Choosing a Pediatric Subspecialty

[calvnandhobbs68]

Urgent Care Fellowship | Children's National

Obviously this isn't anything close to required or standard... But its seems there end to what somebody out there thinks is a good idea for a fellowship.

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What the f’ing ****.

What we now need to do a fellowship to do what an NP who got a degree from an online degree mill does at the CVS minute clinic?

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[DeadCactus]

I think we need to do what EM did and create a second board to compete with the ABP.

ABEM, under the ABMS, is the EM version of ABP and essentially the only EM board. The National Board of Physicians and Surgeons has appeared as an alternative to the ABMS for most specialties but has not gained much in the way of traction.

I think you're thinking of ACEP and AAEM which are two somewhat competing national professional organizations (e.g. AAP) which mostly differ in their relationship to corporate medicine.

 

[SurfingDoctor]

Hey, the ABP ain’t all bad. They got rid of recertification exams. Of course, you still have to pay the fee, but whatever.

 

[shepardsun]

Hey, the ABP ain’t all bad. They got rid of recertification exams. Of course, you still have to pay the fee, but whatever.

When did this happen? So once you've taken the certification exam, that's it, exam wise?

 

[SurfingDoctor]

When did this happen? So once you've taken the certification exam, that's it, exam wise?

That’s my understanding. They’ve piloted for a year. I was suppose to recertify this year and I got a notice that I was all set. You have to do online questions and the other MOC parts and pay the fee annually, instead of every 10 years, but yeah... the exam is gone for now.

 

[mvenus929]

When did this happen? So once you've taken the certification exam, that's it, exam wise?

You do (quarterly?) questions and have to get a certain amount right in 4/5 years. It it’s open book rather than heading to a testing center for certification.

 

[Stitch]

I'm doing the MOC thing now. The questions are actually pretty reasonable and you can do them whenever you have a little bit of time over several months. Much better than before. Now they need to drop part 4.

 

[futuredoctor10]

The main tasks should be to make subspecializing at least financially neutral to general peds (loan forgiveness etc) and a clinical track option that slims fellowships down to 1.5-2 years without research.

Accelerated clinical tracks would largely alleviate the problem. You would see a lot more pediatrics rheumatologists if it was only 1 year after residency.

This "accelerated clinical track" fellowship is an interesting concept and I think could help improve the pediatric subspecialty shortage gap.

The number of incoming interns expressing interest in a pediatric fellowship in our residency rapidly dropped by the time they reached 3rd year of residency. Many fellowships could likely be reduced to 1-2 years also (Adolescent Medicine, Hospitalist, Endo, Rheum, A/I).

One interesting aspect for the field of A/I (given ability to enter the track from Peds or IM): due to ABP requirements, pediatric residents entering Allergy/Immunology must do three year fellowships while the IM trained residents can do the same in 2 years.

 

[MEN2C]

I think that’s false. I know someone in Peds who marched into a two year AI fellowship.

 

[Hala Alsofi]

I would suggest updating the website with more practical information for candidates. For example, I don't see a mention of the extremely difficult job market in pediatric cardiology or pediatric heme/onc - many who go through that fellowship end up having to do general pediatrics (this fact should be acknowledged). This is a HUGE thing that every applicant should know, so they go into it with their eyes open. It would also be helpful to have exact data in terms of competitiveness. A better sense of what fellowship schedule might be like.

I agree

 

[Goneril]

Re: the Urgent Care Fellowship...

Wow... that's an awful idea. I hope it fails and I wonder about the kind of pediatrician that would apply to it.

 

[NurWollen]

Re: the Urgent Care Fellowship...

Wow... that's an awful idea. I hope it fails and I wonder about the kind of pediatrician that would apply to it.

Not involving pediatrics, but a good illustration of what I see as over-dependence on fellowships in medicine in general.

General Internal Medicine Onco-Hospitalist Fellowship

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[Vandalia]

Not involving pediatrics, but a good illustration of what I see as over-dependence on fellowships in medicine in general.

General Internal Medicine Onco-Hospitalist Fellowship

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I don't know if that is a good example. That seems to be what fellowships traditionally were: an opportunity to develop a research program and publications for a tenure-track academic position. The same as a post-doc in other academic specialties like physics, chemistry, etc. The fellowship you linked is not designed for clinical work in a community hospital.

 

[NurWollen]

I don't know if that is a good example. That seems to be what fellowships traditionally were: an opportunity to develop a research program and publications for a tenure-track academic position. The same as a post-doc in other academic specialties like physics, chemistry, etc. The fellowship you linked is not designed for clinical work in a community hospital.

Makes sense, but I feel like of someone wanted to do academic oncology, they would just do a heme-onc fellowship. But to each their own.

