Medicine vs. Pediatrics

[Dr. Pepper]

Hey guys,

Wanted to ask your opinion on medicine vs. peds. I just recently finished both my medicine and peds rotations and they have been my favorite rotations thus far, but I wanted some advice, particularly from those who have gone through the process, of deciding between the two.

I'm hoping to go into either adult heme/onc or peds heme/onc; I also am considering immunology and ID.

Overall, I think that medicine is more interesting in terms of the analytical approach coming up with a differential but I generally like working more with kids.

After thinking a lot about it, I've come up with the following assessment:

1. General: I think that general medicine issues (HTN, diab, COPD) are more interesting than general peds issues (FTT, URI)

2. Specialties: I think that peds specialties are generally more interesting (esp. cardiology, endocrinology, heme/onc) because of rarer diseases, genetic diseases, different presentations than adult specialties.

3. Adults vs. kids: I like working more with kids. I feel better taking care of them because I feel like they have done nothing wrong (lifestyle wise) and that they still have a lot to look forward to. I also feel like working with kids lends some creativity to the process.

4. Personalities: I enjoy both the medical cerebral attitude and the pediatric playful attitude. I feel less stressed on pediatrics, but I feel like I learned more on medicine. I would probably prefer to hang out with peds residents.

5. Research: I am very interested in doing research in the future, and, for some reason, probably due to the amount of medicine vs. peds taught in medical school, I feel like medicine just has significantly better research than peds. Probably because I just read more about adult issues and more major research is done on adults (adults are sicker than kids), but I thought I would just mention it. Please clarify for or against.

6. Pay/Lifestyle: Lifestyle is more important to me than money. At this point, I don't care about money, but I realize that may change in the future. I still think lifestyle will be more important though in the future. All I do in my free time is watch movies and read books (no horse riding, boat racing or skydiving or any of that) so I don't think money is that important.

7. Peer pressure: Most of my friends/colleagues predict I will go into medicine. They say that I am very analytical, come up with good differentials and would be a really good medicine resident. Most of my friends don't see me in peds because they think that it isn't as serious as medicine and most people just write it off. I mention this just because I'm sure it's having an effect on me.

Anyway, sorry for the long post. Let me know your opinions. And for those who recommend med/peds, I am shying against that because I plan on specializing and I would rather make a decision and focus on one specialty instead of being a jack-of-all-trades.

Thanks for your advice.

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[group_theory]

Anyway, sorry for the long post. Let me know your opinions. And for those who recommend med/peds, I am shying against that because I plan on specializing and I would rather make a decision and focus on one specialty instead of being a jack-of-all-trades.

Thanks for your advice.

Med-Peds isn't jack-of-all-trades, we're internists and pediatricians. We take the same ABIM board as the internal medicine residents, and the same ABP board as the pediatric residents. When I was on medicine, I was treated like a medicine resident and expect to have the knowledge and skillsets of a medicine resident. Likewise for pediatrics. You will be surprised how the strength of one field complements the weakness of the other. Very frequently, across multiple hospitals and programs, you will hear faculty comment on how med-peds residents are one of the stronger residents, likely due to the breath and depth of knowledge require.

As for post-residency plans - there are numerous - from being hospitalists (from both joint med-peds hospitalists, medicine hospitalists, pediatric hospitalists), primary care, and fellowship options from both medicine or pediatrics (or allergy/immunology). You can even combined an adult and pediatric fellowship (if you want to train that long) if you want, or given your background, train in one and work on transition care medicine (which is a growing fields) to help bridge the gap between pediatrics and internal medicine. Adult Congenital Heart and Adult Cystic Fibrosis are among areas that need specialists. You will need adult heme/onc specialists who will understand what a pediatric childhood cancer survivor went through (and the downstream effects of chemotherapy, radiation therapy, or even BMT)

Med-Peds is not for everyone. You must like both Internal Medicine and Pediatrics. Generally pediatric residents can't stand taking care of adults, and internal medicine residents can't stand taking care of kids (and parents, mostly the parents). Plus knowing all the various genetic syndromes/abnormalities, behavioral/adolescent medicine, neonatal medicine, etc are all turn-offs for medicine residents.

