High unfilled numbers this year in pediatrics

[oldbearprofessor]

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This discussion has morphed a bit into what is a very interesting discussion of academic careers and research careers in pediatrics. Speaking from my career experiences and experiences as a senior academic faculty, I can say that the rewards of academics really come from enjoying this environment and having the willingness to accept things like a lower wage, often demanding deadlines, and the real stress of funding that never stops. But the rewards of being an educator and influencer in policy and practice are real as well. Each person needs to evaluate these trade-offs and make their best decision. However, here can be no doubt that it is very difficult to maintain a long-term academic research career and getting a good start with a K award is no guarantee of long-term success in getting the funding needed to make this happen. There is no easy answer to this.

 

[SurfingDoctor]

I've posted this in other threads... but this is the gospel on the topic of academics...

Understanding Academic Medical Centers: Simone’s Maxims

Academic medical centers today represent a unique fusion of traditional academia, hospital functions, several levels of education, and, above all, patients. They are complex organizations trying to discharge an often conflicting melange of responsibilities. This complexity has grown in recent...

aacrjournals.org

Even though its 25 years old at this point, it's still 100% on point.

 

[sloh]

Thread has been a great read. Best thread on SDN right now imo

 

[Splenda88]

Yea, true research careers need addition training. And yes, true research careers need support early on. And unfortunately, neither of those things are desirable from an individual and institutional standpoint, respectively, anymore. I personally view it as a tragedy and one of the several reasons that physicians have become and will continue to be easily replaced by APRNs.

I mean, doing research makes one think critically. Not just in critical illness and acute situations, but globally. But to think critically, you need foundational knowledge. You need mechanistic expertise. All of that has been thrown out though in the modern era. You just follow the recipe (ie protocol). There’s no foundational knowledge or critical thinking skills in any of that, it’s literally following the flow diagram. The physicians’ skill (driven mostly by the business of medicine and top level ineptitude) of emphasizing Press Ganney surveys and not understanding the NADPH replenishment via Pentose Phosphate Shunt has made physicians non-cognitive operators. Maybe there is a reversal in all of that, but frankly, I mostly see physicians and institutions doubling down.

Oh well.

Can you elaborate on that?

 

[SurfingDoctor]

Can you elaborate on that?

Well, in most pediatric subspecialties, there is required scholarly activity. Unfortunately, by nature, most people don't want to do research or any sort of scholarly pursuit. If they did, they would need institutional by in and infrastructure to support it and to make it more rigorous. Often that requires financial investment for the institution and additional time from the individual to learn. However, both of those things are costly to both the individual and the institution because there are both opportunity and direct costs to both the individual and the institution. From a strictly business standpoint, it makes sense to generate money in the quickest and most cost-effective manner possible. That means, providing no institutional monetary support to the individual and in turn, the individual providing the least amount of effort to the institution. The net result is a generation of "just-qualified enough" physicians at the completion of training.

However, as was stated in Simone's Maxims number 1 and 2, the institution doesn't love you back AND has a much longer time scale for both direct and opportunity cost. At the end of the day, it’s a very slow machine designed, above all other things, to generate money for itself. Now, if the institution generates "just-qualified enough" physicians, it starts to realize that the difference between just-qualified enough physicians is similar to just-qualified enough APRNs. They both can follow the same CPG. The both can be told to order less labs. They both can be given the right text to get the maximum return on a DRG. All of those things generate the exact same revenue for the institution. In fact that skill set becomes so close, that it becomes unnecessary to pay someone more to do essentially the same thing, as the institution would rather pocket the difference, usually to build more infrastructure to repeat the same process. These also result in Maxims numbers 3 and 4, which is exactly how the first paragraph came to be in the first place and the cycle perpetuates till the wheels come off. Though again, for the institution, the wheels never really come off.

