Pediatric Emergency Medicine Residency

[JPO17]

Hi! I am currently a third year medical student and was wondering if anyone had any insight or information on doing a residency in pediatric emergency medicine. I have previously worked in an ER for two years prior to med school and I have found in med school that I absolutely love peds, but am more interested in acute care of pediatrics.

I have looked into peds EM residency and know that there are four programs currently offered where you do a combined peds and EM residency. I saw that you can also match general peds then do a peds EM fellowship or match EM followed by a peds EM fellowship. Would anyone be able to break this down for me? I am pretty set on wanting to be a peds EM doc, but just am unsure which way to go. Thanks in advance!

Also, I live in VA and was interested in doing an elective in peds EM and am looking for suggestions on where I should reach out to.

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[Tenk]

If your end game is a peds ED, it’s better to go EM residency -> peds fellowship. You’ll see more actual emergencies this way.

 

[ciestar]

I’ve only done a peds sub-i, so my view is somewhat limited, but if you want peds EM ultimately, do an EM residency, not peds. The peds residents don’t spend a lot of time in the ED and a lot of their residency is spent on inpatient medicine.

 

[JPO17]

Thanks for the information! The only thing that I heard from my school about this was that I would have a harder time working a children’s hospital in their ER if I did EM to peds fellowship because they prefer the peds to the EM fellowship (They want more peds training). I don’t know if anyone can confirm or deny that...

 

[acciobutterbeer]

The Undifferentiated Medical Student podcast has an episode on Combined EM and Peds that might be interesting to check out.

 

[Tenk]

Thanks for the information! The only thing that I heard from my school about this was that I would have a harder time working a children’s hospital in their ER if I did EM to peds fellowship because they prefer the peds to the EM fellowship (They want more peds training). I don’t know if anyone can confirm or deny that...

It’s not hard to find a peds ed job because it doesn’t pay nearly as well as a general ed job.

 

[ace_inhibitor111]

I’ve only done a peds sub-i, so my view is somewhat limited, but if you want peds EM ultimately, do an EM residency, not peds. The peds residents don’t spend a lot of time in the ED and a lot of their residency is spent on inpatient medicine.

I’ve heard the same thing and I think it’s better asking an expert on the subject at your school. My understanding is that the children’s hospitals prefer peds -> EM partly because of the extra year of training. There might be a difference in board certification too from what I remember

 

[GoSpursGo]

I'm also far from an expert, but I think rather than "preferring" either EM->PEM vs peds->PEM, it's just much more COMMON that someone chooses to go peds->PEM. The reason is that relatively few people coming out of an EM residency want to spend another 3 years to take a pay cut, whereas PEM is one of the few peds fellowships that actually does increase your earning potential.

But ultimately, I agree the best person to talk with is the PEM chair/PD at your home institution.

 

[BadHorse]

I'm an emergency medicine doc who thought about going the peds route, rotated through a couple pediatric EDs including CHOP. Most PEM people out in the wild are peds trained initially, mostly because it's a salary bump for pediatricians and a salary drop for EM docs. Most of what you do is bread and butter pediatrics, kids don't get sick very often, so pediatric training will serve you well-- but when true emergencies do happen an adult trained EM doctor is better able to handle them, just because these are so rare in pediatric training. I think true bias towards one or the other is a myth and demand remains high regardless of how you approach training. I would advise you to go the route you can see yourself doing for the rest of your life if fellowship loses its appeal, because from what I've seen most people lose steam after residency and it's impossible to know how you'll feel after going through that ordeal. If the emergencies appeal more and you could see yourself as an adult EM doctor, do that first. If you won't be happy unless you're working with kids, do pediatrics. Don't undervalue the importance of happiness during residency, too. Hope that helps, good luck!

 

[CyrilFiggis]

Most PEM fellowships are 3 years for Peds residents and 2/3 years for EM residents. There is really no difference in the hiring once you’re fellowship trained. If you go peds/EM dual, some children’s hospitals won’t hire you because you are not fellowship trained (Peds is getting more fractioned, you now need a fellowship for Peds hospitalist).

