Inpatient vs Ambulatory Pediatrics

[runningpenguin]

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What's the difference between inpatient and ambulatory pediatrics? I know that kids in inpatient will be much more sick, but what are other differences?

What sort of impact can pediatricians working in an ambulatory setting make? For example, do pediatricians working in both outpatient and inpatient focus on the overall wellness/comprehensive care of the child? Or is it much more so outpatient that focuses on this?

How frequently do pediatric subspecialists work in ambulatory care as well?

Thanks.

 

[Redpancreas]

It's basically what you're saying. Ambulatory is most commonly well-child check ups with a day or two of Asthma clinic where you'll titrate their albuterol and tell them they need ICS if they're using their SABAs too much. A great deal of thought is spent on every little thing that could better the child's wellness (limiting milk if constipation, concerns about speech/cognitive delays) even if it's not the main concern. Inpatient Peds is usually an acute exacerbation of RSV vs. Asthma as well as neonatal complications if you rotate on Gen Peds for babies, but you'll see emergencies too if you're there for a while. In older children, you'll see admits for CF, DKA, Crohn's issues as well. If you do a specialty like ID you'll see tons of Pneumonia and Heme/Onc I heard is sad, but interesting. I did Peds Cardio as my week-elective which I highly recommend. I saw almost every valve disorder I had learnt about and very advanced thought processes were being made with every visit. Don't expect to learn everything because as always the real life mx. contradicts the board answers due to complexity but it provided me with a good opportunity to review all the valve abnormalities with the fellows. They had days 2/week with dedicated clinic care so there's definitely a significant outpatient component for Cards at least. As a whole, I found IP Peds to be more interesting because AMB for for general peds, but the opposite was true for the specialties probably because of how much I was able to follow.

As for cons, I disliked Peds for many of the same reasons I disliked OB/GYN. Residents micro-managed quite a bit, but student expectations were minimal but we had to show interest none-the-less. Also, we were shunted around quite a bit (newborn, IP, Ambulatory, and specialty) making us unable to really establish much of a groove.

 

[mvenus929]

Ambulatory focuses on overall health, inpatient deals with an acute crisis. Isn't this how it works everywhere?

In terms of pathology, in outpatient peds, you're seeing more (relatively) controlled chronic disease--the child with CP, or asthma, or diabetes (though gen peds doesn't manage diabetes, they do manage the rest of the child's care). Gen Pediatricians are managers of all the specialties--they often have to write referrals to see specialists, and help coordinate care and be the overseer of things. You'll get some sick kids--usually URIs and AOM, with some asthma exacerbations and some injuries, with the occasional patient you have to send on to the ED. Depending on the hospital setting, outpatient or inpatient peds sees the newborns.

On inpatient, you're going to see the sick kids. This is variable depending on the time of year--we are starting to get into respiratory season where the kids with asthma, chronic lung disease, and generally low reserve will come in for some additional respiratory support. We see acute GI illnesses that require hydration, injuries and trauma. We get admissions for failure to thrive, and things that we aren't sure what they are yet and need more workup.

Peds also has all the subspecialties, with the addition of NICU just for the babies. More of the pathology tends to be congenital than in adults, which is one of the things that draws people to the specialty.

If you have any more questions, feel free to ask.

 

[Neopolymath]

Ambulatory focuses on overall health, inpatient deals with an acute crisis. Isn't this how it works everywhere?

In terms of pathology, in outpatient peds, you're seeing more (relatively) controlled chronic disease--the child with CP, or asthma, or diabetes (though gen peds doesn't manage diabetes, they do manage the rest of the child's care). Gen Pediatricians are managers of all the specialties--they often have to write referrals to see specialists, and help coordinate care and be the overseer of things. You'll get some sick kids--usually URIs and AOM, with some asthma exacerbations and some injuries, with the occasional patient you have to send on to the ED. Depending on the hospital setting, outpatient or inpatient peds sees the newborns.