 

[DO2015CA]

Well, in most pediatric subspecialties, there is required scholarly activity. Unfortunately, by nature, most people don't want to do research or any sort of scholarly pursuit. If they did, they would need institutional by in and infrastructure to support it and to make it more rigorous. Often that requires financial investment for the institution and additional time from the individual to learn. However, both of those things are costly to both the individual and the institution because there are both opportunity and direct costs to both the individual and the institution. From a strictly business standpoint, it makes sense to generate money in the quickest and most cost-effective manner possible. That means, providing no institutional monetary support to the individual and in turn, the individual providing the least amount of effort to the institution. The net result is a generation of "just-qualified enough" physicians at the completion of training.

However, as was stated in Simone's Maxims number 1 and 2, the institution doesn't love you back AND has a much longer time scale for both direct and opportunity cost. At the end of the day, it’s a very slow machine designed, above all other things, to generate money for itself. Now, if the institution generates "just-qualified enough" physicians, it starts to realize that the difference between just-qualified enough physicians is similar to just-qualified enough APRNs. They both can follow the same CPG. The both can be told to order less labs. They both can be given the right text to get the maximum return on a DRG. All of those things generate the exact same revenue for the institution. In fact that skill set becomes so close, that it becomes unnecessary to pay someone more to do essentially the same thing, as the institution would rather pocket the difference, usually to build more infrastructure to repeat the same process. These also result in Maxims numbers 3 and 4, which is exactly how the first paragraph came to be in the first place and the cycle perpetuates till the wheels come off. Though again, for the institution, the wheels never really come off.

Meh I think it’s subspecialty dependent too. Quit making them protocol based where a cog in the wheel can be changed and encourage critical thinking. Mine (pulm) has very little and I feel confident APRNs couldn’t replace me.

 

[SurfingDoctor]

Meh I think it’s subspecialty dependent too. Quit making them protocol based where a cog in the wheel can be changed and encourage critical thinking. Mine (pulm) has very little and I feel confident APRNs couldn’t replace me.

I’ve been doing this for 20 years and I see no reverse in the trend.

Our children’s hospital’s Pulmonary service is ranked in the Top 20 for US News (for whatever that’s worth) and the entire Pulmonary Hypertension service is run by an APRN. Of course, there’s a MD in the Director position, but that’s all for show as they don’t do any clinical time. It’s the APRN that runs the show and everyone knows it, because at the end of the day, it’s about following the CPG. Just FYI.

 

[DO2015CA]

I’ve been doing this for 20 years and I see no reverse in the trend.

Our children’s hospital’s Pulmonary service is ranked in the Top 20 for US News (for whatever that’s worth) and the entire Pulmonary Hypertension service is run by an APRN. Of course, there’s a MD in the Director position, but that’s all for show as they don’t do any clinical time. It’s the APRN that runs the show and everyone knows it, because at the end of the day, it’s about following the CPG. Just FYI.

Meh PH is mainly controlled by cardio in a lot of places which is fine. It’s extremely boring. I’m referring to most bread-and-butter pulmonary diseases. The chronic coughers, gray zone asthmatics, aspirators, even trach-vent, rheumatologic disease affect on lungs, etc. All of these shouldn’t run off protocols because they have fine details that determine the etiology. Many well trained pediatricians can’t distinguish these. If there is a world where hospital system force midlevels because they’re cheaper and pts get worse care then that’s one thing but to say they can replace and do a great job is wrong. Too many steroids for not actual steroid responsive pulmonary diseases has been my experience with even the pulm APRNs.

 

[SurfingDoctor]

Meh PH is mainly controlled by cardio in a lot of places which is fine. It’s extremely boring. I’m referring to most bread-and-butter pulmonary diseases. The chronic coughers, gray zone asthmatics, aspirators, even trach-vent, rheumatologic disease affect on lungs, etc. All of these shouldn’t run off protocols because they have fine details that determine the etiology. Many well trained pediatricians can’t distinguish these. If there is a world where hospital system force midlevels because they’re cheaper and pts get worse care then that’s one thing but to say they can replace and do a great job is wrong. Too many steroids for not actual steroid responsive pulmonary diseases has been my experience with even the pulm APRNs.

