MD Honest review from pediatricians?

[A Salty Girl]

Hello everyone!

I love kids but I've felt very discouraged about applying into peds because of it being an under paid, under appreciated specialty that I am told many people regret going into.

I have considered many other specialties and then fellowshipping in peds. For example: peds derm, peds ENT, etc.

Although I've found that I really love in-patient settings, and don't like out patient all that much. So for me doing peds derm is starting to sound much less appealing. I also love pharmacology and medical care! I think I would be such a happy peds hospitalist or intensivist. I just wonder if the long training for PICU (6 years!!) for a commitment to horrible hours and very little pay is worth it. I am sure it's the most rewarding job ever, I don't doubt that. But do people find it worth it? Is this a path that people would encourage?

Can any pediatricians on here talk about if you would do it again? I'm not after a plastic surgeon salary by any stretch - but I would like to at least make enough to pay back my loans and afford Ben and Jerry's for a sizable family.

---

Members don't see this ad.

 

[GoSpursGo]

I think there are people who regret their specialty choice in every specialty. Peds generally is actually near the top of any of those surveys of physician satisfaction. People who highly prioritize earning potential (and there is nothing wrong with that) generally don't go into peds, but they will certainly be quick to share why they didn't choose peds.

I am very happy and would certainly do it again. As an academic pediatric subspecialist, I am very much underpaid relative to my adult colleagues especially once you consider the length of fellowship training which is another very valid concern and a potential reason to avoid peds if that is a significant concern (especially given the recent push to have peds hospitalists do a PHM fellowship... don't get me started). In return, I have significant flexibility in my schedule to spend time with my family, I get to take care of kids, and I get to work with other people who generally enjoy taking care of kids. That has made it worth it for me.

 

[collegestud2013]

Hello everyone!

I love kids but I've felt very discouraged about applying into peds because of it being an under paid, under appreciated specialty that I am told many people regret going into.

I have considered many other specialties and then fellowshipping in peds. For example: peds derm, peds ENT, etc.

Although I've found that I really love in-patient settings, and don't like out patient all that much. So for me doing peds derm is starting to sound much less appealing. I also love pharmacology and medical care! I think I would be such a happy peds hospitalist or intensivist. I just wonder if the long training for PICU (6 years!!) for a commitment to horrible hours and very little pay is worth it. I am sure it's the most rewarding job ever, I don't doubt that. But do people find it worth it? Is this a path that people would encourage?

Can any pediatricians on here talk about if you would do it again? I'm not after a plastic surgeon salary by any stretch - but I would like to at least make enough to pay back my loans and afford Ben and Jerry's for a sizable family.

Not peds, but anecdotally I've seen that those who went into peds but aren't worried about the low pay usually don't have to because they have a higher earning spouse.

The ones that regret it for the low pay tend to be the ones who are trying to be the primary financial supporter for their family, or if they went to an expensive med school and have large amounts of loans (have seen some cases in peds where someone's income is is in the low to mid $200ks but they have >$300k in loans, and they work in PP so don't qualify for PSLF either). Especially in the past few years with inflation going out of control and burnout rates rising among physicians across the board (and hence physicians trying to find work that pays a higher hourly rate so they can cut back on clinical work). Hourly pay rates for peds tend to be low enough that a good deal of non-clinical work that physicians can do pays higher per hour. And I suspect that with birth rates in the U.S. declining as a whole, the trend toward an aging population, and kids as a population being healthy for the most part, the forces of supply and demand won't favor a large rise in pay for peds in the future either.

From a practical standpoint, might make a bit more sense to do combined IM/peds so your practice is more versatile and not just restricted to a small portion of the population that is 18 and under.

 

[TelemarketingEnigma]

From a practical standpoint, might make a bit more sense to do combined IM/peds so your practice is more versatile and not just restricted to a small portion of the population that is 18 and under.

