Pediatric Salaries

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
What if a person has 500K+ of debt?

Don't do Peds. Or at least think carefully about it.

One of the reasons I felt fine with going into Peds knowing the salaries I could expect to make was that I did a PhD and had no med school debt. It's unaffordable with $500k of debt and I wouldn't bank on PSLF. IBR makes things somewhat easier but I'd still be skeptical that the loan forgiveness after 20 years (through IBR) or 10 years (through PSLF) will be there forever, especially for physicians. As far as I understand you still owe taxes on the balance paid off with IBR, which is a huge financial burden:

Think about it this way, paying off $500k in 20 years at 6.8% would mean paying almost $4000 per month, or about $46k per year (you will have paid over 900k for your original 500k debt). As a general pediatrician making $140k per year, that would be about half your after-tax income, or more depending on where you live. You still have to pay for housing, retirement, food, (maybe kids), etc.

If you do it through IBR you're paying 10% of your AGI, or about $1k per month, which doesn't even cover half of the interest on the loan. Now, if PSLF still exists then the rest of the loan (750k after 10 years) if forgiven tax free. If that tax-free forgiveness goes away, though (no guarantees PSLF is still around for physicians 10 years from now), then you're really in trouble since you now have a 750k loan which will only continue to grow. After 20 years for IBR you have to pay taxes on $1.3 million forgiven (at least 500k lump sum). Also, student loans are non-dischargeable in bankruptcy, so if the loan forgiveness goes away there is no other way to get rid of the debt other than paying it off.

I'm not saying don't do Peds, I'm saying know what kind of financial hole you may be getting into. That hole may severely limit life choices in the future. Is doing Peds worth decades of paying off a student loan or perpetually living like a resident when you could do something like medicine and more easily be able to afford your debt?


Sent from my iPhone using SDN mobile app

Members don't see this ad.
 
I don't know any full-time General Pediatricians making 140 (community). And I'm in a major market. Heck, the General Peds academic peeps are making more than that (mostly).
Are most of you who are peds attendings on this forum in academic medicine? Because I had a preceptor, a community pediatrician, one year out of residency who is making over 180k doing 40-50 hours a week, outpatient only. I know of several youngish pediatric hospitalists making 220-230k or more. So I wonder if maybe the amounts cited here aren't really a representative sample?
 
  • Like
Reactions: 1 user
In a large city for academic peds (hospitalists or outpatient) most people I know started at ~130-150k. The first two years may be for less if you are on an academic track. Of course there are other benefits including retirement and bonuses that should be considered. Outpatient private practice started at ~140-180k.
For pediatric critical care I am aware of starting salaries as low as 160k with relatively little clinical time in a highly desirable area. There are major academic centers that start at ~240k or more after taking in to account extra pay for calls. Centers that would be considered private practice (but may still include teaching without the research requirements) start at at more (~260-300k).
If there are multiple specialties that would make you equally happy I can see taking the higher paying job. But in my experience people in peds seems to be happier and suffer less burnout than our adult colleagues (and some surveys back that up). There will always be people making more money, but how much more does one really need when you will be making ~3-6x more than the average family you are taking care of?
 
  • Like
Reactions: 1 users
Members don't see this ad :)
What is this the 1950s? I thought we had moved past this kind of sexist sentiment, especially in the field of pediatrics. Pediatricians earn lower income compared to other physician specialities not because they are women... but because well child checks, the most common office visit type, are not reimbursed well; primary care pediatrics has little to no procedures, again leading to lower reimbursement; and finally adult appointments are reimbursed higher compared to pediatric appointments. Salary negotiations have absolutely no effect on how many RVUs/income a physician brings in. This argument is senseless.

True, but I believe psychMDhopefully still has some valid points. And no way should any FT, BC physician be making close to what a nurse is making, advanced practice nurse or not. That's just so blatantly wrong.
 
  • Like
Reactions: 1 user
let's keep this thread going :D

(almost) pgy-1 pediatrics resident here nervous it might not be feasible to continue living in the northeast after residency...I know I will be happy in pediatrics and happiness over money any day, yet I want to pick a field within peds that is financially more sound than others. I'm not interested in academics, but rather open to all else. Guidance welcome :highfive:
 
Last edited:
NICU has the most opportunities for private practice.

PICU has more limited private practice units that are big enough and busy enough when coming out of fellowship. Otherwise options in smaller locations that make more sense mid-career.

