Pediatrics Vs Family medicine

[RickHarrison]

Another specialty indecision thread from a third year.

I am interested in both pediatrics (most likely general) and family medicine. I like kids and adults but like kids more. Although not a huge fan of neonates.

First, I've been discouraged from mentors and other faculty about going into pediatrics. Most citing its low pay. However, wouldn't pediatrics pay more than family medicine on a per hour basis? Most surveys I look at have peds and fm around the same annual salary but says peds work less.

Second, I really enjoy hospital medicine. I don't really want to do a fellowship and it seems there is a lot of uncertainty about hospital medicine in pediatrics. Will I still be able to do hospital medicine in a community setting (say city of 25,000 to 200,000)

Third, I also like ER work. Is it possible for a pediatrician to work in a community ER but only seeing kids and not adults.

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[FrkyBgStok]

I hate to say pediatrics is a calling because it is so cliche and overdone, however it is somewhat relevant. People don't go into pediatrics for the money. I am planning on applying to PICU this fall and I am fully aware that I will be making significantly less than my adult ICU counterparts, but I absolutely love the pathology I deal with. I think congenital hearts are incredibly interesting compared to primary hypertension. I absolutely loathe working with adults and I feel right not that I would quit medicine if I had to work with adults. that is a little drastic, but it really does illustrate that I am doing what I love.

pediatrics has the lowest yearly salary but I also believe that pediatrics has one of the higher proportions of people working part time which is going to bring salaries down. from what I have seen (at least in my hospital and area), adult and pediatric hospitalists make about the same.

I don't think pediatrics is going to open enough hospitalist fellowships that quickly so I anticipate that yes. It is also possible to work in a peds ED and see only kids, however they will expect you to either be PEM trained for single coverage, or at least pediatrics trained for double coverage. if you are going to work in an ER that sees both children and adults, than no.

 

[RickHarrison]

Thank you. Those were all very helpful answers.

It sounds like pediatrician then make more on a per hour basis. Do you mind sharing how much the adult and pediatric hospitalists make from what you've seen? Also, how do their hours and patient load vary?

 

[physicsnerd42]

Adult doctors will make more than pediatric doctors. Medicare pays more than Medicaid and a large percentage of kids are on Medicaid. If you’re thinking of money (hourly or total), do family med. if you want to take care of kids and have the ability to specialize (while earning 1/3 of what your adult counterparts would make) do Pediatrics instead of family medicine. There is a massive opportunity cost to Pediatrics and only you can determine if it is worth it.


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[MEN2C]

Interestingly, if you look at MGMA (the gold standard) and multiple other actual salary reports, family med and general pediatrics have a very similar median salary, with FM only slightly more (within 10-20k)....

Just something to keep in mind. You'll have more opportunity to moonlight in hospital ERs (especially rural) and things like that as a FM though, so if that's what you want to do, go to FM. On the other hand, you can do hospitalist as a FM, but if you want to subspecialize into a specialty (PICU, NICU, PEM and other primarily hospital subspecialties or a specialty with a decent mix of both like cardiology or heme/onc), then peds might be right for you.

 

[BigRedBeta]

In my mind, it comes down to knowing yourself.

If not seeing adults is going to leave a hole in your professional soul, then you need to do FM (or even better in my mind, Med/Peds - get better training in both IM and Pediatrics). I mean that in the strongest possible way. Sounds like not being able to see kids for you would be a dealbreaker. So you really have to look at what role you want adult medicine to play in your career. If it's just "nice to have" then forget it and come join us pediatricians. If not seeing adults will leave a void, then go FM or Med/Peds.

And while FM gets paid "more" it's dependent on what your patient mix is. If you're only going for the income, it only makes sense to load up on higher paying adults. Your income will suffer if you're an FM person who tailors a practice towards children.

 

[arewethereyet...]

. If you’re thinking of money (hourly or total), do family med.

Don't hear that too often lolz. Hopefully you didn't decide to go into medicine because you wanted to be rich. Pedi is at the bottom of the list for salaries, but still make PLENTY of money to live a happy life.

Why not med/peds? We have at least two, maybe three med/peds trained hospitalists that alternate between peds and adults every few months. They seem pretty happy. We also have at least 2 med/peds trained hospitalists that do just peds. The current med/peds residents I know (they are all wicked smart) seem to want to go all over the place; some adult fellowships, some pedi fellowships, some adult/pedi fellowships, some want to be hospitalists, and some want to do outpatient stuff.

You said you like ED and hospital, you mentioned nothing about liking clinic, so are you sure you don't mean IM vs peds? I have no idea if family docs ever see their patients in the hospital anymore like some community docs do in peds, so maybe that's what you're talking about?

As someone had mentioned, to see only peds in the ED you'd do a PEM fellowship and work in a pedi ED, but as far as I know those don't typically exist in community hospitals because they don't have much of pedi inpatient service.

FWIW I was also discouraged from peds by a lot of older attendings because of pay and "it isn't what it used to be," but all medicine isn't what it used to be. I didn't listen to them and now I'm a pedi intern and happy so I'm confident I made the right call.

 

[mvenus929]

A word of caution if you decide to look into Med/Peds. You should absolutely apply to Peds or IM (or FM...) as back-up. Med/Peds programs are few in number, take few residents, and are thus competitive. So, you will still need to figure out if you are okay with just peds, or if you want the adults for fulfillment.

 

[Stitch]

I'll just add that there's a wide variety of pediatrics practices. In general they do make less, but you can find a practice that makes pretty good living, especially once you partner. Some subspecialties pay well too if you aren't tied to a specific location.

You also have to think about how much you want to do with kids in terms of scope of practice. FM docs can do the basics like well child exams and vaccines, but they really don't have the in depth training with children that pediatricians do. They just can't because they have to focus on so many other things. There really are big differences between adult and pediatric medicine, and it's hard to do both well. I mean no offense to FM docs; they are great and do a good job, especially in areas where they have be the only doc for everyone. But there is absolutely a difference in knowledge and ability to identify and care for some pediatric issues.

 

[ckom5987]

Med/Peds seems like a good option, if you have good scores/application/LOR. That will leave you comfortable with both adults and children

 

[livevibrantly]

Pediatrics makes a low pay? From what I've seen, they're earning 6 figures minimum! Or am I being blindly fed incorrect information from the internet..?
yes i'm asking im not trying to be sarcastic or anything lol

 

[FrkyBgStok]

Pediatrics makes a low pay? From what I've seen, they're earning 6 figures minimum! Or am I being blindly fed incorrect information from the internet..?
yes i'm asking im not trying to be sarcastic or anything lol

you are correct and my wife and I talk about this. about how if someone was listening to our conversation and they were hearing me say "well peds only pays $200k so it doesn't pay much" it would probably get me beaten up.

but relative to everything else in medicine, peds makes a low pay.

 

[livevibrantly]

you are correct and my wife and I talk about this. about how if someone was listening to our conversation and they were hearing me say "well peds only pays $200k so it doesn't pay much" it would probably get me beaten up.

but relative to everything else in medicine, peds makes a low pay.

Oh good- Peds is definitely on my radar for potential specialties once I go through med school, and I got worried I wouldn't get that added bonus of a comfortable salary after ~10 extra years of learning compared to the rest of my peers following graduation. But the work done on a daily basis to help patients is a reward in itself .