I like immediate gratification and procedures....can I find that in peds?

[daringaventura]

I am currently a PGY1 in peds. When I applied for residency, I was deciding between surgery and pediatrics. I ultimately chose pediatrics because I love physiology, working with kids, and I didn't feel like I would only be happy in the OR.

However, in my first few months of internship, I'm wondering if I should look into switching into surgery. I get really frustrated with the lack of immediate gratification on a day to day basis in inpatient and outpatient peds. I like physiology but I need to feel like all my work is doing something! I came in interested in cards or PICU. My question is, do you think I'll be able to get many opportunities for immediate gratification in PICU or cards? Or do I need to look at potentially switching specialties? Any insight would be really appreciated!

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[doopdidoop]

i'd love to hear people's opinions on this too....thanks!

 

[Rutgers06]

I am currently a PGY1 in peds. When I applied for residency, I was deciding between surgery and pediatrics. I ultimately chose pediatrics because I love physiology, working with kids, and I didn't feel like I would only be happy in the OR.

However, in my first few months of internship, I'm wondering if I should look into switching into surgery. I get really frustrated with the lack of immediate gratification on a day to day basis in inpatient and outpatient peds. I like physiology but I need to feel like all my work is doing something! I came in interested in cards or PICU. My question is, do you think I'll be able to get many opportunities for immediate gratification in PICU or cards? Or do I need to look at potentially switching specialties? Any insight would be really appreciated!

Depends on what you mean by immediate gratification. In interventional cards, there are procedures, such as caths and ablations, that provide an immediate fix to a problem. In the PICU, there are lots of procedures which acutely help the kid out, but don't necessarily fix the underlying problem. Some people also like the ED because there are procedures and you get immediate gratification from either discharging or admitting the patient.

 

[michigangirl]

One of the main reasons I chose the PICU is because of the immediate gratification on a regular basis-- I'm an impatient person-- I need results fast. Obviously, there are chronic patients who come in with acute issues, but I can work hard to solve those acute issues. If a child comes in in full arrest, and you resuscitate the child with the end result of spontaneous circulation, that is immediate results-- when you have a child with increased ICP come in and you initiate maneuvers to decrease ICP, so many examples in the PICU. You do have to be willing to deal with chronic issues as well, though. Sometimes everything we do doesn't work. These are the caveats.

I love the PICU cause I never know what's coming next. Trauma? post-op heart? liver transplant? airway emergency? it's all fair game.

 

[bowlofmushypeas]

I am currently a PGY1 in peds. When I applied for residency, I was deciding between surgery and pediatrics. I ultimately chose pediatrics because I love physiology, working with kids, and I didn't feel like I would only be happy in the OR.

However, in my first few months of internship, I'm wondering if I should look into switching into surgery. I get really frustrated with the lack of immediate gratification on a day to day basis in inpatient and outpatient peds. I like physiology but I need to feel like all my work is doing something! I came in interested in cards or PICU. My question is, do you think I'll be able to get many opportunities for immediate gratification in PICU or cards? Or do I need to look at potentially switching specialties? Any insight would be really appreciated!

Another idea would be peds derm - it's a fellowship after a derm residency and can be shortened sometimes if you've done a partial/full peds residency. Procedures and instant gratification..Just a thought!

 

[daringaventura]

Thanks for the info Michigan girl and bowlofmushy peas. Any one have any thoughts on cardiology?

I've also been kicking around the idea of anesthesiology (which I liked as a 4th year but had already committed to peds). Any thoughts on that Michigan girl?

 

[michigangirl]

Cards is a possibility, especially if you do interventional. But still lots of continuity, clinic, chronic patients.

 

[JMMH]

I was somewhat in a similar boat but not quite as I never considered surgery, but I felt like I was not making a difference during residency in that the kids I saw for well child checks would be doing well regardless of whether they came and saw me. Short of doing vaccinations I wasn't sure if I was making much of a difference. It was then that I decided to do a fellowship so I would see pathology on a more routine basis.

Cards can be highly procedure based if you do interventional or electrophysiology. You definitely get to see physiology with post-op management and in the cath lab with measuring sats and BP and observing how things change with oxygen or if you occlude a shunt or fenestration.

Electrophysiology you get to do ablations and implantation of pacemakers, so there is a component of surgery and the OR.

And there's nothing like seeing a delta wave go away after a few seconds in the EP lab to gain immediate gratification, that's for sure.

It's good that you are trying to figure it out now though because the years of both pathways would be the same. 5-6 years for general surgery (plus the 1 for the pediatric internship year) and 3+3 for pediatric cardiology and an extra 1 for interventional or EP.

 

[daringaventura]

I was somewhat in a similar boat but not quite as I never considered surgery, but I felt like I was not making a difference during residency in that the kids I saw for well child checks would be doing well regardless of whether they came and saw me. Short of doing vaccinations I wasn't sure if I was making much of a difference. It was then that I decided to do a fellowship so I would see pathology on a more routine basis.