Cardiology you'll probably need an academic affiliation simply because you need the associated resources to take care of your patients (cath lab, CT surgeons, etc). Many divisions have robust outreach clinics in areas that need the coverage...you could probably swing getting a full time clinical appointment if you were to staff an outreach clinic (assuming the volumes are high enough to support you).

Hospitalist options are varied but will likely to continue to expand. Regional variations will likely play a large part in how attractive these positions are relative to your debt.
 
  • Like
Reactions: 1 user
what about Peds - ER fellowship?


I would also be interested in knowing this. I tried looking at CiM, but then I realized that those numbers would be skewed since those who do PEM from EM make more than those who do it from Peds
 
what about Peds - ER fellowship?

I shadowed a PEM physician last year because I am very interested in going this route as well. The attending told me (indirectly) that his salary was about $220,000. Academic in the south.
 
Last edited:
  • Like
Reactions: 1 user
I shadowed a PEM physician last year because I am very interested in going this route as well. The attending told me (indirectly) that his salary was about $220,000. Academic in the south.
That's on the higher end of things. Most I know are in the 165k realm, but there is obviously a good deal of variance depending on location, practice set up and group. I know one guy who got hired by an adult group with a relatively small number of peds beds at their facility. They just wanted a couple dedicated peds people, and they paid him what they would pay and adult EM physician. It was a pretty sweet deal.
 
  • Like
Reactions: 1 user
That's on the higher end of things. Most I know are in the 165k realm, but there is obviously a good deal of variance depending on location, practice set up and group. I know one guy who got hired by an adult group with a relatively small number of peds beds at their facility. They just wanted a couple dedicated peds people, and they paid him what they would pay and adult EM physician. It was a pretty sweet deal.


That's really disappointing. Its a salary I'd be ok with if I wasn't going to be ~250-300k in debt by the time I graduate.
 
  • Like
Reactions: 1 user
That's really disappointing. Its a salary I'd be ok with if I wasn't going to be ~250-300k in debt by the time I graduate.

Keep in mind that if you're going academic, PSLF is a viable option to get out of debt. 10 years out of Med school, if you do income based repayment for all 10 years, your entire Med school debt will be forgiven.


Large dogs
 
Members don't see this ad :)
Keep in mind that if you're going academic, PSLF is a viable option to get out of debt. 10 years out of Med school, if you do income based repayment for all 10 years, your entire Med school debt will be forgiven.


Large dogs

Dubiously viable. No one's cashed in on it yet and there's already been serious talk of capping it. But we'll see, I'm still hedging on it
 
Keep in mind that if you're going academic, PSLF is a viable option to get out of debt. 10 years out of Med school, if you do income based repayment for all 10 years, your entire Med school debt will be forgiven.


Large dogs

My #1 concern is that won't be an option when I graduate 3 years down the road (PSLF)
 
That's really disappointing. Its a salary I'd be ok with if I wasn't going to be ~250-300k in debt by the time I graduate.
I think we are getting to the point where Pediatricians who are graduating with this kind of debt, and who don't plan to go to the ICU, really need to plan on unloading the debt with at least 2-3 years of full scope of practice primary care Pediatrics before moving on a fellowship.
 
  • Like
Reactions: 1 user
I've read somewhere (can't remember where) that Peds EM generally make about 60-75% of what their adult EM colleagues make. Plenty of adult EM docs are making 350k starting, so I would think 225k should be reasonable for Peds EM. Also, there are still peds EM jobs out there that don't require a fellowship and will take general pediatricians. I would imagine working such a job full time would put one on the higher end of what a general pediatrician can make.
 
Any general pediatricians on here? I would like to have some insight into starting salaries, approx. hours per week, do you really have to spend under 12 minutes per patient just to be able to see enough in a day? I know geographic location is crucial in the overall equation, but any insight into a regular day for you and your stress level is valuable :)
 
  • Like
Reactions: 1 users
Any general pediatricians on here? I would like to have some insight into starting salaries, approx. hours per week, do you really have to spend under 12 minutes per patient just to be able to see enough in a day? I know geographic location is crucial in the overall equation, but any insight into a regular day for you and your stress level is valuable :)

Most of the civilian general Pediatricians I know are starting off at 160-180K for 3-4 patients per hour plus Q3 - Q5 home call for delivery and ED coverage. It seems like the current industry standard is a raise of 10-20K/year for the first two years out of residency, and then a switch to productivity pay in year three that boost you to 220-250K (seriously, every single general Pediatrician I know from Medical school and the civilian residencies we rotate through was offered 3 years of Salary and then productivity pay). Clinic only without call has brutally lower pay, I knew people who were getting offers for less than 100K and the average seems to be 120K. Considering that the clinic is 90% of your time in a traditional scope of practice I can't understand people taking that unless they're also planning to work part time. Lots of them do, though. Takes all kinds.