Ok

 

[dozitgetchahi]

Now I’m going to vent. There was an MD/PhD in the lab. They had no school debt. It was paid off to by their PhD department.

This person was brought into the lab and handed a great project. They submitted a K-grant (junior faculty award) with no data they personally generated and it got scored pretty well, but not funded. The biggest driver against the grant was not the science (which is a rarity for a K) but the candidate. That person, instead of improving themselves and their candidacy, left to go into private practice.

I’m not faulting them because frankly, they sucked at research, but they were given an opportunity and pissed it away. And they did it not because they needed the money, but because they wanted more money.

Just another reason this field doesn’t incentivize good citizens and screws it up for those who follow.

/vent

Meh. I’m betting there was a lot of silly political BS involved here that we’re not hearing about.

Can’t blame anyone for bailing out of academia. I trained in very “high academic” places for residency/fellowship and left for PP after burning out as a fellow under all the pressure to produce, dealing with gigantic attending egos, etc. My wife is a “recovering academic” who left a psych PhD program after having her PhD dragged out by something like 8 years because a micromanaging advisor wanted her to keep re-editing her thesis a bazillion times and moving commas around etc (she gave up dealing with the woman, got a masters and got the hell out - she was just cheap labor to them and everyone knew it by the end).

Academia is laden with BS. I can’t blame anyone for having enough of it and moving on.

 

[SurfingDoctor]

Meh. I’m betting there was a lot of silly political BS involved here that we’re not hearing about.

Can’t blame anyone for bailing out of academia. I trained in very “high academic” places for residency/fellowship and left for PP after burning out as a fellow under all the pressure to produce. My wife is a “recovering academic” who left a psych PhD program after having her PhD dragged out by something like 8 years because a micromanaging PD wanted her to keep re-editing her thesis a bazillion times and moving commas around etc (she got a masters and got the hell out).

Academia is laden with BS. I can’t blame anyone for having enough of it and moving on.

Maybe. I guess they can speak for themselves in 20 years when they are being called by the bedside nurse at home that a child’s BP is undectable.

 

[Putkernerinthehall]

I’ve been doing this for 20 years and I see no reverse in the trend.

Our children’s hospital’s Pulmonary service is ranked in the Top 20 for US News (for whatever that’s worth) and the entire Pulmonary Hypertension service is run by an APRN. Of course, there’s a MD in the Director position, but that’s all for show as they don’t do any clinical time. It’s the APRN that runs the show and everyone knows it, because at the end of the day, it’s about following the CPG. Just FYI.

Remind me not to seek care for PH at your facility. I make it a point to, every time I need to be seen, ask for an MD. Why pay for a NP/PA if it costs the same as an MD? The public needs to push back.

 

[DarkBluMage]

Remind me not to seek care for PH at your facility. I make it a point to, every time I need to be seen, ask for an MD. Why pay for a NP/PA if it costs the same as an MD? The public needs to push back.

I never see NPs/PAs. I don’t play with my health. I’m paying to see an expert in medicine.

 

[SurfingDoctor]

Remind me not to seek care for PH at your facility. I make it a point to, every time I need to be seen, ask for an MD. Why pay for a NP/PA if it costs the same as an MD? The public needs to push back.

Personally, I'd be okay with that. Refractory PH is an awful death.

 

[dozitgetchahi]

Maybe. I guess they can speak for themselves in 20 years when they are being called by the bedside nurse at home that a child’s BP is undectable.

My worst day in PP was better than my best day in academic medicine.

 

[SurfingDoctor]

My worst day in PP was better than my best day in academic medicine.

Congrats I guess.

 

[SurfingDoctor]

I will say, I have found my home in academics and scientific pursuits. Honestly... the discovery aspects of it... I love it. I can't imagine my life otherwise.

That being said.... maybe it's the Old Fashioned(s) or Buck Owens talking... but I hope the younger generations get some balls and tear the mofo down. I'm not in this for the money or prestige... but I think we should, as a field, move toward a better future.. for everyone. But, there are too many fools and incompetents at the top of the pyramid scheme.

