Least sad pediatric subspecialties?

[Dr. Brightside]

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So I'm thinking of what shadowing to try my M2 year and what types of electives I might want to do later. I really love the happy atmosphere of peds primary care except for the anti-vaxxers and sometimes endless ear infections/URIs. For subspecialties, I've only been exposed to areas of neuro and onc. What are some non-surgical subspecialties that are a more positive, ideally longitudinal environment where most of the kids have a good chance at living a normal life? How are Allergy/immuno or PM&R?


Thank you!!

 

[deleted87051]

It’s not longitudinal but I know a lot of very happy pediatric anesthesiologists.

 

[Cheeni17]

Are you asking which peds specialty has sick but not really kids?

 

[Dr. Brightside]

Are you asking which peds specialty has sick but not really kids?

Lol yeah I guess so essentially

 

[BigRedBeta]

Can't escape it in training where you'll have to see everything. And "normal life" is probably not a reasonable expectation for any kid that needs a longitudinal relationship with a specialist.

I'd rank them in the following order

A&I
Sports Medicine
Nephrology (probably a little bit lower if at a transplant center, but kidney transplants usually go pretty well)
Behavior/Development
GI
Endo (more frustrating than most though probably)
Cardiology with Imaging super fellowship
Rheum
Cardiology with EP super fellowship
ID
General Cardiology
Pulm (but trach dependent clinic can be a super bummer)
Peds Emergency Med
Neuro
Heme/Onc
Neonatology (if you got into a small, lower acuity NICU that shipped stuff under 28 or 30 weeks, then it probably jumps up to be equal with GI)
Critical Care
Cardiac Critical Care
Child Abuse Pediatrics






Heart Failure/Transplant and Liver Transplant are their own special category - The lows are really, really terrible, but seeing transplant patients do well is probably the highest of the highs.

 

[Cheeni17]

Lol yeah I guess so essentially

Ones that don’t say critical care in the name for a start

 

[Goro]

Can't escape it in training where you'll have to see everything. And "normal life" is probably not a reasonable expectation for any kid that needs a longitudinal relationship with a specialist.

I'd rank them in the following order

A&I
Sports Medicine
Nephrology (probably a little bit lower if at a transplant center, but kidney transplants usually go pretty well)
Behavior/Development
GI
Endo (more frustrating than most though probably)
Cardiology with Imaging super fellowship
Rheum
Cardiology with EP super fellowship
ID
General Cardiology
Pulm (but trach dependent clinic can be a super bummer)
Peds Emergency Med
Neuro
Heme/Onc
Neonatology (if you got into a small, lower acuity NICU that shipped stuff under 28 or 30 weeks, then it probably jumps up to be equal with GI)
Critical Care
Cardiac Critical Care
Child Abuse Pediatrics






Heart Failure/Transplant and Liver Transplant are their own special category - The lows are really, really terrible, but seeing transplant patients do well is probably the highest of the highs.

The blackest senses of humor I have ever seen in human beings were in the Peds Heme/Onc people I used to know at Sloan-Kettering.

 

[Catalystik]

I really love the happy atmosphere of peds primary care except for the anti-vaxxers and sometimes endless ear infections/URIs. For subspecialties, I've only been exposed to areas of neuro and onc. What are some non-surgical subspecialties that are a more positive, ideally longitudinal environment where most of the kids have a good chance at living a normal life?

Adolescent Medicine. (Not on the above list.)

 

[mvenus929]

Can't escape it in training where you'll have to see everything. And "normal life" is probably not a reasonable expectation for any kid that needs a longitudinal relationship with a specialist.

Endo (more frustrating than most though probably)

Hey now, I have lots of patients that will have a normal life despite their long-term relationship with me (in some cases because of their relationship with me... my CAH kids would die or have some bad outcomes if us endos weren't around). So long as they take their medication, which can be as easy as a single pill per day or as complex as multiple injections and pills per day.

 

[GoSpursGo]

Heme/onc really isn't that sad. The picture you see of the patients when they're hospitalized isn't really indicative of how the majority of patients really do beat their cancer and go on to live (mostly) normal lives. 90% of kids with standard risk pre-B ALL survive their disease these days, and their end-of-chemo parties are super fun 🙂

Similarly, cardiology has good continuity with their patients, and once you fix their congenital heart issues they are mostly normal kids.

Maybe rheumatology, they seem to follow their JIA/SLE/etc patients pretty closely, and once they start therapy it seems like they're mostly fine. But that's one I don't have a ton of experience with myself.

Those are the two (or three) that I would identify that you really wind up with long-term ownership of your patients. Pulm owns their CF kids, and GI owns their IBD kids, but to me both of those diseases is more frustrating than cancer or congenital heart disease, because they are harder to definitively fix.

 

[BigRedBeta]

Hey now, I have lots of patients that will have a normal life despite their long-term relationship with me (in some cases because of their relationship with me... my CAH kids would die or have some bad outcomes if us endos weren't around). So long as they take their medication, which can be as easy as a single pill per day or as complex as multiple injections and pills per day.

Fair enough, but still, the diabetic teenagers that show up 6 + times per year in DKA can't be fun.

