dj_smooth

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After doing peds for 4 weeks I am beginning to wonder if FPs are able to manage acutely ill kids. In residency you may only get a few months at most with peds experience. I really like the little guys compared to the other end of the spectrum, and would much prefer to work with them and do OB, but maybe this expectation is unrealistic. Thoughts?
 

dr.smurf

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you are right to an extent, but no fp pretends that he/she is a pediatrician. i mean come on... 4 peds months in residency does not replace 3 yrs of a peds residency. but, the fp peds training does prepare you to deal with the common ped things and should build a good foundation for treating kids in the clinic. and dont forget that we as fp residents see kids in clinic starting with day 1 of residency so its actually more than the required months dedicated to peds. where im a resident we do 1 peds er month, 1 peds inpt, 1 peds out pt, and one neonate/nursery month. this training should allow the fp to be competent initiating the treatment of acutely ill kids until a pediatrician assumes care. we are also trained in pediatric advanced life support (PALS) in fp residency.
 

Kalel

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In my opinion, FP's who admit peds patients transfer them fairly quickly or bump up their care to higher levels of acuity pretty readily when they become "sick". A lot of peds admits seem similar to out-patient peds in that the patient really isn't all that sick and would probably do fine if he or she spent the day in bed at home; it's more of a cautious, just-in-case, rule out admit. When kids do actually get sick, unless an FP has a lot of post-residency experience dealing with sick kids, I think that most would just transfer to children's hospitals.
 
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dksamp

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Let me interject a little private practice reality. The worlds of residency and private practice are 2 different worlds, and cannot be assumed to be the same. I am a board certifies FP in private practice. I like to see ALL age groups and admit ALL of my own patients when warranted. An FP who sees kids in the office functions no different that a GENERAL PED in private practice. Here is a comparison:

Office Peds see the ?Bread & Butter? cases 95% of the time in the clinic with FEW ?zebras?. WHEN a ?zebra? is encountered, they are almost ALWAYS referred out IRRESPECTIVE of if it is a ped or an FP seeing the kid. The bread & butter stuff that will occupy 95% of your peds work will be (well child checks, upper respiratory infections, otitis media, gastrointestinal infections, ADHD, atopic dermatitis, acne, school physicals, sports physicals, and asthma). Once in a BLUE moon, you will get a zebra. My point is that in the event of a zebra, private practice management of these patients is no different with a ped vs. an FP. BOTH groups will do the MEDICALLY RESPONSIBLE thing and REFER OUT to a specialist if warranted. Yes, during peds training, they do rotate through a variety of subspecialty departments (cardio, Heme-Onc,Pulmonary, etc.) and will tend to take care of more sick inpatient kids during TRAINING, HOWEVER, this is not reflective of the population they will treat out in the NON-residency private practice world. Peds residents after residency veer off into 2 directions, one group will subspecialize which puts them in a totally different world, the other group will go into general outpatient peds with +/- inpatient work.
The latter category will see the bread & butter stuff and admit the bread and butter stuff to the hospital (exacerbation of asthma, dehydration, meningitis, RSV, pneumonia). Unless you have a slew of pediatric subspecialists there, you will ship the exotic stuff out to a tertiary facility, where you will find most of your pediatric sub-specialists.
FP?s who admit their own kids function in the same way. The bread and butter stuff is done the same way, and the funky zebras get specialty referral and/or possible transfer.
"BUT Derek?Aren?t pediatricians trained in their residency to handle complex cases whereas FP?s do not get that same exposure?? The answer is YES, however we must ask ourselves this: Do these differences impact your PRIVATE PRACTICE after residency?? NO because 95+% of your stuff will be the aforementioned ?bread & butter? stuff with LESS THAN 5% being the exotic ?zebra? stuff. If you do get something exotic, the way the insurance/reimbursement/malpractice/liability situation is, there is NO incentive/reason to manage it all by yourself. You are encouraged to refer out. Remember, most kids will tend to fall under Medicaid (fee for service and HMO) and managed care plans that are most likely CAPITATED. Plus, as you get further and further away from your residency training, you lose your skills in the management of complex things that you once managed as a resident.
Just my $0.02...PEACE!

-Derek
 
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