EM/peds and ERAS personal statement

[Powdermonkey]

---

Members don't see this ad.

So I've researched all of the options for doing a PEM fellowship, and in the end I keep coming back to wanting to do both EM and peds residencies. Afterwards I may do either a PEM fellowship or a neonatology or PICU fellowship. Why you ask?

Well, I LOVED my peds rotations I just finished. And I love being in the ER, its my reason for coming to medical school. The thought of dealing only with adults for the rest of my career makes me cringe and honestly, bores me to tears. I like giving high fives to kids when you walk in the room, getting to play with babies and toddlers and how a not so good visit can be made all better with a trip to the treasure chest to pick out a toy 😀.

I know I will be spending lots of time in residency and training, but at the current point I really feel that to be happy later in life and to have the options that I'm looking for this is the best route for me personally. That being said, I'm going to be applying to the 3 EM/peds programs this year in September, but the rest of my time will be spent at or around EM programs I'm interested in. After EM residency if I don't make it into EM/peds the current plan is to do a peds residency too. Though this may change in a few years after being in residency...

Should I write a personal statement that talks more about pediatrics for the EM/peds residency programs, and one that speaks more to my interest in PEM to the EM programs? For the EM/peds programs, what should I even talk about in my PS? Can I talk about my calling to both fields, or would it better to talk about future career goals once I'm trained in both fields? I feel like I have no stinking clue of what to put in this personal statement. Any help or insight would be greatly appreciated.

 

[Stitch]

So I've researched all of the options for doing a PEM residency, and in the end I keep coming back to wanting to do both EM and peds residencies. Afterwards I may do either a PEM fellowship or a neonatology or PICU fellowship. Why you ask?

Whoa, that's a LOT of training, and possibly a lot of unnecessary training (unless I misunderstood your meaning). Slow down! If you want to do PICU or NICU, then you really don't need the EM training, either adult or peds. You would of course need a peds residency though.

Should I write a personal statement that talks more about pediatrics for the EM/peds residency programs, and one that speaks more to my interest in PEM to the EM programs? For the EM/peds programs, what should I even talk about in my PS? Can I talk about my calling to both fields, or would it better to talk about future career goals once I'm trained in both fields? I feel like I have no stinking clue of what to put in this personal statement. Any help or insight would be greatly appreciated.

Have you looked through the threads in the EM forum about peds-->peds EM vs EM-->peds fellowship? Also remember that doing a combined residency won't get you boarded in peds EM, nor will doing a peds fellowship after an EM residency. I don't think this is that big of a deal in terms of jobs, but it's something to think about.

I think that in applying to the combined programs, you can essentially say what you stated in your original post: namely that you really like EM but want to be versatile and not only work with adults (don't mention that working only with adults would bore you to tears though!). Definitely mention future career goals and what you want to be doing in 15 years or so.

Really think about whether you want to be taking care of kids and adults. It sounds like you are definitely excited about the peds aspect, but can you also deal/get excited about adults with chest pain, older people with lots illnesses? Can you deal with crazy parents (on the peds side) or drunks and drug seekers (on the adult side)? If you really want to do both, then EM-->peds fellowship or the combined residency is a great way to go and will leave many options open for you. If you aren't as excited about adults and don't see yourself wanting to take care of them long term, then just do a peds residency.
A lot of people feel like they want to 'do it all,' especially as a medical student, but I've found that most people end up having to narrow things down in the longer term and choose. This is hard to do, but really give thought about where you want to be and what you want to do when you're said and done with training.

 

[Powdermonkey]

Whoa, that's a LOT of training, and possibly a lot of unnecessary training (unless I misunderstood your meaning). Slow down! If you want to do PICU or NICU, then you really don't need the EM training, either adult or peds. You would of course need a peds residency though.

Yes, I realize this. The NICU/PICU thing is just a possibility down the line. My purpose of pursuing both is because I really enjoy the peds clinic and peds inpatient work, but I really enjoy working in the ER too and seeing the strokes, chest pains, GI bleeds, and other random puzzles as well as not so random puzzles and complaints that come through the door. I'm really interested in the EMS and wilderness medicine side of EM, but I also want an outlet to practice in a clinic now and later as well. I've considered IM/peds as well as FP, but ONLY working in a clinic sounds like torture to me, and when I want to go work some ER shifts I want to make certain that I'm giving my patients the best care I can from a board certified EM physician.

