Hate peds residency

[Natremia]

As the title says,

I’m a peds resident and I dread waking up each morning for work. I am utterly drained at the end of each day. I hate rounding. I hate endless notes. I hate care coordination. I miss doing procedures. I absolutely hate the passive aggressive nature of peds: it drives me nuts.

The problem is I’m just not a very competitive applicant on paper (good board scores and interesting background (or so I was told during IVs) but I do have a red flag in my app and I’m not an MD to boot).

I just am at a loss for what to do. I have somewhat enjoyed my time in the peds ED (but 60% match rate this past cycle: yikes...) and I did a sports medicine rotation that I enjoyed. But, neither are fields that I would love, simply would not hate my life in. I am nervous about pursuing either because I don’t want to provide suboptimal care to patients because I picked something I just didn’t hate. I did a peds radiology rotation in med school and totally loved it but again knew I wasn’t competitive for rads so didn’t pursue it.

I don’t know what to do. I’d love any guidance and input from those who have gone through something similar/ know someone who did/ etc etc

Thank you for your time!

P.S. Please do not quote me.

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[xffan624]

Finish your residency. Get a job working in a Peds urgent care. Lots of procedures. Super sick patients go to the hospital.

 

[GoSpursGo]

Agree on urgent care. Also consider PICU which isn’t a particularly competitive fellowship.

 

[rokshana]

<removed quoted post>

So is it the patient population or the grind of residency?
This time of the year, practically everyone gets tired and frustrated with residency...you may have gone without a vacation for a few months, see your non medical friends with regular lives, are sleep deprived and it’s caught up, etc.

if it’s the latter, then you will get over the hump.
If it’s the former, then you have a bigger problem. Not sure how to fix that since practically any fellowship will still involve kids... maybe adolescent medicine since they are older?

 

[Throwawaydoc]

Finish your residency. Get a job working in a Peds urgent care. Lots of procedures. Super sick patients go to the hospital.

So is it the patient population or the grind of residency?
This time of the year, practically everyone gets tired and frustrated with residency...you may have gone without a vacation for a few months, see your non medical friends with regular lives, are sleep deprived and it’s caught up, etc.

if it’s the latter, then you will get over the hump.
If it’s the former, then you have a bigger problem. Not sure how to fix that since practically any fellowship will still involve kids... maybe adolescent medicine since they are older?

The OP said please don’t quote me, but both of you quoted them. Perhaps you can edit your posts to remove the OP quote?

 

[xffan624]

The OP said please don’t quote me, but both of you quoted them. Perhaps you can edit your posts to remove the OP quote?

Sorry I missed the request.

 

[HemeOncHopeful19]

Is it possible you just hate having the crappy job that residency is? This time of year is traditionally the worst for PGY1s in 3 year specialties (not sure how far along you are) as far as burnout/dissatisfaction goes.

The newness of residency is wearing off, you’ve just made it through the holidays and realized that all your non-MD friends have a much better lifestyle, and you’re not far enough along to see a light at the end of the tunnel.

 

[NotAProgDirector]

Finish peds residency. You haven't mentioned where you are in the training timeline. If you're a PGY-1, you might find it much better as a PGY-2+. If you're a PGY-2, then you're half way done. Since you mention a red flag and not being competitive, dropping peds and hoping for something else is not a good plan, unless you are interested in Pathology.

After completing residency, you have options:
1. Find a practice niche you're happy with. Urgent care has been mentioned. There are others.
2. Consider fellowship. Allergy will actually let you see both adults and kids. PICU. Sports. There are others.
3. Consider applying to a new field in your 3rd year of Peds. Perhaps you weren't the best candidate when you graduated, but after 3 clinical years programs may be more interested. You'll be that much farther away from your "red flag". Also might be interested in people who want to focus on Peds Radiology. The split of IR and DR into separate fields has made DR less competitive. There's almost no down side to this other than the damage to your ego if you don't get a spot -- and if you don't care about that, then there's no downside.

 

[BobBarker]

Finish peds and do anesthesia next. Just 3 years more.

 

[BobBarker]

I empathize with you. We had to do an excessive amount of picu and nicu in our anesthesia residency. The catty behavior, intentionally making each other miserable, self flagellation present in the pediatrics residents was terrible. The anesthesia residents would manage the same patients and same number of patients and be done with everything by 10am and the pediatric residents would be trying to dodge checkout at 5pm. They would try to out ”care” each other by staying until 10pm for no reason. The late shift resident would intentionally try to keep everyone there until 7 just because. Really it was an awful mess created by their own terrible decisions or personalities.