Just as an FYI, being trained in Med Peds doesn't magically make employers pay you more if you end up having a pediatrics focused career. It is a great option if you want that versatility though and do want to care for adults! you just have to be aware that it will add you your training time (both in residency, and potentially fellowship if you want a combined career in anything but primary care), so if money is really the number 1 priority Med Peds may not be better than say FM

that said, i'm still only in residency but i'd be so much less happy right now if I weren't caring for kids, so there are other things more important than money

 

[WheezyBaby]

I'm med peds and happy in PICU. Some advice that was given to me that I think is very true ‐ the flexibility (i.e. with regard to geography) offered by a career in a medicine subspecialty should weigh more heavily than the monetary difference as compared to peds.

Just as an FYI, being trained in Med Peds doesn't magically make employers pay you more if you end up having a pediatrics focused career. It is a great option if you want that versatility though and do want to care for adults! you just have to be aware that it will add you your training time (both in residency, and potentially fellowship if you want a combined career in anything but primary care), so if money is really the number 1 priority Med Peds may not be better than say FM

that said, i'm still only in residency but i'd be so much less happy right now if I weren't caring for kids, so there are other things more important than money

I do know someone who was able to leverage their medicine salary to get the same from a peds group in need of staffing. But certainly not common

 

[SurfingDoctor]

Do you like kids? Do you feel bad for kids when they get sick or ill? Is money more important that question 1 or 2? If no, then the answer seems obvious…

 

[A Salty Girl]

I'm med peds and happy in PICU. Some advice that was given to me that I think is very true ‐ the flexibility (i.e. with regard to geography) offered by a career in a medicine subspecialty should weigh more heavily than the monetary difference as compared to peds.



I do know someone who was able to leverage their medicine salary to get the same from a peds group in need of staffing. But certainly not common

Are you planning to do PICU? If I did peds I think that's what I would do.

Why did you choose med peds as opposed to peds? Thanks!!

 

[SurfingDoctor]

I will also say personally, the difference between PICU and Peds Surgery is very small.

It’s a matter of do you like procedures versus do you like physiology. Both groups feel bad for the plight of children. The reality of both fields is that you like both, but that the scales so ever slightly tip to one versus the other.

I thought about Peds Surgery for a long time, but I like physiology (and in particular immunology) more…

 

[Smurfette]

I will also say personally, the difference between PICU and Peds Surgery is very small.

It’s a matter of do you like procedures versus do you like physiology. Both groups feel bad for the plight of children. The reality of both fields is that you like both, but that the scales so ever slightly tip to one versus the other.

I thought about Peds Surgery for a long time, but I like physiology (and in particular immunology) more…

I think that is extremely misleading to a student.
PICU (peds residency followed by peds critical care fellowship, with income on par with other peds specialties) and peds surgery (general surgery residency, mandatory research time, followed by an extremely difficult match into peds surg fellowship, with income similar to other surgical fields) are very different. Pathways are different, pay is different, lifestyle is different, mentality and patient approach is different. Same for other surgical subspecialties (peds ENT/uro/ortho) except those peds fellowships are less competitive than peds surg.
If you are a surgeon, do a surgical field. If you are "peds or bust", do peds.

 

[Dr G Oogle]

I think that is extremely misleading to a student.
PICU (peds residency followed by peds critical care fellowship, with income on par with other peds specialties) and peds surgery (general surgery residency, mandatory research time, followed by an extremely difficult match into peds surg fellowship, with income similar to other surgical fields) are very different. Pathways are different, pay is different, lifestyle is different, mentality and patient approach is different. Same for other surgical subspecialties (peds ENT/uro/ortho) except those peds fellowships are less competitive than peds surg.
If you are a surgeon, do a surgical field. If you are "peds or bust", do peds.

Agree with this, even if the only difference between PICU and peds surgery was strictly cognitive vs procedural, peds surgery is one of the most competitive specialties out there and PICU (although still very rigorous) is not as competitive

 

[GoSpursGo]

I think that is extremely misleading to a student.
PICU (peds residency followed by peds critical care fellowship, with income on par with other peds specialties) and peds surgery (general surgery residency, mandatory research time, followed by an extremely difficult match into peds surg fellowship, with income similar to other surgical fields) are very different. Pathways are different, pay is different, lifestyle is different, mentality and patient approach is different. Same for other surgical subspecialties (peds ENT/uro/ortho) except those peds fellowships are less competitive than peds surg.
If you are a surgeon, do a surgical field. If you are "peds or bust", do peds.