Have you looked through the threads in the EM forum about peds-->peds EM vs EM-->peds fellowship? Also remember that doing a combined residency won't get you boarded in peds EM, nor will doing a peds fellowship after an EM residency. I don't think this is that big of a deal in terms of jobs, but it's something to think about.

Yeah, I've looked at both sides and compared and contrasted them for a while now and I still don't think either of them leave me the freedom to do what I want to do in the future. I'd really like to work 2-3 days in a clinic or inpt peds and 2-3 shifts per week in the ER. Is this possible? I really don't know. But it's something I'm interested in, and if nothing else then I'll be very comfortable with kids in the ER.

I think that in applying to the combined programs, you can essentially say what you stated in your original post: namely that you really like EM but want to be versatile and not only work with adults (don't mention that working only with adults would bore you to tears though!). Definitely mention future career goals and what you want to be doing in 15 years or so.

Ok.

Really think about whether you want to be taking care of kids and adults. It sounds like you are definitely excited about the peds aspect, but can you also deal/get excited about adults with chest pain, older people with lots illnesses? Can you deal with crazy parents (on the peds side) or drunks and drug seekers (on the adult side)? If you really want to do both, then EM-->peds fellowship or the combined residency is a great way to go and will leave many options open for you. If you aren't as excited about adults and don't see yourself wanting to take care of them long term, then just do a peds residency.

Well. I don't mind seeing those types of patients in the ER. But I really don't like adults in the clinic. I really enjoy peds clinic and inpatient though. So thats why the combined programs make so much sense to me, but to do what I want to do, I'd rather put in some extra time now than wishing I would have in 8-10 years. It sounds strange, I know, and its an odd combination of specialties. But it makes me happy to think about it. And in the end if I find that I really, really enjoy neonates or the PICU thats the direction I'll go and I will still be able to work weekend EM shifts if I want. If I want to continue on and do a fellowship in PEM or if I can't stand peds anymore and just want to work in the ER, I can do that too.

A lot of people feel like they want to 'do it all,' especially as a medical student, but I've found that most people end up having to narrow things down in the longer term and choose. This is hard to do, but really give thought about where you want to be and what you want to do when you're said and done with training.

At some point I know I'll have to stop training and start working and paying off my loans. And at this point it is easy to say that I won't mind years more of training. I know things can and will change, but I suppose I'm just looking for available options at the moment.

 

[Bitsy]

Yes, I realize this. The NICU/PICU thing is just a possibility down the line. My purpose of pursuing both is because I really enjoy the peds clinic and peds inpatient work, but I really enjoy working in the ER too and seeing the strokes, chest pains, GI bleeds, and other random puzzles as well as not so random puzzles and complaints that come through the door. I'm really interested in the EMS and wilderness medicine side of EM, but I also want an outlet to practice in a clinic now and later as well. I've considered IM/peds as well as FP, but ONLY working in a clinic sounds like torture to me, and when I want to go work some ER shifts I want to make certain that I'm giving my patients the best care I can from a board certified EM physician.

Yeah, I've looked at both sides and compared and contrasted them for a while now and I still don't think either of them leave me the freedom to do what I want to do in the future. I'd really like to work 2-3 days in a clinic or inpt peds and 2-3 shifts per week in the ER. Is this possible? I really don't know. But it's something I'm interested in, and if nothing else then I'll be very comfortable with kids in the ER.


Well. I don't mind seeing those types of patients in the ER. But I really don't like adults in the clinic. I really enjoy peds clinic and inpatient though. So thats why the combined programs make so much sense to me, but to do what I want to do, I'd rather put in some extra time now than wishing I would have in 8-10 years. It sounds strange, I know, and its an odd combination of specialties. But it makes me happy to think about it. And in the end if I find that I really, really enjoy neonates or the PICU thats the direction I'll go and I will still be able to work weekend EM shifts if I want. If I want to continue on and do a fellowship in PEM or if I can't stand peds anymore and just want to work in the ER, I can do that too.

At some point I know I'll have to stop training and start working and paying off my loans. And at this point it is easy to say that I won't mind years more of training. I know things can and will change, but I suppose I'm just looking for available options at the moment.

