Pediatric Emergency Medicine (Peds-ER, Peds/ER)

[Dr.PPBBB]

I'm hoping to start a discussion here about Pediatric Emergency Medicine as a specialty. I am currently a 4th year medical student applying for residency in Pediatrics.

Personally, I decided that I wanted to go the Peds route:
-3 year Pediatrics Residency (although some programs will knock it down to 2)
-3 year Pediatric Emergency Medicine Fellowship.

This is ideal for me, because I am fairly certain that I do not want to work with adult patients.

However, I did apply to the combined Peds/ER residency programs, and I wanted to know a little bit more about them. What do you guys think?
-2 1/2 year Pediatrics Residency
-2 1/2 year EM Residency (hopefully with a focus on peds-ER)

I also had some general questions about Peds ER that I have been completely unable to find on the web, and I hope some more senior members of the community can answer:
1) What kind of salary can a Peds/ER doc expect if they're coming from the Pediatrics route? I can't find information on that ANYWHERE.
2) If I do a combined residency in Peds-EM, will my future employers expect me to take shifts in the Adult ER?
3) If EM trained physicians can work in a Pediatric Emergency Room, then why is there a separate Peds-ER fellowship for them?

Please, feel free to add your input, insights, or any additional inquiries you may have about the field. Inquiring minds want to know!

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[baya]

I'm hoping to start a discussion here about Pediatric Emergency Medicine as a specialty. I am currently a 4th year medical student applying for residency in Pediatrics.

Personally, I decided that I wanted to go the Peds route:
-3 year Pediatrics Residency (although some programs will knock it down to 2)
-3 year Pediatric Emergency Medicine Fellowship.

This is ideal for me, because I am fairly certain that I do not want to work with adult patients.

However, I did apply to the combined Peds/ER residency programs, and I wanted to know a little bit more about them. What do you guys think?
-2 1/2 year Pediatrics Residency
-2 1/2 year EM Residency (hopefully with a focus on peds-ER)

I also had some general questions about Peds ER that I have been completely unable to find on the web, and I hope some more senior members of the community can answer:
1) What kind of salary can a Peds/ER doc expect if they're coming from the Pediatrics route? I can't find information on that ANYWHERE.
2) If I do a combined residency in Peds-EM, will my future employers expect me to take shifts in the Adult ER?
3) If EM trained physicians can work in a Pediatric Emergency Room, then why is there a separate Peds-ER fellowship for them?

Please, feel free to add your input, insights, or any additional inquiries you may have about the field. Inquiring minds want to know!

Take this with a grain of salt b/c I'm just a third year, but I did some asking around, and here's the answers I got:

1) Most people claim that you get the same salary for working in a given Peds ED regardless of whether you did it via peds or via EM. Some claim you get a little less coming from peds but still more than gen peds.

2 & 3) I was told that the combined Peds-ER residency does NOT get you boarded in Peds ER, as strange as that sounds. It only gets you boarded in the two specialties separately, not in the combined subspecialty. So whether or not you could work in a Peds ER after that 5 year combined residency is probably a matter of where you are in the country, how busy/acute the ER is, and how desparate the people hiring are. If they can get people who've done the fellowship, they'll probably take them instead. Of course, you can still do the fellowship after the combined residency (and you'll be amazingly well prepared for it), it'll just take that much longer. As to whether your future employers expect you to take shifts in the adult ED, that probably depends on where you're working and what you're certified in. If you're certified in ED but not in Peds ED because you did the combined residency but not the fellowship, and you're working in a place that has an adult ED, then I think it very likely that you'll have to take shifts in the adult ED. If you manage to get hired at a place like CHLA that doesn't have an adult ER, then I think you'll be safe from the large hairy patients. But I'm not at all sure you could get hired at a place like CHLA without doing the fellowship.

 

[bjackrian]

I've also been looking at the Peds-EM combined residencies (as far as I know, there are three--Arizona, Indiana, and Hopkins). Does anyone know if other institutions are planning on starting similar programs in the next few years (I believe that the concept is still relatively new to ACGME). Also, does anyone have a sense of how competitive the combined residencies are?

On a related note, my understanding is the same as baya's--you do not get boarded in Peds EM, BUT there is some movement working to change that--I don't know when or if it will happen, but that was the scuttlebutt around my institution.

 

[Apollyon]

On a related note, my understanding is the same as baya's--you do not get boarded in Peds EM, BUT there is some movement working to change that--I don't know when or if it will happen, but that was the scuttlebutt around my institution.

Any movement is Brownian motion. My mentor as a resident is EM/Peds trained, and I asked him about that, and he said that, for now and the foreseeable future, it's dead in the water.

 

[THEMOSIAH]

Maryland, not hopkins has the combined peds/em program. The zona program was just recently started by a Maryland grad.

 

[tkrohn]

I too am interested in pediatric emergency medicine and recently did the pediatric EM rotation at CHLA. Here is what I learned while there...

As it has already been said, the combined program allows you to sit for the boards of general pediatrics and general emergency medicine separately, not pediatric emergency medicine. That does require the fellowship.

If you want to practice pediatric emergency medicine, the national trend is to fill the pediatric ERs around the country with docs trained in general pediatrics followed by a pediatric EM fellowship. You will find some pediatric ED faculty who are only boarded in general pediatrics and/ or general EM, however, most of them have been grandfathered in before the new trend of requiring gen peds and peds EM training. Nowadays, most pediatric ERs won't hire you if you don't have both general peds and peds EM fellowship training.

