I find general peds boring. Should I forget about applying to peds residency?

[dbeast]

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Hey guys, MS3 here looking for a bit of advice. I've spent a lot of time with peds heme/onc and I'm pretty confident it's what I want to do as a career. My issue is the three years of general peds that comes before specializing... RSV, asthma, immunizations, developmental milestones, etc. just don't do it for me (not that those things are bad, I just am not interested). Three years seems like a long time to tolerate a job that I don't like at all. Has anybody else here had to struggle through general peds, and was it worth it after it was all done? Any other advice would be suuuuuper appreciated.

 

[mercaptovizadeh]

Hey guys, MS3 here looking for a bit of advice. I've spent a lot of time with peds heme/onc and I'm pretty confident it's what I want to do as a career. My issue is the three years of general peds that comes before specializing... RSV, asthma, immunizations, developmental milestones, etc. just don't do it for me (not that those things are bad, I just am not interested). Three years seems like a long time to tolerate a job that I don't like at all. Has anybody else here had to struggle through general peds, and was it worth it after it was all done? Any other advice would be suuuuuper appreciated.

There are research track residencies where they can shave off a year of general pediatrics or medicine and stick on your fellowship + 1 extra research year. So you would get 2 years peds + 3 years H/O fellowship (which includes research) + 1 extra year of research. It's really more so for academics, which is consistent with peds H/O (a rather academic specialty). It may also be quite selective and generally for MD/PhDs.

The other option is to go to one of the peds powerhouses like CHOP, Boston Children's, Cincinnati, etc. and hope that general outpatient peds is minimal and count on seeing lots of intellectually stimulating zebras, which you surely would.

 

[oldbearprofessor]

I recommend that those who really cannot stomach a pediatric residency, which includes lots of all of the things mentioned by the OP as in-patient and outpatient rotations and clinics, even at the largest pedi programs, not do a pediatric residency. You'll be unhappy, won't perform well and might discover that you don't get the fellowship spot you want. However, just like most pediatricians don't care for adult medicine/surgery at all, but recognized that learning some of it was important in med school even for a future pediatrician, the reality is that you'll learn a lot that you need during any fellowship and career during your residency. Pediatric cancer patients get asthma, RSV and have developmental challenges that pediatric heme/onc docs need to deal with all the time. So, if you can accept that you won't care for some aspects of residency, but will learn a lot from them and can go at them with a good attitude, then go for it, otherwise don't do it.

 

[Perrotfish]

Hey guys, MS3 here looking for a bit of advice. I've spent a lot of time with peds heme/onc and I'm pretty confident it's what I want to do as a career. My issue is the three years of general peds that comes before specializing... RSV, asthma, immunizations, developmental milestones, etc. just don't do it for me (not that those things are bad, I just am not interested). Three years seems like a long time to tolerate a job that I don't like at all. Has anybody else here had to struggle through general peds, and was it worth it after it was all done? Any other advice would be suuuuuper appreciated.

Your three year residency is not all RSV, asthma, immunizations, and developmental milestones. If it was we would all go nuts. My residency is 8 months ICU (6 NICU, 2 PICU), 3 months ED, 4 months wards, 2 months combined wards/PICU night coverage, 2 months nursery, 4 months general pediatric clinic, and the rest a mix of subspecialty months and electives. So only 4 months + continuity clinic of the general outpatient blocks that you say bores you. Also, because you are necessarily seeing clinic at a tertiary care center, odds are even your outpatient clinic will have way more than a normal number of children with massive comorbidities. Finally I will agree that Peds Heme onc docs, more than any other subspecialists, tend to double as the PCPs for their patients. So its not like you get away from RSV an devo when you get to fellowship.

Have you done your Peds core yet? Where did you do outpatient and inpatient? Have you had a chance to rotate through PICU, NICU, or Peds EM?

 

[dbeast]

Yeah, it's a bit tough, thank you all for the advice. Ideally, I wanted to be a peds surgeon because I love kids and am not a huge fan of rounding, but 10 years of gen surg residency + fellowship (with an uncertain shot at the peds fellowship to begin with) seems like too big of a task to handle... hence my question here about working with kids sans gen peds. I was leaning toward peds heme/onc because it's procedural/acute/helping really sick kids.