Yeah, I think you need to narrow your focus. I can't think of any career path that I've seen that would make it worth your time and not bankrupt you from all the interest accruing on your loans while doing all of these residencies and then possibly fellowships. If you want to do pediatric EM, you can do either peds residency or EM residency or a peds/EM residency I guess. Most of what you've talked about here seems to make sense with a pediatric residency and then choosing from there whether you want to do PICU, NICU, or pediatric ED. If you don't like adult clinic, then you definitely don't want to do IM/Peds or FM because both of those require a good amount of adult clinic time. Generally, you do one specialty....I've never seen NICU or PICU docs "work weekend EM shifts." That would require you to do either pediatric or ER residency (3 or 4 years for some ED programs) plus NICU or PICU fellowship (3 more years) plus another 2-3 years if you wanted to do pediatric ED. If you have any inkling that you want to do NICU or PICU, then it doesn't make sense to do an ED residency. You would simply do a peds residency and then decide there if you wanted to do Peds ED, PICU or NICU. There are certain things that all of us enjoyed as medical students, but it doesn't mean that it is feasible to do all of these as an attending. Plus all of the reading and keeping up on new literature plus CME would make it difficult for you to be the best physician you could be trying to do multiple things. Plus you would likely have to keep up board certification on all these specialties. Not trying to pop your bubble, but I'm not following your reasoning. Good luck in your decisions!

 

[BigRedBeta]

.I've never seen NICU or PICU docs "work weekend EM shifts.

Actually, I know of several children's hospitals, including some in the top 10 in size, that have Intensivists moonlight in the ED. There's very little (any?) a CCM trained MD would be unable to handle that an PEM trained MD could. NICU is a different story though and would probably be a much tougher sell.

To the OP...you need to narrow your focus. You're planning for a lot of what ifs and maybe this, maybe that's. I think it's great to apply to the combined ER/Peds programs, but with only 3 choices, you have to pick a path beyond that. In my opinion, you need to decide "what must I ABSOLUTELY have to be satisfied?" Not just "I enjoy and would like to have" but what you can not live without. The biggest distinction for you has to be kids vs adults. Which can you give up 100% and still be okay with? Or must you absolutely be able to see both? If you can give up peds, then ER is your answer (and in reality you'll still see plenty of peds patients in the ED, especially if you live somewhere where there's not a large peds only ER - which is most places in this country). If you can give up adults, then honestly, I think pediatrics is where you need to go - why limit your exposure to what you really need to be satisfied when you can immerse yourself in it?

I get that the intellectual candy of the adult ER is important to you, but I think you simply don't have enough experience seeing kids in the ER. A lot of that "what is this?" work is still there. There are still pediatric codes, traumas and burns, there are more stitches and splints and way less drug seeking behavior. And there are peds programs out there that put an emphasis on being in the ER - I did a total of 54(!) twelve hour shifts in the ER as an intern in my program. As someone going into PICU, that was a highlight for me.

If the 2-3 days a week aspect is actually the most important thing to you, then you're pretty much left with EM. There are part-time peds clinic jobs and peds urgent care centers, but you take a hit in pay with those positions - part time work gets part time pay.

 

[Apollyon]

nor will doing a peds fellowship after an EM residency.

What do you mean - a general pediatrics fellowship? Never heard of that. However, if it is peds EM after EM residency to which you refer, that will indeed make one eligible to become Peds EM boarded.

 

[TexasRose]

What do you mean - a general pediatrics fellowship? Never heard of that. However, if it is peds EM after EM residency to which you refer, that will indeed make one eligible to become Peds EM boarded.

There is an academic gen peds fellowship. 🙂

 

[Powdermonkey]

...

The biggest distinction for you has to be kids vs adults.
....

Why must I choose? I like peds clinic and I like the excitement and mass chaos that comes with the ER. You get to see acute cases and stabilize patients of all ages and of all sorts of different types of etiologies. And I love the fact that in clinic I'd get to play with the babies and toddlers and get to watch them grow. The kids are like a clean slate. I'm most likely NOT going to live somewhere that has a dedicated pediatric ER so I feel like I would be preparing myself to be the most educated and qualified pediatrician in the area should something go wrong with a peds patient or if a kid came in coding to the ER. Why can't I work 2-3 days in a clinic a week, maybe two Saturdays a month, and work 8-10 shifts in the ER in a month? I'd be helping the clinic fill gaps and cover on the busiest days, and I'd def be helping out the ER docs fill gaps in the schedule.