Most of us, civilian and otherwise, see 3-4 patients per hour. 12 minutes a patient would be 5 per hour and, while not unheard of, is rare and not particularly safe. If you are doing that kind of pace chances are you are working with 2 MAs and are relying on them to do a huge chunk of your history and documentation. Or you're an employee getting bullied into an unsafe situation. One of the two.

The total time in the office is obviously dependant on how quickly you can get all of that work done. The AAP published an article showing PCMs tended to work a little over 40 hours a week. For the first year, though, 60+ seems like its pretty standard. Things take a lot longer when you're learning efficiency and looking things up. I'm about one year out. Starting off this year a full clinic schedule would keep me in the office until after 7. Now its getting closer to 5. I'm hoping to be walking out the door at 4 in a few months.
 
  • Like
Reactions: 4 users
Most of the civilian general Pediatricians I know are starting off at 160-180K for 3-4 patients per hour plus Q3 - Q5 home call for delivery and ED coverage. It seems like the current industry standard is a raise of 10-20K/year for the first two years out of residency, and then a switch to productivity pay in year three that boost you to 220-250K (seriously, every single general Pediatrician I know from Medical school and the civilian residencies we rotate through was offered 3 years of Salary and then productivity pay). Clinic only without call has brutally lower pay, I knew people who were getting offers for less than 100K and the average seems to be 120K. Considering that the clinic is 90% of your time in a traditional scope of practice I can't understand people taking that unless they're also planning to work part time. Lots of them do, though. Takes all kinds.

Most of us, civilian and otherwise, see 3-4 patients per hour. 12 minutes a patient would be 5 per hour and, while not unheard of, is rare and not particularly safe. If you are doing that kind of pace chances are you are working with 2 MAs and are relying on them to do a huge chunk of your history and documentation. Or you're an employee getting bullied into an unsafe situation. One of the two.

The total time in the office is obviously dependant on how quickly you can get all of that work done. The AAP published an article showing PCMs tended to work a little over 40 hours a week. For the first year, though, 60+ seems like its pretty standard. Things take a lot longer when you're learning efficiency and looking things up. I'm about one year out. Starting off this year a full clinic schedule would keep me in the office until after 7. Now its getting closer to 5. I'm hoping to be walking out the door at 4 in a few months.
With my level of debt, 180k vs. 220k is a huge difference. It's good to know that it's attainable after a couple of years.
 
  • Like
Reactions: 1 user
That's on the higher end of things. Most I know are in the 165k realm, but there is obviously a good deal of variance depending on location, practice set up and group. I know one guy who got hired by an adult group with a relatively small number of peds beds at their facility. They just wanted a couple dedicated peds people, and they paid him what they would pay and adult EM physician. It was a pretty sweet deal.

Most of the civilian general Pediatricians I know are starting off at 160-180K for 3-4 patients per hour plus Q3 - Q5 home call for delivery and ED coverage. It seems like the current industry standard is a raise of 10-20K/year for the first two years out of residency, and then a switch to productivity pay in year three that boost you to 220-250K (seriously, every single general Pediatrician I know from Medical school and the civilian residencies we rotate through was offered 3 years of Salary and then productivity pay).

You guys are both attendings, so why is it that you have such different views on compensation? Stitch is saying 165k and Perrotffish is saying 160-180k starting and then 220k+ after a few years.
 
Thanks @Perrotfish for your reply! Could I ask you what location more or less these offers are? East coast by any chance hehe..
 
You guys are both attendings, so why is it that you have such different views on compensation? Stitch is saying 165k and Perrotffish is saying 160-180k starting and then 220k+ after a few years.

Stitch is giving you info on an academic PEM salary - most likely at the assistant professor level.

Perrotfish is saying private practice gen peds in a pretty traditional practice model, and probably in a mid-major city.

