Pediatricians moonlighing?

[Coltuna]

I currently work in the ER at a small rural hospital and many of the family practice physicians pick up a 3-4 shifts in the ER monthly. Has anyone heard of Pediatricians doing this? Or is their scope too specific? Although I'm not a medical student yet, I'm just curious as I'm very interested in Pediatrics but think I would miss the acute nature of ER.

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[Coltuna]

Might be better to ask this question in the Peds forum instead of the premed forum 😉

Here's the link: https://forums.studentdoctor.net/forums/pediatrics.38/

Wasn't even aware there was such a thing haha. Thank you!

 

[Neuronix]

Hi pre-allo,

It's SDN policy that questions from pre-medical students stay in the pre-medical forums. The professional forums are for working physicians or senior medical students. This is the appropriate place for the question.

Thanks,
Neuronix

 

[WheezyBaby]

General pediatricians can potentially work in a peds ED. Just like the adult ED already has though, peds EDs are going to likely going to continue to transition to peds EM fellowship trained physicians

 

[samac]

If you're in a small town a lot of adult ER moonlighting is done by people who haven't done an ER fellowship. Just throwing that out there.

But I've never heard of someone in Peds moonlighting in a non-Peds ER. Training for just tiny humans is a little bit more limited scope than what you see in adults.

 

[Ho0v-man]

I know a pediatrician who switched to full time ER for about 12 years. No fellowship or repeat residency or anything crazy like that. Got paid the same as everyone else supposedly. Now she does part time urgent care.

 

[tantacles]

I currently work in the ER at a small rural hospital and many of the family practice physicians pick up a 3-4 shifts in the ER monthly. Has anyone heard of Pediatricians doing this? Or is their scope too specific? Although I'm not a medical student yet, I'm just curious as I'm very interested in Pediatrics but think I would miss the acute nature of ER.

This question doesn't have an answer that fits all, but it always boils down to two main things:

1. What is the demand for moonlighters?

2. Are there enough moonlighters in this field to cover these shifts?

Technically, your medical license entitles you to practice all fields of medicine on all people in all settings. So ultimately, it comes down to what a particular hospital needs in a particular field to keep going. In our major children's hospital, there aren't enough dedicated hospitalists to cover all weekends. Thus, some of the general pediatricians cover shifts on the evenings and weekends when there's demand for them (in other words, when no hospitalist wants to cover the service).

In an ED, you might imagine that a general pediatrician can cover the patients as well. Our ED is always staffed by a peds EM trained physician, but pediatric generalists see patients frequently and staff patients, with varying degrees of depth and sometimes none, with that attending. The fellows serve a similar role.

 

[Coltuna]

This question doesn't have an answer that fits all, but it always boils down to two main things:

1. What is the demand for moonlighters?

2. Are there enough moonlighters in this field to cover these shifts?

Technically, your medical license entitles you to practice all fields of medicine on all people in all settings. So ultimately, it comes down to what a particular hospital needs in a particular field to keep going. In our major children's hospital, there aren't enough dedicated hospitalists to cover all weekends. Thus, some of the general pediatricians cover shifts on the evenings and weekends when there's demand for them (in other words, when no hospitalist wants to cover the service).

In an ED, you might imagine that a general pediatrician can cover the patients as well. Our ED is always staffed by a peds EM trained physician, but pediatric generalists see patients frequently and staff patients, with varying degrees of depth and sometimes none, with that attending. The fellows serve a similar role.

Thanks for the in depth reply! Btw, love the picture. I was partial to Haschel myself, but Dart was solid.

 

[tantacles]

Thanks for the in depth reply! Btw, love the picture. I was partial to Haschel myself, but Dart was solid.

Meru is my personal favorite.

 

[Kgizzle]

I know a pediatrician who switched to full time ER for about 12 years. No fellowship or repeat residency or anything crazy like that. Got paid the same as everyone else supposedly. Now she does part time urgent care.

That was a long time ago. Stuff like that doesn't happen anymore...

 

[tantacles]

That was a long time ago. Stuff like that doesn't happen anymore...

Depends on the hospital. It does indeed happen. Very unlikely to happen at a university hospital, but at a community hospital, this is more commonplace.

 

[Coltuna]

Two or our ER providers are Family Med doctors gone EM doctors.

 

[Kgizzle]

Depends on the hospital. It does indeed happen. Very unlikely to happen at a university hospital, but at a community hospital, this is more commonplace.

I stand corrected... I wonder how prepared they are to handle EM cases? Is it a big learning curve?

 

[cbrons]

Two or our ER providers are Family Med doctors gone EM doctors.

Triggered.

"Provider, Use of Term" (Position Paper)

 

[Coltuna]

Triggered.

"Provider, Use of Term" (Position Paper)

Lol work with 1 PA too. Creature of habit.

 

[DoctorCrush]

The small community hospital in my town even have peds NP staffing their ER too. So I would imagine it wouldn't be a crazy thought to have pediatricians who are non-fellowship trained staffing it if they can attract one.

 

[Ismet]

I stand corrected... I wonder how prepared they are to handle EM cases? Is it a big learning curve?

Are you referring to handling any EM case, adults included? Or any peds EM case?