Which can you give up 100% and still be okay with? Or must you absolutely be able to see both? If you can give up peds, then ER is your answer (and in reality you'll still see plenty of peds patients in the ED, especially if you live somewhere where there's not a large peds only ER - which is most places in this country). If you can give up adults, then honestly, I think pediatrics is where you need to go - why limit your exposure to what you really need to be satisfied when you can immerse yourself in it?

Following the logic of this argument, why on earth would anyone do a combined residency to begin with? Why do med/peds? Pick adults or kids to work on or you're destined to mediocrity in both fields, right? Why EM/FM? Why EM/IM? Pick the ER or pick the clinic/wards. Why can't you do both? Med/peds is actually something I've seriously looked at, but I would really rather be BE/BC in EM if I am going to step foot in an ER, and I really don't like adult inpatient or clinic medicine.

I'm looking at 5 years to do a combined residency or 6 to do them separately, but I feel like it will let me see the patient population that I'm interested in. I've worked in an ER as a tech before med school, and I've gone back and shadowed the docs I've worked with 12-15 days over the past few years. Granted, thats not a lot by any standards, but at the same time, I kind of have a decent idea of what goes on in the ER. Thats what I like about it. And kids are just too dang fun in the clinic. Even the adolescents when you get to smack them around some for being little snots and encourage them to do well in school and aspire to do great things when their parents wont. Does it make a difference... maybe not, but even if it does once, it's worth it. Pediatrics is a tough field and everyone I talk to tells me that the parents are awful and I'll hate it. But to me the parents in peds are just like the families in adult medicine. They suck. Sometimes. But the parents who listen and who really want to learn and who will listen to you are amazing and it makes me smile to see them come in the clinic. The difference in my mind is that kids are still moldable and still have a chance to do right. Sometimes they need someone in their court who will stick up for them and do right when the parents don't or won't, no matter the age.

Is this a bit altruistic/naive/ignorant since I'm still just a lowly medical student? Perhaps. But if I don't set my goals and aspirations high, where does that leave me if I don't quite make it to them? I'm applying to EM/peds and EM programs this fall, and I'll do the EM residency first if I don't manage to make it into a combined program. I know the odds are long, but if I don't have a dog in the hunt how can I ever expect to catch anything? After EM if I still feel as I do, I'll pursue a peds residency. I'll be able to moonlight during the peds residency to help augment my salary (or lack thereof since I've already used my GME funding), and I'll still end up where I want to be. Or I'll do a PEM fellowship and get my fill of taking care of sick kiddos that way.

EM + PEM = 5-6 years depending on the EM program
peds + PEM = 6 years
EM + peds = 6-7 depending on the EM program
EM/peds = 5 years
EM/peds + PEM = 7 years

My best odds are 5 years, my worst 7. And I'll get to do what I want to do, whatever I decide that may be.

If the 2-3 days a week aspect is actually the most important thing to you, then you're pretty much left with EM. There are part-time peds clinic jobs and peds urgent care centers, but you take a hit in pay with those positions - part time work gets part time pay.

But if I'm happy doing what I'm doing, does it matter? If I do nothing but work 15-20 ER shifts a month I'm sure I'd stand to make more money. As a physician (and leaving politics and the future decisions of our government out of the discussion currently) I'll make pretty decent pay either way. If I want more money, I work more. Id rather be comfortable and work less than have boatloads of money and no time to enjoy it. In the places I'm interested in living $175k/yr puts you pretty high on the food chain. And working full time as a pediatrician I'd be making close to that at least, around here. Cutting back a few clinic days but filling in with ER shifts each month, things just go up from there. I get to play in the ER and I'll get to take care of kids. I don't see how thats not a win/win situation....

 

[Apollyon]

There is an academic gen peds fellowship. 🙂

For whom? I am guessing it's for peds residents, for those that are going to do academic peds (ie, not non-peds trained people, and it would not be an AAP approved fellowship if it was, as all fellowships are 3 years (except one which I don't recall) - which would make it peds residency). Right?

 

[BigRedBeta]

Why must I choose?