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[Perrotfish]

Re: the Urgent Care Fellowship...

Wow... that's an awful idea. I hope it fails and I wonder about the kind of pediatrician that would apply to it.

The same kind that would apply to a hospitalist fellowship.

 

[BigRedBeta]

Thanks for feedback, re: exposure not the issue- of note, there are a few fellowships (Child Abuse and Development/Behav Peds come to mind) that some peds residents tell us they did not know existed until they are into residency, but otherwise you make a good point- med students come into residency knowing of sub opportunities already.
And I agree with the financial challenges you point out-

So, in general, "exposure" isn't needed for residents to be aware that subs exist... I still wonder if there's an "exposure" that influences the choice a resident ultimately makes, to do a certain subspecialty? Some data tells us residents decide quite early in their training which sub they want to do- makes us think we have more to learn about opportunities to influence that choice.

I'm collating themes within all of these comments to present back to CoPS- thanks everyone-
.

Intentional necrobump.

Any follow up from the CoPS about this?

 

[shepardsun]

Not holding my breath for any significant change in the right direction.

Equally not surprised to see that earlier jokes about outpatient peds fellowships now becoming reality.

 

[Matthew9Thirtyfive]

Not holding my breath for any significant change in the right direction.

Equally not surprised to see that earlier jokes about outpatient peds fellowships now becoming reality.

To be fair I think this fellowship is primarily a research track for people who want to go into academics.

Fellows devote at least 80 percent of their time to their research training.

Physicians and other doctorally-trained individuals (e.g., Ph.D., Sc.D.) with a strong track record of academic and (where applicable) clinical excellence.

 

[shepardsun]

@Matthew9Thirtyfive That's exactly how the hospitalist fellowships started.

 

[Matthew9Thirtyfive]

@Matthew9Thirtyfive That's exactly how the hospitalist fellowships started.

What has been will be again,
what has been done will be done again;
there is nothing new under the sun.
Ecc. 1:9

 

[Ho0v-man]

I think I’d really enjoy peds but all this crap is just dumb. They can’t seriously expect people to go $300k+ in debt and train for 5-6 years post med school to make <$150k.

Also can’t believe there’s seriously hospitality, urgent care, and outpatient fellowships now happening in this field. I guess the powers that be saw that people weren’t pursuing specialty training bc of pay. So instead of upping pay in those fields, they decide to create fellowships in general peds!? Unreal.

 

[NurWollen]

I think I’d really enjoy peds but all this crap is just dumb. They can’t seriously expect people to go $300k+ in debt and train for 5-6 years post med school to make
Also can’t believe there’s seriously hospitality, urgent care, and outpatient fellowships now happening in this field. I guess the powers that be saw that people weren’t pursuing specialty training bc of pay. So instead of upping pay in those fields, they decide to create fellowships in general peds!? Unreal.

You could always do PICU or NICU or peds cards. You won't make as much as their adult counterparts, but you'll be well paid overall, but if you enjoy it, I'd say it's worth it.

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[Perrotfish]

You could always do PICU or NICU or peds cards. You won't make as much as their adult counterparts, but you'll be well paid overall, but if you enjoy it, I'd say it's worth it.

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Or you could just not do a fellowship, get a job, and be well paid.

 

[calvnandhobbs68]

You could always do PICU or NICU or peds cards. You won't make as much as their adult counterparts, but you'll be well paid overall, but if you enjoy it, I'd say it's worth it.

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Cards is a terrible suggestion. Job market for cards is junk. Most people have to do another year of super-fellowship to land a job. PICU is even starting to get to the point where people do another year after fellowship to make themselves more marketable.

EM gets you a better job market than cards.

 

[captianplanet]

Cards is a terrible suggestion. Job market for cards is junk. Most people have to do another year of super-fellowship to land a job. PICU is even starting to get to the point where people do another year after fellowship to make themselves more marketable.

EM gets you a better job market than cards.

Peds ID is wide open for the taking fellow placement is near top choice and jobs are on the upswing. No need to do extra years of fellowship.

 

[DO2015CA]

Peds ID is wide open for the taking fellow placement is near top choice and jobs are on the upswing. No need to do extra years of fellowship.

Yes, but the pay is not there at all. I think money is a part of their decision

 

[NurWollen]

Stills pays pretty well, from what I understand, could be an option if you love cardiology and are flexible in where you settle down.

Cards is a terrible suggestion. Job market for cards is junk. Most people have to do another year of super-fellowship to land a job. PICU is even starting to get to the point where people do another year after fellowship to make themselves more marketable.

EM gets you a better job market than cards.

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[NurWollen]

Yes, but the pay is not there at all. I think money is a part of their decision

Agreed. I love ID and think it's a great specialty, but unfortunately with the crappy pay and longer-than-general-surgery training, most people with significant debt (which is most people) are going to self select out of it.

