How competitive is pediatric EM?

[WillyWonkerer]

Is it up there w/ derm and radiology?

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[deleted109597]

Except that Peds EM is a fellowship, and not a residency.
That and it isn't as competitive as those two.

 

[AmoryBlaine]

Peds EM fellowships are moderately competitive, there aren't a ton of spots but most people who go into pediatrics are not that interested in EM. I think it's actually one of the smaller subspecialties.

 

[MEK]

there are a few routes to go about to get to this destination...EM first with fellowship, peds first with fellowship, or the combined option. all are relatively competitive mainly because space is limited. but all will get you to the same destination. although, the combined residencies will get you there in a year less.

 

[Apollyon]

The post above is not quite correct, for two reasons.

First is combined EM/Peds - this gets you double-board eligible in EM and Peds, but NOT Peds EM - ABEM sold a piece of their soul on this 30 years ago. These programs are 5 years.

Second, Peds --> Ped EM is 6 years (3+3), as the ABP says all fellowships are 3 years. However, for about half of the Ped EM programs, people that come from EM (whether a 3 or 4 year program) do 2 years. For the other half of the programs, there is parity for all fellows, and all (EM and Peds) do 3 years.

So, in summary, one could do EM --> Ped EM in 5 years, or EM/Peds, with no Ped EM board possible in 5 years.

 

[Tiger26]

Or just treat whoever comes in the door--peds to geriatric--by doing 3 years of EM . . .

 

[AmoryBlaine]

A further $0.02 on Peds EM:

If that is your dream go for a Peds residency followed by an EM fellowship. It's longer but you'll be better trained for the work. The VAST majority of Peds EM is still ambulatory pediatrics that a general pediatrician could easily handle. I think this is very different from adult emergency medicine where even a pretty savvy internist would flounder quickly.

So rather than spending your residency in the ICU, on the adult trauma service, etc why not be learning about kids since that's what you want to do anyway?

 

[NRAI2001]

Bumping this old thread... So is Peds EM competitive to get into? Why would one go do 3 years fellowship in Peds Em and be limited, when they can do 3 years of EM and see everyone? Is this considered a lifestyle field or high paying field? I met a few Peds residents recently that were interested in this route?

 

[dotcb]

Pediatric emergency medicine generally pays the same or less than general emergency medicine. The acuity tends to be lower than in adults, so to earn the same amount, you need to see more children who are less sick (Ex. URI).

Compared to general pediatrics, however, pediatric emergency medicine may be high-paying, which may incentivize it among pediatricians.

For EM grads, there is no financial incentive, and maybe overall cost to do this fellowship (loss of income 2-3 yrs with lower or equal salary after fellowship).

Reasons to do the fellowship would be if you really want to be an expert in PEM AND work with adult patients, you really want an academic job at a children's hospital, or you really want a niche and are OK spending 2-3 years developing it.

Just a handful of adult EM trained graduates tend to go into pediatric emergency medicine for these practical/financial reasons.

FWIW - I feel that my EM training prepared me very well to take care of children, and have not felt lacking in ability to care for children in the ED.

 

[BoardingDoc]

I met a few Peds residents recently that were interested in this route?

Peds EM is a salary bump over general pediatrics. It is a salary step-down from general EM. As such, there are a decent number of peds residents who are interested in it, and a far far fewer number of EM residents who are interested.

 

[EM/CC_23]

I found it really interesting working under peds trained PEM fellows vs. EM trained PEM fellows as a subi. The peds-trained ones (n= only 3, so i realize not at all externally valid) consistently wanted to know about grandma's breast cancer history for school-aged male kids with viral URIs, did not know how to use ultrasound at all, and did not let me or even the EM interns do simple procedures like basic lacs. Their biggest concerns in general were the developmental history, and avoiding blood draws/lines at all costs (even for lactate levels/IVF in patients with clinical sepsis) "to avoid traumatizing the kids". The EM trained ones (n=2) treated everything in many ways like the adult ED, except they seemed to know every paper published about everything pediatric EM and pediatric critical care in depth.

Why is it (per recent statistics) only 5-10% of PEM fellows are EM trained? Is it a matter of money (discouraging EM trained trainees to apply), or fellowship director preference for peds trainees?

 

[Daedalus]

Why is it (per recent statistics) only 5-10% of PEM fellows are EM trained? Is it a matter of money (discouraging EM trained trainees to apply), or fellowship director preference for peds trainees?

Yeah, its basically because there isn't a huge amount of benefit for EM-trained docs other than gaining further insight and training in pediatrics. They are already able to see peds patients as part of their practice. Also, Peds EM training doesn't increase pay, and in fact can lower it if they decide to do only Peds EM.
On the other hand, a Peds resident doing an EM fellowship gains a new skillset and ability to work in a Peds ED, and also increases their pay over a general pediatrician.

 

[Hook_EM]

I found it really interesting working under peds trained PEM fellows vs. EM trained PEM fellows as a subi. The peds-trained ones (n= only 3, so i realize not at all externally valid) consistently wanted to know about grandma's breast cancer history for school-aged male kids with viral URIs, did not know how to use ultrasound at all, and did not let me or even the EM interns do simple procedures like basic lacs. Their biggest concerns in general were the developmental history, and avoiding blood draws/lines at all costs (even for lactate levels/IVF in patients with clinical sepsis) "to avoid traumatizing the kids". The EM trained ones (n=2) treated everything in many ways like the adult ED, except they seemed to know every paper published about everything pediatric EM and pediatric critical care in depth.

Why is it (per recent statistics) only 5-10% of PEM fellows are EM trained? Is it a matter of money (discouraging EM trained trainees to apply), or fellowship director preference for peds trainees?

From my experience, the nature of peds training is a lot of hand holding. I think that's just the culture of the pediatric world. On some of my rotations I'd have to run EVERY order by the "senior" pediatric resident (same level resident as me). I get it, they're kids, but at some point you have to feel and show that you're comfortable. I guess it's difficult for the pediatricians to do so though. Anyway, I think it's just the culture of pediatrics.. they just can't let go.