Pediatric subspecialization in non-peds fields

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tulsajoe94

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Hello! First off, please be kind, I'm just trying to see what options are available to me.

I'm a med student who feels pretty sure kids are my patient population. I love kids, I love parents, and I don't love much else. However, I also am concerned about finances. My partner wants to pursue a PhD in a field that will probably not lead to a financially rewarding job, so I'm trying to plan as if I will be our sole income to support a family. Would there be a significant increase in salary if I saw peds patients through peds derm or peds PM&R? Both of those fields interested me before deciding I really like working with kids. And if I pursued a combined peds/PM&R residency, could I do primary care pediatrics down the line? I did really enjoy outpatient peds during my rotations and think I would like to work beyond "retirement" age in a more rural area.

Thank you for any help you can give!

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Kids are the best :)

Unfortunately, choosing to treat them almost invariably comes with a salary decrease. Peds derm will make more money than a general pediatrician, but less than a general dermatologist. I'm not directly familiar with Peds PM&R, but I think that is similarly the case and I don't think that PM&R makes as much as other specialties to begin with.

Your question of primary care peds in a rural area further down the line is a little more complicated. Technically speaking, as an MD with an active unrestricted medical license, you CAN practice whatever medicine you feel is within your scope of practice. Practically speaking, in most major metropolitan areas it's difficult to impossible to get credentialed to practice a specialty that you are not board certified/board eligible in because the malpractice premiums are super high. The only way to become board certified in Peds is to do a residency in Peds, or one of the combined residency programs like Med/Peds, Peds/Neuro, Peds/Psych, etc, so since your path would be Derm-->Peds Derm or PM&R-->Peds PM&R you would never be able to get board certified. Now, if you're truly in a rural area, is it possible you could get credentialed? Maybe. Almost impossible to guess what the environment will be in 30-40 years.

The other question to ask is whether you SHOULD practice as a general pediatrician after you've spent an entire career as a peds derm/peds PM&R doc. Developmental milestones, anticipatory guidance, other bread and butter peds requires its own residency for a reason and isn't really something you can glean from brushing up on up to date. But you'd ultimately need to decide on your own comfort level down the road.
 
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Kids are the best :)

Unfortunately, choosing to treat them almost invariably comes with a salary decrease. Peds derm will make more money than a general pediatrician, but less than a general dermatologist. I'm not directly familiar with Peds PM&R, but I think that is similarly the case and I don't think that PM&R makes as much as other specialties to begin with.

Your question of primary care peds in a rural area further down the line is a little more complicated. Technically speaking, as an MD with an active unrestricted medical license, you CAN practice whatever medicine you feel is within your scope of practice. Practically speaking, in most major metropolitan areas it's difficult to impossible to get credentialed to practice a specialty that you are not board certified/board eligible in because the malpractice premiums are super high. The only way to become board certified in Peds is to do a residency in Peds, or one of the combined residency programs like Med/Peds, Peds/Neuro, Peds/Psych, etc, so since your path would be Derm-->Peds Derm or PM&R-->Peds PM&R you would never be able to get board certified. Now, if you're truly in a rural area, is it possible you could get credentialed? Maybe. Almost impossible to guess what the environment will be in 30-40 years.

The other question to ask is whether you SHOULD practice as a general pediatrician after you've spent an entire career as a peds derm/peds PM&R doc. Developmental milestones, anticipatory guidance, other bread and butter peds requires its own residency for a reason and isn't really something you can glean from brushing up on up to date. But you'd ultimately need to decide on your own comfort level down the road.
I appreciate the detail of the response! For the Ped/PM&R program, it is actually a combined residency program, so I would get 30 months of pure pediatric training with 6 months of rehab specific to pediatrics to round out the 3 years. Whether or not that training is valuable 20 years down the line is where I falter. Some physicians I spoke with said that a peds heme/onc or PEM physician could transition to primary care later, but it might be harder for someone practicing cardiology because they hadn't seen as much breadth in their day-to-day. I would definitely get my board certification if I did the combined training programs.
 
I appreciate the detail of the response! For the Ped/PM&R program, it is actually a combined residency program, so I would get 30 months of pure pediatric training with 6 months of rehab specific to pediatrics to round out the 3 years. Whether or not that training is valuable 20 years down the line is where I falter. Some physicians I spoke with said that a peds heme/onc or PEM physician could transition to primary care later, but it might be harder for someone practicing cardiology because they hadn't seen as much breadth in their day-to-day. I would definitely get my board certification if I did the combined training programs.
Oh cool, I didn't realize that Ped/PM&R was also a combined program.

Anyways, then yes you absolutely could practice provided that you kept up your gen peds certification. Of course, whether you should is another matter.
 
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