Let’s Vent…

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Zidovudine

I’m really just a grumpy old man on the inside.
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Calling all peds folks… it’s time for a good ole fashioned vent post. Just let it all out here… it’s a safe space. What are the things you dislike about peds? Your peds subspecialty?

I’ll go first…. The crazy, anxious, consistently-on-the-verge-of-tears, helicopter parent who thinks they know more than you and DEMANDS you do what they want you to do. Like “give a steroid shot to prevent an infection”. Wow. 6+ years of post-graduate training and I had NO idea steroids prevent infections….. where was this gem of knowledge pre-covid?

Tag, you’re it!

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Calling all peds folks… it’s time for a good ole fashioned vent post. Just let it all out here… it’s a safe space. What are the things you dislike about peds? Your peds subspecialty?

I’ll go first…. The crazy, anxious, consistently-on-the-verge-of-tears, helicopter parent who thinks they know more than you and DEMANDS you do what they want you to do. Like “give a steroid shot to prevent an infection”. Wow. 6+ years of post-graduate training and I had NO idea steroids prevent infections….. where was this gem of knowledge pre-covid?

Tag, you’re it!
You should drop this knowledge on them:

Conclusions and Relevance This study suggests that corticosteroid bursts, which are commonly prescribed for children with respiratory and allergic conditions, are associated with a 1.4- to 2.2-fold increased risk of GI bleeding, sepsis, and pneumonia within the first month after initiation of corticosteroid therapy that is attenuated during the subsequent 31 to 90 days.
 
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It's so frustrating that Peds specialities are paid so much less than their adult counterparts. I am 7 years removed from medical school, have no money in my checking account and have a mountain of student debt (and some credit card debt). It's stressful! While my close med school friends have paid off their student loans, own houses, are making 400k+ per year, and are deciding how best to invest their savings.
 
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This thread could not be timed better, thank you.
Being severely underpaid for our years of training, constant fear of being replaced by a nurse practitioner (happened to a friend of mine recently), and the ****ing board exam which has been the bane of my existence and greatest source of stress honestly. Adjusting to my first year as an attending at a high volume clinic with lots of call which has been tough, but having to come home and study knowing I am severely behind in my study schedule and a poor test taker to begin with on top of the new job has been overwhelming. If I wasn't in so much debt or had another option, I'd quit tomorrow honestly. I do genuinely like what I do at it's purist sense, but the BS tied to it is too much. If I fail my boards, I might change to a part time job or just take an extended length of time off and just focusing on studying and relaxing/figuring out my life.
 
Welp... this has clearly (and quite quickly... noice) become a thread of "Why pediatrics sux"... good luck to all.

While I doubt that was its intention... get ready for "I'm in debt and don't want to do pediatrics" (yes, there are legitimate concerns there... but then again... healthy doesn't pay... blame the anesthesiologists)... and "NPs are taking over our jerbs" (ha... alrighty then)...

Did anyone ever stop and wonder why people think that pediatricians are the most passive, aggressive group of doctors? :unsure:
 
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The decreased pay is totally worth not having to deal with treating adults in my mind :p

I think my biggest complaint about pediatric training is the borderline over-supervision of residents and fellows. Procedural competency is hard to achieve because procedures have become less common than previously so I understand helicopter attending-ing for those but the day-to-day medical decision making inpatient and outpatient (not sub-specialized) needs to be delegated to residents more so than it is currently. Otherwise, trainees will just learn to use their attending crutch and not commit to decisions on their own.
 
The decreased pay is totally worth not having to deal with treating adults in my mind :p

I think my biggest complaint about pediatric training is the borderline over-supervision of residents and fellows. Procedural competency is hard to achieve because procedures have become less common than previously so I understand helicopter attending-ing for those but the day-to-day medical decision making inpatient and outpatient (not sub-specialized) needs to be delegated to residents more so than it is currently. Otherwise, trainees will just learn to use their attending crutch and not commit to decisions on their own.

This is very true.

I was med/peds in residency. The difference in ICU training was ridiculous. In IM, I ran codes solo as a 2nd year in many cases, I had done at least 50 intubations and 20+ chest tubes and I wasn't even trying to get those numbers, the upper levels FORCED me to do that kind of volume. That would never, ever happen in peds. Even 3rd years/chief residents in peds rarely get to have any significant input on codes. I know peds residents that did zero intubations, zero lines, and zero chest tubes during their PICU rotations. That's obscene.
 
This is very true.

I was med/peds in residency. The difference in ICU training was ridiculous. In IM, I ran codes solo as a 2nd year in many cases, I had done at least 50 intubations and 20+ chest tubes and I wasn't even trying to get those numbers, the upper levels FORCED me to do that kind of volume. That would never, ever happen in peds. Even 3rd years/chief residents in peds rarely get to have any significant input on codes. I know peds residents that did zero intubations, zero lines, and zero chest tubes during their PICU rotations. That's obscene.
I mean, to be fair, codes are a very rare event in pediatrics, but happen all the time on IM. I probably attended more codes as a phlebotomist working in a general hospital than I did as a resident in pediatrics (and I was a resident for twice as long as I was a phlebotomist). During my PICU rotation, there were a total of 2 chest tubes placed... so yeah, residents weren't first choice for them.

There are ways to improve pediatric training, don't get me wrong, but part of the difference between adult and pediatric training is that people get more worked up over mistakes done to 2 year olds compared to 80 year olds.
 
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go for gen peds in rural area. Dont go for peds subspecilaty . Will lose out
APNs and PAs are taking over the subspecialty
 
go for gen peds in rural area. Dont go for peds subspecilaty . Will lose out
APNs and PAs are taking over the subspecialty
Mid-level practitioners are not taking over any subspecialty in pediatrics, at least not at any level even remotely close to nurse anesthetists in anesthesia. It is true there are more mid-level practitioners entering some fields (Child neuro, Peds GI) but I think that's more of a reflection of the dearth of pediatricians willing to go into those fields more than anything. In some fields (Peds Cardiology, Peds Heme-onc, PICU, NICU, Peds EM) they are basically perpetual residents.
 
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Mid-level practitioners are not taking over any subspecialty in pediatrics, at least not at any level even remotely close to nurse anesthetists in anesthesia. It is true there are more mid-level practitioners entering some fields (Child neuro, Peds GI) but I think that's more of a reflection of the dearth of pediatricians willing to go into those fields more than anything. In some fields (Peds Cardiology, Peds Heme-onc, PICU, NICU, Peds EM) they are basically perpetual residents.
I think the vent is a little overstated (it IS the venting thread after all :) ). But I will say that the influx of APPs is making it difficult in several subspecialties to "just take care of patients." Since many subspecialties only exist at academic centers, it means you have to have some sort of research focus to justify keeping you around, which is maybe not desirable to some fellowship grads. There obviously are some specialties that are immune to this (NICU and PEM of course).
 
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I think the vent is a little overstated (it IS the venting thread after all :) ). But I will say that the influx of APPs is making it difficult in several subspecialties to "just take care of patients." Since many subspecialties only exist at academic centers, it means you have to have some sort of research focus to justify keeping you around, which is maybe not desirable to some fellowship grads. There obviously are some specialties that are immune to this (NICU and PEM of course).
It's like one of those chicken or the egg situations. Historically many of the pediatric subspecialties had a heavy research focus (including even basic) and over time that has faded as has interest among residents in pursuing those fields entirely. There was thus a gap and APPs filled it. My hope is that if enough of a physician workforce is created then we'll gradually start to see a shift back.
 
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