IM vs Peds

[sliceofbread136]

Has anyone else struggled with this decision? I am more attached to the patient populations in peds but find IM more interesting intellectually. IM also gets paid more.

I've been struggling with this one for awhile and the deadline is coming fast. Any suggestions?

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[TwinsFan]

Will you be subspecializing?
Also, think about where you want to practice (academic vs private)? the options can be more limited in peds subspecialties (location/jobs etc)

 

[arewethereyet...]

We were told to think about the things in each specialty that you would really miss/couldn't live without. What specifically do you find interesting in IM? Is it a thing in peds that you just haven't been exposed to yet? Have you done inpatient peds (I found that much more interesting) or only outpatient?

 

[eteshoe]

Why not look into Med-Peds combined residencies?

 

[Crayola227]

some don't struggle in giving up Peds

there's way more reasons as I see it for cutting those little tiny bastards out of your medical practice, far more than reasons to keep them, IMHO

1) they are not little adults, so you are responsible for a whole body of knowledge just for their species
2) kids tend to be healthy, and when they aren't, they tend to be really sick. Really sick kids are scarier and sadder than adults for many people. Well child visits and sniffles are boring.
3) parents suck on both extremes of helicoptering vs the amount of neglect you see that is legal
4) there is nothing less funny than an actual dead baby
5) legal liability (I don't know that it's worse but being on the hook for kids this way sounds like a nightmare)
6) I hate getting sneezed or coughed on right in the face by patients
7) when inevitably I make a medical error and someone dies, I would rather that it's statistically impossible that they are a child and that it's statistically probable it's someone who has led a fuller life
8) in IM you can still do adolescent medicine and see the 12-18 cohort, this would be more likely in clinic than inpt
9) you can't rationalize with kids like you do adults, and they are likely to cry just because, and making kids cry on a daily basis as part of my job description is just unappealing to me
10) if you like kids, you can just have some and be an active parent, you don't have to interact with kids in the medical sphere to spend time with that demographic

 

[Crayola227]

Why not look into Med-Peds combined residencies?

I wouldn't look at combined programs out of indecision and as a way of staving off picking a specilaty

they should be pursued when you have a clear picture of what specific job you would like to do that will necessitate a combined residency

I say this because it's an awful lot of bother otherwise, not to mention, the combined residency will want to know why you're pursuing it, will ask the above question, and anything that sniffs of less than 100% commitment to your chosen specialty is one of the biggest turn offs ever for programs

also when looking at combined residencies, you have to ask yourself how your app to date demonstrates this passion for the joint deal

 

[ProfMD]

People I have known to do med/peds end up picking one or the other.

Besides looking at what you like, also look at what is common and make sure you can stand doing that for the rest of your career.

Things I can't stand about peds and IM:
1) pediatric well care checks
2) polypharmacy in adults
3) managing chronic conditions in adults
4) medication tweeking
5) endless rounding on inpatients

 

[Crayola227]

my fave post on IM: (written by an ED doc on what they admit)

Make up of things I admit:
-50 % are chronic conditions with a known diagnosis (COPD, CHF, CAD, DM, etc.). Mostly caused by smoking, diet, and medication non-compliance. The healthcare system would likely have improved outcomes and decreased costs if instead of involving an internist we just got these patients a life coach, personal trainer and nutritionist.
-20% are dumps from other services with admission to medicine because the specialists hate dealing with all the social bull**** and/or don't want to come to the ER after 5pm and say "just admit to medicine."
-15% are social admits because our healthcare system sucks and instead of providing resources to EM docs to facilitate placement of patients, we instead have the 3 day inpatient rule for SNF placement.
-10% have actual acute medical problems through no fault of their own. The diagnosis of this is generally pretty straight forward.
-5% have something interesting/confusing that I truly need the broad differential of an internist to help me with before a specialist gets involved as once they get involved they will only be focused on their specialty.