On inpatient, you're going to see the sick kids. This is variable depending on the time of year--we are starting to get into respiratory season where the kids with asthma, chronic lung disease, and generally low reserve will come in for some additional respiratory support. We see acute GI illnesses that require hydration, injuries and trauma. We get admissions for failure to thrive, and things that we aren't sure what they are yet and need more workup.

Peds also has all the subspecialties, with the addition of NICU just for the babies. More of the pathology tends to be congenital than in adults, which is one of the things that draws people to the specialty.

If you have any more questions, feel free to ask.

I have an ignorant question. Are there many in-patient only jobs available for peds given that most kids are healthy and also don't have that "self-neglect" component that gives adult inpatient so many patients? I'm trying to keep an open mind about peds but at first glance I would worry about there being less jobs available given there are less sick kids and less children's hospitals in a given area. Is it realistic to go into peds with the intent to never do outpatient past fellowship and not have a hard time getting a good job in an average city?

 

[Keona]

I have an ignorant question. Are there many in-patient only jobs available for peds given that most kids are healthy and also don't have that "self-neglect" component that gives adult inpatient so many patients? I'm trying to keep an open mind about peds but at first glance I would worry about there being less jobs available given there are less sick kids and less children's hospitals in a given area. Is it realistic to go into peds with the intent to never do outpatient past fellowship and not have a hard time getting a good job in an average city?

Where do you want to live? Yes there are lots of inpatient jobs, if there’s a pediatric hospital. If not usually you’ll need to do a mix of inpatient and outpatient (usually not a lot of in hospital time because most of the kids will be healthy). In an area with a pediatric hospital you wouldn’t need to do any hospital work or in an area with a hospitalist group comfortable with peds

 

[FindMeOnTheLinks]

misread post, please delete

 

[Neopolymath]

Where do you want to live? Yes there are lots of inpatient jobs, if there’s a pediatric hospital. If not usually you’ll need to do a mix of inpatient and outpatient (usually not a lot of in hospital time because most of the kids will be healthy). In an area with a pediatric hospital you wouldn’t need to do any hospital work or in an area with a hospitalist group comfortable with peds

In case it wasn't clear, I'm trying to avoid outpatient work not do it.

 

[PTPoeny]

If you want to do zero outpatient work at all your options are PICU, PEM or hospitalist. NICU frequently has a small follow up clinic responsibility but some groups may not have all attendings participate. There are starting to be a few pediatric urgent care centers but pediatric urgent care mostly resembles outpatient sick clinic so it might not be what you want. Depending on where you want to work you may or may not have to do a fellowship for hospitalist by the time you are looking for a job. These jobs are going to be limited to areas with a children's hospital, so if you strongly want to live somewhere rural you will have a hard time finding jobs. As with many other areas lots of people want to live in big cities so there may not be a lot of jobs in a particular city at the exact time you graduate. But if you are flexible with where you live there are lots of jobs in these fields.

 

[Keona]

In case it wasn't clear, I'm trying to avoid outpatient work not do it.

Do you want to live in a large city? If so yes you can avoid outpatient because most people working outpatient don’t want to work in the hospitals.

 

[Neopolymath]

Thanka, guys!

 

[BigRedBeta]

I have an ignorant question. Are there many in-patient only jobs available for peds given that most kids are healthy and also don't have that "self-neglect" component that gives adult inpatient so many patients? I'm trying to keep an open mind about peds but at first glance I would worry about there being less jobs available given there are less sick kids and less children's hospitals in a given area. Is it realistic to go into peds with the intent to never do outpatient past fellowship and not have a hard time getting a good job in an average city?