Now that you all hopefully know my reasoning a little better, any other suggestions that I'm missing? Thanks again, identity crises are no fun :/

 

[mvenus929]

Yeah, it's a bit tough, thank you all for the advice. Ideally, I wanted to be a peds surgeon because I love kids and am not a huge fan of rounding, but 10 years of gen surg residency + fellowship (with an uncertain shot at the peds fellowship to begin with) seems like too big of a task to handle... hence my question here about working with kids sans gen peds. I was leaning toward peds heme/onc because it's procedural/acute/helping really sick kids.

Now that you all hopefully know my reasoning a little better, any other suggestions that I'm missing? Thanks again, identity crises are no fun :/

With those motivations, I suggest peds EM, PICU, or NICU. Lots of procedures all around.

 

[chhsu]

I think I may have some useful insight having recently finished a pediatric hem-onc fellowship. As a peds HONC physician you should keep in mind that once a patient is diagnosed with cancer (or serious chronic hematologic condition like Diamond Blackfan anemia, etc), that patient's general care will be transferred to you in most cases. This means all general pediatric issues will be addressed by the peds HONC physician whether it be otitis media, vaccination, hip dysplasia or developmental delay, you as the peds HONC MD are responsible for all work up, follow up and referals on these issues. The reason is because once a patient is diagnosed with a condition that falls under HONC, they will be under your care, on average, weekly for about 2-3 years, but sometimes it's longer. And because they are immunocompromised and are often taking chemotherapies/immunotherapies, understanding of drug interactions and immune recovery can only be managed safely by the peds HONC MD. In other words, you will be practicing general pediatrics as a significant part of your specialty. This also goes for practically any pediatric specialty - that's why we are expected to be board certified in gen peds before we can take any specialty boards.

So, if you don't find gen peds stuff interesting, then you will likely find many peds specialties (and particularly peds HONC) boring or a miserable profession. This will also be reflected in the critical reviews of your clinical performance, important for matching into a competitive fellowship. Attendings will be able to tell if you don't put your heart and soul into your gen peds rotations during residency. This means less than stellar evaluations, a difficult time convincing fellowships that you have a passion for the specialty and thus difficulty matching. I've seen smart people with good credentials but couldn't get into a top notch fellowship because they didn't show strong interest during their gen peds residency.

I'm also not sure where you got the idea that peds HONC is procedural. We are only known for 2 procedures - LPs and bone marrow biopsies/aspirates. It's practically minimal compared to many other specialties (NICU, PICU, EM) as one member posted.

 

[mercaptovizadeh]

Hey guys, MS3 here looking for a bit of advice. I've spent a lot of time with peds heme/onc and I'm pretty confident it's what I want to do as a career. My issue is the three years of general peds that comes before specializing... RSV, asthma, immunizations, developmental milestones, etc. just don't do it for me (not that those things are bad, I just am not interested). Three years seems like a long time to tolerate a job that I don't like at all. Has anybody else here had to struggle through general peds, and was it worth it after it was all done? Any other advice would be suuuuuper appreciated.

Honestly, if your dream is peds surgery, just do that. It's a very cool field (I loved my rotation) and even thought of going into it. But it is a big commitment of at least 9 years (assuming you match with no extra research needed, and assuming an academic 7-year surgical residency prior to fellowship). Compare that to peds heme-onc (+/- bone marrow transplant), which comes to 6-7 years. So this time commitment is not negligible and the differential comes to 2-3 years.

 

[Perrotfish]

Yeah, it's a bit tough, thank you all for the advice. Ideally, I wanted to be a peds surgeon because I love kids and am not a huge fan of rounding, but 10 years of gen surg residency + fellowship (with an uncertain shot at the peds fellowship to begin with) seems like too big of a task to handle... hence my question here about working with kids sans gen peds. I was leaning toward peds heme/onc because it's procedural/acute/helping really sick kids.

Now that you all hopefully know my reasoning a little better, any other suggestions that I'm missing? Thanks again, identity crises are no fun :/

What is it that attracts you to working with children? Why is heme/onc in particular attractive to you?

 

[dbeast]

Honestly, if your dream is peds surgery, just do that. It's a very cool field (I loved my rotation) and even thought of going into it. But it is a big commitment of at least 9 years (assuming you match with no extra research needed, and assuming an academic 7-year surgical residency prior to fellowship). Compare that to peds heme-onc (+/- bone marrow transplant), which comes to 6-7 years. So this time commitment is not negligible and the differential comes to 2-3 years.

I've taken this into consideration too. Even though it's only 2-3 years of a difference, the 9 years of surgery are going to be way more exhausting than peds with a fellowship, where you're a fellow after only 3 years. Quantity-wise, they're not that different, but day to day time commitment is pretty substantial.