No one is saying you have to choose. You're the one who asked for insight, so I put in my opinion, if you don't like what I have to say, no worries. I'm just offering another way to look at it, since the ideal choice for you is so limited, and with that in mind you need some sort of strategy for picking whether you're going to do EM or peds out of med school.

Following the logic of this argument, why on earth would anyone do a combined residency to begin with? Why do med/peds? Pick adults or kids to work on or you're destined to mediocrity in both fields, right? Why EM/FM? Why EM/IM? Pick the ER or pick the clinic/wards. Why can't you do both? Med/peds is actually something I've seriously looked at, but I would really rather be BE/BC in EM if I am going to step foot in an ER, and I really don't like adult inpatient or clinic medicine.

There are certainly plenty of people who absolutely cannot stand the idea of not seeing patients of both populations. And there are certainly people who love the idea of taking care of the chronic disease kiddos (cystic fibrosis, congenital heart kids, etc) once they've become adults and start having adult problems. There are PLENTY of good reasons to do combined residencies, I'm just of the opinion that if one patient population is merely "just a bonus" (which was the case with me for adult medicine), but not ultimately vital to your happiness, then picking one field is a better option. If being able to do both EM and peds clinic is absolutely necessary for your happiness, then yes, you'd be someone who needs a combined program and that's fine. But I've seen it time and time again that people who do combined residencies for anything less than absolute necessity, they end up picking one field, and dropping the other entirely from their clinical practice. Alternatively, I've seen residents who struggled with the decision as a med student, pick a single specialty, then after a year realize they needed that other field and have to go through the hassle of getting back to a combined residency (which in one case meant moving half way across the country because there was no combined program where he was at)

But if I'm happy doing what I'm doing, does it matter?

Sorry, I apologize, the part about salaries came out different than I intended. All I'm saying about that is, if the limited hours is your key criteria, then there may be consequences to such a decision - most notably in pay scales.

The bottom line, your situation is unique, with very particular desires in what type of patients you see and where you see them. It is further compounded by a very limited combination residency. With that in mind, the feasibility of what you want to do is at best a struggle. Analyzing what you absolutely want to achieve career-wise, if nothing else will crystallize your goals and allow you to head down the right path, but on the other hand if you realize you can prioritize one aspect over another, then perhaps you'll make everything that much easier on yourself. But without a significant amount of self-reflection and self-awareness, you'll run the risk of doing a lot of work for very little reward.

 

[J-Rad]

There are a lot of debates about combined residencies and their respective utitilities. Some make a fair degree of sense-like med peds-and others, I scratch my head at. Peds/PM&R? Why spend the time getting peds boarded when you can do a peds fellowship from PM&R and you're most likely going to practice only peds PM&R (not peds). Same for Peds/Derm. But Peds/genEM? I actually see that making some sense. There is a significant pediatric component to EM and a lot of EM docs feel very uncomfortable with peds. Since Peds/genEM generally takes the same amount of time as genEM+PEM, I can see this as being a good path for someone who wants to be the pediatric expert in the ED, but doesn't necessarily aspire to geographically limiting themselves to locations with dedicated peds EDs. No, you won't be a boardable peds EMP, but you will be very marketable in a lot of places. Somewhat tangentially, I also wonder if the Peds/genEM pathway is of superior quality to the genEM+PEM pathway given that the former has a much greater depth of pediatric training than the latter (and really somewhat equivalent to the Peds+PEM pathway). Now, good thoughts aside, the practical thing that has to be considered in your long term goal: your practice as both an EMP and a pediatrician, while possible, may be somewhat hampered by your work environment. If the hospital employs both groups, it might be easier, but they may not want you splitting your time. One person, dedicated part time to two areas, may not be seen as superior to two people dedicated to their respective areas. And the truth is, in a lot of places, the general pediatricians come to the ED to help out when the SHTF on peds cases. Trickier will be when there are two employment groups, and a lot of EDs, are staffed by an employment group that isn't part of the hospital. It may be difficult to impossible to arrange your desired split time between two employers. Overall, I actually-intellectually-like the flexibility of the Peds/genEM path*, but be aware that your future practice might still have practical limitation.

*Way off to the side: I also wonder why there were never any Peds/FM residencies like the IM/FM residencies. They see a lot of kids, and a good few of them are undertrained for it. A combined Peds/FM makes more sense to me than even IM/FM.