Salaries and practice models are hyperlocal, so it's hard to really say you're bound to find X setup. Big city with major children's hospitals and huge neonatology penetration in the birthing hospitals will result in very different options than the mid-sized city of ~100-250k with the nearest children's hospital 2+ hours away. In what qualifies as your dream location, you may not find your dream practice model exists. That goes in both directions - I had friends in residency looking to go "home" to smaller towns in Southern states and their dream practice was clinic only, no nursery coverage, no call. Didn't exist. Likewise in fellowship in a major metro area, saw residents who were wanted to stay in the city and have those responsibilities because they realized it meant more $$$ but couldn't find practices that offered such setups.
 
  • Like
Reactions: 1 users
A while ago- I can't remember if the was this thread or another- we talked about how big corporate medicine has less penetration in peds than in adult medicine. I wonder of this has something to do with why peds seems to start lower than FM but then after a few years seems to catch up.

Basically, if you're a new pediatrician and get hired by a small group, they need to you build up your production from you to get paid well. On FM/IM, on the other hand, big health systems can lure new docs by essentially subsidizing their income for a few years.
 
  • Like
Reactions: 1 users
A while ago- I can't remember if the was this thread or another- we talked about how big corporate medicine has less penetration in peds than in adult medicine. I wonder of this has something to do with why peds seems to start lower than FM but then after a few years seems to catch up.

Basically, if you're a new pediatrician and get hired by a small group, they need to you build up your production from you to get paid well. On FM/IM, on the other hand, big health systems can lure new docs by essentially subsidizing their income for a few years.

There's definitely some truth to this. Most of the Pediatricians I know who were getting 180K+ offers right out of residency are going to work for a giant health system or HMO. Not all, but most.
 
Stitch is giving you info on an academic PEM salary - most likely at the assistant professor level.
This. But, as you say, salaries are hyperlocal. My wife joined a sizable private practice group and was making 140k as a hospitalist. They started their general pediatricians around that as well, though some made less (closer to $120-130).

I've read somewhere (can't remember where) that Peds EM generally make about 60-75% of what their adult EM colleagues make. Plenty of adult EM docs are making 350k starting, so I would think 225k should be reasonable for Peds EM. Also, there are still peds EM jobs out there that don't require a fellowship and will take general pediatricians. I would imagine working such a job full time would put one on the higher end of what a general pediatrician can make.
I worked in a dedicated peds ED as a general pediatrician and barely made $100k, though that was at an academic center. A good friend did the same job for a larger group and was making $140. Many of those jobs are going away though. Again, if you get in with a good adult group who wants you to see kids, you'll make a good deal more than with a dedicated peds group.
 
  • Like
Reactions: 1 user
barely $100K? I just still don't understand how peds is so completely off the scale compared to family and internal. Fortunately, I will only have about 100,000 in loans and plan to start paying it off asap.. yet, I realize I'm the minority and completely feel for the people that answered their calling into peds but have serious debt to pay off.
 
Last edited:
As a premedical student, I have been interested in Peds EM for awhile now, and researching both quality of life, career satisfaction, and salary have been somewhat difficult. I did look up the salaries of the Peds EM faculty at my local state medical school and the average was around $220k (n=7), with no one higher than $300k. A community-based Peds ED is opening up soon here in FL, and I would imagine it will perhaps pay marginally higher?
 
barely $100K? I just still don't understand how peds is so completely off the scale compared to family and internal. Fortunately, I will only have about 100,000 in loans and plan to start paying it off asap.. yet, I realize I'm the minority and completely feel for the people that answered their calling into peds but have serious debt to pay off.

Because the vast majority of children ar covered under some sort of public insurance (at least the ones that tend to go to public hospitals. Private groups pay more because they see more private insurance). And children can't advocate for themselves, so politicians frequently put programs for them on the chopping block for budget cuts. The result is that insurance reimbursements for Peds are less than adults, even if the same service is being provided.
 
  • Like
Reactions: 1 users
Has anyone worked in those urgent care clinics they now set up all over (either extra shifts or full-time)? I wonder what that is like...from what I've read you can really make some money if you enjoy that type of work.
 
General pediatrician here. Live in a state capital close to (but not quite as expensive as) some very HCOL areas. Graduated residency in 2014. Starting salary (I'm salaried) 195, currently at 205 With end of year payment, grossed 225 last year (I do some admin stuff that I get a little extra for)

I work full time: each day is 2 four hour blocks, appointments every 15min, usually see about 20-25 a day (plus phones and emails). I don't to any newborns or deliveries.