What is it that attracts you to working with children? Why is heme/onc in particular attractive to you?

I think my communication style and personality is well-suited for peds. Anybody who knows me on this forum can hopefully see where I'm coming from. Heme/onc in particular because it seems to be a field with a good balance of acute care (yes I had considered PICU/ER for those of you who recommended it), but also has longitudinal relationships with the patients and their families. Plus, I've worked with peds cancer patients pretty extensively in the past, and they're just awesome people.

 

[Perrotfish]

I think my communication style and personality is well-suited for peds. Anybody who knows me on this forum can hopefully see where I'm coming from. Heme/onc in particular because it seems to be a field with a good balance of acute care (yes I had considered PICU/ER for those of you who recommended it), but also has longitudinal relationships with the patients and their families. Plus, I've worked with peds cancer patients pretty extensively in the past, and they're just awesome people.

Some more specific questions:

1) Do you particularly enjoy interacting with children, or do you get more satisfaction from interacting with the parents?

2) Do you get a lot out of procedures, or do you just hate rounding and see procedural specialties as a better alternative?

3) Do you mind rounding on more critically ill patients? How do you feel during your ICU rotations (if you've had any)?

4) How much do patient outcomes matter to you? Is it more about solving the puzzle/doing the job, or do you get satisfaction primarily from the percentage of really sick patients that you make well?

5) Do you like the idea of research? Have you ever done any?

6) How did you like your adult gen surg rotation?

7) How about EM?


FWIW I agree with your reasoning for not banking on Peds Surg. Peds surg is a brutal grind, while Peds fellowships are often lighter in hours than a normal peds practice, with a full year for just research. Also Peds surg is one of the most competitive fellowships in medicine, so if you don't think Gen Surg is an acceptable second choice I wouldn't bet my career on doing peds

 

[futuredoctor10]

Interesting discussions. Perrotfish makes a good point too, that Peds Surgery is one of the most highly competitive fellowships and so keep that in mind in making your decision.

 

[mdphd2b]

Hey guys, MS3 here looking for a bit of advice. I've spent a lot of time with peds heme/onc and I'm pretty confident it's what I want to do as a career. My issue is the three years of general peds that comes before specializing... RSV, asthma, immunizations, developmental milestones, etc. just don't do it for me (not that those things are bad, I just am not interested). Three years seems like a long time to tolerate a job that I don't like at all. Has anybody else here had to struggle through general peds, and was it worth it after it was all done? Any other advice would be suuuuuper appreciated.

I just sent you a long PM...

 

[oldbearprofessor]

I just sent you a long PM...

Is there any insight you have about the topic that you'd be willing to share publicly? You don't need to post that you've sent someone a PM, they'll get notified of it, but it does make the rest of us want to know what you think about the topic without, of course, giving up your anonymity.

 

[slford00]

A lot of good discussion here.

I'm a Peds resident who knew pretty much for certain going in that I wanted to do a critical care fellowship. I also love general pediatrics, but I can't lie--I'm not going to miss evaluating 20+ kids a day with URIs during winter months when I'm a fellow, so I can somewhat understand what the OP is saying.

I will also say--without hesitation and with significant personal bias--that Peds Heme/Onc is awesome and allows you to interact with some incredible, amazing families. As a Peds intern, I dreaded H/O all year thinking it would be miserable, but that changed after doing the rotation and I would absolutely consider it for a career if it weren't for NICU.

The bottom line, though, is that you (OP) need to figure out what you REALLY want to do day-in and day-out for the rest of your career, and not just fixate on the vague idea of what you think a specialty might be like. You've made a couple statements that really stick out when considering if Peds + H/O fellowship is for you. As others have noted, Heme/Onc involves a LOT of primary care--you take over ALL care for these patients once they receive their diagnosis, and that involves vaccines, asthma, and so on. A seven year old patient shows up at 11 pm to the ED with moderate dehydration 2/2 viral gastroenteritis who was treated for ALL from ages 5-7? That admission is going to H/O. One H/O doc in our department specifically told me that this is the very reason he chose the field--that he could be a specialist treating very ill kids while also working as a "primary care" doctor.

Additionally, you say that you hate rounding and that you love procedures. As another poster commented, in H/O your procedures are LPs and bone marrows. And rounds? In all of my residency rotations, I consistently spent much more time rounding on H/O than on any other rotation. Those are some of the most medically complicated sick kids you'll ever encounter.