No one can tell you if you should pursue a medicine residency or pediatric residency. Look at the pros and cons, look at your career options and what you want to do (and what are your options should you change your mind), look at the most annoying part of each, and decide which field would serve you better. Unfortunately you don't have the luxury of time since you have to get your LORs and application ready (and audition rotations) by the beginning of your 4th year. And your perception of a certain field can change as you go through residency (you might get bored of htn management, or diabetes management, or hyperlipidemia management, but you might get bored of viral URI, unknown rash, baby constipation/diarrhea, middle of night mommy calls, earaches, etc). You'll never get bored of well-child checks (esp if they are healthy) - you get to play with babies 😛

 

[group_theory]

As written above, I'll try to address some of your questions/concerns (from a perspective of a med-peds graduate, currently in fellowship)

Hey guys,
I'm hoping to go into either adult heme/onc or peds heme/onc; I also am considering immunology and ID.

Cool beans. Adult heme/onc and Peds heme/onc are competitive fellowships. ID (whether adult or peds) are not as competitive. Allergy/Immunology is a competitive fellowship which can be achieved via medicine residency or pediatric residency (but you will be expected to be able to see and treat all age range in allergy/immunology)

Overall, I think that medicine is more interesting in terms of the analytical approach coming up with a differential but I generally like working more with kids.

Both are analytical. Fever of Unknown Origin workup is different in kids than in adults. Failure to Thrive in kids is different than in adults. Unexplain acidosis is different in kids than in adults. Both have lots of overlap (SVT is SVT, whether kids or adults, ARDS/sepsis is the same, etc). You still have to recognize the different types of murmurs in kids, just as you do in adults.

1. General: I think that general medicine issues (HTN, diab, COPD) are more interesting than general peds issues (FTT, URI)

that's a personal preference that only you can decide which is more interesting. Just a word of caution - what you find interesting now may not be as interesting as a resident/attending.

2. Specialties: I think that peds specialties are generally more interesting (esp. cardiology, endocrinology, heme/onc) because of rarer diseases, genetic diseases, different presentations than adult specialties.

I think the specialities in both adults and kids are interesting. There are rare diseases in adults, just as you see in kids. Managing a 25 yo with single ventricle physiology after having a completed Fontan is just as complex (and requires knowledge of corrected anatomy/physiology) as a newborn baby with a hypoplastic left ventricle s/p Norwood. Managing an adult cystic fibrosis patient with severe bronchiectasis with MDR cepacia is just as difficult as a newborn diagnosed with CF through newborn screen. NICU is a different beast without any adult equivalent. Adolescent Medicine has a lot of overlap between pediatrics and general medicine. What is interesting for you may be boring or disinteresting to someone else. So this is a personal decision.

3. Adults vs. kids: I like working more with kids. I feel better taking care of them because I feel like they have done nothing wrong (lifestyle wise) and that they still have a lot to look forward to. I also feel like working with kids lends some creativity to the process.

Yup. But don't forget the parents in the equation ... can't deal with kids and forget the parents. A lot of time, dealing with parents makes the experience all the more enjoyable. Sometimes, dealing with parents makes you want to or or

4. Personalities: I enjoy both the medical cerebral attitude and the pediatric playful attitude. I feel less stressed on pediatrics, but I feel like I learned more on medicine. I would probably prefer to hang out with peds residents.

You will find all types of people in both medicine and pediatrics. By its very nature, people going into pediatrics will be good at working with kids (and parents). But you will find some people (nurses, attendings, residents) who will make you wonder why they are working with kids. But there is definitely stress in both medicine and in pediatrics (for residents). But you can also find easy going medicine residents as well. Just have to pick the right environment (with hospital that supports the residents, and administration that supports the residents as well)

5. Research: I am very interested in doing research in the future, and, for some reason, probably due to the amount of medicine vs. peds taught in medical school, I feel like medicine just has significantly better research than peds. Probably because I just read more about adult issues and more major research is done on adults (adults are sicker than kids), but I thought I would just mention it. Please clarify for or against.

There are definitely lots of research going on in the pediatric world, especially at some of the larger academic children hospitals, such as CHOP, Children's Boston, Cincinnati Childrens, Texas Children, etc. Still same IRB approval process. As a requirement to graduate from a pediatric fellowship, you need to do research and publish.