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[captianplanet]

Agreed. I love ID and think it's a great specialty, but unfortunately with the crappy pay and longer-than-general-surgery training, most people with significant debt (which is most people) are going to self select out of it.

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Man the way people talk about ID, you would think we make less than 100K?? I think considering the quality of life measure is important. With other specialties saturating and unavailable in the large hospital/cities, the field of ID is actively growing with jobs available at most large centers/cities. Most jobs are academic which for sure decreases the pay, but does open the opportunity for loan repayment through the NIH. I will have my 200k debt paid for by NIH leaving me with a blank slate and happy to take a lower pay specialty in a desirable city. I have committed myself to research which isn't for everyone, but I am doing clinical research that I still would have done without committing to NIH.

Low paying job, no debt in desirable city >>>>> saturable market, high paying job, debt, weird city.

I only see ID value/pay improving as we continue to see more and more literature showing decrease mortality with ID consults.

 

[DO2015CA]

Man the way people talk about ID, you would think we make less than 100K?? I think considering the quality of life measure is important. With other specialties saturating and unavailable in the large hospital/cities, the field of ID is actively growing with jobs available at most large centers/cities. Most jobs are academic which for sure decreases the pay, but does open the opportunity for loan repayment through the NIH. I will have my 200k debt paid for by NIH leaving me with a blank slate and happy to take a lower pay specialty in a desirable city. I have committed myself to research which isn't for everyone, but I am doing clinical research that I still would have done without committing to NIH.

Low paying job, no debt in desirable city >>>>> saturable market, high paying job, debt, weird city.

I only see ID value/pay improving as we continue to see more and more literature showing decrease mortality with ID consults.

200k is about half of what my peers are graduating with. Plus with the uncertainty of repayment options. People going into peds as a whole aren’t dying to be rich but we also can’t be barely making ends meet working full time while repaying 5k a month in loans

 

[captianplanet]

200k is about half of what my peers are graduating with. Plus with the uncertainty of repayment options. People going into peds as a whole aren’t dying to be rich but we also can’t be barely making ends meet working for time while repaying 5k a month in loans

While I would have doubts on PLSF, NIH seems to be budgeting for more. They have upped the ante from 35k to 50k a year. Whichever specialty you end up choosing would strongly consider as free money is free money.

 

[calvnandhobbs68]

Man the way people talk about ID, you would think we make less than 100K?? I think considering the quality of life measure is important. With other specialties saturating and unavailable in the large hospital/cities, the field of ID is actively growing with jobs available at most large centers/cities. Most jobs are academic which for sure decreases the pay, but does open the opportunity for loan repayment through the NIH. I will have my 200k debt paid for by NIH leaving me with a blank slate and happy to take a lower pay specialty in a desirable city. I have committed myself to research which isn't for everyone, but I am doing clinical research that I still would have done without committing to NIH.

Low paying job, no debt in desirable city >>>>> saturable market, high paying job, debt, weird city.

I only see ID value/pay improving as we continue to see more and more literature showing decrease mortality with ID consults.

So here's the problem with the peds subspecialities that don't pay any more (and sometimes less) than gen peds. You're forgoing anywhere from 400-600K of lost gross income (admittedly less after taxes) by doing a fellowship for 3 years than just working in outpatient peds or in an ER or urgent care or whatever. Gen peds overall isn't THAT hard to find a job an most general locations (outside of very popular areas which are difficult for all specialities). So yeah, you don't get paid less than 100K in ID but you also don't get paid significantly more than gen peds most of the time either (which is true for most of the non-procedural, non-critical care peds subspecialities). So it's a hard sell to ask someone to give up several hundred thousand dollars in lost income. The loan repayment through NIH for the ID research is a little bit of a sweetener but probably not enough for many people.

 

[captianplanet]

So here's the problem with the peds subspecialities that don't pay any more (and sometimes less) than gen peds. You're forgoing anywhere from 400-600K of lost gross income (admittedly less after taxes) by doing a fellowship for 3 years than just working in outpatient peds or in an ER or urgent care or whatever. Gen peds overall isn't THAT hard to find a job an most general locations (outside of very popular areas which are difficult for all specialities). So yeah, you don't get paid less than 100K in ID but you also don't get paid significantly more than gen peds most of the time either (which is true for most of the non-procedural, non-critical care peds subspecialities). So it's a hard sell to ask someone to give up several hundred thousand dollars in lost income. The loan repayment through NIH for the ID research is a little bit of a sweetener but probably not enough for many people.

