"Not finding the medicine interesting in pediatrics" - what does that mean?

[DigNewton]

tl;dr – Title basically says it all.

I've read/heard several people say they ended up not going into pediatrics because they "didn't find the medicine interesting in peds" or something along those lines, but none of them elaborated on what they meant. I've asked a couple MS4s that I know who are going into pediatrics, and they have no idea what that means. Does anybody here know what people mean when they say that?

This is a relatively pointless post, as I'll see firsthand how I like peds during clerkships... I'm just curious what people might mean, and I'm procrastinating on SDN.

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[HemeOncHopeful19]

You’re kinda preaching to the choir by posting in the Peds forum, but I’ll take a stab at it as someone who didn’t pick Peds.

First off, the pay in Peds is low, much lower than it should be but will never be fixed (IMO) with the way society feels about healthcare today. If anything we will all be down there with you in 20 years. This more than anything else probably drives “student interest” the most.

People in Peds tend to be kinda softies who “just love kids” and I feel like for the majority that is why they pick it and not for “interesting medicine.” Obviously there is interesting pathology in kids but I felt like on AVERAGE your typical Peds patient is less complex than an adult so maybe that’s what they meant. In reality if Pediatricians made $500k+ a year you would suddenly find a massive wave of medical students fascinated with pediatric pathology and passionate about taking care of children.

 

[SurfingDoctor]

Pediatric medicine is just medicine in smaller individuals. What they really mean as far as “the medicine isn’t interesting” is they don’t like 1) medicine in general and/or 2) don’t like dealing with kids. But shock is shock and trauma is trauma and hypertension is hypertension, kids or adults. There is more preaching of prevention though in pediatrics, because once they hit adulthood, the prevention ship has sailed and all you can do is bail water to slow the speed of sinking. Or maybe it is as stated, they just want more money and they feel awkward saying it aloud and prefer to lie.

To each their own though.

 

[GoSpursGo]

I do generally agree that peds patients tend to be medically less complex than adult patients. In fact, the whole idea about general outpatient peds is that you're seeing kids and giving anticipatory guidance--meaning there's literally nothing wrong with a decent proportion of the kids you're seeing! On the inpatient side, a decent proportion of patients will be there with one problem (bronchiolitis, osteomyelitis, pneumonia, etc...) and won't have a cadre of other chronic medical problems that you would see on an adult medicine ward (i.e. diabetes, HTN, HLD, chronic heart failure, dialysis...). That's a positive for some, while others like the cerebral dance of managing multiple problems all at once. To each their own.

 

[BigRedBeta]

The average pediatric clerkship doesn't expose students to the more complex patients with 5-9 subspecialists, and that's fine. They are definitely a small minority of patients (though responsible for majority of hospitalizations and medical spending). And genetic syndromes are usually rare, which, when most students are still in the "I just need to see something to understand it" mode makes it hard to develop any interest.

But there definitely specialties that mirror the multiple problem approach of adult inpatient medicine that seems to attract students: PICU, NICU, Cardiology and Pulm (for the CF patients) all are able to have just as much complexity as any adult patient. That was absolutely the draw to PICU for me (and I would have done a pulm fellowship had I liked outpatient medicine).

 

[DeadCactus]

Apart from the economic argument, I would argue medical student pediatric education focuses on well child checks, a few relatively straightforward acute diagnoses, and a few syndromes. Medical student education on adult medicine is months general and subspecialty rotations. This leads to a false impression that adult medicine is inherently more complicated. This is exacerbated by how regional pediatric care is and the many medical students who's pediatric exposure does not include the pathology at a tertiary/quaternary center.

 

[Oso]

Overall most kids are healthy, even a large degree of the hospitalized ones.

Agree with most 3rd year students spending most of their time doing well child checks, newborn nursery, and some bread and butter hospital medicine, which is fine. Even when there was an interesting patient in clinic (in residency), we were told to bring students to the well checks or simple diagnoses (ex. Otitis media) because that’s what the focus of their rotation was. That’s fine I guess but definitely makes it seem like there’s not much pathology in peds.

Every now and then we have a 3rd year student join us in the nicu. It’s cool to show them some of the more interesting CHD, neuro, and surgery patients, though they tend to pick up and present the more stable feeder grower patients.

 

[Dr. Wexler]

There is less medicine in pediatrics. Much of pediatrics is "reassurance". Most children will do fine with no treatment or the wrong treatment.

If you can tolerate adults and are going to do primary care do family medicine or internal medicine.

I am a happy pediatrician.

 

[mvenus929]

Peds gets less exposure than medicine at all levels of medical education. In the preclinical years, the focus is on managing adults, with the occasional pediatric topic thrown in. The peds clerkship is about exposing students to the basics of pediatric medicine, which means a lot of well visits and simple medicine (since most kids are healthy). However, once you get further into peds, it is more challenging than adult medicine in some aspects (medication doses and physiology changes with age), though most of our patients are fairly healthy. The complex patients can be much more complex than in adult medicine because they have rarer conditions, so subspecialty pediatrics (especially ICU, genetics, etc) is actually really interesting.

But a lot of people don't want to consider peds because of the pay. Or they don't like caring for patients who can't talk to them and give them a history.

 

[Funke]

People think of pediatrics as runny noses, bronchiolitis, and asthma. Of course there's lots of that, but there's a ton of interesting medicine. In the last two weeks of residency, I've diagnosed nephrotic syndrome that was misdiagnosed as hypothyroidism, Sydenham chorea that was misdiagnosed as tics (and no hx of GAS), dermatomyositis, finally controlled the bleeding of a girl who had been menstruating the better part of two years, taken care of transplant rejections, and have had several parents cry in relief when I've reassured them that the weird thing their kid is doing is just a weird movement and not epilepsy. If you want interesting medicine, you can sure find it in pediatrics. Just train at a large academic center and you'll see more "once in a lifetime" diagnoses than you will be able to remember.

 

[GBCrzzyy]

I am going into my PGY2 year in pediatrics and feel the exact same about adult medicine. So many adult medical problems are just not fixable and it's just medication management until the inevitable end. I love old people almost as much as I love kids but the idea of seeing an 80 yo woman for chronic back pain with a medical history of HTN, hyperlipidemia, CHF, DM, history of strokes, etc, makes me want to gouge my eyes out with a spoon. Don't get me wrong, there are medically complex kids with chronic health issues but so many more kids have medical problems that are actually fixable. Our most common inpatients are asthma (not necessary fixable but it's more satisfying to manage than HTN or CHF by a long shot) or some kind of infectious problem so infectious disease knowledge goes a long way. It all comes down to personal preference but I'm much happier seeing a healthy baby for a well child check and sending them on their way afterwards. The boring stuff in Peds is easy and fun, the boring stuff with adults is annoyingly complicated. But this is all my opinion, different strokes for different folks.

I also want to go into child abuse pediatrics, so "medication management" is the furthest thing from what I want to do.

 

[SurfingDoctor]