When I finished residency, my debt was 342k. So of course being a pediatrician makes no sense compared to what other specialties make. But I couldn't see myself doing any other field. I refinanced my loans once (hope to again when my spouse's grad school loans are gone), am paying aggressively, renting. Spouse works part time and makes a middle class salary. 2 kids in daycare. Saving decently for retirement. Hope to be educational debt free 8 years after graduating.

Being a pediatrician, it will take longer to get where we want to financially (all of our college friends have or are buying their own homes), but I'm happy at work each day.
 
  • Like
Reactions: 17 users
Hi guys, I've been following this thread for a while and I understand high degree of variability in estimates of salary. But I am hoping someone might be able to provide some insight to the accuracy of Doximity "Careers in Medicine" tab and Medscape's survey.

I head estimates at my school from pediatricians in ballpark ranges of what I've heard here. Outpatient of 130-160, and ~$160 f. 2 wks of inpt.

But both Doximity and Medscape seem to rate a minimum of at least $160 (outpt) and high #s up to $220s. Any thoughts? Are these numbers more accurate of what it's like outside of academia (if so, how much more crazy are the hours) or is it bias of years in practice?
 
Hi guys, I've been following this thread for a while and I understand high degree of variability in estimates of salary. But I am hoping someone might be able to provide some insight to the accuracy of Doximity "Careers in Medicine" tab and Medscape's survey.

I head estimates at my school from pediatricians in ballpark ranges of what I've heard here. Outpatient of 130-160, and ~$160 f. 2 wks of inpt.

But both Doximity and Medscape seem to rate a minimum of at least $160 (outpt) and high #s up to $220s. Any thoughts? Are these numbers more accurate of what it's like outside of academia (if so, how much more crazy are the hours) or is it bias of years in practice?

It will depend on location and the efficiency of the clinic as well as whether you are chained to salary or if you are paid based on production. Those numbers seem reasonable for an outpatient (9-5) type of job in the Midwest. I can't speak to other locations. My income is quite a bit higher than that but there are other variables to consider - Midwest location, outpatient as well as inpatient and a level II NICU. I work more hours and suspect that my stress level is higher than many other Pediatricians but I am compensated for it.
 
  • Like
Reactions: 1 user
Practicing pediatrician here. Been in practice 15 years in my current location. Salary is quite a bit more than what's being mentioned here. The key is to find the right practice with the right balance of insurance plans. We have two offices staffed with 2 pediatricians and a PA.

I will be looking for a Pediatrician to join our practice effective fall 2017, hoping he/she would eventually take over one practice, as I am starting to slow down not to mention managing two practices is not easy.

With us, you would make a starting salary of $150,000-$160,000 + benefits and if you own the practice, than sky is the limit. I would be very surprised, if you didn't make easy $200,000+

PM if you have any questions and or are interested in this opportunity

BTW, office is located just outside Louisville, KY

Later
 
To make decent money in general peds (250k+) you need to be either a hospitalist or do private practice in an affluent area with no Medicaid.

In those 2 areas, 250k is easily obtainable within 3-4 years after residency.

If you REALLY want to make money, then you should do private practice peds and start up your own clinic with a PA or two. In a typical practice that you own you could make 300k+ after your practice is established after a couple of years.

I'm surprised more peds people don't do this. You get the satisfaction or running things YOUR WAY and answer to nobody. It's tremendously empowering, but yes it's a ****load of work too. If you run your own clinic you will run circles around the big corporate owned clinics wehre their doctors clock in and clock out like employees.

Another huge benefit of running your own clinic is that if you can prove a good track record 2 to 3 years out, banks will throw money at you to open up expansion clinics. If you are smart about picking locations that are in growing areas without a lot of competition, then you could start more clinics and end up with at least 5k per month of mostly passive income for each location. I work in the suburbs around a huge metro area in Texas and let me tell you there are opportunities all over the place in the outer ring suburbs that are growing like crazy with no peds clinics. I see opportunity everywhere if you are willing to take the risk and work your ass off.

If you want an easy lifestyle and work 4 days a week with no responsibilities after 5 PM, then pick an academic job and be happy with 150k.
 
Last edited:
  • Like
Reactions: 1 users
If you want an easy lifestyle and work 4 days a week with no responsibilities after 5 PM, then pick an academic job and be happy with 150k.

Hmm. I work 60 to 80 hours per week with many responsibilities. But in the end, I enjoy my job and have great flexibility. Of course, everyone's priorities are different, but there are some things money can't buy.
 
