Is Pediatrics the answer?

[Leukocyte]

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Guys, I am wondering if you could help me decide.

I personally love working with children, but this does not mean that I would be a good Pediatrition. It takes a special person to be a general pediatrition. I know I can never be happy as a general pediatrition because:

-I do not like "ward medicine"
-I want to specialize in only one area.
-I am a "do-er" rather than a "think-er"
-I hate long rounds, and very comprehensive H&Ps
-I hate "talking" and just want to go in and fix the problem
-I want to work with my hands most of the time
-I do not enjoy primary care

Would you still advice me to go into Pediatrics?

Would the Pediatric Fellowships help full-fill my needs?

And if so, would you advise someone who does not "like" general pediatrics to go into it anyway JUST FOR THE FELLOWSHIPS? Is this an acceptable "risk" to take?

Thank You. 🙂

 

[kas23]

Ah, leukocyte, such a lost soul....

All those attributes you listed sound like a surgeon. Surgeons hate rounds (takes away from OR time), they hate floor medicine (same reason), they don't sit around reading notes and "thinking" they go and "do" things, they hate talking and just want to go in a "fix" things, they love working with their hands, they usually don't like primary care, and have you ever read a surgeon's H&P?

You should really re-eval your leaning towards peds. A peds fellowship may fulfill your needs, but don't go into peds thinking it would be the end of the world if you happened to just become a generalist.

Don't just think loving children is good enough to go into peds. Most people do love children, so they get married (or don't) and have children. End of story. You need more to than just loving children to become a pediatrician (and be happy). However, loving children seems to be a requirement to become a good peds doc.

 

[VentdependenT]

Rad Onc, ER, Optho, Uro.

 

[KidDr]

Guys, I am wondering if you could help me decide.

I personally love working with children, but this does not mean that I would be a good Pediatrition. It takes a special person to be a general pediatrition. I know I can never be happy as a general pediatrition because:

-I do not like "ward medicine"
-I want to specialize in only one area.
-I am a "do-er" rather than a "think-er"
-I hate long rounds, and very comprehensive H&Ps
-I hate "talking" and just want to go in and fix the problem
-I want to work with my hands most of the time
-I do not enjoy primary care

Would you still advice me to go into Pediatrics?

Would the Pediatric Fellowships help full-fill my needs?

And if so, would you advise someone who does not "like" general pediatrics to go into it anyway JUST FOR THE FELLOWSHIPS? Is this an acceptable "risk" to take?

Thank You. 🙂

If you love working with children, then you should! Especially if you don't think you'd be happy working with adults. We need more good kid-loving people in peds, and many of us got here because we couldn't imagine spending our days dealing with adults who destroy their bodies then expect you to fix them.

I agree that a peds residency may not be the way to go. With the way you described yourself above, you'd probably be miserable. We tend to round a LOT (not as bad as IM, but it's up there).

It might be worth putting up with a 3 year peds residency then doing one of the peds subspecialities that does procedures (EM, GI, cards, maybe ICU too but they still round a lot).

Or think about doing either a general EM residency, followed by a fellowship in peds EM, or any of the surgical subspecialities (ophthal, ortho, ENT, urology) followed by a peds fellowship in the subspecialty. There's a big need in many parts of the country for peds surgical subspecialists, and most I've met seem very satisfied with their lives and they really love what they do. Most of them take a pay cut to work with kids (compared to their colleagues working with adults) but can't imagine doing anything else.

There's not a perfect way to do it, because you either get to work with kids the whole way through but have to put up with lots of wards, primary care, etc, before you get to do the kind of work you really love (peds residency-->peds fellowship), OR you get to enjoy the work you do but have to put up with adults for several years before you get to finally work with kids (surgical subspecialty-->peds fellowship). In the end, though, I have a feeling you'd be happier with the latter rather than the former, because even though some peds subspecialists do procedures (GI, Cards), it's a long road for the amount of procedures you'll be able to do (6 yrs) and unless you're in private practice you'll probably have to spend some time attending on the wards, which means long H&Ps, long rounds, an so on. The exception would be EM...but EM does tend to encompass a lot of primary care.

Anyway, just some things to think about.

 

[14022]

Guys, I am wondering if you could help me decide.

I personally love working with children, but this does not mean that I would be a good Pediatrition. It takes a special person to be a general pediatrition. I know I can never be happy as a general pediatrition because:

-I do not like "ward medicine"
-I want to specialize in only one area.
-I am a "do-er" rather than a "think-er"
-I hate long rounds, and very comprehensive H&Ps
-I hate "talking" and just want to go in and fix the problem
-I want to work with my hands most of the time
-I do not enjoy primary care

Would you still advice me to go into Pediatrics?

Would the Pediatric Fellowships help full-fill my needs?

