And you shall receive
Career Paths
First let me explain the different routes you can take to become a pediatric ER doctor and I think this will help you in understanding the different options.
1. You can do a pediatric residency followed by an emergency medicine fellowship. This takes 6 years to complete. At the end of 6 years you will be able to work in an outpatient clinic as a pediatrician, work as a pediatric hospitalist, and work as a pediatric emergency medicine physician.
Pros: you will never see an adult. You will be able to take the pediatric emergency medicine boards allowing you to work in any pediatric ED in the country. You will be versed in skilled in nearly every pediatric disease pathology. You have options of working in a clinic or as a hospitalist if you get burned out in the ED.
Cons: You will never see an adult, and since adults are sicker and sicker more often, you will experience less critical care. You will place very few central lines, perform few intubations, and medically resuscitate very little in your residency. You will get more experience in this area in your fellowship but very little since kids just aren't often critically sick. A retrospective study done in a tertiary care pediatric institution done in 2013 by Mittiga et al found that only 0.22% of all ED visit represented a pediatric patient requiring a critical procedure. There were 261 pediatric critical care procedures performed over a 12 month period. 61% of pediatric emergency medicine faculty did not perform a single critical procedure, 63% did not perform a single orotracheal intubation.
2. You can do an emergency medicine residency followed by a pediatric fellowship. This takes 5-6 years to complete. At the end of this time you will be able to work in an adult ED and in a peds ED.
Pros: You will be able to take the pediatric emergency medicine boards allowing you to work in any pediatric ED in the country. You will be skilled in seeing adults and your critical care skills will be maximized. If you choose to work in a community ED you will be very versatile and comfortable seeing any patient that comes in the front door. If you choose to work in an academic center you will be able to balance your time in the pediatric and adult departments.
Cons: You will spend 2-3 extra years to take a pay cut to see kids rather then adults. You can't practice in a pediatric outpatient clinic nor as a pediatric hospitalist.
3. You can do a combined residency. This takes 5 years. At the end of 5 years you can be an outpatient pediatrician, a hospitalist, an adult EM physician, a pediatric EM physician, or continue your training and do a fellowship in whatever you would like
Pros: You will graduate with many types of practice options. You will be versed in skilled in nearly every pediatric disease pathology. You will be skilled in seeing adults and your critical care skills will be maximized-which easily transitions to increased comfort in managing critical pediatric patients. You can work in the adult ED, peds ED, as a pediatric hospitalist, and/or in a pediatric clinic.
Cons: You will be NOT be able to take the pediatric emergency medicine boards. Meaning some of the academic pediatric ER which require this certification would not hire you, though I am not sure which ones require they are. They are very few. You may end up on a career path that didn't require the additional training.
I think this combined residency works best for individuals who desire to work with both adults and peds in a critical care/EM environment. I plan on working in an ED splinting my time evenly between the adult and pediatric sides of the ER. I also plan to gradually build an outpatient clinic that I can grow as I age. Ultimately as ER burnout sets in; I plan to transition completely to an outpatient pediatrician.
Also I found this gem. A study on what EM/Peds residents do with their training.
A SURVEY ON THE GRADUATES FROM THE COMBINED EMERGENCY MEDICINE/PEDIATRIC RESIDENCY PROGRAMS
Dale P. Woolridge and Richard Lichenstein