Last edited:
Hmm. I work 60 to 80 hours per week with many responsibilities. But in the end, I enjoy my job and have great flexibility. Of course, everyone's priorities are different, but there are some things money can't buy.

Is that your running average for a whole month? I'm not challenging you; I'm just hoping you're making more than 150k with those hours.
 
If you want an easy lifestyle and work 4 days a week with no responsibilities after 5 PM, then pick an academic job and be happy with 150k.

I get this sentiment. You pick up one end of the stick and you have to pick up the other. That's life, and that's what so often frustrates me when I see the news reports of these general pediatricians (usually in California so the cost of living adds greater context) only making $85k and I want to scream about the other limitations they've placed on themselves - location, hours (probably part time), lack of call, no nursery coverage, no weekends, etc. There does seem to be a portion of general pediatricians who want dermatology hours with similar pay scales and can't seem to understand why that's impossible.

Bottom line, pediatrics doesn't maximize your income after medical school (although neither does med school after undergrad), and other priorities can further limit that take home pay. If you can tolerate caring for adults, then you have other options in medicine. If you can't stand adult medicine, then you need to decide on a more lucrative subspecialty within peds and then be flexible in your post-fellowship job considerations. If the medicine/lifestyle of those fields is intolerable, then you need to do Gen Peds and work hard (perhaps even more hours than the NICU/PICU/Cards cohort and with more risk). If that's not going to work for you, then you're left with the alternative which is a comfortable life compared to most of your patients.
 
This is timely as I've recently had access to standards for salaries for pediatric cardiology. I'm not going to reproduce the entire table but will hit highlights for assistant professors since that's what people start at for the most part.

Note this is all for US academic positions only.

Numbers will be listed like this:
25%
Mean
75%

MGMA data for 2015:

Base compensation
Assistant Professor
180,000
204,054
224,811

Total compensation
Assistant Professor
192,874
233,211
257,965

Here's the AAMC data for 2015, and as a bonus I have it for PICU also.

Pediatric Cardiology
Assistant Professor
195,000
222,600
241,000

PICU
Assistant Professor
202,000
237,300
264,000
 
  • Like
Reactions: 2 users
This is timely as I've recently had access to standards for salaries for pediatric cardiology. I'm not going to reproduce the entire table but will hit highlights for assistant professors since that's what people start at for the most part.

Note this is all for US academic positions only.

Numbers will be listed like this:
25%
Mean
75%

MGMA data for 2015:

Base compensation
Assistant Professor
180,000
204,054
224,811

Total compensation
Assistant Professor
192,874
233,211
257,965

Here's the AAMC data for 2015, and as a bonus I have it for PICU also.

Pediatric Cardiology
Assistant Professor
195,000
222,600
241,000

PICU
Assistant Professor
202,000
237,300
264,000

Thanks! This is helpful information.
 
I get this sentiment. You pick up one end of the stick and you have to pick up the other. That's life, and that's what so often frustrates me when I see the news reports of these general pediatricians (usually in California so the cost of living adds greater context) only making $85k and I want to scream about the other limitations they've placed on themselves - location, hours (probably part time), lack of call, no nursery coverage, no weekends, etc. There does seem to be a portion of general pediatricians who want dermatology hours with similar pay scales and can't seem to understand why that's impossible.

Bottom line, pediatrics doesn't maximize your income after medical school (although neither does med school after undergrad), and other priorities can further limit that take home pay. If you can tolerate caring for adults, then you have other options in medicine. If you can't stand adult medicine, then you need to decide on a more lucrative subspecialty within peds and then be flexible in your post-fellowship job considerations. If the medicine/lifestyle of those fields is intolerable, then you need to do Gen Peds and work hard (perhaps even more hours than the NICU/PICU/Cards cohort and with more risk). If that's not going to work for you, then you're left with the alternative which is a comfortable life compared to most of your patients.


there are lots of jobs for peds in rural areas or suburban areas that exceed $200 to start fwiw
 
Glad to see so many are planning ahead. I'm an idealist and did do as much planning, graduated with 250 in debt that quickly went to 300k ( I took a small loan to buy a house in residency because in my particular residency location locking in housing costs is important- my mortgage is less than a lot of people I know who rent). I already paid off that extra debt by the way. I will probably remain in this area because it's where the spouse's industry is focused.