 

[solitarius]

But they're ALL so nice!

 

[rokshana]

Finish peds and do anesthesia next. Just 3 years more.

I thought peds anesthesia was a fellowship out of anesthesia... you can do it the other way?

 

[GoSpursGo]

I thought peds anesthesia was a fellowship out of anesthesia... you can do it the other way?

So this wouldn't be a peds fellowship, this would be doing a completely separate anesthesia residency after doing a peds residency. Voila, board-certified in peds and anesthesia.

Out of the various "do another residency" options presented here, this is the first one I see where the OP would make use of their peds training, so it's something to consider.

 

[GoSpursGo]

I empathize with you. We had to do an excessive amount of picu and nicu in our anesthesia residency. The catty behavior, intentionally making each other miserable, self flagellation present in the pediatrics residents was terrible. The anesthesia residents would manage the same patients and same number of patients and be done with everything by 10am and the pediatric residents would be trying to dodge checkout at 5pm. They would try to out ”care” each other by staying until 10pm for no reason. The late shift resident would intentionally try to keep everyone there until 7 just because. Really it was an awful mess created by their own terrible decisions or personalities.

But they're ALL so nice!

Sounds like you guys trained at a place where the peds residency had a crappy culture. It does not need to be so.

 

[Goro]

As the title says,

Very sorry to hear this, but can you enlighten us, didn't you know what you were getting into?

 

[Natremia]

Thank you to all who have replied so far. I’ll tag people in response so as to not quote (would seem rather hypocritical of me).

@xffan624 thank you for that suggestion. I worry I would be bored out of my mind with urgent care. Even with my ED shifts sometimes the low acuity aspect of it all, in general, bores me. Though, I do like the unpredictable nature in general so this is an idea for me to ponder.

@GoSpursGo I’ve considered PICU but I just really hate rounding. I do like the procedures and acuity of it, though sometimes the chronic kids and deaths do get to me. I’m unsure if I could make a career out of telling people their child has died..

@NotAProgDirector I’ve considered this. Especially since I know peds rads isn’t competitive. Still that would be 8 year total training, which is a long time (4 more years of rads and 1 year of peds rads). Though, I guess beggars can’t be choosers. And, no ego issues here. I just want to be happy and provide excellent medical care (and pay off my massive debt...).

@BobBarker I’ve actually really considered anesthesia! I excel at and really like pharm and physiology. Though, like rads, I didn’t think I would be competitive in med school due to my red flag + DO combo so never pursued it. Perhaps finishing peds residency would make me a much stronger candidate? Not sure. Ironically, I once also considered the dual residencies.

Thank you all for your contributions so far. I am quite miserable each day. But I have a lot of debt (400k) so I’m just trying to forge ahead, doing my best to be a team player, and am working hard. I guess that’s all I can do right now.

 

[BobBarker]

@Natremia I don’t think you will have any problems. Completing your residency, should be enough to negate your red flag and being a DO won’t matter. Like stated above, apply to advanced anesthesia positions to start after you complete your residency. You will still just have 6 years in and will make a lot more money than a pediatric GI or whatever else you would do. Which you will clearly need a lot of money to pay off $600k in debt by the time you finish. 🤮

 

[wendalltwolf]

Had a friend who’s a DO and did anesthesia after pediatrics, I say go for it.

 

[BigRedBeta]

Not procedural, but might hit well on your other boxes (wanting to provide excellent care, not really a "rounding" specialty) is Child Abuse Peds.
Its a different beast to be sure, but you'd be making a difference, the care coordination is done by SW/Case Management and you'll spend more time working with the court system than in the hospital.

Also, do you think you could be competitive for Peds Cardiology? Can do Interventional or EP if you need the procedures, or an imaging (echo/3D echo/cardiac MRI) superfellowhip may scratch that radiology itch. You'll have to put up with rounding in fellowship, but might be more tolerable when you're in a position of greater agency.

A lot of your complaints are actually institutionally dependent - how much care coordination the residents have to do, the culture of the program. Even how rounds are organized can be very different. Additionally, as a residency, peds is a lot more inpatient specific than most actual practice is as an attending, but for example, most places don't put residents into Heme/Onc clinic routinely, and that's a very different experience than the Onc wards. I'd try not to miss the forest for the trees.