And if so, would you advise someone who does not "like" general pediatrics to go into it anyway JUST FOR THE FELLOWSHIPS? Is this an acceptable "risk" to take?

Thank You. 🙂

Pediatric Psychiatry sounds right up your alley!

Of course I am kidding, but I do not think that going into Peds for the fellowship is a bad idea. Everyone does it in medicine, why not peds? I hate general pediatrics. I hate outpatient medicine. I hate having to refer for anything complex. I am 99% sure I am going into peds, and if I do it is for the sole purpose of going into cards or nicu. In terms of competition for fellowships, it is still a buyers market. I think cards is the most competitive peds fellowship (definately among the top 3) and there are more spots available than US grad applicants. Some programs are paying people extra stipends to come and do fellowships at their programs in less popular fields like nephrology and rheum and others. But from the way you are describing your interests, I think a peds surgical subspecialty would be more up your alley. If you do not want to be in the OR day after day, fields like peds uro, ent, ophtho would be up your alley. Getting into ophtho, uro, and ent is the hard part. The fellowships are relatively easy to get into.

 

[KidDr]

Pediatric Psychiatry sounds right up your alley!

Of course I am kidding, but I do not think that going into Peds for the fellowship is a bad idea. Everyone does it in medicine, why not peds? I hate general pediatrics. I hate outpatient medicine. I hate having to refer for anything complex. I am 99% sure I am going into peds, and if I do it is for the sole purpose of going into cards or nicu. In terms of competition for fellowships, it is still a buyers market. I think cards is the most competitive peds fellowship (definately among the top 3) and there are more spots available than US grad applicants. Some programs are paying people extra stipends to come and do fellowships at their programs in less popular fields like nephrology and rheum and others. But from the way you are describing your interests, I think a peds surgical subspecialty would be more up your alley. If you do not want to be in the OR day after day, fields like peds uro, ent, ophtho would be up your alley. Getting into ophtho, uro, and ent is the hard part. The fellowships are relatively easy to get into.

You're right, I forgot about NICU. There's lots of procedures in NICU. But still a decent amount of rounding, at least in some hospitals.

 

[14022]

You're right, I forgot about NICU. There's lots of procedures in NICU. But still a decent amount of rounding, at least in some hospitals.

If you don't want to round, do pathology or radiology. As long as you have patients in a hospital, you need to round on them. Even family practice docs got to round on their patients.

 

[Leukocyte]

You guys are great! Thank you so much for the valuble advice.

I was just wondering if any of you guys know how is it like in Pediatric Cadiology.

-Do they spend most of their time performing Interventional cath. procedures like the adult guys?

or...

-Is it mostly clinic/floor work and consultation with occasional interventional cath cases here and there?

Thank you guys again! 🙂

 

[14022]

I was just wondering if any of you guys know how is it like in Pediatric Cadiology.

-Do they spend most of their time performing Interventional cath. procedures like the adult guys?

or...

-Is it mostly clinic/floor work and consultation with occasional interventional cath cases here and there?

please see this post...i talked a lot about interventional cardiology in this post...if more questions after, please shoot

http://forums.studentdoctor.net/showthread.php?t=196703

In answering your other questions, I can only say how it is at my school, which is far away from being an intense program (no fellows or anything like that). Everyone in the group takes turns covering the floors. At my place, they switch every week so you cover wards for one week q3-4 weeks. Cardiology has clinic every day but only one or two docs are there at a time. They do echos in clinic and read them right after theyre performed before the patient leaves. Every cardiologist can do diagnostic cath (see the link to the other post for more info) but only interventionally trained people can do intervent perocedures. We only have one guy who does interventional. They do 3-4 total procedures a WEEK in the cath lab at my school.

Call can be grueling from what I understand. If baby is born in the middle of the night and needs the PFO dialted to allow shunting, you get called in. If a baby is born in heart failure and needs an echo to help the surgeon decide what to do, you get called in. But rememeber that the incidence of heart defects is 8/1000, and that includes minor defects like ASD's, VSD's, PDA's, PFO's and other things that are not emergencies and need no acute (ie, called in the middle of the night) attention. This is unlike adult cards where a fat man feels an elephant sit on his chest every minute of every day. Hell, missed MI's are such a liability that the cardiologist is called when a guy feels pressure in his chest after he lets out a huge fart.

This is besides the point, but if you are interested in congenital heart disease and the history behind it, rent the movie "Something the Lord Made." It is about how the Blalock-Taussig shunt was discovered. Fantastic movie. It is a real movie, not a documentary or anything.

 

[kas23]

This is besides the point, but if you are interested in congenital heart disease and the history behind it, rent the movie "Something the Lord Made." It is about how the Blalock-Taussig shunt was discovered. Fantastic movie. It is a real movie, not a documentary or anything.