Pediatric hospitalist work is more geographically limiting as children's hospitals are generally limited to larger cities. And even within large cities, there are only so many locations (eg Chicago only has about 10 hospitals that admit kids versus dozens and dozens of facilities that take care of adults). But there are jobs and will continue to be so. Most children's hospitals are still seeing year over year growth in admissions, and the number of places that have built new or expanded their children's hospital in the last decade (or have plans to) is substantial (off the top of my head: Colorado, Arkansas, Northwestern, MUSC, Ohio State, Rush, Oklahoma, UT Southwestern, Children's Healthcare of Atlanta & Emory, Pittsburgh, UCSF, UofNebraska, Stanford, Phoenix Children's, UofArizona, UAB, UofMichigan, Iowa, UofWashington/Seattle)

While there are less peds hospitalist jobs available than compared to adults, it's important to note that a much larger percentage of peds grads are going into outpatient general peds than IM grads going into outpatient general medicine.

If you want to take care of kids but really like the complexity of adult patients without the outpatient work in peds, go into NICU or PICU, or consider doing Peds Cardiac ICU (by doing two additional years of training to get dual boarded in PICU and Cardiology, or an extra year in Cardiac ICU after a regular PICU or Cards fellowship). Most people who choose the PICU do so because it's entirely inpatient

 

[Neopolymath]

Pediatric hospitalist work is more geographically limiting as children's hospitals are generally limited to larger cities. And even within large cities, there are only so many locations (eg Chicago only has about 10 hospitals that admit kids versus dozens and dozens of facilities that take care of adults). But there are jobs and will continue to be so. Most children's hospitals are still seeing year over year growth in admissions, and the number of places that have built new or expanded their children's hospital in the last decade (or have plans to) is substantial (off the top of my head: Colorado, Arkansas, Northwestern, MUSC, Ohio State, Rush, Oklahoma, UT Southwestern, Children's Healthcare of Atlanta & Emory, Pittsburgh, UCSF, UofNebraska, Stanford, Phoenix Children's, UofArizona, UAB, UofMichigan, Iowa, UofWashington/Seattle)

While there are less peds hospitalist jobs available than compared to adults, it's important to note that a much larger percentage of peds grads are going into outpatient general peds than IM grads going into outpatient general medicine.

If you want to take care of kids but really like the complexity of adult patients without the outpatient work in peds, go into NICU or PICU, or consider doing Peds Cardiac ICU (by doing two additional years of training to get dual boarded in PICU and Cardiology, or an extra year in Cardiac ICU after a regular PICU or Cards fellowship). Most people who choose the PICU do so because it's entirely inpatient

Yeah, I want to eventually live in/near Atlanta. Thanks for providing some perspective on this.Are most of these jobs academic in nature due to them being sequestered in these major hospitals? SDN is filled with a lot of advice that distorts what reasonable expectations are for careers/working environments so it is hard to gauge pediatrics beyond what all medical students know about the field at the surface level.

 

[mvenus929]

I have an ignorant question. Are there many in-patient only jobs available for peds given that most kids are healthy and also don't have that "self-neglect" component that gives adult inpatient so many patients? I'm trying to keep an open mind about peds but at first glance I would worry about there being less jobs available given there are less sick kids and less children's hospitals in a given area. Is it realistic to go into peds with the intent to never do outpatient past fellowship and not have a hard time getting a good job in an average city?

As others have said, yes, it's possible to have a hospital based job. You will more than likely have to do a fellowship, though.

These jobs are going to be limited to areas with a children's hospital, so if you strongly want to live somewhere rural you will have a hard time finding jobs. As with many other areas lots of people want to live in big cities so there may not be a lot of jobs in a particular city at the exact time you graduate.

Eh, that's not entirely true. I get emails from recruiters all the time to do peds hospitalist work in relatively small areas (the four 'children's' hospitals in the state are in Norfolk, Fairfax, Charlottesville, and Richmond, with another smaller unit in Roanoke). Off the top of my head, I know people who work as hospitalists in Williamsburg, Fredricksburg, and I get head hunter emails for some areas south of Richmond. Most of the smaller places you will also do nursery as a part of your hospitalist job.