In the ideal medical system most patients would fall under the last category and we would actually use our medicine colleagues for their diagnostic acumen. Instead, the medicine service is the dumping ground of the hospital system. The trash comes in through the ER front door and leaves through the back door which is the Medicine service. It is one continuous assembly line of processed ****, fueled by unrealistic consumer expectation and malpractice attorney cupidity. It's why i'm forced to admit that 85 year old with chest pain because god forbid that one 85 year old dies comfortably in her bed while sleeping from a massive STEMI. Instead we must send her to the assembly line for the million dollar workup only to die 6 months later from metastatic cancer after suffering 4 horrible months on chemo.

 

[zafonte86]

Kids are the best! End of story. DO IT!

 

[sliceofbread136]

Will you be subspecializing?
Also, think about where you want to practice (academic vs private)? the options can be more limited in peds subspecialties (location/jobs etc)

Subspecialty, likely academic

We were told to think about the things in each specialty that you would really miss/couldn't live without. What specifically do you find interesting in IM? Is it a thing in peds that you just haven't been exposed to yet? Have you done inpatient peds (I found that much more interesting) or only outpatient?

I did inpatient and outpatient. I don't really like outpatient in general, and thought well baby visits were fairly boring. There were a few cases I found interesting on the inpatient side, but I really did not like failure to thrive or bronchiolitis which seemed to be the bread and butter. Even the common things in IM I found more interesting.

On another note, I highly enjoyed workign with the kids especially adolescents. Felt much more invested.

Why not look into Med-Peds combined residencies?

I havent really been, I feel like it is another year and most end up doing one or the other eventually anyway.

 

[Perrotfish]

As a Pediatrician:

Things I like about Pediatrics:
1) Patients who get well. Kids mostly come in two varieties, the ones who aren't really sick and the ones you can fix. Pediatric cancers might be some of the most satisfying disease in medicine: you use all of your powers and all of your skills and what was a dying child gets to live a full and happy life. Adults often can't be fixed, and when they can many of them aren't really so much 'well' as 'they'll make it another 5 years'.
2) Patients who are fun: When nothing is wrong with a child you make funny faces at each other. When nothing is wrong with an adult they ask for Dilaudid
3) (almost) no drug seekers
4) (Almost) no gyn exams
5) significantly less polypharmacy
6) Patients almost universally have at least SOME resources for follow up, prescriptions, food, and shelter. And when they don't its treated as a problem that the social worker has to help fix, rather than a reality you have to deal with.
7) Lawsuits are really rare. Average Pediatrician is sued once per lifetime.
8) Bad outcomes are treated as an enemy: Life always ends the same way, and they say you have to make peace with it if you go into medicine. Well Pediatrics is the exception to that rule. It was important, at least for me, to know that I would pretty much always do everything, and always fight as hard as I could for every patient, and it would always be the right choice (NICU and PICU are the exception to this rule)

Things I hate about Pediatrics
1) The pay is bad. If you don't want to do NICU, PICU, or outpatient general pediatrics with nursery coverage you might not break 160K. If you want to do a subspecialty the pay is truly horrendous: three years of extra training to make 120K for 55 hours/week. Pediatric subs is the rare medical career where you'd actually be financially better off as a nurse.
2) You are legally and ethically responsible for AMA decisions. When an adult wants to try healing crystals rather than chemotherapy that's on them. When they want it for their kid you are responsible for precisely straddling the line between being overbearing and negligent, and calling CPS the second that you cross it.
3) There is not a lot of research. It is really, really hard to do experiments on kids. There are good ethical reasons for this, but the consequence is that when kids get sick the data you're working with is often, when you really look at it, not much better than an educated guess, particularly for the more critical patients. This also makes training worse, because in the absence of data attendings like to yell at you for not doing it 'their' way.
4) You make decisions without data. your patients are mostly nonverbal, they can't pee in a cup, and they scream at the top of their lungs through the physical exam. Also, for both good and bad reasons, Pediatricians are very lab/radiology phobic. It can make what would be a simple diagnosis like 'UTI' into a mess of clinical criteria and return precautions.
5) The residency kinda sucks. Pediatrics splits off into a lot of different directions, with a large proportion of graduates becoming clinicians with nursery coverage, another big chunk working inpatient, and another huge chunk specializing. This is as opposed to IM that can basically say that they're not really going to do real clinic, or FM which doesn't really feel the need to prep you for inpatient at a tertiary care center. The result is a residency that works you 80 hours a week most of the way through to try to get you ready for any of those things, and yet fails to do so because there's not enough time to devote to any one of them. It also might be the most micromanaged residency, because the fear of a mistake in Pediatrics is so much higher than in adults.
6) You will be sick. You will be sick all the time.
7) When they happen lawsuits are really bad. Pediatric lawsuits are emotional wringers that end in the highest payouts of any specialty.
8) Bad outcomes are the worst thing ever. If it was unavoidable its an emotional nightmare. If it was even arguably avoidable that nightmare will be compounded by the most vicious M&M process in all of medicine.