 

[Natremia]

To piggy back off my own thread lol. Hopefully not a totally stupid question but.... does the research one does in residency have to be specific to the field they apply? Say I end up applying for fellowship. Lets use cards as an example, but did research in something more general (a QI in xyz) would that be frowned upon? Or, is it a de facto check box to have specific research in the field you are going into?

I kinda feel like this is a really dumb question....

 

[Mad Jack]

Agree on urgent care. Also consider PICU which isn’t a particularly competitive fellowship.

Just gotta deal with dying kids, nbd

 

[GoSpursGo]

Just gotta deal with dying kids, nbd

Well I'm in peds onc, so I made my peace with that a while back

 

[Mad Jack]

Well I'm in peds onc, so I made my peace with that a while back

Thank god there's people like you in the world who can do it. Though people say stuff like that about child psych too and that's my area so I guess medicine really needs all types

 

[rokshana]

To piggy back off my own thread lol. Hopefully not a totally stupid question but.... does the research one does in residency have to be specific to the field they apply? Say I end up applying for fellowship. Lets use cards as an example, but did research in something more general (a QI in xyz) would that be frowned upon? Or, is it a de facto check box to have specific research in the field you are going into?

I kinda feel like this is a really dumb question....

No, though if you have a lot of say, gi research and now you are applying to critical care, it may raise some eyebrows... but research... good research will have value.

 

[GoSpursGo]

To piggy back off my own thread lol. Hopefully not a totally stupid question but.... does the research one does in residency have to be specific to the field they apply? Say I end up applying for fellowship. Lets use cards as an example, but did research in something more general (a QI in xyz) would that be frowned upon? Or, is it a de facto check box to have specific research in the field you are going into?

I kinda feel like this is a really dumb question....

Research in the field you're applying to is ideal because it gives them some idea of the direction you want to take your career. But ANY research is good because it shows that you're a curious person who wants to contribute to increasing scientific knowledge, which isn't the case for everyone in medicine.

Even fewer are able to demonstrate commitment to a project and see it through to publication. So bottom line, any research that you do that is meaningful is going to help you down the line.

 

[mcat_taker]

No one has mentioned doing fellowship in PEM or NICU. Both procedurally oriented if you miss procedures. Higher acuity and shift work. Perhaps OP you would like them? Rather than starting over after peds.

 

[GoSpursGo]

No one has mentioned doing fellowship in PEM or NICU. Both procedurally oriented if you miss procedures. Higher acuity and shift work. Perhaps OP you would like them? Rather than starting over after peds.

The OP mentioned PEM, but is concerned about the pretty low match rate and potentially not being a competitive applicant. NICU is not AS competitive, but you ARE rounding forever which the OP didn't like.

 

[Natremia]

I appreciate everyone’s input so far.

To respond:

PEM— I actually like it a lot: quick in and quick out, procedures, quick non-485 page length notes, NO rounding; wish the trauma aspect was more but can’t win em all! Abysmal match rate though so not confident.....

NICU— I do love babies. Cool physiology and pathophys. I enjoy the OR and procedures but man you round and round and round... rounding literally ages me: I feel my soul being sucked away each day I do it.

Im still miserable each day. Part of which is my extremely toxic program. That is partly why I took so long to make the post (trying to figure out if I hated my malignant program or peds in general, turns out it’s both: yay (sarcasm)).

Still at a loss for what to do. I absolutely dread waking up each day: sucks...

 

[WholeLottaGame7]

I second the Finish Peds Residency --> Anesthesia --> Peds Anes Fellowship route, if you like kids and procedures but hate rounding. Tons of people have gone that route, any major academic peds anesthesia division will have several of those people on faculty.

You don't mention what exactly the red flag is, which is the big wild card, but being a DO isn't a huge strike against you. Neither is research in a different field, as long as you can articulate what led to your change of heart.

I'd at least look into that possibility to see how feasible it would be.

 

[mcat_taker]

I appreciate everyone’s input so far.

To respond:

PEM— I actually like it a lot: quick in and quick out, procedures, quick non-485 page length notes, NO rounding; wish the trauma aspect was more but can’t win em all! Abysmal match rate though so not confident.....

NICU— I do love babies. Cool physiology and pathophys. I enjoy the OR and procedures but man you round and round and round... rounding literally ages me: I feel my soul being sucked away each day I do it.

Im still miserable each day. Part of which is my extremely toxic program. That is partly why I took so long to make the post (trying to figure out if I hated my malignant program or peds in general, turns out it’s both: yay (sarcasm)).

Still at a loss for what to do. I absolutely dread waking up each day: sucks...

