How much peds does FM see? (West Coast)

[Peetz]

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Hi, I am a rising MS-4 trying to decide between FM and IM, and only planning to apply West Coast (also interested in med-peds but just not enough programs). One of my main decisions is whether or not to give up on peds. I really enjoy both adult and pediatric medicine, much less so obgyn and surg, and while I'm not set on primary care I enjoyed my outpatient rotations and think I would be happy in it. I like the idea of cradle-grave care, but many people have brought up the point that FM residency is just 3-6 months peds training, and many FM docs end up seeing far more adults. I feel like if peds won't end up being a significant part of my practice, I might as well go full-send on IM. On the other hand, I think I could be happy in FM with 20-30% of my patients being a good mix of ages 0-18. So my question is, how much peds is it realistic to expect in FM practice on the West Coast, especially in the urban/suburban areas?

 

[hallowmann]

As FM you will absolutely see Peds, but it will likely be in the 10-20% range at most, and as you age, if you aren't delivering babies, then you'll see less and less kids over time. That said, in IM you won't get any of that. Literally the vast majority of IM wouldn't touch a kid with a 10 foot pole, and 17 year olds are kids. If your goal is outpatient primary care, I would lean towards FM or if there is PC track for IM.

 

[cabinbuilder]

Honestly, it depends on the contract and who you work for. Where I work right now in West Texas no FM sees anyone under 18 because they have an entire Peds department and that is the policy of the company. Remember that when you negotiate your contract, if you want to be an FM who sees peds, you will likely need to stipulate that in your contract or at least bring it up before you sign.

 

[VA Hopeful Dr]

Honestly, it depends on the contract and who you work for. Where I work right now in West Texas no FM sees anyone under 18 because they have an entire Peds department and that is the policy of the company. Remember that when you negotiate your contract, if you want to be an FM who sees peds, you will likely need to stipulate that in your contract or at least bring it up before you sign.

That seems.... odd. I've worked for 5 different hospital systems and none of them contractually limited me from seeing peds.

 

[cabinbuilder]

That seems.... odd. I've worked for 5 different hospital systems and none of them contractually limited me from seeing peds.

I work in a very odd place. GI here doesn't see anyone under 18 either.

 

[VA Hopeful Dr]

I work in a very odd place. GI here doesn't see anyone under 18 either.

That's not unusual. My wife is an internist and her malpractice policy has a hard limit at age 18. Sometimes I've seen internist policies go down to age 16 but never lower.

 

[dozitgetchahi]

That's not unusual. My wife is an internist and her malpractice policy has a hard limit at age 18. Sometimes I've seen internist policies go down to age 16 but never lower.

Same here. Malpractice coverage starts at age 18, so as a rheumatologist I won’t see anyone a day under 18.

At my PP, the vast majority of the FM PCPs don’t see kids either.

 

[NRAI2001]

Depends on your clinic. Most FM docs I know in California see a lot of peds. I probably see 20-30% of my visits as peds. I feel more than comfortable seeing peds patients in the clinic (well visits, physicals, urgent care visits, mild to moderate chronic issues). I use to feel comfortable seeing inpatient peds and I m sure I could get back into it quickly but I havent done any inpatient peds since residency. I see many newborns and children of all ages.

 

[Peetz]

Depends on your clinic. Most FM docs I know in California see a lot of peds. I probably see 20-30% of my visits as peds. I feel more than comfortable seeing peds patients in the clinic (well visits, physicals, urgent care visits, mild to moderate chronic issues). I use to feel comfortable seeing inpatient peds and I m sure I could get back into it quickly but I havent done any inpatient peds since residency. I see many newborns and children of all ages.

Very cool to hear. Follow-up question, how much OB do you/those colleagues see? I've heard similar things to what was mentioned above, that the way to make peds a significant portion of your practice is to do OB and you'll continue to work with those kids after birth.

 

[Hollow Knight]

I don't know where the narrative that FM doesn't see peds comes from but in my (albeit limited) experience that's nonsense. I did FM specifically to do primary care for adults and children. 3-6 months of peds usually means inpatient or specialized rotations, theoretically we all should be seeing kids in continuity clinic all through residency, and many family medicine hospital services will admit peds.

My residency has 6+ months of inpatient peds, neonatal resuscitation, PICU, etc. But I prioritized peds when I was applying because I knew I liked peds. FM programs are somewhat variable.

If you aren't sure about primary care, you could make an argument for IM leaving you with fellowship options. But if you know you want primary care do FM! It's a great specialty.

 

[NRAI2001]

I don't know where the narrative that FM doesn't see peds comes from but in my (albeit limited) experience that's nonsense. I did FM specifically to do primary care for adults and children. 3-6 months of peds usually means inpatient or specialized rotations, theoretically we all should be seeing kids in continuity clinic all through residency, and many family medicine hospital services will admit peds.

My residency has 6+ months of inpatient peds, neonatal resuscitation, PICU, etc. But I prioritized peds when I was applying because I knew I liked peds. FM programs are somewhat variable.

If you aren't sure about primary care, you could make an argument for IM leaving you with fellowship options. But if you know you want primary care do FM! It's a great specialty.

Completely agree. I was doing OB the first 5 years or so after residency at my clinic but i started to phase it out. I still got many newborn pts. Once you establish with a young family the mom/dad continue to bring any new family members to you.

Yes I did about 6 months or so of inpatient peds and saw peds all 3 years in our FM residency clinic. During out OB months we saw newborns as well as the mothers so we got even more peds during that time. We also saw peds during our 4 months or so of ER rotations and our 3-4 months of inpatient family med rotations.

I remember in medical school I rotated in peds at peds hospitals where peds residents were literally sharing peds patients inpatient because there weren't enough patients. This was a regular occurrence. I saw this at the 3 peds departments I rotated at as a medical student. Anything outside of the bread and butter peds cases were heavily rounded on by every specialty (peds pulm, cardio and ID often rounded on the same patient for the same minor-ish issue) in the peds department. A good FM program prepares you well to see peds patients outpatient (probably inpatient bread and butter as well).