I LOVE this movie. It is not just about CHD, it is about discovery, innovation, and overcoming adversity (a real inspiration story). I agree, go rent it. It is an HBO movie and is on HBO now and again also. And besides, it stars Mos Def.

 

[Monika]

Guys, I am wondering if you could help me decide.

I personally love working with children, but this does not mean that I would be a good Pediatrition. It takes a special person to be a general pediatrition. I know I can never be happy as a general pediatrition because:

-I do not like "ward medicine"
-I want to specialize in only one area.
-I am a "do-er" rather than a "think-er"
-I hate long rounds, and very comprehensive H&Ps
-I hate "talking" and just want to go in and fix the problem
-I want to work with my hands most of the time
-I do not enjoy primary care

Would you still advice me to go into Pediatrics?

Would the Pediatric Fellowships help full-fill my needs?

And if so, would you advise someone who does not "like" general pediatrics to go into it anyway JUST FOR THE FELLOWSHIPS? Is this an acceptable "risk" to take?

Thank You. 🙂

What about Pediatric Orthopaedic Surgery? You are fixing things all day in that subspecialty. 🙂

 

[JudoKing01]

Dude, screw mos def. It totally stars Snape from Harry Potter.

 

[Leukocyte]

Took your reccomendations and saw the movie today, But I guess now I am more confused.

The movie is motivating all right, but not for Peds Cards!!! It tried to motivate me to suck it up and go through 10-12 years of residency/fellowship to be a Peds CT Surgeon!!! Ahh! Man that sucks. I mean I spent sleepless nights trying to convince myself NOT to go the Peds CT Surgery route, and after finally succeeding, this Hollywood gig comes and skrews it all up!!!! 😡

Good Movie though 👍

 

[14022]

Took your reccomendations and saw the movie today, But I guess now I am more confused.

The movie is motivating all right, but not for Peds Cards!!! It tried to motivate me to suck it up and go through 10-12 years of residency/fellowship to be a Peds CT Surgeon!!! Ahh! Man that sucks. I mean I spent sleepless nights trying to convince myself NOT to go the Peds CT Surgery route, and after finally succeeding, this Hollywood gig comes and skrews it all up!!!! 😡

Good Movie though 👍

You are forgetting the second half of the name of the shunt. Blalock-TAUSSIG shunt. She was a pediatrician who studied congenital heart disease (technically there weren't strictly cardiologists back then). Hook up with some sucker Peds CT surgeon and take half the credit for the work of a brilliant lab worker. Seriously though, peds cardiac surgery is awesome, but you're life will be hell. At most places, there are only 1-2 peds heart surgeons so that means you are on call 182-365 nights a year for the rest of your life. And the technique is so difficult. Say your doing valve work. A tiny but too tight and the baby has valvular stenosis; a little too loose and baby has valvular insufficiency. It demands a bit too much perfection for my taste.

 

[Leukocyte]

You are right. And also, the future of CT surgery (in general) is unpredictable. I mean who knows, maybe in the future, interventional Cath. might cure every cardiac anomaly, even Teratology of Fallot, and there might not be a need for CT surgery at all!!!

 

[oldbearprofessor]

YSeriously though, peds cardiac surgery is awesome, but you're life will be hell. At most places, there are only 1-2 peds heart surgeons so that means you are on call 182-365 nights a year for the rest of your life.

Minor point, there are relatively few emergency cases in pediatric CT surgery compared to the adult version. Most of these come from newborns. Even then, in the last 15 yrs, I've only seen a small number of stat cases come from the NICU in the middle of the night (virtually always these are obstructed TAPVR). Of course, there are emergency surgical revisions post-op due to bleeding, anastamosis problems, etc, but the overwhelming majority of things at night are handled by the cardiologists, not the CT surgeons. Not that the field doesn't demand long hours and unbelievable devotion, but nighttime cases are rare in the pedi side of things.

By the way, did I really see you list NICU as a potential career in another post somewhere 🙄

Regards

OBP

 

[oldbearprofessor]

Guys, I am wondering if you could help me decide.

I personally love working with children, but this does not mean that I would be a good Pediatrition. It takes a special person to be a general pediatrition. I know I can never be happy as a general pediatrition because:

-I do not like "ward medicine"
-I want to specialize in only one area.
-I am a "do-er" rather than a "think-er"
-I hate long rounds, and very comprehensive H&Ps
-I hate "talking" and just want to go in and fix the problem
-I want to work with my hands most of the time
-I do not enjoy primary care

Would you still advice me to go into Pediatrics?

Would the Pediatric Fellowships help full-fill my needs?

And if so, would you advise someone who does not "like" general pediatrics to go into it anyway JUST FOR THE FELLOWSHIPS? Is this an acceptable "risk" to take?