Heme/onc really isn't that sad. The picture you see of the patients when they're hospitalized isn't really indicative of how the majority of patients really do beat their cancer and go on to live (mostly) normal lives. 90% of kids with standard risk pre-B ALL survive their disease these days, and their end-of-chemo parties are super fun 🙂

Yes, yes, I hear this all the time even from the BMT/Stem Cell attendings about how "great" all their patients do. When they do terribly (which does happen), it's supremely awful. And I loathe when they try to tell me that I shouldn't intubate their GVHD kid with sats in the 60s on Bipap "because mortality for intubated SCT patients is over 70%" as if somehow the intubation is key point in the clinical picture. I think the overall success rate for standard risk cancers has also affected a lot of the newer Heme/Onc attendings causing them to paint an overly rosy picture to families. I feel like the old school attendings who have seen some things in their career are much more realistic with families and provides them with a better sense of the situation...but you have to be a little bit more sad with them in order to paint an accurate picture.

 

[MSTPlease]

The blackest senses of humor I have ever seen in human beings were in the Peds Heme/Onc people I used to know at Sloan-Kettering.

What’s the difference between Citi Field and Memorial Sloan Kettering?


The Mets always win at MSK

 

[right500]

The blackest senses of humor I have ever seen in human beings were in the Peds Heme/Onc people I used to know at Sloan-Kettering.

The saddest I have ever seen a person in my life was the hospital clown in a heme/onc unit at the end of his shift (this was at a regional academic medical center). It takes strong coping mechanisms to go home and have a normal life. I ended up doing a journal club about hospital clowns' impact on pain management. Totally undervalued volunteers (at least the quality ones, that guy was a retired school teacher).

 

[GoSpursGo]

Yes, yes, I hear this all the time even from the BMT/Stem Cell attendings about how "great" all their patients do. When they do terribly (which does happen), it's supremely awful. And I loathe when they try to tell me that I shouldn't intubate their GVHD kid with sats in the 60s on Bipap "because mortality for intubated SCT patients is over 70%" as if somehow the intubation is key point in the clinical picture. I think the overall success rate for standard risk cancers has also affected a lot of the newer Heme/Onc attendings causing them to paint an overly rosy picture to families. I feel like the old school attendings who have seen some things in their career are much more realistic with families and provides them with a better sense of the situation...but you have to be a little bit more sad with them in order to paint an accurate picture.

IIRC, you're a PICU attending right? Your point is well taken, but even if it feels like out patients are causing your worst train wrecks some weeks, it really is a pretty small proportion of our population who wind up in the ICU.

In any event, there I feel the perception that heme/onc is a sad field is overstated, and if anything I said is interesting to the OP I'd at least recommend they give it a shot.

 

[mvenus929]

Fair enough, but still, the diabetic teenagers that show up 6 + times per year in DKA can't be fun.

Sure, but out of my entire population of patients, those patients make up a very small percentage of them (we have >2000 kids with Type 1 seen in our system, and maybe 10ish come in multiple times per year in DKA). The harder ones are actually the teenagers who take just enough insulin to keep themselves out of DKA (so they are never seen by the residents in the hospital), but have A1cs in the low to mid-teens.

 

[galactus]

This is easy. Pedi Sports Medicine! You take care of injuries and help with injury prevention, and depending on your gig, also cover some high school games! It's also the only fellowship in pediatrics that's 1 year where the rest is three.

 

[Carlin]

The blackest senses of humor I have ever seen in human beings were in the Peds Heme/Onc people I used to know at Sloan-Kettering.

The pediatric heme oncs I have worked with are some of the loveliest, most compassionate, caring physicians I have ever known. ‍I haven’t encountered the black humor variety.

 

[Goro]

The pediatric heme oncs I have worked with are some of the loveliest, most compassionate, caring physicians I have ever known. ‍I haven’t encountered the black humor variety.

My colleagues matched the bolded as well. They just had dark senses of humor.

 

[Going Incognito]

Child and Adolescent Psychiatry?

 

[raiderette]

Child and Adolescent Psychiatry?

My worst ob/gyn case I had as a third year was a 10 year old who had been sexually assaulted. I can't imagine child psych is happy. Never underestimate the ability we humans have to damage our young and vulnerable.

 

[Going Incognito]

My worst ob/gyn case I had as a third year was a 10 year old who had been sexually assaulted. I can't imagine child psych is happy. Never underestimate the ability we humans have to damage our young and vulnerable.

I did not underestimate anything! I CERTAINLY NEVER SAID that child psych was happy!!!!!

 

[mvenus929]

What are some non-surgical subspecialties that are a more positive, ideally longitudinal environment where most of the kids have a good chance at living a normal life?

Child and Adolescent Psychiatry?

I CERTAINLY NEVER SAID that child psych was happy!!!!!

Ok then.

I’d also toss in that many kids seen in psych will not live a normal life. But it is a badly needed field.

 

[SurfingDoctor]

Either you want to help kids struggle through their illnesses.... or you don't.

The "least sad" is a mentality that will probably lead to burnout...