Going into peds residency if you didn't enjoy peds outpatient rotation?

[blackcadillacs]

Hi all, I have kind of an odd question about peds residency and hem/onc

Thinking about going into peds hem/onc - I really love hem/onc, and I think the disease processes in kids are much, much more interesting than in adults (lots of solid tumors, much less hematology)

I do generally like kids. However, I didn't really enjoy my Peds rotation. My rotation was almost all outpatient (so pretty much just well child checks and URIs for a month) which I found very boring. There are also other aspects of Peds that I'm not a fan of, like having to coerce kids into cooperating with a physical exam; I found it tedious to keep pretending that kids had fairies in their ears to get them to cooperate. I also get frustrated that there are different sets of normal vitals and lab values to know for different age groups.

With that said - if I applied for a peds residency with the intent of going into hem/onc, would I be miserable during residency? Is residency significantly different from the outpatient stuff I did? Sorry if these are dumb questions, but I don't know if I'm crazy for considering a peds residency when I didn't particularly love my peds rotation!

I've shadowed a little bit for peds hem/onc and did enjoy my limited experience. The kids generally seem really cooperative with the physical exam. I think they're just so used to being poked at that they don't really fuss!

Thanks in advance for any advice!

---

Members don't see this ad.

 

[p1ggy]

I think the best way to find out is by doing a solely Inpatient Peds rotation or a Peds Heme/Onc rotation. This would give you exposure to your field of interest and help you determine if you like inpatient more than outpatient. If you find that you really can't stand taking care of kids even on heme onc rotations, then maybe Peds isn't for you. If it's just outpatient Peds you can't stand, then I think that's okay since you don't want to do that in the future and just have to make it through those rotations in residency. But if you can't stand Peds in general (like doing physical exam on kids), then it might not be the right field for you since you will have to tolerate doing pediatric exams, knowing the age-specific vital sign ranges, etc. even in Peds heme/onc.

 

[Omar Little]

http://forums.studentdoctor.net/thr...get-about-applying-to-peds-residency.1053342/

 

[blackcadillacs]

Wow thanks so much for sharing the link, that's essentially my exact situation! Should've searched rather than assuming my question was unique! Thanks again

 

[Step Up]

It'd DEFINITELY okay to dislike outpatient gen peds and still go into peds. Many of my co-residents HATE clinic, yet are happy overall. The VAST majority of residency is centered around inpatient medicine - i.e. inpatient floor, PICU, NICU, ED. Residents spend a lot of time managing acute care type situations and this can be extremely mentally stimulating in order to do it well. You also have several elective rotations so you can tailor those rotations towards what you enjoy. Most residency programs have you do gen peds clinic about 1/2 day per week. Plus you have a few other outpatient rotations like adolescent and developmental/behavioral peds. Residents who dislike clinic in general migrate towards hospitalist/NICU/PICU/ED careers. For the rest of us who like clinic but also want to manage complex patients - consider peds heme/onc, cards, renal, genetics, neuro, etc.

Ask any peds ED attending what they think of clinic...

 

[Cytarabine]

I've shadowed a little bit for peds hem/onc and did enjoy my limited experience. The kids generally seem really cooperative with the physical exam.

It depends on their mental age, how sick/scared they are, your past relationship with them, etc., and it varies from kid to kid. Kids getting steroids can be jerks 🙂 As far as general outpatient stuff, I'm much more of an inpatient person, but I enjoy the variety and continuity offered by clinic. In my experience, peds onc staff frequently serve as more or less the primary care provider for their patients, at least in the early stages of their treatment, and a fair amount of the practice of a peds oncologist is in the outpatient setting. Just some things to think about, definitely get some more exposure to the field

 

[mvenus929]

So, if you go into Peds Heme/Onc, you're going to be a primary care provider for a good chunk of your patients. A good portion of sickle cell patients only see their Heme/Onc doc, not a PCP. Kids undergoing chemo tend to go to their Oncologist with issues. And, of course, a ton of Peds Heme/Onc takes place as an outpatient.