A good portion of the kids that come to the ED are things that could be handled by a general pediatrician in their clinic (ear infections, rashes, gastroenteritis, viral infections, mild asthma exacerbations), but the benefit of being in the ED is that you don't have to send the kid out for labs or imaging, and you may have consult services that can come down to the ED. Of course there are the real medical emergencies that should be in the ED and not the clinic, which a general pediatrician should still be able to handle. I think the major learning curve would be the traumas, as general pediatricians typically don't get ATLS trained, but if you're moonlighting in a community hospital, you're not going to be seeing the traumas that a Level I-II trauma center would be seeing. All the serious traumas come to our ED, not to the community hospital ED down the way.

 

[Ho0v-man]

That was a long time ago. Stuff like that doesn't happen anymore...

She went urgent care like 2 years ago. Not exactly the good ol days. It doesn't happen often at university hospitals. But that's not most hospitals.

I imagine it's seen infrequently not because it's difficult for pediatricians to break into, but instead because most wouldn't want to work in the ER in the first place.

 

[tantacles]

I stand corrected... I wonder how prepared they are to handle EM cases? Is it a big learning curve?

They are prepared to handle the outpatient nonsense that comes in, and if you're at a hospital that isn't the right kind of center to handle a case that comes in and the kid is stable, you transfer. If the kid isn't stable, you stabilize and then transfer.

 

[Kgizzle]

Are you referring to handling any EM case, adults included? Or any peds EM case?

A good portion of the kids that come to the ED are things that could be handled by a general pediatrician in their clinic (ear infections, rashes, gastroenteritis, viral infections, mild asthma exacerbations), but the benefit of being in the ED is that you don't have to send the kid out for labs or imaging, and you may have consult services that can come down to the ED. Of course there are the real medical emergencies that should be in the ED and not the clinic, which a general pediatrician should still be able to handle. I think the major learning curve would be the traumas, as general pediatricians typically don't get ATLS trained, but if you're moonlighting in a community hospital, you're not going to be seeing the traumas that a Level I-II trauma center would be seeing. All the serious traumas come to our ED, not to the community hospital ED down the way.

I see what you are saying... it's interesting to me though cause there's a peds EM fellowship and I'm sure there's more to the training than just ATLS on top of a gen peds residency but it doesn't sound like it matters because of practice setting

 

[Tenk]

In the current age, virtually no hospital is going to staff an adult ED with a pediatrician and for good reason: people would die. Most pediatric EDs require peds EM fellowship or EM trained but pediatricians can staff these. Now the chances of a general pediatrician picking up random shifts in a pediatric ED (but doesn't do peds EM full time) is also slim to none because again: people would die.

 

[mvenus929]

We have a fast track in our Peds ED that is exclusively staffed by general pediatricians. These are kids that are triaged as 4 or 5 and don't require procedures. Occasionally, they are triaged wrong, but most of the time, it's providing reassurance to families regarding fever, conjunctivitis, giving Zofran to kids with vomiting, etc.

 

[Coltuna]

We have a fast track in our Peds ED that is exclusively staffed by general pediatricians. These are kids that are triaged as 4 or 5 and don't require procedures. Occasionally, they are triaged wrong, but most of the time, it's providing reassurance to families regarding fever, conjunctivitis, giving Zofran to kids with vomiting, etc.

Is this a larger hospital?

 

[tantacles]

In the current age, virtually no hospital is going to staff an adult ED with a pediatrician and for good reason: people would die. Most pediatric EDs require peds EM fellowship or EM trained but pediatricians can staff these. Now the chances of a general pediatrician picking up random shifts in a pediatric ED (but doesn't do peds EM full time) is also slim to none because again: people would die.

Well, actually, it's not slim to none. Why do I say that? Because it happens quite frequently, even at my academic hospital. Again, are the general peds people the big boss? no. But they are seeing patients independently and don't staff every patient.

 

[Tenk]

Well, actually, it's not slim to none. Why do I say that? Because it happens quite frequently, even at my academic hospital. Again, are the general peds people the big boss? no. But they are seeing patients independently and don't staff every patient.

You're telling me that a young attending general pediatrician (i.e. Not grandfathered) who has their own private practice that is not fellowship trained in pediatric emergency medicine is staffing occasional shifts in an academic pediatric emergency department?

 

[tantacles]

You're telling me that a young attending general pediatrician (i.e. Not grandfathered) who has their own private practice that is not fellowship trained in pediatric emergency medicine is staffing occasional shifts in an academic pediatric emergency department?

Who said anything about private practice? These are general pediatricians affiliated with our institution, many of them who trained at this institution within the last few years, and they occasionally do shifts in the ED. They also occasionally pick up shifts in the satellite hospitals of our institution.

 

[mvenus929]

Is this a larger hospital?

Stand alone children's, but not super big. We also have several urgent cares in the area that are staffed by general pediatricians.

 

[BigRedBeta]

Certainly will be variable by location.

My residency program typically had 2 attendings on at any one time - one was PEM fellowship trained (or grandfathered in) and the other was a general pediatrician, but the general pediatrician was never there alone. Occasionally the PEM spot was filled by a Peds Critical Care attending. There was also a general pediatrician in the Fast Track area.

Other moonlighting opportunities for general pediatricians could include level 2 NICU's (feeder/grower population), newborn nursery, or for a hospitalist service depending on the situation.

Now the chances of a general pediatrician picking up random shifts in a pediatric ED (but doesn't do peds EM full time) is also slim to none because again: people would die.

@Tenk You're really overstating what life is like in the peds ED. Most of what comes through, even those kids that will end up going to the PICU, should be readily stabilized by a general pediatrician who went through a decent residency program.