As was once said by the prophets of old...

 

[SurfingDoctor]

As was once said by the prophets of old...

My wife who is in institutional admin and knows salaries (up to the CEO)... told me that some random NP makes $100K/year more than me. Enough that the institution had to break the rules to keep the salary. I mean, I get it... they prescribe way more Z-pacs than I perform CPR and I don't blame them, but still what the system rewards is nuts...

Again, I don't really care that much about money as I live comfortably and don't think I need more (so much as everyone else deserves less)... but I hope this whole system burns down....

Ode to the AAP and to the US healthcare system...

 

[SurfingDoctor]

Opinion | Why Doctors Aren’t Going Into Pediatrics

Some kids are unable to get the care they need because of a shortage of pediatricians, and the problem could get worse.

www.nytimes.com

 

[DO2015CA]

Opinion | Why Doctors Aren’t Going Into Pediatrics

Some kids are unable to get the care they need because of a shortage of pediatricians, and the problem could get worse.

www.nytimes.com

Nice read. At least from the medical students I talk to, it’s only going to get worse with this hospitalist fellowship. I have a couple that are interested in peds and hospital medicine but are choosing internal because they value being a hospitalist more than only treating kids

 

[SurfingDoctor]

Nice read. At least from the medical students I talk to, it’s only going to get worse with this hospitalist fellowship. I have a couple that are interested in peds and hospital medicine but are choosing internal because they value being a hospitalist more than only treating kids

Oh, I'm anxious (as in like excited) to slowly watch the wheels come off (if they can) and some crisis institute change. We just had a discussion the other day in our own faculty group about how we are graduating too many fellows for a constrained labor market. When the question was posed to the PD about how other PD they interact with plan to address the issues, the answer was things will just "autocorrect". Like WTAF does that even mean? There's a problem now and the action (or inaction) is to sit down in the Barcalounger, smoke a stogie with a cocktail and listen to Vera Lynn's "We'll Meet Again"? Ha... okay. Genius!

Having done this long enough, these "calls to action" are meaningless. Congress isn't going to expand Medicaid payouts and many states (including my rural state) are just a happy to gut state-funding to the program. So pay is never going to improve. Honestly, people are NEVER going to vote to improve the healthcare of children, like ever. That's just not how this country works. A vast majority of people only vote for their own self-interests (and I mean that on an individual level, not even on a family level).

I suppose if the wheels come off for healthcare for children, maybe something will happen, but children are robust and can't vote, and adults and the elderly are frail and can... so I'm going to go into the nothing will ever change camp.

 

[DO2015CA]

Oh, I'm anxious (as in like excited) to slowly watch the wheels come off (if they can) and some crisis institute change. We just had a discussion the other day in our own faculty group about how we are graduating too many fellows for a constrained labor market. When the question was posed to the PD about how other PD they interact with plan to address the issues, the answer was things will just "autocorrect". Like WTAF does that even mean? There's a problem now and the action (or inaction) is to sit down in the Barcalounger, smoke a stogie with a cocktail and listen to Vera Lynn's "We'll Meet Again"? Ha... okay. Genius!

Having done this long enough, these "calls to action" are meaningless. Congress isn't going to expand Medicaid payouts and many states (including my rural state) are just a happy to gut state-funding to the program. So pay is never going to improve. Honestly, people are NEVER going to vote to improve the healthcare of children, like ever. That's just not how this country works. A vast majority of people only vote for their own self-interests (and I mean that on an individual level, not even on a family level).

I suppose if the wheels come off for healthcare for children, maybe something will happen, but children are robust and can't vote, and adults and the elderly are frail and can... so I'm going to go into the nothing will ever change camp.

I don’t think money will raise as you say but my hope would be for the fellowship to dissolve and for subspecialty fellowships to transition to 2 years with 3rd year research track options.

 

[SurfingDoctor]

I don’t think money will raise as you say but my hope would be for the fellowship to dissolve and for subspecialty fellowships to transition to 2 years with 3rd year research track options.