Thank You. 🙂

Your list does not mention research. Virtually all pedi subspecialties, including cardiology, require a research project. Now, for sure, there is a large range of how this is done and whether they are basic science or clinical science, but you should include in your thinking how you feel about research. You will probably spend most of 2 yrs doing research in a pedi fellowship. Note that pediatric surgeons have almost always done 2 yrs of research somewhere in their training pathway also.

Also, even if you don't want primary care, you may find, as I did, that there was a lot to be learned from one day a week or more in clinics seeing general patients. I never, ever wanted a career of it, but knowing that it wasn't my future career, but I was there to help the patients and get my one chance at understanding primary care, made it quite tolerable.

Regards

OBP

 

[14022]

By the way, did I really see you list NICU as a potential career in another post somewhere 🙄

Why yes I did, is this a problem? I love the NICU. Neonates are my favorite demographic in peds. Right now, I would choose cards over NICU because of the variety of clinical locations (echo, cath lab, PICU, NICU, general floors, outpatient clinic, fetal echo clinic). As much as I love the NICU, I think I would get cabin fever by being in the same unit all the time. But who knows? I have electives in both coming up in a few months.

And about the call thing. You are correct that there are not many times you get called in as a peds CT surgeon. BUT, if you are on call on the schedule, and regardless of the likelihood of getting called in, wouldn't the fact that you are on the schedule and carrying the pager eliminate your ability to go to a bar and have a drink or two, go play poker with your friends and have a beer or two, go on vacation with your significant other and children, etc.???

 

[Leukocyte]

Thanks for the advice Oldbearprofessor!

I do not mind research at all, espesially if it involves Cardiology. However, my biggest concern here is the amount of time that I will spend performing Interventional procesures as a Pediatric Cardiologist. The ability to work with by hands, and seeing the success of my "hand-work man-ship" is very important to me. The satisfaction is even sweeter if it involves helping a child!

Thanks again. 🙂

 

[oldbearprofessor]

Thanks for the advice Oldbearprofessor!

I do not mind research at all, espesially if it involves Cardiology. However, my biggest concern here is the amount of time that I will spend performing Interventional procesures as a Pediatric Cardiologist. The ability to work with by hands, and seeing the success of my "hand-work man-ship" is very important to me. The satisfaction is even sweeter if it involves helping a child!

Thanks again. 🙂

You're welcome. From what I can see, in the biggest programs, most cath work, especially the interventional stuff is handled by cardiologists who spend most of their time there. I think many of the fellows wishing to do that are even doing an extra year of cath/interventional training, just like the rhythm folks (EPS) are doing an extra year. So, I think if this is what you want, and you demonstrate talent at it (they won't offer you this training if you don't have the knack for it!), you can have a focused career in the cath lab in pedi heart.

It is very tense stuff in the cath lab with babies though. The catheters don't glide in with ease and the babies don't care to have them there either. But it is life-saving work and quite a challenging and exciting environment for those with the "Right stuff."

Regards

OBP

 

[oldbearprofessor]

Why yes I did, is this a problem? I love the NICU. Neonates are my favorite demographic in peds. Right now, I would choose cards over NICU because of the variety of clinical locations (echo, cath lab, PICU, NICU, general floors, outpatient clinic, fetal echo clinic). As much as I love the NICU, I think I would get cabin fever by being in the same unit all the time. But who knows? I have electives in both coming up in a few months.

Of couse it isn't a problem, just noticed that after all those posts about pedi cards, you mentioned NICU! 🙂

We don't get stuck in the NICU all the time....we do go to the delivery room too

Regards

OBP

 

[JudoKing01]

Also, I've heard that Peds CT Surgeons have to pretty much be great all the time...a couple screw ups on kids and you're pretty much out of the business. Just what I've read.

 

[imconfused2005]

Hey Leukocyte,
Why not general peds surgery? I guess you'd have to do a surgery residency; are you trying to avoid that?

 

[Leukocyte]

Hey Leukocyte,
Why not general peds surgery? I guess you'd have to do a surgery residency; are you trying to avoid that?

Yes, I am not very thrilled about going through a General Surgery residency were the mean patient age is 60 years.

Also getting a Peds Sx fellowship is very difficult - ONLY 30 spots!!! And the length of training that is required is not much different from Peds CT Sx:

-General Surgery: 5-7 years
-Research is REQUIRED for peds sx: 2 years is the minimum
-Peds Fellowship: 2 years

Total time of training: 9 - 11 years!!!!

I do not mind that, but given the highly competetive nature of obtaining a Peds fellowship, it would really suck to go through 8 years of adult general surgery and not get accepted into a Peds fellowship. It is a huge risk to take.

 

[pedsid]

you realize that the 5-7 years you are describing for gen surg ... the 2 extra years on there are for research. So it's really 7-9, not like that's a cakewalk. I spoke to a peds surg fellowship director a few months ago who also said that research wasn't absolutely essential ... but you do need to "stand out."