child psych. Psych pays much, much better than Peds, and you can also see adults if you want. You won’t get enough or any real training in mental health if you do peds, you won’t have time to treat those kids and you will end up referring them to psych anyway. Developmental Behavioral Peds gets paid less than General Peds, and your options for jobs are limited to academic centers, whereas in Psych you can do so much more and have a private practice easily as it pays more from insurance then Dev Beh Peds. Adolescent Medicine is mostly teenagers with STDs and GYN concerns, not really mental health. Triple Board programs are a great option but it’s 5 years so you are shortening your training in all 3 specialities. I would do the traditional Psych —> Child Psych option. Or, the Post Pediatric Portal Program! Where you do 3 years in peds and then 3 years in Psych and Child Psych! Keep in mind starting base salary for psych or child psych is approximately 80-150k more than peds, so that is good to remember too; you work very hard and when you start out you want to be paid well if you want to really help kids!

Post Pediatric Portal Programs

www.aacap.org

Triple Board Residency Training

www.aacap.org

Program Requirements

www.aacap.org

Either way, if you like working with kids and like psych, Psych is the way ( whereas Gen Peds doesn’t give you time to treat psych issues or do behavioral stuff, as your visits won’t allow for that, you will be seeing newborns and vaccine visits and urgent care visits in 10-15 min, and you won’t be able to bill like a psychiatrist if you do Gen Peds). Psych visits allow for more time, 60-90 min for new pts, or 30-45 min for follow ups. And you can do psychotherapy and bill for it.

 

[mistafab]

I'm biased, but if you are interested in psych and want to work with kids - definitely do psych. Psych is not easy to learn if you don't do a residency. So I imagine it would be harder the other way around if you went peds -> behavioral compared to psych ->cap if you want to primarily manage mental health.

 

[Ice Lotus]

<Re-Posting from my final post on the pediatrics thread as comments definitely apply to the great guidance here as well>

Thank you for all the great advice! This is a lot to think about and was really helpful.

I definitely see the benefits of both paths and think I will speak with my mentors more as well. I think the option to involve both pediatric and psych aspects in my training would be valuable, and I think there is value to it beyond just delaying a decision between psych vs peds. The portal option is certainly a good shout; it's just a pity that there are so few (of both the portal and the triple board).

I think what I'll end up doing is applying mostly psych + triple board, as I don't think I can justify applying only peds when there are so few portal/dbp programs and the state of pediatrics at the moment. That said, I'll still keep an open mind and may still apply to a few pediatric programs.

I'll try to update the thread with what I end up doing in case anyone's curious! Happy to leave the thread open in case anyone else is in a similar position and wants to ask any related questions. Also thought I'd note that it's interesting to see the commonalities and differences in perspectives between the responses in this questions' threads on the pediatrics and psychiatry boards. Really helpful advice on both ends, just from different points of view.

Thanks again

 

[Merovinge]

<Re-Posting from my final post on the pediatrics thread as comments definitely apply to the great guidance here as well>

Thank you for all the great advice! This is a lot to think about and was really helpful.

I definitely see the benefits of both paths and think I will speak with my mentors more as well. I think the option to involve both pediatric and psych aspects in my training would be valuable, and I think there is value to it beyond just delaying a decision between psych vs peds. The portal option is certainly a good shout; it's just a pity that there are so few (of both the portal and the triple board).

I think what I'll end up doing is applying mostly psych + triple board, as I don't think I can justify applying only peds when there are so few portal/dbp programs and the state of pediatrics at the moment. That said, I'll still keep an open mind and may still apply to a few pediatric programs.

I'll try to update the thread with what I end up doing in case anyone's curious! Happy to leave the thread open in case anyone else is in a similar position and wants to ask any related questions. Also thought I'd note that it's interesting to see the commonalities and differences in perspectives between the responses in this questions' threads on the pediatrics and psychiatry boards. Really helpful advice on both ends, just from different points of view.

Thanks again

FWIW I have worked with a few triple boarders in academic centers (as a trainee) and all of them got mileage out of going that way. People regularly decry it, but I think if you have a specific interest in peds c/l work its almost certainly the best training pathway. I will say a lot of people think they want to do academics prior to training and then decide they rather not be part of a huge machine and make terrible pay so I wouldn't hold tight onto what setting you want to practice in until you actually get to rotate through them as a trainee.