What I didn't know was how much less academics pays Than private medicine. As a resident I started to snoop around and ask attendings/recent grads, so I could make an informed decision.
Academic hospitalists start at 160,000, PICU 180, I took a private hospitalist gig for 210. Academic gen Peds 140k.
I'm working for a few years and need to have kids, then probably back to PICU/EM or another subspecialty.
I have parents to think of who will need help in retirement- meaning I'll probably have to pay their mortgage, so I'm more money focused than I'd like to be. I know academic subspecialists who did moonlighting at private practices weekends to make extra money.

205 for private gen peds, yes you have 12 min per patient, but most aren't sick.

I do wish there were 1-2 year clinical focused fellowships. Because salary info is so hard to get its hard to feel comfortable making the decision to go back to fellowship. The opportunity cost is huge. Not just the loss of salary, but the loss of years saving for retirement, the loss of years throwing chunks of money at the student loans....I think we may suffer a brain drain away from academic Peds which is the last thing we need in this field.

But money isn't everything. If I can find a job I love, help my parents in retirement, pay off my debt, do some global health work, have a good marriage and offer my talents to society, that's enough for me. I have to pull myself away from the balance sheet sometimes because it's really easy to get focused on the numbers.
 
I do wish there were 1-2 year clinical focused fellowships

Mandating a 3 year fellowship is easily one of the biggest, misguided mistakes in medical training the ABP/ACGME has ever done. For people who want to do fellowship and go into private practice and just see patients, the 18 months of scholarship is a complete waste of time and nothing valuable is generally obtained. On the other hand, for those who want to pursue research, academics, etc., 18 months is woefully inadequate to gain the expertise (or even the foundation of knowledge) to be successful in that endeavor, and typically you need ~ 3 years of scholarship beyond the clinical time. Everyone in my group agrees with this sediment, and I know this is a frequent topic of conversation at the program director meetings for pediatric critical care. I desperately hope it will change someday, but I just don't see it happening any time soon. What I do see happening (potentially/eventually), is that as cost of education rises, so will the debt and people will avoid pediatrics or subspecialty training due to the financial disincentive. This, coupled with more private practice jobs, will force the ABP to drop the 3 year mandated training program and have a clinical 1.5 year program to fill the needs. I suspect though, this change in training and policy will only happen when the system of caring for children with subspecialty needs is on the brink of, or has had, a meltdown. Though I try to avoid policy and committees as much as possible in my academic time, the exposure I've had has taught me that when it comes to policy or system changes, people only act in a reactive manner, never in a proactive manner. Typically you need a sentinel event (or a couple) to really make administrative people want to take action.
 
Last edited:
  • Like
Reactions: 2 users
Mandating a 3 year fellowship is easily one of the biggest, misguided mistakes in medical training the ABP/ACGME has ever done. For people who want to do fellowship and go into private practice and just see patients, the 18 months of scholarship is a complete waste of time and nothing valuable is generally obtained. On the other hand, for those who want to pursue research, academics, etc., 18 months is woefully inadequate to gain the expertise (or even the foundation of knowledge) to be successful in that endeavor, and typically you need ~ 3 years of scholarship beyond the clinical time. Everyone in my group agrees with this sediment, and I know this is a frequent topic of conversation at the program director meetings for pediatric critical care. I desperately hope it will change someday, but I just don't see it happening any time soon. What I do see happening (potentially/eventually), is that as cost of education rises, so will the debt and people will avoid pediatrics or subspecialty training due to the financial disincentive. This, coupled with more private practice jobs, will force the ABP to drop the 3 year mandated training program and have a clinical 1.5 year program to fill the needs. I suspect though, this change in training and policy will only happen when the system of caring for children with subspecialty needs is on the brink of, or has had, a meltdown. Though I try to avoid policy and committees as much as possible in my academic time, the exposure I've had has taught me that when it comes to policy or system changes, people only act in a reactive manner, never in a proactive manner. Typically you need a sentinel event (or a couple) to really make administrative people want to take action.
What do you think of the ABP's plan to make hospital medicine an official subspecialty with its own board and required two year fellowship down the road? I think it's a little absurd that some residents will spend 4-6 months a year or more doing inpatient medicine and maybe a month in clinic, then be told they have to do a fellowship for hospital medicine but be allowed to go right in to outpatient.
 
