Pediatrics

[KeepOnGoing]

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What do you guys recommend as far as pediatrics? Is one better than another (Army/Navy/A.Force)? I'm mentoring an undergrad and he's curious...

Thanks 🙂

 

[FutureNavyFP]

What do you guys recommend as far as pediatrics? Is one better than another (Army/Navy/A.Force)? I'm mentoring an undergrad and he's curious...

Thanks 🙂

From what I hear, Peds is one of the more competative specialties (at least for the Navy) which is opposite than the civilian programs.

 

[BomberDoc]

What do you guys recommend as far as pediatrics? Is one better than another (Army/Navy/A.Force)? I'm mentoring an undergrad and he's curious...

Thanks 🙂

If you want to be a good mentor, steer him away from the military.

 

[KeepOnGoing]

If you want to be a good mentor, steer him away from the military.

That bad eh

 

[BigNavyPedsGuy]

That bad eh

The training in Navy pediatrics is top notch - they're (we're) as good as anybody else - I mean that and can back it up. That being said, I think if I were talking to an undergrad interested in pediatrics I would recommend staying a civilian. While the training is good, the career options are more limited. It's more competitive to get a spot in the first place. It's VERY difficult to get any subspecialty besides Neonatology - which is still tough. The military is in the business of winning wars. They only want enough peds folks to keep kids around for surgical subspecialties, take care of dependants and fill general doc billets.

If this person loves the military then yes they could (hopefully) end up as a pediatrician. But there would likely be less obstacles in the civilian world.

My 2 cents - feel free to PM me.

 

[BigNavyPedsGuy]

OK I'm getting tons of PMs from concerned HPSP students that want to do pediatrics. Let me give my two cents. Disclaimer: I am an intern (a very involved intern, but still just an intern).

From what we hear and see the number of Navy peds spots is on the up-swing. A couple of years ago the Navy tried to do away with peds and it didn't work out for a myriad of reasons. Bottom line: The pendulum is swinging pro-peds.

Training: like I said, it's great. Last year, among the 200+ programs that take the peds inservice exam, our 3rd years got 2nd in the country! I know boards are only one measure, but it's one of the only objective measures.

There are no other programs that train you to go anywhere in the world and manage any pediatric problem alone. DKA, status epilepticus, premature infant, you name it, the expectation is that by the time we leave our program, we can go to Guam or Diego Garcia and get it done.

Among all the GME programs that are struggling in the military, peds (at least Navy peds) isn't really one of them. The peds dept here is one of, if not the best residency program/dept in my hospital.

Hope that helps to undo some of the negativity. I've said other times in this forum that I love my program and dept. I just don't know if view through the retrospectascope would change things.

Keep PMing me as needed. Any med students out there might get to be my cohort after my GMO is done 🙂

 

[BomberDoc]

...by the time we leave our program, we can go to Guam or Diego Garcia and get it done.

There are no kids on Diego Garcia, so no pediatricians. Sorry, I can't resist being a smarta$$. Diego is, however, one of the most beautiful places on the planet. Ah, paradise. You Navy guys do have some great locations.

 

[NavyFP]

OK I'm getting tons of PMs from concerned HPSP students that want to do pediatrics. Let me give my two cents. Disclaimer: I am an intern (a very involved intern, but still just an intern).

From what we hear and see the number of Navy peds spots is on the up-swing. A couple of years ago the Navy tried to do away with peds and it didn't work out for a myriad of reasons. Bottom line: The pendulum is swinging pro-peds.

Training: like I said, it's great. Last year, among the 200+ programs that take the peds inservice exam, our 3rd years got 2nd in the country! I know boards are only one measure, but it's one of the only objective measures.

There are no other programs that train you to go anywhere in the world and manage any pediatric problem alone. DKA, status epilepticus, premature infant, you name it, the expectation is that by the time we leave our program, we can go to Guam or Diego Garcia and get it done.

Among all the GME programs that are struggling in the military, peds (at least Navy peds) isn't really one of them. The peds dept here is one of, if not the best residency program/dept in my hospital.

Hope that helps to undo some of the negativity. I've said other times in this forum that I love my program and dept. I just don't know if view through the retrospectascope would change things.

Keep PMing me as needed. Any med students out there might get to be my cohort after my GMO is done 🙂

I agree with the above. Peds is definately safe for the moment. Add to the equation that 50-100 former GMO positions will end up as Peds and you will see a significant increase in needs.

 

[rotatores]

I agree with the above. Peds is definately safe for the moment. Add to the equation that 50-100 former GMO positions will end up as Peds and you will see a significant increase in needs.

Umm...not sure if there are even 100 Navy general pediatricians out there?

Rotatores
PGY-2 Pediatrics

 

[edmadison]

I'll add my two cents worth here.