 

[QuizzicalApe]

Subspecialty, likely academic

IM subspecialties will pay a lot better...

Just sayin'.

I did inpatient and outpatient. I don't really like outpatient in general, and thought well baby visits were fairly boring. There were a few cases I found interesting on the inpatient side, but I really did not like failure to thrive or bronchiolitis which seemed to be the bread and butter. Even the common things in IM I found more interesting.

Boy howdy, if you don't like taking care of "failure to thrive", do I have a surprise for you about IM

 

[ACSurgeon]

As a Pediatrician:

Things I like about Pediatrics:
1) Patients who get well. Kids mostly come in two varieties, the ones who aren't really sick and the ones you can fix. Pediatric cancers might be some of the most satisfying disease in medicine: you use all of your powers and all of your skills and what was a dying child gets to live a full and happy life. Adults often can't be fixed, and when they can many of them aren't really so much 'well' as 'they'll make it another 5 years'.
2) Patients who are fun: When nothing is wrong with a child you make funny faces at each other. When nothing is wrong with an adult they ask for Dilaudid
3) (almost) no drug seekers
4) (Almost) no gyn exams
5) significantly less polypharmacy
6) Patients almost universally have at least SOME resources for follow up, prescriptions, food, and shelter. And when they don't its treated as a problem that the social worker has to help fix, rather than a reality you have to deal with.
7) Lawsuits are really rare. Average Pediatrician is sued once per lifetime.
8) Bad outcomes are treated as an enemy: Life always ends the same way, and they say you have to make peace with it if you go into medicine. Well Pediatrics is the exception to that rule. It was important, at least for me, to know that I would pretty much always do everything, and always fight as hard as I could for every patient, and it would always be the right choice (NICU and PICU are the exception to this rule)

Things I hate about Pediatrics
1) The pay is bad. If you don't want to do NICU, PICU, or outpatient general pediatrics with nursery coverage you might not break 160K. If you want to do a subspecialty the pay is truly horrendous: three years of extra training to make 120K for 55 hours/week. Pediatric subs is the rare medical career where you'd actually be financially better off as a nurse.
2) You are legally and ethically responsible for AMA decisions. When an adult wants to try healing crystals rather than chemotherapy that's on them. When they want it for their kid you are responsible for precisely straddling the line between being overbearing and negligent, and calling CPS the second that you cross it.
3) There is not a lot of research. It is really, really hard to do experiments on kids. There are good ethical reasons for this, but the consequence is that when kids get sick the data you're working with is often, when you really look at it, not much better than an educated guess, particularly for the more critical patients. This also makes training worse, because in the absence of data attendings like to yell at you for not doing it 'their' way.
4) You make decisions without data. your patients are mostly nonverbal, they can't pee in a cup, and they scream at the top of their lungs through the physical exam. Also, for both good and bad reasons, Pediatricians are very lab/radiology phobic. It can make what would be a simple diagnosis like 'UTI' into a mess of clinical criteria and return precautions.
5) The residency kinda sucks. Pediatrics splits off into a lot of different directions, with a large proportion of graduates becoming clinicians with nursery coverage, another big chunk working inpatient, and another huge chunk specializing. This is as opposed to IM that can basically say that they're not really going to do real clinic, or FM which doesn't really feel the need to prep you for inpatient at a tertiary care center. The result is a residency that works you 80 hours a week most of the way through to try to get you ready for any of those things, and yet fails to do so because there's not enough time to devote to any one of them. It also might be the most micromanaged residency, because the fear of a mistake in Pediatrics is so much higher than in adults.
6) You will be sick. You will be sick all the time.
7) When they happen lawsuits are really bad. Pediatric lawsuits are emotional wringers that end in the highest payouts of any specialty.
8) Bad outcomes are the worst thing ever. If it was unavoidable its an emotional nightmare. If it was even arguably avoidable that nightmare will be compounded by the most vicious M&M process in all of medicine.

