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I was referring to Pediatric hospitalists not Pediatric primary care physicians.
Pediatricians really that sub-optimally compensated?
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Pediatric hospitalists working in Children's Hospitals have a lot of complex kids to handle--along with a fair number of stressed parents. I have worked more than a few. It's a lot of stress; but they typically have more support and back-up IMO as compared with hospitalists covering in a general hospital.
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I was referring to medical complexity and comorbity in comparison to adult hospitalists.
Yes. I understand that you are. Many kids in children's hospitals have multiple disorders r/t genetics and other reasons. They are super tricky. That's why the general approach is way more "mother, may I" in children's hospitals or certain pediatric or neonatal areas. I have done both settings, and it gets real scary with these kids.
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Yikes. Apparently it is discrimination to not let those with less training and qualifications to lead.
To think, MLB has been discriminating against me all this time. But I want to play in the majors, I just don't have the training or skill set. I think I'll make my own baseball league with my own rules then once it is powerful enough lobby to get the teams added to MLB. But it won't be overseen by the commissioner or the owners, cause those rules would be further discrimination. That would be quite a racket...
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There's also the potential to make a lot less. Nephrologists, for instance, are essentially required to work in academia (not a large enough patient population to work outside of a children's hospital, and most children's hospitals are teaching institutions), and generally make less than the standard general pediatrician, despite having an additional 3 years in fellowship. Many also have to work on grants to make up part of their salaries.
As others have said, payer mix. If you work in a low-income neighborhood, you'll probably see mostly Medicaid patients, and your compensation will take a hit. Work in suburbia and most of your patients are likely private, so you get a better compensation.
Children's hospitals do a LOT of fundraising. The whole fiscal system for Children's hospitals is designed differently than adult hospitals.
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Yes, and I'm telling you that it is not COMMON in the ER where every child has a zebra.
Yes and I am telling you that in a Pediatric ED or for a intensivist (especially at a children's hospital), zebras are not necessarily zebras--there are serious conditions that occur more than the average person ever realizes. And this is exactly why they need children's hospitals; b/c people often have no clue how to proceed optimally with these children. And thanks to research and modern advances, they are less rare, b/c often they can be identified, treated appropriately, and live longer. Children's hospitals or university based hospitals that are closely associated with top children's hospitals, are more likely to either reach out to the right folks for insight and proper treatment; and of course strong hospitals, such as those in this article, http://health.usnews.com/best-hospitals/pediatric-rankings , are better able to identify, treat, and support children and families, b/c these things are not considered "zebras" there. I don't think you should comment about things with which you have limited to no exposure. And this is exactly why I encourage parents with medically fragile, complex care children, to, in most cases, just head straight to the children's hospital, where they have attending physicians anyway. It's a pain, b/c sometimes it involved travelling a bit further or crossing bridges and heading into urban areas, but, in general it's worth it. No sense in playing with those that aren't in the know.
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We're not talking about the average. Realize most medical school graduates do NOT work in academic medical centers. They work in the community and at private hospitals. No one said we don't need private hospitals. But the problems that a pediatric hospitalist encounters (not a specialist) and an IM hospitalist encounters in terms of complexity and comorbid conditions all interacting are not on the same plane ON AVERAGE, so not surprisingly, IM hospitalists are paid more than a Peds hospitalist.
Also, please note that Burns at al has shown that "The relative medial complexity of hospitalized pediatric patients has increased over the past 15 years." http://pediatrics.aappublications.org/content/126/4/638.full.pdf
But many strong children's hospitals have a lot of endowments.
In general the above article and others suggest that those in community centers need to get exposure to these seriously problematic kids, b/c, they often arise in the community setting.
Many a very fragile baby's or child's issues have been missed or treated in a seriously wrong manner in these settings, even prior to transfer--if indeed they were transferred at all. I'd have to dig through the databases, but even from anecdotal experiences, I can tell you a number of horrifically mishandled pregnancies, neonates, infants, and older children in the community hospital setting. If anything, it points to the need for more education and clinical exposure. Besides, medicine in the kind of field where one should be learning for life.
Thanks for the discussion.
In general the above article and others suggest that those in community centers need to get exposure to these seriously problematic kids, b/c, they often arise in the community setting.