I do think a peds residency would be miserable for you if you don't enjoy working with kids. You should do some sort of elective to figure out if it's just the well visits and minor care visits that you abhor, or if it's all of peds.

 

[DeadCactus]

Plenty of pediatricians and pediatric residents hate general out-patient pediatrics just as many hate wards or the ICU. Outpatient subspecialty care is different from general peds even when you become the de facto PCP for your patients. I don't think not liking general pediatrics is a contraindication to being a pediatrician as long as you like hospitalist or urgent care work enough if the subspecialty route doesn't work out for whatever reason.

I worry about the other stuff in your post more. Different vital signs is kind of negligible thing to annoy you so much that it warrants mentioning. And while not every pediatrician has to be super-cutesy and break out the puppets or funny voices, you do have to be able to build a rapport with kids and their families and you should get at last some enjoyment out of interacting with and taking care of kids.

 

[dbeast]

Wow, what an interesting trip down memory lane with that link. Now as a first year pediatrics resident, maybe I can share some additional insight.

First of all, I still don't have any interest in using a baby voice or giving out stickers. But aside from that, I've been largely happy with my decision, particularly as fellowship gets closer and closer. My program is weighted very heavily in favor of inpatient medicine, which is more demanding in terms of hours, but also more enjoyable to me. It's much different than where I went to medical school, for example, which has a greater outpatient general pediatrics component, and nearly turned me off to the specialty entirely (which you'll see in the linked post earlier in this thread). If you do choose pediatrics, be sure to consider the amount of ICU and inpatient time at each residency program compared to outpatient clinic. Also, remember that any pediatric subspecialty besides NICU/PICU will have a lot of clinic, but I'm guessing that you'll be okay with this if it's in a medical subject that you find more interesting.

On a more philosophical level- and I've had this discussion with many co-residents who agree- pediatrics seems to attract two diametrically opposed personality types: first, those who enjoy caring for a largely healthy population, helping them grow and develop, and appreciating the benefits of essentially having fun playing with healthy kids. The other type specifically chooses pediatrics because they want to test their own emotional limits, and try and reverse some of the most horrific diseases imaginable to an innocent patient population. I sometimes imagine there could be two different residencies for these two types of people, but like others have noted above, a solid general pediatrics foundation is necessary for any subspecialist.

I can't tell you what works best for you, but I can assure you that you aren't the only person who feels the way you do. My friends who are doing surgery have much better stories from their trauma rotations, but I'd argue that I get a different and equally satisfying type of fulfillment when I'm on a service that cares for the really sick kids. And then, when I'm in clinic with healthy babies, it's a nice break from wards, which can get exhausting depending on the severity of your patients' diseases.

One last note- the patients in heme/onc tend to be older than average pediatric patients (newborn and infant cancers are pretty rare by comparison) and this info may be useful in your decision making. The vast majority of my onc patients are old enough to cooperate with my exams. Still, you better get good at looking in 2-year-olds' ears until fellowship. Sorry :/

 

[dbeast]

Ask any peds ED attending what they think of clinic...

 

[hmockingbird]

I just matched into peds (!!!). I think there is a lot of great advice above especially doing an inpatient or even heme/onc peds rotation ASAP before you have to submit your app. I'm not the hugest fan of clinic - there are things I like about it but I don't think I would want to make my career all outpatient.

I have substantial experience with peds heme/onc though. I'm a little confused about your idea that there is less hematology because there is tons of hematology in peds heme/onc - especially sickle cell. I've been involved with my department since M1 and I'd say it's at least 60/40 onc/heme. Maybe it depends on your hospital as I have heard that some fellowships can be heavy on one side but that's something to consider. (Also I'm not as familiar with adult heme/onc.) As far as cranky kids... still lots of toddlers and preschoolers. They will get cranky if they are sick. Also, you have the teens who are over the idea of chemo and really don't want to be there. I think this is just a reality of life in any peds specialty and you have to figure out if it's a deal breaker for you.