Again, I think the field is incredible, and the research is absolutely fascinating, but you have to decide what is the best fit for YOU, and only you can answer that. It may be that only surgery with minimal rounding can do it for you, and that this type of practice is worth the risk of doing gen surgery if Peds fellowship doesn't work out. Or maybe PICU/EM or even NICU may be more to your liking.

Or maybe, if Peds Heme/Onc is really what you're meant to do, you'll find with time that some of those things you think you hate are much more bearable once you start practicing them in the context of your long-term career plans.

 

[DermViser]

Hey guys, MS3 here looking for a bit of advice. I've spent a lot of time with peds heme/onc and I'm pretty confident it's what I want to do as a career. My issue is the three years of general peds that comes before specializing... RSV, asthma, immunizations, developmental milestones, etc. just don't do it for me (not that those things are bad, I just am not interested). Three years seems like a long time to tolerate a job that I don't like at all. Has anybody else here had to struggle through general peds, and was it worth it after it was all done? Any other advice would be suuuuuper appreciated.

If you can't stomach doing general pediatrics, don't do a general pediatrics residency. At the end of a Pediatrics residency, you will have to be board certified in General Peds in order to continue in a fellowship, and you will have to be ok with doing all that mundane crap for 3 years, before you can continue with what you really want to do.

If you don't like General Peds - it will show greatly in your work ethic and your attitude which will affect your evaluations. Trust me - you can't fake enthusiasm in residency, bc your are a doctor 24/7. You're no longer in school at this point so the reward of a "grade" or "Honors" is no longer there. Word gets around fast to residents and faculty about a resident not being a "team player", etc. which will affect your chances at fellowship since you will ask faculty for letters.

You will be competing among many residents who are also likely going for fellowship, so there is very much a real possibility that you may not match into a fellowship. You have to be very ok with the possibility of not matching, just like there are tons of IM residents who didn't make it to Cardiology or GI.

Have you thought about Pediatric Anesthesiology? You get to work in the OR and be with children. It would be a fellowship after anesthesiology residency.

 

[oldbearprofessor]

If you can't stomach doing general pediatrics, don't do a general pediatrics residency. At the end of a Pediatrics residency, you will have to be board certified in General Peds in order to continue in a fellowship, and you will have to be ok with doing all that mundane crap for 3 years, before you can continue with what you really want to do.


You will be competing among many residents who are also likely going for fellowship, so there is very much a real possibility that you may not match into a fellowship. You have to be very ok with the possibility of not matching, just like there are tons of IM residents who didn't make it to Cardiology or GI.

Just to clarify a few things, as dermatologists might not be aware of the details related to pediatrics...

1. Although you must pass the general pediatric board exam in order to take the subspecialty pediatric board exams, you do NOT have to pass, take or even be eligible for the general pediatric boards in order "to continue in a fellowship", i.e. match into fellowship or do the fellowship. Most, but not all, pedi specialty fellows will take the general pedi boards during their first year of fellowship and currently, few foreign-trained residents who will not be pedi board eligible enter US subspecialty fellowships, but it is not an absolute rule. Also, you only need to certify general pedi once, after that, if you are also certified in a subspecialty you can recertify only in the subspecialty if you wish.

2. Pedi fellowships vary in their competitiveness from very non-competitive to moderately competitive. Although, as correctly pointed out by others, a poorly performing resident is not going to get their pick of fellowship areas and places necessarily, it would not be accurate to compare competitiveness for ANY pedi fellowship with adult cardiology or GI. I am personally unaware of any US resident in pedi who was "forced" to do general pedi for a career because they could not match into any fellowship. Note that depending on exactly how you count some areas including hospitalists, about 1/2 of pedi residents overall will do a fellowship compared to about 80% (I believe?) of IM residents.

 

[DermViser]

Just to clarify a few things, as dermatologists might not be aware of the details related to pediatrics...

1. Although you must pass the general pediatric board exam in order to take the subspecialty pediatric board exams, you do NOT have to pass, take or even be eligible for the general pediatric boards in order "to continue in a fellowship", i.e. match into fellowship or do the fellowship. Most, but not all, pedi specialty fellows will take the general pedi boards during their first year of fellowship and currently, few foreign-trained residents who will not be pedi board eligible enter US subspecialty fellowships, but it is not an absolute rule. Also, you only need to certify general pedi once, after that, if you are also certified in a subspecialty you can recertify only in the subspecialty if you wish.