I agree, and would add that PICU also suffers from the plight of a relatively tight job market that is increasingly an issue for many peds subspecialties (other than NICU, PEM, and I'm sure a handful that I'm just not super familiar with) due to the fact that they simply don't exist outside of academic medical centers. Whereas peds surgeons are presumably in high demand.

Not that pay and job market need to be the end-all-be-all when deciding on a specialty. Job market in my own subspecialty is tight, and I would still do it again.

 

[A Salty Girl]

I agree, and would add that PICU also suffers from the plight of a relatively tight job market that is increasingly an issue for many peds subspecialties (other than NICU, PEM, and I'm sure a handful that I'm just not super familiar with) due to the fact that they simply don't exist outside of academic medical centers. Whereas peds surgeons are presumably in high demand.

Not that pay and job market need to be the end-all-be-all when deciding on a specialty. Job market in my own subspecialty is tight, and I would still do it again.

What is your subspecialty? If you are willing to share.

 

[GoSpursGo]

What is your subspecialty? If you are willing to share.

Peds heme/onc. I've talked about it a few times on the forum

 

[A Salty Girl]

Peds heme/onc. I've talked about it a few times on the forum

Oh good to know - I will look into your posts. Thanks so much for the help!

I was a PICU nurse before medical school, and one of the peds oncology cases is what inspired my journey to medicine.

 

[GoSpursGo]

Oh good to know - I will look into your posts. Thanks so much for the help!

I was a PICU nurse before medical school, and one of the peds oncology cases is what inspired my journey to medicine.

That's great! You'd probably have to wade through a LOT of posts to find my peds heme/onc focused posts, but I more mean it is relatively common knowledge. There may be a few more posts related to my specialty in the peds forum.

 

[mvenus929]

As another peds subspecialist making >100K less than my adult colleagues with 1 year more training, I would still do it again. My patient gave me a sticker today. Hard as some of my days are, it only takes a couple patients to make it all better for me, and I'm definitely happier than I would have been doing adult medicine.

I'm also perfectly capable of buying a nice house on my own (and no, I don't have a high paying spouse--or a spouse at all) and saving up enough for a nice retirement while still traveling abroad when I so desire. And I would definitely still pursue my field, though may have made slightly different choices about where I trained and ended up looking back.

 

[A Salty Girl]

As another peds subspecialist making >100K less than my adult colleagues with 1 year more training, I would still do it again. My patient gave me a sticker today. Hard as some of my days are, it only takes a couple patients to make it all better for me, and I'm definitely happier than I would have been doing adult medicine.

I'm also perfectly capable of buying a nice house on my own (and no, I don't have a high paying spouse--or a spouse at all) and saving up enough for a nice retirement while still traveling abroad when I so desire. And I would definitely still pursue my field, though may have made slightly different choices about where I trained and ended up looking back.

Good to hear!! Thank you! Would you mind sharing your field?

 

[SurfingDoctor]

I think that is extremely misleading to a student.
PICU (peds residency followed by peds critical care fellowship, with income on par with other peds specialties) and peds surgery (general surgery residency, mandatory research time, followed by an extremely difficult match into peds surg fellowship, with income similar to other surgical fields) are very different. Pathways are different, pay is different, lifestyle is different, mentality and patient approach is different. Same for other surgical subspecialties (peds ENT/uro/ortho) except those peds fellowships are less competitive than peds surg.
If you are a surgeon, do a surgical field. If you are "peds or bust", do peds.

I think I’m aware of the differences, since I live it. PICU requires mandatory research training as well. Both have lifestyle sacrifices (in-house weekends and holidays, available in-house 24/7 etc.). Peds Surgery has clinic, PICU doesn’t. While Peds Surgery is a very competitive match, PICU has become of the most competitive matches in peds. Actually Peds Surgery is a tough match because the powers that be realized they were creating more trainees than jobs available. Both have limited job markets but Peds Surgery actually did something about it and have restrictions in matching cycles. Of course, PICU could and should do that too, but fellows are cheap. So instead our division gets 40 fresh graduate applications for a job that doesn’t exist. There is a pay different as you state, but everything in pediatrics is paid less compared to adults. But that’s all to say, as you state, if one like procedures more and physiology less, do a surgical field, if one likes physiology more and procedures less, do anesthesia or critical care or emergency medicine. And if money is the ultimate concern, become a hospital administrator and get paid to do nothing of value.