Many a very fragile baby's or child's issues have been missed or treated in a seriously wrong manner in these settings, even prior to transfer--if indeed they were transferred at all. I'd have to dig through the databases, but even from anecdotal experiences, I can tell you a number of horrifically mishandled pregnancies, neonates, infants, and older children in the community hospital setting. If anything, it points to the need for more education and clinical exposure. Besides, medicine in the kind of field where one should be learning for life.
Thanks for the discussion.
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Online BSN programs do allow online labs as part of their degree. (University of Wilmington for example). NP programs aren't required to have any labs. Drexel University has an online NP course that's completely online with the exception of a couple days to teach them physicals and then their self-arranged clinical experiences that aren't online.
If having clinicals means that they aren't completely online, that's true, but you should see their tests. My husband took his pathophysiology final after studying for 24 hours. He completed the test in 8 minutes and got an A. He's the first to say that what he's learning in NP school can't compare at all to what I'm doing in med school. In fact, after that test, he said he's scared about practicing as an NP if that's all he has to know to graduate. (It makes me more worried about what NP students without 15 years of nursing experience are going to be doing in practice after taking that same course.)
Gerontology NP: program is comprised of 57 credits and can generally be completed in 3 years of part-time study. As part of the curriculum, 800 clinical hours are required--more is required for NP acute peds, etc.
No argument from me that that is crap in comparison with physician residency and fellowship programs.
Now, mind you, I strongly disagree with admission requirements of 1 year in the particular area of interest. It's just not enough in my humble opinion. I would mandate change in this regard. Truth is, however, those with > 1 year and strong acute/critical care experience and 3.25 to 3.50 GPA are more likely to be accepted--particularly when enrollment is down.
But even med schools will take lesser evaluation -numbers if enrollment is down across the board--b/c SCHOOLS ARE BUSINESSES, PERIOD.
For the formerly referenced programs, arrangement of clinical time is often up to the student to set up and must meet with school approval at every point--which is often easier said than done; b/c hospitals don't want to worry about liability issues--so it's better to use the healthcare institutions with whom the school/s have connection. Also, if you don't get enough hours of the right kinds of clinical experiences, you are bound to have problems passing your boards. Head knowledge w/o direct, clinical application will not solidify things and it won't get you very far--unless you are some "political" kind of appointee to a position. And yes. It happens; b/c life can suck and idiotic politics has way too much influence in things--even healthcare. Still, you have pass the boarding/licensing exam, so . . .
Personally, I don't think anyone should be accepted into such programs--for NP or for PA--without a good 3 years, full-time clinical practice, which can be carefully articulated in a CVs and then reviewed through solidly objective-based LORs. I have never been supportive of relatively new grads entering graduate level programs. EVER! I am pretty conservative about this; but I don't sit on these boards, committees, and accrediting agencies. The schools would hate me, b/c I would make it A LOT tougher to gain acceptance--and that would "lose them" some money. GPA would only be one piece of the puzzle. Strong and successful experience in acute and critical care and membership in specializing organizations would be a big deal for me.
Most people would find more promise from a NP obtained from say Penn. Not simply b/c it's an IVY League school. Drexel is a higher tier school, but is not Ivy League. Still, it's a great school. No. It's b/c PENN is better about the clinical exposure time. B/c of that, if I were going NP route, I'd be more likely to choose U of Penn--also b/c of it's affiliate institutions, such as the Children's Hospital of Philadelphia, HUP, and Pennsylvania Hospital, etc.
No argument from me that that is crap in comparison with physician residency and fellowship programs.
Now, mind you, I strongly disagree with admission requirements of 1 year in the particular area of interest. It's just not enough in my humble opinion. I would mandate change in this regard. Truth is, however, those with > 1 year and strong acute/critical care experience and 3.25 to 3.50 GPA are more likely to be accepted--particularly when enrollment is down.
But even med schools will take lesser evaluation -numbers if enrollment is down across the board--b/c SCHOOLS ARE BUSINESSES, PERIOD.
For the formerly referenced programs, arrangement of clinical time is often up to the student to set up and must meet with school approval at every point--which is often easier said than done; b/c hospitals don't want to worry about liability issues--so it's better to use the healthcare institutions with whom the school/s have connection. Also, if you don't get enough hours of the right kinds of clinical experiences, you are bound to have problems passing your boards. Head knowledge w/o direct, clinical application will not solidify things and it won't get you very far--unless you are some "political" kind of appointee to a position. And yes. It happens; b/c life can suck and idiotic politics has way too much influence in things--even healthcare. Still, you have pass the boarding/licensing exam, so . . .