PEM docs make mid $200k, EM docs make $300k+. There are some EM residency PEMs who split time in both world. This happens a lot in community EDs where they see both adults and children but don’t have a dedicated PedsED. You basically become the “Peds doc”. This can make you a more attractive hire in some areas and you can negotiate a salary at or above an adult EM doc. Other times you sign two contracts at different hospitals and you total salary is relative to your FTE from each hospital.

For aways, if you’re EM bound make sure you get the adult ones first, but VSAS has a ton of PEM rotations too.

 

[emergentmd]

If you want to work in all Ped ERs you need a PEM fellowship. Many Ped ERs will take ABEM docs b/c there is not enough PEM docs but this could potentially close if more PEM residencies open up.

Bottom line is if you want to do Ped ER then Do Ped+PEM or Er+PEM. Do not do combined Peds/EM b/c this really adds very little to your hiring in an ER.

Now this may be biased but I would definitely do ER then PEM. You can get a 3+2 yr track. I believe most if not all Peds then PEM is a 3+3 track although I may be wrong.

But bottom line is Er then PEM makes you much more marketable and opens up all ERs to you. Plus
1. You get to moonlight and make 200+/hr while doing PEM
2. You can still work in many Pedi ERs with just a ER residency if you decide to not complete PEM
3. Peds to PEM will never work in an adult ER and have a much narrower scope.

 

[mvenus929]

Peds is getting more fractioned, you now need a fellowship for Peds hospitalist).

You don't *need* a fellowship for peds hospitalist (yet), but there is now a fellowship. There aren't enough positions for it to be a requirement of employment, but it is likely in the next x years that academic peds hospitalists will need board certification, which you can now only get via the fellowship. Doesn't mean you can't find a job as a peds hospitalist at a non-academic center.

OP, I agree with the above posters--doing a combined EM/Peds residency probably won't serve you well if your ultimate goal is to be a PEM doc. You need to figure out whether you want to do EM (with a 2/3 years PEM fellowship) or Peds (with a 3 year PEM fellowship). Both have their advantages and disadvantages--the EM route gives you better training on procedures and emergency situations, but it's a paycut to go from general EM to PEM. Peds will give you much more comfort taking care of kids, and PEM fellowship boosts your salary compared to Peds, but you don't get as good of training in the dire emergency situations (i.e. traumas, cardiac arrest, etc) because they don't happen as often in peds.

 

[BigRedBeta]

I'd look at it this way:

Knowing that you want to take care of kids in the ED, how tied are you to adults and adult medicine? Because the EM->PEM route is going to be a lot of time rotating through adult care.

There are a lot of pediatric residents who count down to their last day they have to take care of adult patients. If this sounds like you, then the Peds route is probably better for you.

Additionally in terms of educational efficiency, some people might feel like they would be wasting a lot of their energy and effort to learn all the stuff they need to for EM boards (eg rotations in the adult ICU), that won't apply to their future career. That's not to say there isn't a lot of excess stuff in a peds residency but on the balance would seemingly be higher yield overall.

Lastly, knowing that you are headed down this PEM path now, allows you to be very selective in your residency choice. If you decide to do Peds, then you can seek out residency programs that are heavy on the ER rotations and have a track record of putting people into PEM fellowships. Given the right setup for residency I think you can get enough exposure to a lot of emergencies/traumas even as a peds resident, but you have to find a place that does a lot of ER rotations and expects residents to take a lot of responsibility. Alternatively you can look for EM programs with strong ties to their children's hospital sites in terms of Peds ED, PICU and Peds inpatient rotations, which is not always true.

 

[kykd]

I think the route comes down to whether or not you want to work with kids most of the time. If you see yourself in a pediatric emergency department as the goal then I would do pediatrics and then PEM. It may be true that the emergency medicine residents have a lot more exposure in emergency situations and trauma but as a pediatric resident, you will have far far more exposure to pediatric development, long-term care, medications, etc. I think it’s easier to teach peds residents how to do procedures and handle emergency situations in a short amount of time than it is to train adult emergency residents the three years of pediatric residency they missed. In Pem Fellowship, the EM resident’s knowledge of MI management and COPD are going to be less useful than the pediatric resident’s skills in neonatal BPD and nonaccidental trauma screening.