I mean, yes everyone with more than 2 brain cells know a hospitalist fellowship is pointless, but even if that particular fellowship dissolves (and it won’t), none of that address other pediatric work force issues, nor cost, nor access to healthcare, etc.

The 2 year fellowship may encourage other to pursue subspecialty training due to 1 year less opportunity cost. In that regard, at least for some specialties, it may succeed, but temporarily. For my field, it will just speed the rate at which the labor market is completely saturated. Since I’m already employed, I guess I’m indifferent to that outcome.

 

[DO2015CA]

I mean, yes everyone with more than 2 brain cells know a hospitalist fellowship is pointless, but even if that particular fellowship dissolves (and it won’t), none of that address other pediatric work force issues, nor cost, nor access to healthcare, etc.

The 2 year fellowship may encourage other to pursue subspecialty training due to 1 year less opportunity cost. In that regard, at least for some specialties, it may succeed, but temporarily. For my field, it will just speed the rate at which the labor market is completely saturated. Since I’m already employed, I guess I’m indifferent to that outcome.

Are you saying hospital admin don’t have 2 brain cells? Cause if you are then I agree. lol.

Ya and for your subspecialty, one could argue should remain 3 years material wise. You do so many different systems management. But mine and many others can’t. We spend more time on research to kill time.

 

[SurfingDoctor]

Are you saying hospital admin don’t have 2 brain cells? Cause if you are then I agree. lol.

Ya and for your subspecialty, one could argue should remain 3 years material wise. You do so many different systems management. But mine and many others can’t. We spend more time on research to kill time.

Critical care training is not that hard. I once had an attending tell me as a new first year fellow they could teach a monkey to do my job. They weren’t wrong. And despite having 18 months of “research”, most fellows use it to do nothing research related.

Expanding or contracting that time in “training” doesn’t address labor market issues in the field.

 

[WheezyBaby]

Oh, I'm anxious (as in like excited) to slowly watch the wheels come off (if they can) and some crisis institute change. We just had a discussion the other day in our own faculty group about how we are graduating too many fellows for a constrained labor market. When the question was posed to the PD about how other PD they interact with plan to address the issues, the answer was things will just "autocorrect". Like WTAF does that even mean? There's a problem now and the action (or inaction) is to sit down in the Barcalounger, smoke a stogie with a cocktail and listen to Vera Lynn's "We'll Meet Again"? Ha... okay. Genius!

Having done this long enough, these "calls to action" are meaningless. Congress isn't going to expand Medicaid payouts and many states (including my rural state) are just a happy to gut state-funding to the program. So pay is never going to improve. Honestly, people are NEVER going to vote to improve the healthcare of children, like ever. That's just not how this country works. A vast majority of people only vote for their own self-interests (and I mean that on an individual level, not even on a family level).

I suppose if the wheels come off for healthcare for children, maybe something will happen, but children are robust and can't vote, and adults and the elderly are frail and can... so I'm going to go into the nothing will ever change camp.

Posed the same question to program leadership and was given the same answer (+we're applying for funding for an additional fellow). If/when we have a graduating trainee unable to find employment or relegated to undesirable employment maybe it'll shift perspective. I feel like there are blinders secured in place by some data on national PICU job forecasting that I'm too cynical to believe I suppose

 

[Putkernerinthehall]

If/when we have a graduating trainee unable to find employment or relegated to undesirable employment maybe it'll shift perspective. I feel like there are blinders secured in place by some data on national PICU job forecasting that I'm too cynical to believe I suppose

The quote here from WheezyBaby says "if and when we have a graduating trainee unable to find employment...." That doesn't sound like a current crisis. Is this a future fear or a current problem?

Expanding or contracting that time in “training” doesn’t address labor market issues in the field.

Pardon my ignorance, but what "market issues in the field"? Is the job market for graduating PICU fellows that poor? Are jobs are really hard to find? Pay is dropping? Can you, as practicing docs in the field, shed some light on regional demand, pay, etc. ?