2. Pedi fellowships vary in their competitiveness from very non-competitive to moderately competitive. Although, as correctly pointed out by others, a poorly performing resident is not going to get their pick of fellowship areas and places necessarily, it would not be accurate to compare competitiveness for ANY pedi fellowship with adult cardiology or GI. I am personally unaware of any US resident in pedi who was "forced" to do general pedi for a career because they could not match into any fellowship. Note that depending on exactly how you count some areas including hospitalists, about 1/2 of pedi residents overall will do a fellowship compared to about 80% (I believe?) of IM residents.

I count a pediatric hospitalist as general pediatrics, just like internal medicine hospitalists practice general internal medicine. They may not practice outpatient medicine ("primary care" in the traditional sense) but they are a generalists nonetheless.

I think the rate of specialization among pediatrics residents is also affected by the fact that 1) many residents that enter peds are women and thus want to start making money quickly and 2) children don't have like 11 medical problems the way adults do, so from a time perspective - outpatient peds works relatively fine. I was comparing Pedi Cards and GI within Peds subspecialties in general.

In internal medicine, most residents don't want to have to deal with the entire gamut of medical problems the patient has, and is much more comfortable dealing with 1 organ system in their expertise. Not to mention, adults are much more annoying than children.

 

[oldbearprofessor]

I think the rate of specialization among pediatrics residents is also affected by the fact that 1) many residents that enter peds are women and thus want to start making money quickly

Can you share with us, from the sociological literature or your personal experience the rationale by which women want to make money more quickly than men?

 

[DermViser]

Can you share with us, from the sociological literature or your personal experience the rationale by which women want to make money more quickly than men?

I should rephrase that. I meant start becoming an attending sooner, as many female pediatrics residents want to have children and start families, or already have children. Male residents on the other hand, usually want to make much more money (in comparison to female residents whose priorities are different) and thus gun for specialties.

 

[oldbearprofessor]

I should rephrase that. I meant start becoming an attending sooner, as many female pediatrics residents want to have children and start families, or already have children. Male residents on the other hand, usually want to make much more money (in comparison to female residents whose priorities are different) and thus gun for specialties.

Thus, in your view, male residents are clearly not very economically clever, because doing a specialty in pediatrics is not usually financially advantageous.

 

[DermViser]

Thus, in your view, male residents are clearly not very economically clever, because doing a specialty in pediatrics is not usually financially advantageous.

Um, how am I wrong?
"In this scenario, the largest Lifetime Relative NPV is seen in cardiology, which yields a positive $349 532 financial return relative to general pediatrics over the working lifetime. In addition, critical care and neonatology experience positive financial returns compared with general pediatrics."

 

[mvenus929]

Um, how am I wrong?
"In this scenario, the largest Lifetime Relative NPV is seen in cardiology, which yields a positive $349 532 financial return relative to general pediatrics over the working lifetime. In addition, critical care and neonatology experience positive financial returns compared with general pediatrics."

Keyword there is usually. Cardiology, critical care and neonatology are the exceptions, not the rule.

 

[mytirf]

I have to agree with a number of posts here. If you don't like general pediatrics don't do a general pediatric residency or try to pursue a pediatric fellowship. In nearly all of the sub-specialities you will continue to draw upon your knowledge of diagnosing and treating basic pediatric problems. I'm a pediatric cardiologist and one of the most common things we care for is general pediatric problems such as RSV bronchilitis in patients with heart disease. Now, I think this is completely fascinating because you get to see how the physiology changes with different stresses and one has to really understand both the cardiology and the general pediatrics. Frankly, I have always had the feeling that if you can't at least find some joy in the bread and butter of a particular field rather than the very rare or exciting aspects you should really reconsider your decision. One PICU attending I spoke with when I was trying to decide between pediatric critical care and cardiology said "Every aspiration pneumonia is different and interesting..." I just didn't share that sentiment and therefore found myself in the field of cardiology. If everything changed today and all of heart disease was cured, I think I would still be happy seeing kids in clinic and making sure they had their vaccines.

Just my 2c

 

[DermViser]

Keyword there is usually. Cardiology, critical care and neonatology are the exceptions, not the rule.

You have to understand it's bc you lose an "attending" salary when you train during fellowship. Hence the "negative return". It also said, "Incorporating the federal loan-repayment program targeted toward pediatric subspecialists and decreasing the length of fellowship training from 3 to 2 years would substantially increase the financial returns of the pediatric subspecialties."