What do you think of the ABP's plan to make hospital medicine an official subspecialty with its own board and required two year fellowship down the road? I think it's a little absurd that some residents will spend 4-6 months a year or more doing inpatient medicine and maybe a month in clinic, then be told they have to do a fellowship for hospital medicine but be allowed to go right in to outpatient.

Fellowship for a Private practice hospitalist? That is a complete waste of time. Academic hospitalist where one also gets a higher degree, typically an MPH, that's fine and has been the typical model I've seen. But have its own board and certification? There's only one reason for that. Money to the ABP. I agree with you, if the ABP thinks residency is insufficient to train pediatricians to take care of non-critically ill children, then they should probably address that, instead of requiring an additional 2 years of training and an additional board certification.
 
Last edited:
  • Like
Reactions: 1 users
. I agree with you, if the ABP thinks residency is insufficient to train pediatricians to take care of non-critically ill children, then they should probably address that, instead of requiring an additional 2 years of training and an additional board certification.

Although maybe if they were fellowship trained, I wouldn't get stuck watching kids in the ICU who aren't critically ill with easily explained abnormal lab values and plain as day clinical courses. Last night it was the infant with 4 days of diarrhea and a bicarb of 8...but they didn't 'feel comfortable' on the floor although they couldn't explain to me exactly what it was they thought might happen.
 
  • Like
Reactions: 1 user
Although maybe if they were fellowship trained, I wouldn't get stuck watching kids in the ICU who aren't critically ill with easily explained abnormal lab values and plain as day clinical courses. Last night it was the infant with 4 days of diarrhea and a bicarb of 8...but they didn't 'feel comfortable' on the floor although they couldn't explain to me exactly what it was they thought might happen.

Ha. I've been planning to make PICU unit shirts that say "PICU, I'm incomfortable and no one gives a damn" but with more colorful language. But I was told it was insensitive. Lame.

Anyway, at least in my experience the "uncomfort" comes from nursing and nurse management who don't or can't handle kids with a potential, albeit remote, to get a sick. Some of that is nursing ratio and short staffing, some of it is just plain inexperience and lots of new nursing graduates. In the end, its best for the kid who can receive closer monitoring and maybe better care, and I get RVUs. Win-win.
 
Last edited:
Although maybe if they were fellowship trained, I wouldn't get stuck watching kids in the ICU who aren't critically ill with easily explained abnormal lab values and plain as day clinical courses. Last night it was the infant with 4 days of diarrhea and a bicarb of 8...but they didn't 'feel comfortable' on the floor although they couldn't explain to me exactly what it was they thought might happen.

Without more information that could be an infant in shock. Possibly on a floor with nursing not capable of replacing and monitoring IVs. Just saying.....


Sent from my iPhone using Tapatalk
 
Without more information that could be an infant in shock. Possibly on a floor with nursing not capable of replacing and monitoring IVs. Just saying.....


Sent from my iPhone using Tapatalk

The lack of experience or ability to care is definitely an issue and unfortunately for the kids and their family, can have a huge impact both in cost to care and finances. Despite most inpatient units providing no differential pay between a PICU nurse and an floor nurse, which drives huge nursing disparity in pay and satisfaction and in my opinion is an utter travesty, it is the lack of experience, training, staffing ratios and whatever else, that causes children to need a higher level of nursing coverage and in turn causes 1) disincentives to floor nurses of managing even the most treatable of problems and 2) creates a huge financial burden on the patient's family and system (ie charge of a floor admission to the family $2000-3000/day versus a charge of admission to an ICU $8000-10000/day). Why would a nurse work to take care of a child who is dying when they could get the same pay to have a MA collect all their vitals and when something remotely is amiss, transfer the patient out of their care to lighten their burden? Unfortunately, over time, I have seen the floor level of comfort diminish, the level of mismanagement increase and all the while, cost the system and the patients and there family more. I don't know the answer to the problem, maybe improved nursing ratios with pay differentials (which do exist, but tend to be the exception not the norm)? Whatever it is that is lacking, it seems to be getting worse over time. This observation is a as someone who works solely in the hospital and whose own children have been admitted to the floor and the ICU. After 1 day in the hospital with my child, I realize I was doing 70% of the floor nurses work but being charge $5000 a day. That really makes no sense and on the whole, is poor care. It also unfortunately, is not unique to any one particular children's hospital but a healthcare wide issue.

All that being said, requiring a hospitalist fellowship with a board certification is a complete misunderstanding of the true issue. I don't think the ABP has any real understanding of the practice of pediatrics...
 
Last edited:
Top