 

[SurfingDoctor]

The quote here from WheezyBaby says "if and when we have a graduating trainee unable to find employment...." That doesn't sound like a current crisis. Is this a future fear or a current problem?


Pardon my ignorance, but what "market issues in the field"? Is the job market for graduating PICU fellows that poor? Are jobs are really hard to find? Pay is dropping? Can you, as practicing docs in the field, shed some light on regional demand, pay, etc. ?

Pay is not going down. Jobs are just harder to find than they used to be, especially jobs in desirable locations. I linked somewhere in this forum an AAP article about the future of the pediatric work force. It addressed the future labor market in it.

 

[WheezyBaby]

The quote here from WheezyBaby says "if and when we have a graduating trainee unable to find employment...." That doesn't sound like a current crisis. Is this a future fear or a current problem?


Pardon my ignorance, but what "market issues in the field"? Is the job market for graduating PICU fellows that poor? Are jobs are really hard to find? Pay is dropping? Can you, as practicing docs in the field, shed some light on regional demand, pay, etc. ?

I'm at a large program with a reasonable reputation. I think the challenges finding a job will be somewhat skewed by institution. Agree with surfingdoc though. Pay is good (in my eyes / within the spectrum of pediatric subspecialties) and not decreasing. Jobs exist, but if the job you want is in a generally desirable location, at a prestigious institution, etc, your options may be limited. If you're not geographically constrained, interested in private practice, etc then there are certainly options. My gestalt is if programs continue to expand fellowship size based on their clinical volume allowing rather than national job forecasting, things will eventually come to a head, but that's just my feeling based on fellow experience exploring the job market, certainly wouldn't claim to have expertise. I wouldn't consider the experts infallible in this regard though, see the progression of rad onc within quite a limited period of time.

Pay is not going down. Jobs are just harder to find than they used to be, especially jobs in desirable locations. I linked somewhere in this forum an AAP article about the future of the pediatric work force. It addressed the future labor market in it.

 

[SurfingDoctor]

I'm at a large program with a reasonable reputation. I think the challenges finding a job will be somewhat skewed by institution. Agree with surfingdoc though. Pay is good (in my eyes / within the spectrum of pediatric subspecialties) and not decreasing. Jobs exist, but if the job you want is in a generally desirable location, at a prestigious institution, etc, your options may be limited. If you're not geographically constrained, interested in private practice, etc then there are certainly options. My gestalt is if programs continue to expand fellowship size based on their clinical volume allowing rather than national job forecasting, things will eventually come to a head, but that's just my feeling based on fellow experience exploring the job market, certainly wouldn't claim to have expertise. I wouldn't consider the experts infallible in this regard though, see the progression of rad onc within quite a limited period of time.

There are no “experts” in the job market. If anything, the “leaders” often make decisions that directly counter reality. Think of the hospitalist fellowship and the requirement of scholarly activity. People who get elected to be head of program X aren’t because they understand the reality of the program, they just have friends in high places, or sometimes, literally no one wants that job and they find any old person to do it.

 

[Socrates25]

Okay folks, why let Reddit have all the fun with this topic! Why was there an approximate tripling of the number of unmatched positions in the pedi match this year to about 250? What can be done about this in the future?

Peds has always been low paying relative to other specialties but what's new is that the $$$ separation is getting way higher over time.

When I first entered training peds docs were paid about 30% less than other specialties. Now that gap is more like 50-75%.

Also the cost of med school education has more than doubled in that time period.

Med students that were previously sympathetic towards peds have now discovered the pay gap is too large and their loans too large to countenance that reality.

There's been a few med schools that have been given extraordinary grants to make their schools tuition free. So perhaps those schools might have more people who may go into peds because they dont have to worry about student loans. But I'm not optimistic.

 

[DO2015CA]

Peds has always been low paying relative to other specialties but what's new is that the $$$ separation is getting way higher over time.

When I first entered training peds docs were paid about 30% less than other specialties. Now that gap is more like 50-75%.

Also the cost of med school education has more than doubled in that time period.

Med students that were previously sympathetic towards peds have now discovered the pay gap is too large and their loans too large to countenance that reality.