Kids don't always get well. Their problems can't always be fixed. I'm not talking about developmental problems. Chronic diseases in kids really suck. Kids who get admitted multiple times a year to slowly get worse over the next ten years is the farthest thing from rewarding.

Pediatric cancers have a much higher cure rate then adults. True. However, the emotional damage that comes with the treatment must be significant (don't have data). Also, there's still large enough number you can't make better, and they still get the toxicity of cancer management to prolong life without a prospect of a cure.

Kids can't understand why they are undergoing morbid medical and surgical treatments. This makes the risk/benefit scale fuzzy. An adult consenting to feeling miserable with chemo to try and live 3 months to see their daughter get married has motivation to put up with the treatment. A child just feels like they're being tortured.

 

[ACSurgeon]

Has anyone else struggled with this decision? I am more attached to the patient populations in peds but find IM more interesting intellectually. IM also gets paid more.

I've been struggling with this one for awhile and the deadline is coming fast. Any suggestions?

Litmus test: when you hear someone say kiddos, do you get butterflies in your stomach or do you roll your eyes?

 

[sliceofbread136]

Update on this thread. I'm really considering doing med/peds now, will pursue a joint fellowship or try and piece together a fellowship where I can get both med and peds training (apparantly this can be done). If the whole joint fellowship doesn't work out I'll end up just pick either one or the other.

Only downside I see to this is possibly wasting an extra year of training, but atm that gamble seems worth it to me. It is also slightly more competitive than straight med or peds but I think I am still fine on that front.

Any input/suggestions?

 

[mvenus929]

Update on this thread. I'm really considering doing med/peds now, will pursue a joint fellowship or try and piece together a fellowship where I can get both med and peds training (apparantly this can be done). If the whole joint fellowship doesn't work out I'll end up just pick either one or the other.

Only downside I see to this is possibly wasting an extra year of training, but atm that gamble seems worth it to me. It is also slightly more competitive than straight med or peds but I think I am still fine on that front.

Any input/suggestions?

Figure out which one you couldn't live without and apply to that as a back-up.

 

[sliceofbread136]

Figure out which one you couldn't live without and apply to that as a back-up.

Why do you say that? I'm 1st quartile at a top 20 school with a high step 1, so I don't think I really need a backup per say. Would it be just in case I change my mind last minute?

Appreciate the advice btw

 

[mvenus929]

Why do you say that? I'm 1st quartile at a top 20 school with a high step 1, so I don't think I really need a backup per say. Would it be just in case I change my mind last minute?

Appreciate the advice btw

No, it's because even super-star applicants can end up screwed in the match (I've seen a number of people fall down much lower on their list than they thought, and a handful go unmatched), and there aren't that many Med-Peds programs all things considered. It's not going to hurt you to apply to a handful of IM or Peds programs as a back-up. And if you do change your mind last minute, you have things in place anyway.