Fellowships that DON'T deal with child abuse

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SouthParkStudio

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I did a quick search and didn't come up with anything.

I loved my pediatrics rotation 😍😍😍 but I cannot deal with child abuse or children dying. My heart breaks when caring for these children and I cannot do it.

So I was wondering what fellowships have little to no child abuse cases or cases where children rarely die?
 
I mean, if you stay out of PICU and ED, in general, you're not going to see that many children who are abused. You'll see some neglect, certainly, but not many abused. And stay away from Heme/Onc and NICU if you can't handle patients dying (though NICU tends to be a bit easier to rationalize death, since most of the time, the babies shouldn't have been born yet).

Pulm you'll see patients die occasionally of really bad asthma or CF; Cards you'll see a number of congenital heart patients die. Genetics, they tend to have life limiting illnesses at baseline, so also not great. ID you don't see too many deaths except for severe infections--which you see briefly as a consultant. Not too many outpatient ID patients die. But you'll also have to deal with neglect a fair amount, and crazy, crazy parents. Endo, you may see some deaths, and may see some neglect and abuse, but it's not terribly frequent. Allergy, you'll occasionally have a patient with anaphylaxis that may die, but again, not terribly common. GI has its own issues with psych patients, but not too many deaths. Some abuse, though, and certainly neglect. Neuro is largely seizures, headaches, and sleep issues, but you may take care of patients with muscular dystrophies that die young, or neuroimmunological disease (like MS) that have chronic disabilities. Rheum you probably don't see too many deaths.

Bottom line, you'll see it in every field, but it'll be least concentrated in the outpatient heavy specialties. But if you can't handle sick kids, you probably shouldn't go into pediatrics. We tease that we became pediatricians to work with kids and to be a forever kid, but really, we enjoy the medicine more than adult medicine (because it is a totally different beast). If we couldn't deal with sick kids (or their parents), we wouldn't go into peds in the first place.
 
Neurodevelopment I wouldn't expect to see very many abuse cases or have the kids die under your care. I agree with you that rheum good the criteria as well.

I feel like heme/onc gets consulted on a fair number of abuse cases regarding bruising and bleeding.

No matter what though, anyone will see both child abuse and child death in a peds residency in order to get to any of these fellowships.

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General pediatrics isn't going to have any more death or abuse than any of the fellowships named and the fellowships that offer a financial incentive to pursue them tend to be the higher mortality fields. So with no financial incentive and no incentive in terms of avoiding death/abuse, your question is kind of pointless. You can tailor any sub-specialty to be outpatient heavy with little direct involvement in death or abuse (aside from ED, PICU, and NICU) so the question is what you like most. You will have to make it through 3 years of taking care of those patients in multiple settings as a fellow first though and will deal with some very sick kids (acutely or chronically) some of which will die.
 
I honestly think this is the wrong way to think about these things. Child abuse is an issue that every pediatric provider (generalist, sub-specialist, intensivist) must deal with and should be vigilant about. If you are that bothered by it, you should consider a field that does not involving the care of children since you probably going to end up seeing it one day.
 
What thetubes said. If you must never deal with child abuse or children dying then pediatrics is not the right choice for you. I know it sounds harsh, but if that is a dealbreaker then I would advocate you go with another area of medicine. General peds, subspecialty, psych, all will deal with these issues at some point.
 
What thetubes said. If you must never deal with child abuse or children dying then pediatrics is not the right choice for you. I know it sounds harsh, but if that is a dealbreaker then I would advocate you go with another area of medicine. General peds, subspecialty, psych, all will deal with these issues at some point.

Thirding. Death and abuse are unfortunately a part of caring for children (like any other population). At the least, you will have to do ED, PICU, NICU and likely heme-onc rotations as part of your residency. You could ask yourself, is it worth it to go onto an outpatient subspecialty/gen peds practice? But still even in outpatient peds (or heck even family med) you will see the occasional very sick or abused child. If you already know these aren't things you can handle than I would look at it as a positive in that you know yourself well and have defined your limits, instead of finding out when a switch away from peds would be harder to make.

ETA: Alternatively after reading a sort-of similar thread in the med student section maybe try an elective early in 4th year in one of the heavier peds subspecialties (e.g. PICU) to see if with experience, it is actually something you can do. I don't advise doing something that's going to destroy you emotionally but on the other hand, if you have no experience with very sick or abused children, you might just be scared and may find that you actually get fulfillment out of working wth these kids (even if that's not your final subspecialty choice).
 
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