Lifetime Earning Potential - Pediatric Cardiac ICU vs. Pediatric ICU

[wickedprophet]

Does anyone know what the lifetime earning potential is for Pediatric Cardiac ICU (4 or 5 years of fellowship total) versus Pediatric ICU (3 years of fellowship)?

This study (Differences in Lifetime Earning Potential for Pediatric Subspecialists - PubMed) is a great reference, but doesn’t look at if after the standard 3-year fellowship, is doing an extra year or two [to work in pediatric cardiac critical care] a negative financial decision in regards to lifetime financial returns.

---

Members don't see this ad.

 

[DO2015CA]

Not sure if it specifically increases money but the job market of CVICU is a lot better than PICU at this point so even if the financial differences arent worth it then the job prospects are imo.

 

[SurfingDoctor]

CVICU typically earns more (I would juncture in the 10%-15% range based on comparable years out of practice). It also depends on the model (private versus academic) and the type of billing codes applied, but generally speaking, sick neonates generate the highest reimbursement in pediatrics (especially when you add in things like mechanical ventilation, ECMO, vasoactives, renal replacement) and the CVICU is just sick neonates. This combined with high revenue generation from OR times generally leads to higher incomes.

Then of course, you have to deal with the politics of the CVICU (there are a lot of "invested" parties) and for some, that bump in salary isn't worth the headache.

 

[BigRedBeta]

Yes you'll very likely earn more over the course of a *academic* career...
but I think most PICU attendings would advise you should actually like the heart, heart kids (and their parents), and find CV surgeons tolerable before thinking about this on purely economical terms.

There are a lot of PICU attendings where the variety of the patient population is one of the draws. If you're heart-centric, it may make more sense to go 3 year cards-> 2 year PICU fellowship. But then you'd be comparing CVICU salaries to Cardiology salaries. The math there is different given that most people are doing a super fellowship. However the salary gaps are narrower for CVICU (or perhaps even a deficit compared to something like interventional or procedure heavy EP) but a wider discrepancy in terms of lifestyle (eg - CVICU vs advanced imaging super subspecialists).

 

[Putkernerinthehall]

Yes you'll very likely earn more over the course of a *academic* career...
but I think most PICU attendings would advise you should actually like the heart, heart kids (and their parents), and find CV surgeons tolerable before thinking about this on purely economical terms.

There are a lot of PICU attendings where the variety of the patient population is one of the draws. If you're heart-centric, it may make more sense to go 3 year cards-> 2 year PICU fellowship. But then you'd be comparing CVICU salaries to Cardiology salaries. The math there is different given that most people are doing a super fellowship. However the salary gaps are narrower for CVICU (or perhaps even a deficit compared to something like interventional or procedure heavy EP) but a wider discrepancy in terms of lifestyle (eg - CVICU vs advanced imaging super subspecialists).

How strong is the market for PICU docs? Lots of job opportunities or is it something where you have to be willing to move to very specific places to work because of limited openings?

 

[BigRedBeta]

I think it's relatively ok for straight PICU docs. It's still a better market for CVICU attendings, as I don't think there's enough graduates of those programs to really saturate the market quite yet and most places are still trying to grow their units/improve their coverage models if they can. CVICU is still a relatively young sub-subspecialty and so it has taken a lot of time to create the workforce.

PICU job market is never wide open but it doesn't seem quite as tight as it was a few years ago, and certainly better than a lot of other peds subspecialty fields <looks at Peds Heme/Onc, eyes widen>. But there is definitely an inability to just pick your destination and go. The standard advice is that graduating fellows still need busy, high acuity units in their first job after fellowship in order to continue to maximize their development as an intensivist. That will 100% place you in larger cities. After 3-7 years, probably ok to move out to smaller towns/PICU's if that's what you're after. The work life balance in larger units will *generally* be more consistent, while smaller units will have more variance and greater highs and lows (from nothing doing to completely swamped).

 

[SurfingDoctor]

Not to beat a dead horse... but for future applicants, if you are going into critical care medicine based on the idea of money (and not straight up physiology and nothing more) or market forces are a road to satisfaction... prepare to be massively disappointed.

I'm not personally interested in more burnouts in this field based on my most recent service time, because pursuing critical care for monetary reasons will get you exactly that. Go treat some kid with diabetes in Montana. I swear, you will find that more rewarding.... finanically and personally. It’s best to just keep moving on, and ignore critical care if that’s the goal.

 

[Putkernerinthehall]

Not to beat a dead horse... but for future applicants, if you are going into critical care medicine based on the idea of money (and not straight up physiology and nothing more) or market forces are a road to satisfaction... prepare to be massively disappointed.

I'm not personally interested in more burnouts in this field based on my most recent service time, because pursuing critical care for monetary reasons will get you exactly that. Go treat some kid with diabetes in Montana. I swear, you will find that more rewarding.... finanically and personally. It’s best to just keep moving on, and ignore critical care if that’s the goal.

Conversely, if one loves the practice of critical care and salary is secondary then what helpful advice can you provide for those who want to take this path?

Is it rewarding?
Do you like your career?
Are job opportunities plentiful in urban areas?
What about jobs in rural areas?
What is the downside of the specialty besides the challenge of healing very sick / injured children, some of whom don't pull through?

 

[SurfingDoctor]

Conversely, if one loves the practice of critical care and salary is secondary then what helpful advice can you provide for those who want to take this path?

1)Is it rewarding?
2)Do you like your career?
3)Are job opportunities plentiful in urban areas?
4)What about jobs in rural areas?
5)What is the downside of the specialty besides the challenge of healing very sick / injured children, some of whom don't pull through?

1) Depends how one defines that and what views one as a reward. I bet you’d get many different answers.
2) Personally, yes. I can’t imagine doing anything else at the moment. I personally flirted with the idea of leaving pediatric critical care and joining the army, but my wife wouldn’t have it and now things are kinda too much on a roll.
3) How urban you talking about? For most major cities, the answer is no unless you have some prior years of experience or a unique skill set (research, informatics, administrative, etc). There are smaller towns (pop >50K) that have basic services where a lot of ICU physicians cover procedural sedation. That tends to be where the jobs are these days, or expanding healthcare systems.
4) Pediatric critical care is fundamentally a resource heavy rare disease. It doesn’t really exist in rural areas in isolation.
5) That’s about it. Relative to other pediatric specialities you are paid well, though compared to adult medicine you are not. That is the biggest downside I hear. Though salary is depend on DRGs and RVUs and because pediatric patients are generally more healthy, there’s less to bill for as opposed to great grandpa who doesn’t have one organ system left that functions. In the US system, old meat bags/unfermented newborns on deaths door and with private insurance are a gold mine, if that’s one’s sort of thing.