 

[A Salty Girl]

I think I’m aware of the differences, since I live it. PICU requires mandatory research training as well. Both have lifestyle sacrifices (in-house weekends and holidays, available in-house 24/7 etc.). Peds Surgery has clinic, PICU doesn’t. While Peds Surgery is a very competitive match, PICU has become of the most competitive matches in peds. Actually Peds Surgery is a tough match because the powers that be realized they were creating more trainees than jobs available. Both have limited job markets but Peds Surgery actually did something about it and have restrictions in matching cycles. Of course, PICU could and should do that too, but fellows are cheap. So instead our division gets 40 fresh graduate applications for a job that doesn’t exist. There is a pay different as you state, but everything in pediatrics is paid less compared to adults. But that’s all to say, as you state, if one like procedures more and physiology less, do a surgical field, if one likes physiology more and procedures less, do anesthesia or critical care or emergency medicine. And if money is the ultimate concern, become a hospital administrator and get paid to do nothing of value.

I've heard the job market for PICU is tough. Thanks for the insight on surgery/PICU. What are your thoughts on NICU fellowship and jobs available?

 

[mvenus929]

Good to hear!! Thank you! Would you mind sharing your field?

I'm peds endo

Or, as I like to refer to it, all the interesting things about gen peds (growth, puberty) plus some weird stuff.

 

[SurfingDoctor]

I've heard the job market for PICU is tough. Thanks for the insight on surgery/PICU. What are your thoughts on NICU fellowship and jobs available?

There are more jobs in NICU because there are more community positions available.

Probably best to ask a neonatologist in the Pediatrics forum to get insight into that though.

 

[oldbearprofessor]

I've heard the job market for PICU is tough. Thanks for the insight on surgery/PICU. What are your thoughts on NICU fellowship and jobs available?

First off, I've never for a minute doubted my decision to do peds, in large part because I really don't like adults (and vice-versa). Neonatology remains a field with a fairly good job market, that may get better as fewer and fewer non-neo pediatricians handle Level II and delivery room. To be sure, the pure academic market is always tight unless you are strongly interested and gifted in research, but a lot of academic places hire non-research neos for both the big house and the community setting. Private practice opportunities are still fairly good but may not draw as big a salary gap compared to community based academic practices as in the past. Like every other field in medicine, the farther you are from the biggest cities, the more opportunities. In the case of NICU, most metro areas > 60-80K population will have a neonatologist around (I know, YMMV on the exact size, but as I said, it's coming down).

 

[SurfingDoctor]

Also… since I didn’t necessarily comment on the OP… I LOVE my job.

I do think whatever speciality you pick though, you need something that gets you excited to go to work everyday that isn’t direct patient care. For me… that’s research and I could easily imagine myself doing half-clinical and half-research in pediatrics into my 60s.

Of course, not everyone does research. For some it’s administration, or advocacy, or philanthropy or whatever. And then, there are some who just want to make money and retire to leave medicine as fast as possible and open up a circus (true story).

 

[SurfingDoctor]

First off, I've never for a minute doubted my decision to do peds, in large part because even I don't like adults (and vice-versa). Neonatology remains a field with a fairly good job market, that may get better as fewer and fewer non-neo pediatricians handle Level II and delivery room. To be sure, the pure academic market is always tight unless you are strongly interested and gifted in research, but a lot of academic places hire non-research neos for both the big house and the community setting. Private practice opportunities are still fairly good but may not draw as big a salary gap compared to community based academic practices as in the past. Like every other field in medicine, the farther you are from the biggest cities, the more opportunities. In the case of NICU, most metro areas > 60-80K population will have a neonatologist around (I know, YMMV on the exact size, but as I said, it's coming down).

Dude… did your spidey-sense go off or something?!

 

[oldbearprofessor]

Dude… did your spidey-sense go off or something?!

It's like when your kid asks how you know something and you answer "I know everything"......

Actually sometimes I check out the "What's new" function on SDN and happened to see it....