6. Pay/Lifestyle: Lifestyle is more important to me than money. At this point, I don't care about money, but I realize that may change in the future. I still think lifestyle will be more important though in the future. All I do in my free time is watch movies and read books (no horse riding, boat racing or skydiving or any of that) so I don't think money is that important.

Lifestyle is completely up to you. It also depends on what field, what location, etc. You can be part-time in both pediatrics as well as general medicine ... just have to find the right place. Now will you get paid as much as someone working fulltime? Probably not. You can work hard and earn more money, or work less and earn less. You can be in private practice and make more money, or in academia and earn less. Or you can work extremely hard in an underserve area with low reimbursement rate (and high uninsure rate) and not make lots of money. It's all in choices. There are opportunities in peds where you can make lots of money, and fields where you will not. Same with internal medicine.

7. Peer pressure: Most of my friends/colleagues predict I will go into medicine. They say that I am very analytical, come up with good differentials and would be a really good medicine resident. Most of my friends don't see me in peds because they think that it isn't as serious as medicine and most people just write it off. I mention this just because I'm sure it's having an effect on me.

It will probably have some subtle subconscious effect, but in the end, you have to decide which is the right choice for you, which will make you happy (and be able to sleep at night). You will need that when in residency, when you are stress, overworked, and tired. Picking a field because your classmates (or friends, or family) think you should go to a field will backfire. You pick what you think you want. Input from friends, families, anonymous strangers on the internet, classmates, advisors, etc. are helpful but in the end, you have to decide.

Anyway, sorry for the long post. Let me know your opinions. And for those who recommend med/peds, I am shying against that because I plan on specializing and I would rather make a decision and focus on one specialty instead of being a jack-of-all-trades.

Thanks for your advice.

Good luck. You don't have to go into Med-Peds if you don't want to. But it is something to consider. I suggest you talk to a faculty member who is med-peds, or a resident in med-peds, to know what your options are. Also talk to someone in pediatrics, and someone in medicine, get their perspectives too. And soon you will be graduating from medical school and this decision will be behind you, with a bright future ahead of you. And congrats on making it this far.

 

[nogolfinsnow]

Full disclosure, I'm a peds resident, but like many peds residents was deciding between medicine and peds. Before I address your points, realize that most med school programs are tailored to adult medicine; you learn physiology and pathophys of adult issues, you do IM and FP rotations that in sum are much, much longer than peds. Your surgery, OB, and psych rotations will be mostly adults as well. Now onward...

Hey guys,

Wanted to ask your opinion on medicine vs. peds. I just recently finished both my medicine and peds rotations and they have been my favorite rotations thus far, but I wanted some advice, particularly from those who have gone through the process, of deciding between the two.

I'm hoping to go into either adult heme/onc or peds heme/onc; I also am considering immunology and ID.

Overall, I think that medicine is more interesting in terms of the analytical approach coming up with a differential but I generally like working more with kids.

After thinking a lot about it, I've come up with the following assessment:

1. General: I think that general medicine issues (HTN, diab, COPD) are more interesting than general peds issues (FTT, URI)

Unfortuntely, HTN, DMII, and obesity are now peds issues as well. You'll see a ton of asthma. Also, understanding development is a huge peds issue that doesn't exist in adults.

4. Personalities: I enjoy both the medical cerebral attitude and the pediatric playful attitude. I feel less stressed on pediatrics, but I feel like I learned more on medicine. I would probably prefer to hang out with peds residents.

Don't shortsell the cerebral attitude of pediatricians. Adult issues are more prevalent, so you really need to be at a high volume, wide catchment area peds hospital to see the full spectrum of pediatrics. And residents vary from program to program; this is something that is best assessed through away rotations and interview days.

5. Research: I am very interested in doing research in the future, and, for some reason, probably due to the amount of medicine vs. peds taught in medical school, I feel like medicine just has significantly better research than peds. Probably because I just read more about adult issues and more major research is done on adults (adults are sicker than kids), but I thought I would just mention it. Please clarify for or against.

There is tons of peds research going on, your exposure just depends on what med school you happen to be at. You can glance at the index of Pediatrics each month to get a taste for what's going on in the world of peds.

6. Pay/Lifestyle: Lifestyle is more important to me than money. At this point, I don't care about money, but I realize that may change in the future. I still think lifestyle will be more important though in the future. All I do in my free time is watch movies and read books (no horse riding, boat racing or skydiving or any of that) so I don't think money is that important.