Total agreement in the loss $$$ from gen peds career. The argument was towards people who have already decided on fellowship and plan to forgo the gen peds salary for more PGY time. In that situation, ID fellowship is not that bad of deal

 

[kinematicKid]

Just wanted to resurface this and see of CoPS Docs could provide any updates in the last 3 years. One thing that I didn't see get mentioned was how over the last several decades, physicians have been displaced from providing bedside care. How much of what physicians used to do had been displaced onto nurses, PAs, NPs, RTs etc? As a current resident trainee I'm tired of hearing about the older attendings boast on how they used to do hundreds of different things at the bedside that we don't get experience with anymore. Whether it's starting IVs, doing blood draws, managing vent settings, I feel like a lack of these experiences contributes significantly to the missed opportunities in learning about your patients and their pathologies.

 

[SurfingDoctor]

Ha… even nurses don’t do IV or phlebotomy anymore. Though I’ve always found, that if you want to learn, usually more often than not, people are willing to teach you and let you try if you’re nice and ask politely. I got to do quite a bit of phlebotomy as a resident ages ago and not because it was my job but because I would make nice with the nurses and ask.

 

[Rumalum]

I don't understand everyone wanting their MD to just end up as a glorified NP or RN ...start your own IV's? Are you kidding? I simply don't understand the professional satisfaction in doing straight clinical work and dealing with all the awful people out there with no end to the work. There is no greater feeling than overseeing/directing the care of children, but leaving all the tedious/mundane/repetitive work to nurse coordinators and NPs while you enjoy the sweet lifestyle of funded research. Also, research is actually what helps kids - long-term perspective. When I was a resident, I actively avoiding seeking out "procedures" because ultimately, these are a colossal waste of my time knowing I would never actually need to do those things - I would much rather go home early than stay late doing even more uncompensated clinical work. I left residency very good at clinical care and managing the breadth of pediatric pathology. However, good clinical care is the bare minimum of what you can achieve for childhood health, and therein lies the power of an MD - an NP is not going to operate a lab, be PI of a clinical trial, or direct an institute

 

[BigRedBeta]

I don't understand everyone wanting their MD to just end up as a glorified NP or RN ...start your own IV's? Are you kidding? I simply don't understand the professional satisfaction in doing straight clinical work and dealing with all the awful people out there with no end to the work. There is no greater feeling than overseeing/directing the care of children, but leaving all the tedious/mundane/repetitive work to nurse coordinators and NPs while you enjoy the sweet lifestyle of funded research. Also, research is actually what helps kids - long-term perspective. When I was a resident, I actively avoiding seeking out "procedures" because ultimately, these are a colossal waste of my time knowing I would never actually need to do those things - I would much rather go home early than stay late doing even more uncompensated clinical work. I left residency very good at clinical care and managing the breadth of pediatric pathology. However, good clinical care is the bare minimum of what you can achieve for childhood health, and therein lies the power of an MD - an NP is not going to operate a lab, be PI of a clinical trial, or direct an institute

Why not just get a PhD then?

Not saying the MD doesn't provide a different perspective, but many PhD's would take the exact same sentiment towards MD's that you do towards NPs.
There's nothing preventing NP's from entering the lab space and accumulating enough expertise to operate a lab. Where I did fellowship we had one NP who was frequently our site PI for major multi-site trials.

And the research life is absolutely not for everyone. Not everyone considers endless grant writing satisfying. I'd argue much of lab work and research is very tedious. There's undoubtedly a shortage of subspecialists throughout the country given the difficulty in obtaining clinic visits, so I think you're extremely wrong that clinical work is somehow less critical to patients. At the rate things go from lab to bedside in any field besides Oncology, how many fellows starting today will actually see their bench research make a difference in the lives of actual patients during the span of their career?

 

[DO2015CA]

I don't understand everyone wanting their MD to just end up as a glorified NP or RN ...start your own IV's? Are you kidding? I simply don't understand the professional satisfaction in doing straight clinical work and dealing with all the awful people out there with no end to the work. There is no greater feeling than overseeing/directing the care of children, but leaving all the tedious/mundane/repetitive work to nurse coordinators and NPs while you enjoy the sweet lifestyle of funded research. Also, research is actually what helps kids - long-term perspective. When I was a resident, I actively avoiding seeking out "procedures" because ultimately, these are a colossal waste of my time knowing I would never actually need to do those things - I would much rather go home early than stay late doing even more uncompensated clinical work. I left residency very good at clinical care and managing the breadth of pediatric pathology. However, good clinical care is the bare minimum of what you can achieve for childhood health, and therein lies the power of an MD - an NP is not going to operate a lab, be PI of a clinical trial, or direct an institute

Ya, no thanks. I went into medicine to treat patients. I was already headed down the PhD route and took a sharp turn towards medicine because I realized I hated the lab