There's been a few med schools that have been given extraordinary grants to make their schools tuition free. So perhaps those schools might have more people who may go into peds because they dont have to worry about student loans. But I'm not optimistic.

As much as people want to believe the gap is expanding which is only partially true for gen peds. The gap really shows itself in subspecialty. I am 1 of 2 from my graduating class that did subspecialty and the rest did pcp. All of their contracts were within 10-15k of the outpatient FM/IM jobs in their respective locations (perhaps this gap expands in California or northeast idk). Granted this is employed positions right out of training and might become differential overtime when production kicks in etc etc. Another anecdote is one of my best friends in a private owned peds outpatient group ~5 years out is making just at 300 in the west working 4 days per week. Of course these are anecdotal but when I decided to commit to fellowship I took a deep dive just to realize the amount of financial suicide I was making and that’s what I discovered.

 

[DarkBluMage]

Any hope for inpatient compensation rise on the horizon? I hate outpatient work. Being in clinic is so miserable to me.

 

[DO2015CA]

Any hope for inpatient compensation rise on the horizon? I hate outpatient work. Being in clinic is so miserable to me.

No. And with more competition for the spots they can underpay you. We are in an era where peds units are shutting down in community hospitals because of the financial loss to these business a-holes making decision. This is leaving children’s hospitals only as the majority of peds hospitalist positions. These children’s hospitals are disproportionately academic which then in turn pays like ****.

 

[DarkBluMage]

Hopefully something changes before I finish residency/fellowship

 

[DO2015CA]

Hopefully something changes before I finish residency/fellowship

Do another fellowship or don’t do fellowship at all. People choosing to do the hospitalist fellowship is part of the reason it persists

 

[DarkBluMage]

Do another fellowship or don’t do fellowship at all. People choosing to do the hospitalist fellowship is part of the reason it persists

I’m an M4. Planning to match peds and do a critical care or neonatology fellowship. Interested in nicu/picu cause I like to work with my hands and want some procedural work in my day to day.

 

[DO2015CA]

I’m an M4. Planning to match peds and do a critical care or neonatology fellowship. Interested in nicu/picu cause I like to work with my hands and want some procedural work in my day to day.

Oh ok. Sorry I misinterpreted your first message. When you said inpatient work I took that as hospitalist. Both of picu/nicu should increase your salary from outpatient

 

[DarkBluMage]

Oh ok. Sorry I misinterpreted your first message. When you said inpatient work I took that as hospitalist. Both of picu/nicu should increase your salary from outpatient

It’s all good, id think that would be the logical assumption. Glad to hear it’d actually be an increase. I heard most Peds fellowships actually decrease your pay which is kind of crazy to me.

 

[DO2015CA]

It’s all good, id think that would be the logical assumption. Glad to hear it’d actually be an increase. I heard most Peds fellowships actually decrease your pay which is kind of crazy to me.

Yes but that’s also pure dollars. People don’t take in account that most peds subspecialists are academic so they compare employed/private practice gen peds salary to academic salary. If you compare academic outpatient gen peds to subspecialty salaries they aren’t that far off.

 

[Oso]

It’s all good, id think that would be the logical assumption. Glad to hear it’d actually be an increase. I heard most Peds fellowships actually decrease your pay which is kind of crazy to me.

An increase from gen peds, and thus financially worth it, yes. Still significantly less paid than adult critical care specialties, sadly.

I believe some IM sub specialties also pay less, but their pay is still nice compared to peds (ex. adult vs peds endo) and there’s much more flexibility in the type of job you can get.

Agree that the hospitalist fellowships are a joke

 

[Putkernerinthehall]

Agree that the hospitalist fellowships are a joke

Meaning a joke in that the training is unnecessary? Or a joke in the sense that they result in poor compensation for the effort expended? Or a joke in some other way? A friend of mine is trading hospitalist vs critical care (PICU).