The purpose of getting general EM training is if you want to work in a general ER (i.e. adults and kids). If you are boarded in general EM most employers will expect you to help treat the adult patients regardless of whether you also have boards in general pediatrics (from a combined program) or a peds EM fellowship (following your general EM training). The general ER docs who have done the peds EM fellowship tell me that they do it to increase their desirability and salary in a general ER, NOT to work in a pediatric ER.

If you do pediatric EM you can expect to make $100K - $200K per year depending on where you are and how long you have been practicing. Of course, if you hold a chairmanship you can make a little more, but otherwise I wouldn't expect anymore than $200K anywhere.

Bottom line... if you want to practice pediatric emergency medicine and have no interest in treating adults (i.e. like me), you will waste your time doing the combined program nowadays. If you want to work in a general ER and want to have a strong foundation in pediatrics the combined programs are a great option. However, if you want to work in a pediatric ER at a children's hospital you had best do a general pediatrics residency and a pediatric EM fellowship.

 

[sabres30]

First off compensation should not be a primary motivator.
Now real world... it is a factor.

I am a PGY 6 in PEM.
after interviews and offers there is such variability in place to place it is staggering.

in a small PEM in a 100K town with a large capture area I was looking at starting out at around 200K with benefits and some academic responsibility
Just remember the ones who offer benefits are taking it out of your salary. There is no such thing as free benefits.
Moderate size city offers: Some had you starting at 170K and working up to 240K over 5 yrs

Bigger city offers: Some non academic had offers of 280K- 320K depending on productivity with a base hourly salary and no academic responsibility but no "benefits"

 

[sabres30]

I think the peds route is best. Most of what you do is gen peds. The 10 % of ER you get in your fellowship. Got to know your bread and butter peds in order to be efficient and avoid errant workups.

PGY6

 

[Prop]

First off compensation should not be a primary motivator.
Now real world... it is a factor.

I am a PGY 6 in PEM.
after interviews and offers there is such variability in place to place it is staggering.

in a small PEM in a 100K town with a large capture area I was looking at starting out at around 200K with benefits and some academic responsibility
Just remember the ones who offer benefits are taking it out of your salary. There is no such thing as free benefits.
Moderate size city offers: Some had you starting at 170K and working up to 240K over 5 yrs

Bigger city offers: Some non academic had offers of 280K- 320K depending on productivity with a base hourly salary and no academic responsibility but no "benefits"

Thanks for giving a fair picture of what range the compensation lies within. Could you comment on the amount of work hours during a week/month? Is it mainly 8 or 12 hour shifts, and how many shifts per month?

Thanks!

 

[Prop]

Anybody want to comment on work schedules for a peds EM attending?
Is it mainly 8 or 12 hour shifts? How many shifts per month/how many hours per month?
If in an academic center, how many months of clinical duties and how many months of research/administrative duties?

Thanks

 

[mfleur]

I think that's pretty site specific. The community PED where I work is normally 8's but goes to 12's during the summer.

 

[deleted109597]

That's strange. Winter is usually the high season for PED visits, unless you're a summer tourism area. We're hit doubly hard by the people visiting the warmth in the winter, while the rest of the kids here still get their adenoviruses then as well.

As far as hours, we do 12s and 13s for double coverage. PED pay isn't all that great, however, only around 130/hr. Most kids are on Medicaid, and Medicaid just doesn't pay well.

 

[McGillGrad]

PED pay isn't all that great, however, only around 130/hr. Most kids are on Medicaid, and Medicaid just doesn't pay well.

That is true when compared to adult EM. When you compare Peds EM to other peds salaries, it does pay well.

It's all relative.

 

[deleted109597]

That is true when compared to adult EM. When you compare Peds EM to other peds salaries, it does pay well.

It's all relative.

My wife makes more as a pediatrician than I could make working the same hours at the peds ED.

 

[SurfingDoctor]

There was an article on pediatric subspecialties and lifetime salary in relation to medical school debt in the journal of "Pediatrics" about 1 year ago. You can loosely base assumptions of salary from one subspecialty to another off that article.

 

[ASchuster]

I'll take anything over the 5/hr we make now

 

[dsherida]

How many fellowship programs is the norm to apply to?

 

[habeebi82]

i am currently applying and applied to 23. so far 7 interviews, 4 nos.

 

[Slade]

Is there a general consensus about the top 5 (ie best training) Peds EM fellowships? Can we assume the bigger programs are the most competitive or is that untrue?
I'm really interested in Peds EM and hence looking at residency programs that send their graduates to good fellowships but I have no idea which programs are good...

 

[Perrotfish]

Does anyone know the salary and benifits for general Pediatricians (not fellowship trained) staffing Peds EDs?

 

[McGillGrad]

Is there a general consensus about the top 5 (ie best training) Peds EM fellowships? Can we assume the bigger programs are the most competitive or is that untrue?
I'm really interested in Peds EM and hence looking at residency programs that send their graduates to good fellowships but I have no idea which programs are good...

As with most things in life, there is no right answer.

There are ~72 programs that run the gamet from fully academic and research oriented to small and purely clinical with only the bare minimum QA/QI/Research.

Your goals determine what the top 5.

 

[McGillGrad]

Does anyone know the salary and benifits for general Pediatricians (not fellowship trained) staffing Peds EDs?

It depends on whether you are part of the private group that staffs the ED or if you are academic faculty at the hospital or med school.

In my experience, the private groups provide benefits in line with PEM faculty. I am not sure about the academic positions when working for the hospital or med school but I do not see them being different from PEM faculty.

Although PEM is paid a decent amount more.