Cards can be highly procedure based if you do interventional or electrophysiology. You definitely get to see physiology with post-op management and in the cath lab with measuring sats and BP and observing how things change with oxygen or if you occlude a shunt or fenestration.

Electrophysiology you get to do ablations and implantation of pacemakers, so there is a component of surgery and the OR.

And there's nothing like seeing a delta wave go away after a few seconds in the EP lab to gain immediate gratification, that's for sure.

It's good that you are trying to figure it out now though because the years of both pathways would be the same. 5-6 years for general surgery (plus the 1 for the pediatric internship year) and 3+3 for pediatric cardiology and an extra 1 for interventional or EP.

Thanks for the insight! That's exactly how I feel, I'm working hard but I don't really feel like I'm making a difference! Appreciate knowing that I'm not alone and that there are good options for fellowship that may fit me better than gen peds.

 

[Giic]

Another idea would be peds derm - it's a fellowship after a derm residency and can be shortened sometimes if you've done a partial/full peds residency. Procedures and instant gratification..Just a thought!

HAHAHAHAHAHA!!!!
Peds Derm!!!!!

 

[Giic]

Thanks for the info Michigan girl and bowlofmushy peas. Any one have any thoughts on cardiology?

I've also been kicking around the idea of anesthesiology (which I liked as a 4th year but had already committed to peds). Any thoughts on that Michigan girl?

I would say Anesthesiology is all immediate gratification. You put the patient to sleep for surgery - thats gratifying when they dont move; then it goes well, and you see them wake up - another major gratification. That's a great idea if you really love instant gratification.

PICU and NICU are of course good too.

I would be careful, though - to make sure that what you really need is instant gratification, and not that there is some other underlying reason why you don't like your pediatric residency. It seems strange that someone would wish to change a pediatric residency based on the need for instant gratification - and I feel like you should have had a fair idea going into it, about what pediatrics is all about. There is some instant stuff, like reducing a Nursemaid elbow in your clinic, or diagnosing something unexpectedly either in the inpatient or outpatient setting through a thorough history/physical. All that provides gratification. So it seems to me that you just don't LIKE peds, and it's not necessarily an instant gratification issue. Choose carefully for your next move. Unless you will end up in a specialty with procedures and instant gratification, and then realize that that wasnt really what it was.

 

[bjb0403]

What about peds GI? Are there alot of procedures they get to perform like adult GI? I know there arent many peds colon cancers but what about Chrons and UC? Im wondering if peds GI get to do as much as adult GI docs as far as colonoscopies, endoscopes, ERCP, etc...

 

[michigangirl]

Anesthesia has a lot of instant gratification, yes-- but Glic simplified it quite a bit-- every case involves the excitement of induction and emergence, with all the constant management in between. Yes, some cases are slow and easy, and are a bit like autopilot, but there's nothing more instantly gratifying than running two rooms as an attending anesthesiologist, one with 8 tonsils and adenoids and another room with a 2 month old craniofacial reconstruction and massive blood loss/ongoing resuscitation. Running around like a chicken with your head cut off all day but boy is it instant gratification! ICU specialties can be similar depending on the acuity of the unit.

I disagree with Glic on this--I wouldn't be too pessimistic about peds just because you're frustrated with intern year and lack of instant gratification. I'll be honest with you-- I hated anything that involved clinic and didn't terribly enjoy gen peds months-- but I knew it was important for me to learn learn learn and make the most of them so I could be a strong intensivist.

 

[Giic]

Anesthesia has a lot of instant gratification, yes-- but Glic simplified it quite a bit-- every case involves the excitement of induction and emergence, with all the constant management in between. Yes, some cases are slow and easy, and are a bit like autopilot, but there's nothing more instantly gratifying than running two rooms as an attending anesthesiologist, one with 8 tonsils and adenoids and another room with a 2 month old craniofacial reconstruction and massive blood loss/ongoing resuscitation. Running around like a chicken with your head cut off all day but boy is it instant gratification! ICU specialties can be similar depending on the acuity of the unit.

I disagree with Glic on this--I wouldn't be too pessimistic about peds just because you're frustrated with intern year and lack of instant gratification. I'll be honest with you-- I hated anything that involved clinic and didn't terribly enjoy gen peds months-- but I knew it was important for me to learn learn learn and make the most of them so I could be a strong intensivist.

Hmmm, I'm not quite sure what you're disagreeing with me on... Maybe my point is not that clear? Because I agree with all what you have typed above, and I also hated clinic as a peds resident (typical ICU soul).... My point was, the individual concerned should be careful to make sure that instant gratification is truly what they need, and to make sure there is not some other reason why they hate peds... which could mean that they could end up in another specialty which does have instant gratification, but which they similarly hate (and then realized that they made a mistake)... I'm not encouraging pessimism about peds....actually, the opposite. Analyze carefully the situation, to see what it is you really do not like.

 

[NickNaylor]

HAHAHAHAHAHA!!!!
Peds Derm!!!!!