This is an intensely personal decision that you need to think long and hard about both now and once you're in residency. Can't offer much help here

7. Peer pressure: Most of my friends/colleagues predict I will go into medicine. They say that I am very analytical, come up with good differentials and would be a really good medicine resident. Most of my friends don't see me in peds because they think that it isn't as serious as medicine and most people just write it off. I mention this just because I'm sure it's having an effect on me.

Again, this is a bias that comes from how med school is structured. Most med students are exposed to such a tiny fraction of what pediatrics is that they write it off as less serious. Many med schools are not affiliated with stand-alone peds hospitals, so you don't get exposed to the vast world of peds pathology that you see at a large Children's hospital. I think these factors create the thoughts that your friends have of "peds isn't a serious as medicine," but if you had the chance to work at a tertiary care peds hospital with a busy peds ED (including trauma), a high level NICU and PICU and busy medicine service, then you'd probably develop a new appreciation for the seriousness of pediatrics. Maybe in your 4th year you can do a rotation at a busy Children's hospital to get a little more of an idea of the breadth of pediatrics. Pediatricians are very serious people, and while we do enjoy seeing a perfectly healthy and happy baby, we also relish the challenges of the unique health and development issues that only kids encounter.

Best of luck!

 

[Dr. Pepper]

Thank you both to nogolfinsnow and group_theory for the very thoughtful responses. I really appreciate it.

For group, I hope that I didn't come off as disrespectful at all to med-peds. I was simply told that a lot of people who go into med-peds decide between med-peds and FM, and so I assumed that they trended towards generalist medicine. I will certainly get in touch with a med-peds attending in addition to a meds and peds one.

For golfin, I agree that an away rotation would be good at a large stand-alone children's hospital to get a better idea of inpatient pediatrics.

I was discussing this with a peds attending earlier today and she told me that she had a similar dilemma and simply did an ACE in medicine and an ACE in pediatrics and asked which one she was happy to get up and go to. It may be simplistic, but it made the most sense to me, so I'm going to try and set up ACEs in both and find a mentor familiar with both fields.

I'd love to hear more responses. Thank you all.

 

[IlDestriero]

Anyone who thinks "adults are sicker than kids" hasn't spent any time at a Children's hospital.

 

[Brigade4Radiant]

Anyone who thinks "adults are sicker than kids" hasn't spent any time at a Children's hospital.

No not really in general adults are sicker. I have spent plenty of time in a children's hospital.

 

[Kaputt]

Cool beans. Adult heme/onc and Peds heme/onc are competitive fellowships. ID (whether adult or peds) are not as competitive. Allergy/Immunology is a competitive fellowship which can be achieved via medicine residency or pediatric residency (but you will be expected to be able to see and treat all age range in allergy/immunology)

As a slight aside, would being a med-peds person strengthen your training if you went into A/I, compared to being trained med or peds alone? Med-peds and A/I seem like a match made in heaven.

 

[calvnandhobbs68]

Anyone who thinks "adults are sicker than kids" hasn't spent any time at a Children's hospital.

Oh you mean that place where all the sick kids go?

If kids were sicker than adults then we wouldn't have many adults around.

 

[IlDestriero]

That's the point. If you're worried you won't find enough pathology in the pediatric population to keep your interest, go work at a stand alone Children's hospital. I obviously wasn't suggesting that the world is populated with children with multiple medical problems. Though the pediatric obesity epidemic is probably bringing us closer.
I love how everyone on SDN is so clever...

 

[Cali2]

5. Research: I am very interested in doing research in the future, and, for some reason, probably due to the amount of medicine vs. peds taught in medical school, I feel like medicine just has significantly better research than peds. Probably because I just read more about adult issues and more major research is done on adults (adults are sicker than kids), but I thought I would just mention it.

Probably not the major reason most research is done in adults. There is simply a higher threshold to risking adverse effects or poor outcomes when your subjects are kids.

I think you also left out a significant factor in your decision that many have alluded to, parents. You have to feel comfortable with extensive family interactions with anxious or difficult parents. And while kids may not be to blame for lifestyle related illnesses, as childhood obesity rates increase, you will be facing parents who refuse to help make good choices for their kids.