Who cares if PEM is competitive if it's what you like start tailoring your app/CV/network for it and gun for it. You won't know unless you try.

 

[SurfingDoctor]

Agree on urgent care. Also consider PICU which isn’t a particularly competitive fellowship.

Just so people know this is wrong. The match rate for PICU applicants was about 80% last year, where ED was 72%. These are only superseded by PHM, which has a match rate of only 68%.

Those three subspecialties are consistently the most competitive annually for pediatric residents.

Press Release: NRMP Releases Results of Pediatric Specialties Match for Appointment Year 2021 - The Match, National Resident Matching Program

1,414 matched applicants to begin pediatric fellowship training positions in July 2021 Washington, D.C., December 21, 2020 – The National Resident Matching Program® (NRMP®) has released the results of the 2020 Pediatric Specialties Match (PSM) for appointment year 2021. The 2020 PSM surpassed...

www.nrmp.org

 

[SurfingDoctor]

I appreciate everyone’s input so far.

To respond:

PEM— I actually like it a lot: quick in and quick out, procedures, quick non-485 page length notes, NO rounding; wish the trauma aspect was more but can’t win em all! Abysmal match rate though so not confident.....

NICU— I do love babies. Cool physiology and pathophys. I enjoy the OR and procedures but man you round and round and round... rounding literally ages me: I feel my soul being sucked away each day I do it.

Im still miserable each day. Part of which is my extremely toxic program. That is partly why I took so long to make the post (trying to figure out if I hated my malignant program or peds in general, turns out it’s both: yay (sarcasm)).

Still at a loss for what to do. I absolutely dread waking up each day: sucks...

I agree with urgent care. There are lots of places that have dedicated urgent care positions within hospital and university systems.

As for rounding, I mean, who likes rounding? But nearly every specialty has rounding, unless, like you mentioned there is some diagnostic specialty only.

The other option is to reapply to a different specialty. I would still suggest completing the residency you are in because jumping ship mid-residency can be a red flag on an application, but could apply to something else. Trying to think of a profession with procedure related things without rounding, have you ever considered pathology? I have no idea what the competitiveness of that field is, but it would meet some of your criteria. Ultimately though, you probably shouldn't pursue something you hate indefinitely, though you may have to push on temporarily to complete this part and then continue in training till you find something that doesn't make you smack yourself in the face every morning.

 

[GoSpursGo]

Just so people know this is wrong. The match rate for PICU applicants was about 80% last year, about the same as ED. These are only superseded by PHM, which has a match rate of only 68%.

Huh good to know. I wonder if that’s a change from when I applied for my own fellowship some 6-7 years ago, or if my perception was just off.

In any event thanks for the correction

 

[SurfingDoctor]

Huh good to know. I wonder if that’s a change from when I applied for my own fellowship some 6-7 years ago, or if my perception was just off.

In any event thanks for the correction

Yes, about 5 years ago or so, it went from typically programs going unfilled to now applicants going unmatched. I don't know the specific reason, but compensation would be my best guess. Of course, its probably the subspecialty in which its one of the hardest to get jobs since it is only tertiary hospital-based, but anywho.

 

[Gastrapathy]

One thing I don’t see mentioned yet is...outpatient clinic. Clinic is terrible as a resident and there are often very few good mentors. But a traditional outpatient practice has lots of advantages including potentially owning your own business, setting your own hours, etc. Before jumping into another residency, you might want to just be an outpatient pediatrician for a year or two. It’s hard to know what you’ll like when you’re in this kind of cycle.

 

[FrkyBgStok]

I am in a DO in PEM and this match rate was crazy because of covid so everyone who wasn’t sure if they wanted PEM applied whereas when you pay for travel and everything associated with it, you get the people that actually want to be there more.

Med school matters much less for fellowship and talking to my program director, they want to see you did something in fellowship. Can be research, QI, teaching, basically anything as long as you do it well. I think PEM is a good choice for you for the same reasons I love it. No rounding, clinic is miserable, etc. and you can make physiology and pharm a big part of it like i have. Get involved in stuff in residency and then just apply broadly. Yes it is competitive but it is better to have someone who was lackluster in med school and who killed in peds residency than someone who killed it in med school and was lackluster in residency.

 

[SurfingDoctor]

Two points in general...

1) No one cares about your clinical grades in fellowship...

2) The concept that because people like kids they are less passive-aggressive... is a complete fallacy. Most people who pursue a MD are like that... at the end of the day, you have to enjoy the pathology and people that your treat... not your colleagues/peers idiosyncrasies...