Personally, I don't think anyone should be accepted into such programs--for NP or for PA--without a good 3 years, full-time clinical practice, which can be carefully articulated in a CVs and then reviewed through solidly objective-based LORs. I have never been supportive of relatively new grads entering graduate level programs. EVER! I am pretty conservative about this; but I don't sit on these boards, committees, and accrediting agencies. The schools would hate me, b/c I would make it A LOT tougher to gain acceptance--and that would "lose them" some money. GPA would only be one piece of the puzzle. Strong and successful experience in acute and critical care and membership in specializing organizations would be a big deal for me.
Most people would find more promise from a NP obtained from say Penn. Not simply b/c it's an IVY League school. Drexel is a higher tier school, but is not Ivy League. Still, it's a great school. No. It's b/c PENN is better about the clinical exposure time. B/c of that, if I were going NP route, I'd be more likely to choose U of Penn--also b/c of it's affiliate institutions, such as the Children's Hospital of Philadelphia, HUP, and Pennsylvania Hospital, etc.
D
deleted158872
They earn as much as family physicians; that IMO is fairly compensated.
Wait. You are referring to pediatricians (general)? Personally, I don't believe that FP or Peds (gen) are fairly compensated. And again, yes. Medicaid is a big issue.
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They are generally small in number and therefore their complaints don't sound as loud. Also, if you asked them if they would rather go general IM for the same money, most, would probably decline.
For some reason I've gotten to know a few nephrologists, a fellow and an attending. The pay is, as you say, no better than general IM. And the fellow says the job market he's applying to is bleak. But both would rather be consulting specialists. Both have a similar aversion to general IM that I do. And they started there.
If I had signed up to be a infantry man in medicine. I would've taken the first assignment elsewhere that I could get. If not ID, then blank, if not blank then blank. Etc.
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My husband does a mix of inpatient and outpatient peds and his salary exceeds 200K. Now [as you might guess from my username] he is practicing in relatively rural area. He is also practicing in a great small town that has retained a sense of community and where we feel comfortable raising children.
So just know that I am curious as to the area of medicine in which you landed. 😉 Don't write it here. I am just saying, I am curious. I am wondering, ED, anesthesiology. . .hmmm.
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Are you IM-Peds perhaps? (I ask because I am.)
Oh, so awesome. As I said. . .my dream job. No, I am currently a long-time, experienced critical care RNBSN that works w/ adults and now mostly children/babies. I am on the pre-med path. But rural medicine of children and adults is my dream. I'd love critical care of peds; but at this point in my life, doing what you are doing is more of a fit for me. And it's funny; b/c although in peds we focus medically (and otherwise) on the children, we care of the whole family/parents in a real sense. So, it's like the family unit is the whole that you really treat--in a bigger sense of things. I share this b/c people think you are just dealing with children. No people that think they will be primarily dealing with children are incorrect. Usually, if you are treating the child, you are also dealing very closely with the family unit. You get the one, and you get the other. This happens with adults in critical care too, but in general, it's not the same kind of intensity.
I would love to pick your brain some time. 🙂
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It's not really a secret that he's in psych.
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I don't know about the adult subspecialties, but as I posted in another thread, in Peds love is definitely not filling the fellowship slots. The only Peds fellowships that are consistently fillings are the ones that involve big pay raises: EM, ICU, NICU, and Cards. For everything else, 40-60% of fellowship slots are going unfilled. ID, nephrology, pulmonology, adolescent, child abuse, etc. Sooner or later this needs to be addressed or Peds subspecialists aren't going to exist any more.
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Wow. That's gloomy. But now that you make me aware of it makes sense that the medical education model we have is starting to stall out at the extreme ends of low return on investment. 7 years or more of residency training better net those doc's a better salary than a CRNA or I guess the public's chickens will be coming home to roost in the context of sick kids and no specialists. It's like they just refuse to know what they have until they don't have it.
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Yeah I don't really see how the leaders of industry in these fields can't see these problems arising. Same thing with rads loophole. These problems are pretty obvious, so it seems like they're just trying to squeeze out as much juice as they can before the whole thing collapses..Don't see any other way it would happen as it has.