I think peds can be adaptable for a lot of personalities. I have had attendings who are more of the super interactive, funny, play-acting type and those who were more serious or even just more reserved. You obviously have to find a way to build rapport but that can be unique and I think can be developed with experience. I know I was a lot more comfortable after doing a lot of peds rotations as an M4 than during my M3 rotation. I remember this hilarious time we were rounding and the attending was trying to play with the patient (who seemed nervous) and I was freaking out because he wouldn't let me start presenting and I got super stressed because I thought I was doing something wrong. lol

 

[blackcadillacs]

So much great information here, thank you everyone! It seems like I will have to do a peds inpatient rotation, or at least get some shadowing in, to really decide what route to go.

^ and I actually meant there is much less hematology with adults, which is one reason peds hem/onc is appealing, since it's much more hematology heavy!

I do have another question to complicate things a little more - I am geographically tied to Northern CA where there are only 2-3 hem/onc fellowship programs, all of which seem like they'd be extremely competitive (ucsf, stanford, chori). It's very important to me to stay close to my family, which would enormously limit the fellowships I'd apply to. Therefore, a huge concern for me is that I go through a peds residency with the intent of doing hem/onc and then not get into a fellowship.

Is it valid to be concerned about that? There are other residencies I can see myself happy in too, so if it's unwise to bank all of my future career goals on the idea of getting a UCSF or Stanford fellowship, then maybe I would be better off in a different residency =\

 

[philodendron9]

Be very careful about locking yourself into a small handful of hematology (or residency) programs due to geography or other reasons. Aside from competitiveness issues, you may discover that your interests and needs are better met at a center outside of the most convenient location and find that you are choosing between so-so (for your interests) training near your family vs. well-suited training farther away.

 

[dbeast]

So much great information here, thank you everyone! It seems like I will have to do a peds inpatient rotation, or at least get some shadowing in, to really decide what route to go.

^ and I actually meant there is much less hematology with adults, which is one reason peds hem/onc is appealing, since it's much more hematology heavy!

I do have another question to complicate things a little more - I am geographically tied to Northern CA where there are only 2-3 hem/onc fellowship programs, all of which seem like they'd be extremely competitive (ucsf, stanford, chori). It's very important to me to stay close to my family, which would enormously limit the fellowships I'd apply to. Therefore, a huge concern for me is that I go through a peds residency with the intent of doing hem/onc and then not get into a fellowship.

Is it valid to be concerned about that? There are other residencies I can see myself happy in too, so if it's unwise to bank all of my future career goals on the idea of getting a UCSF or Stanford fellowship, then maybe I would be better off in a different residency =\

If you can somehow expand your choices to all of California, then you'll be set. With that being said, if you're already in NorCal, have a strong application, and can start making connections now, then those programs you mentioned are certainly doable. Try and do residency in the area if possible to continue those relationships. Heme/onc is competitive, but peds subspecialties in general tend to be easier than their IM counterparts.

 

[hmockingbird]

So much great information here, thank you everyone! It seems like I will have to do a peds inpatient rotation, or at least get some shadowing in, to really decide what route to go.

^ and I actually meant there is much less hematology with adults, which is one reason peds hem/onc is appealing, since it's much more hematology heavy!

I do have another question to complicate things a little more - I am geographically tied to Northern CA where there are only 2-3 hem/onc fellowship programs, all of which seem like they'd be extremely competitive (ucsf, stanford, chori). It's very important to me to stay close to my family, which would enormously limit the fellowships I'd apply to. Therefore, a huge concern for me is that I go through a peds residency with the intent of doing hem/onc and then not get into a fellowship.

Is it valid to be concerned about that? There are other residencies I can see myself happy in too, so if it's unwise to bank all of my future career goals on the idea of getting a UCSF or Stanford fellowship, then maybe I would be better off in a different residency =\

Ahh, that makes a lot more sense lol. Yeah, I would try to get in an inpatient rotation or shadow. At my school, it's really easy to set up shadowing with pretty much any department... I think I just did this through the main office during 1st and 2nd year.

I've heard that fellowships can really be about your connections. I interviewed at one residency (actually my top choice) where at least half the fellowships its grads got were at a nationally-known, top program... b/c it was just down the street so I imagine it's easy to make connections there. Otherwise I don't know much about that process yet.