General Pediatrics VS Subspecialty

[clarkalim]

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Hello All!

Is this possible:

To do your residency in general pediatrics, your fellowship in pediatric hematology/oncology, and then to be a primary care (general pediatrics) physician, just with extra knowledge about heme/onc issues?

I want to do a subspecialty because so many people have warned against NOT doing one (if you don't = lower pay, less opportunities in the job market, etc).

But, I also want to be the VERY FIRST person that patients see. I want to be the one to examine all of the various symptoms a patient might have and send them to a specialist only if I, myself can't give a diagnosis.

It seems to me that (correct me if I'm wrong) if you are a specialist in a certain thing (pediatric heme/onc, pediatric endocrinology, pediatric nephrology), you receive the patients when they have already been diagnosed.

But I don't want that! I want to be the one to put all (or most) of the puzzle pieces together.

So, what would you recommend? I know that I definitely want to do pediatrics (I'm planning to do the MD/PhD ["MSTP"] program, and I want to conduct research on pediatric genetic, immune system, blood and/or neurological diseases, and HIV/AIDS, cancer, etc.), but after completing my residency in pediatrics, should I go on to do a fellowship in a subspecialty? Or should I just go straight into the workforce w/o doing a fellowship in a subspecialty?

Thanks!!!!!

(Forgive me for my lack of knowledge with the topics above--I am a pre-medical sophomore in college, and I am still trying to learn how everything works in the wonderful world of medicine!) 🙂

 

[Stitch]

Okay, take a big, deep breath, then let it out. Now relax a little. You've got a very long road ahead of you before you have to make these decisions, and as your interest in medicine matures, you may find yourself looking at things differently. There's plenty of time to decide on fellowships and what kind of practice you want to have.

To answer the questions, I need to point out that no one 'calls all the shots' or always puts all of the puzzle together. PCPs are the medical home and often are the first to find something abnormal, but they're not always figuring everything out. So subspecialists do not constantly get kids already diagnosed. They (heme/onc especially, but plenty of others) frequently make new diagnoses, and the work up can be very challenging and interesting.

It's a lot of extra work to do a fellowship, especially since most fellowships require 1.5 to 2 years of research in that field. Going through that then practicing general pediatrics is certainly possible, but there's no real reason to do it. Moreover, the MD/PhD route tends to be focused on producing physician scientists, often in a specific field. You can practice general medicine that way, but again it's a waste of training. Most do a significant amount of ongoing research and cut down clinical time.

So take your time, work hard to get into medical school, and don't cement your life into a grand plan. Be flexible.

 

[michigangirl]

Slow down young grasshopper! Your enthusiasm is well placed, but you are too early in your studies/training to be worried about these questions-- you will figure out what you want to do at the right time. First, get into medical school-- and if you are doing ph.D, by all means do pediatric research if that's what interests you. Then go through all of your clerkships and see what excites you-- if it IS pediatrics that ends up being your calling, then apply to pediatric residency. THEN once you start pediatric residency and rotate through the ICU, floors, clinics, specialities you will know if you are actually interested in a specialty or would prefer to do general pediatrics.

Specialists are called such because they often have to diagnose complex diseases when the pediatrician cannot manage them. Examples are when a general pediatrician hears a murmur, the cardiologist is consulted to do an echocardiogram of the heart and see if there's a cardiac defect because the armamentarium of diagnostic tools the general pediatrician has is limited. They may have an idea what the murmur is, but need the echo to confirm. If a child has a fever that seems not to be secondary to common things and the pediatrician sees something funny with the lab work, they will refer the patient to the appropriate doctor based on what the lab work shows (oncologist, hematologist, etc.)-- a general pediatrician is excellent and managing healthy kids and diagnosing and managing common illnesses as well as recognizing when something is not right and referring to the next step, whether it's the emergency room, the ICU, or a specialty clinic visit.

I would venture to say MOST people would not do an additional three years of fellowship unless they planned to spend a significant amount of their clinical time doing work specific to that field. It's a huge time investment. In the end, if peds heme or onc ends up being your passion, then you will want to spend all of your time doing it, and not taking care of diarrhea, giving shots, colds, etc. and well child checks.

Bottom line-- concentrate on your studies, rock your classes so that you can go to your dream med school and get an MSTP program if that's your choosing, then rock your med school classes so you can match into a great residency and THEN decide what you want to do. Good luck.

 

[clarkalim]

So take your time, work hard to get into medical school, and don't cement your life into a grand plan. Be flexible.

True! 🙂

 

[clarkalim]

Bottom line-- concentrate on your studies, rock your classes so that you can go to your dream med school and get an MSTP program if that's your choosing, then rock your med school classes so you can match into a great residency and THEN decide what you want to do. Good luck.

Yeah..thanks for the advice. I guess I shouldn't stress myself out so much about it now, when I'll have plenty of time to develop my interests along the way. Thanks 🙂

 

[rock_climber]

Agree with all the above. Also, think carefully about the PhD if you want to practice clinically in the manner mentioned above. It's an extra four years and if you don't intend to do a lot of research (and even if you do, many MDs do full-time research without getting the PhD) you may be delaying life, salary, practice, etc. etc. Just something to consider - talk to MD/PhD students and faculty to find out if it will really be what is best for you.