 

[WheezyBaby]

The training is unnecessary

 

[Oso]

Meaning a joke in that the training is unnecessary? Or a joke in the sense that they result in poor compensation for the effort expended? Or a joke in some other way? A friend of mine is trading hospitalist vs critical care (PICU).

Joke as in the training is unnecessary as most of peds residency is inpatient heavy and there is no need for an extra two years training. IM docs don’t need extra training to be a hospitalist.

 

[Splenda88]

Joke as in the training is unnecessary as most of peds residency is inpatient heavy and there is no need for an extra two years training. IM docs don’t need extra training to be a hospitalist.

IM training is "hospitalist" training. On the other hand, our outpatient training is not as good as our inpatient, but we still do outpatient with no issues.

There was talk about 1-yr IM hospitalist fellowship and it has never materialized because everyone laughed at it.

I might be wrong here, but I think it happens in peds it's probably because of the type of medical students peds attract.

To put it bluntly, people who pursue IM seem to be more aggressive than the ones who pursue peds based on my experience in medical school. That was simply my observation, but I could be wrong.

1-yr fellowship would not have been the end of the world, but 2-3 years is indefensible.

Look at what is happening to nephrology. They can't even find applicants so they are resorting to recruit FMG with no US residency training. Yes, it's a thing right now. These FMG are doing nephrology fellowship first and then IM. They are doing it in reverse because after a nephrology fellowship, they become competitive to get into IM.

The moment people find out working conditions (eg., salary, lifestyle etc..) are not ok, they flee. Peds and OBGYN prospects for some reason do not seem to care.

 

[Oso]

IM training is "hospitalist" training. On the other hand, our outpatient training is not as good as our inpatient, but we still do outpatient with no issues.

Peds residency has historically been very general inpatient heavy, plus ICU and ED. It’s the outpatient side that is underrepresented. Thus the hospitalist fellowship is redundant and unnecessary, even if it was one year

 

[DO2015CA]

IM training is "hospitalist" training. On the other hand, our outpatient training is not as good as our inpatient, but we still do outpatient with no issues.

There was talk about 1-yr IM hospitalist fellowship and it has never materialized because everyone laughed at it.

I might be wrong here, but I think it happens in peds it's probably because of the type of medical students peds attract.

To put it bluntly, people who pursue IM seem to be more aggressive than the ones who pursue peds based on my experience in medical school. That was simply my observation, but I could be wrong.

1-yr fellowship would not have been the end of the world, but 2-3 years is indefensible.

Look at what is happening to nephrology. They can't even find applicants so they are resorting to recruit FMG with no US residency training. Yes, it's a thing right now. These FMG are doing nephrology fellowship first and then IM. They are doing it in reverse because after a nephrology fellowship, they become competitive to get into IM.

The moment people find out working conditions (eg., salary, lifestyle etc..) are not ok, they flee. Peds and OBGYN prospects for some reason do not seem to care.

Peds is set up essentially the same way. Vastly more inpatient experience with little outpatient. You are correct that the personality difference is likely driving it.

 

[DarkBluMage]

Peds is set up essentially the same way. Vastly more inpatient experience with little outpatient. You are correct that the personality difference is likely driving it.

I heard acgme is trying to force the hospitalist fellowship by changing Peds residency requirements to be more outpatient heavy than inpatient. That’s what I’ve heard from a few PDs anyways.

 

[DO2015CA]

I heard acgme is trying to force the hospitalist fellowship by changing Peds residency requirements to be more outpatient heavy than inpatient. That’s what I’ve heard from a few PDs anyways.

Yes. They are trying to legitimize their stupid idea.

 

[DO2015CA]

I heard acgme is trying to force the hospitalist fellowship by changing Peds residency requirements to be more outpatient heavy than inpatient. That’s what I’ve heard from a few PDs anyways.

Their excuse was that the post-residency ACGME surveys said that residents felt unprepared to enter outpatient practice because of the little outpatient experiences they get. All residents are nervous to start practice. If they really cared then they would do what IM did and make IM primary care residency spots. Instead they wanted cheap labor and they are preying on pediatricians because they know as a specialty we won’t fight back.