Military programs are good, but you can't compare the experience in a military program to that of a high volume academic center. Also, the inservice examination is not a good comparison, because most military programs make a big deal out of it (we had weekly prep) while civilian programs don't care a bit. Comparing military vs civilian is like comparing apples and oranges. I had the benefit of having my best friend doing peds a civilian center very close by. We talked several times a week a frequently compared our programs. I did three rotations at her children's hospital so I have more than just second hand information.

My program. Very intimate -- personal relationship with the attendings. Stressed actual teaching in morning report rather than death-by-power point. Tons of outpatient medicine. Most subspecialty rotations were predominantly outpatient. Good level III NICU training with enough experience to be comfortable. Big weak point: inpatient volume. The number and variety of patients was lower than would have been optimal.

Her program. Almost the opposite. Very little outpatient medicine. Even subspecialty rotations focussed on inpatient. High volume inpatient services with interns carrying 10-15 patients daily. These patient tended to be quite sick because there was an attending service for patients with little teaching value. Hundreds of attendings, so less mentoring. Much more and better acute care as the peds residents ran the Emergency Department and spent a tremendous amount of time there.

Am I happy that I went were I did? Yes. But there are downsides. My colleague is much more comfortable taking care of a very sick patient than I am. I can do it, but she's done a ton more than I have. On the other hand, I have much more clinic experience and am much more comfortable in that environment.

Now here's the big disclaimer. I was deployed almost immediately out of residency. It will probably be two years following graduation from residency before I treat a child. This is the way of life in the Army. I can't speak for the other services. Army pediatrics is one of the greatest sources for operational medicine positions (flight and brigade surgeon).

Take it from someone who was very pro HPSP and military while I was in residency. It's not worth it. I would not do it again and if you offered me a bonus of $1,000,000, I would not extend my obligation.

Ed

 

[NavyFP]

Umm...not sure if there are even 100 Navy general pediatricians out there?

Rotatores
PGY-2 Pediatrics

We are going to have to make more.

 

[Mirror Form]

Now here's the big disclaimer. I was deployed almost immediately out of residency. It will probably be two years following graduation from residency before I treat a child. This is the way of life in the Army. I can't speak for the other services. Army pediatrics is one of the greatest sources for operational medicine positions (flight and brigade surgeon).

That's complete crap, they should give you at least one year following residency to consolidate your knowledge and skills before deploying you.

 

[Galo]

That's complete crap, they should give you at least one year following residency to consolidate your knowledge and skills before deploying you.

I'm glad people post this stuff. Maybe it will sink in at some point. You are just a body, and they will shuffle you where they need you without regards to your specialty or how it will affect you in the long run. Happens EVERY day.

 

[BigNavyPedsGuy]

That's complete crap, they should give you at least one year following residency to consolidate your knowledge and skills before deploying you.

Totally agree. I think (scary words, I know) for the most part the Navy tries to give you peds right of residency so you can take your boards. It's the next billet where they get you.Oor they deploy you after you take your boards. Either way, you pay them back by the time your done with your payback (snazzy phrase, huh?)

 

[Homunculus]

i agree with edmadison and navypedsguy.

i graduated the same year as ed-- only i'm not deployed yet.

the army grossly abuses its pediatricians as GMO's. no, they're not called "GMO's" anymore but flight surgeon and brigade surgeon-- same difference medically. we can go 15 months without a delivery resusciation, UVC, intubation, infant IV, etc etc. seeing KBR employees and sick call-- great use of our skill sets.

the army deploys us like this for two reasons-- 1) the GME programs actually support this, as it gives them ammo to use to keep army pediatric GME running ("hey, we support the war more than the IM docs, you can't get rid of us" kind of thing) and 2) because they can.

the training is good, but at the MEDCEN i trained at, the atmosphere is not positive. which is sad, because the area is a great place to live-- if you had time to actually enjoy it. the majority of the staff (save a few very supportive notable exceptions without whom the place would be a cesspool) aren't particularly interested in teaching or supporting the residents. for example, when residents attempt to have yearly parties or retreats, getting coverage for services in like pulling teeth. the residents are leaned on heavily to accomplish most of the "work", and staff have pretty easy lives. they take 2 weeks of attending call (while they're attending the ward) a year. that's it. i do more than that as a meddac attending a couple of months. they also never cover the nursery (they have contractors for that).

at my program we rotated at a major children's hospital for PICU and peds ER. other than that it was all in house. which is good and bad, but overall the education is good.

in the end in the military you will graduate with good pediatric knowledge and skills. but overall it's easy to be a pretty mediocre pediatrician, and very difficult (almost impossible) to be a thorough and excellent one (you've probably run into the type i'm talking about).

--your friendly neighborhood jaded army pediatrician

 

[Homunculus]

Take it from someone who was very pro HPSP and military while I was in residency. It's not worth it. I would not do it again and if you offered me a bonus of $1,000,000, I would not extend my obligation.

Ed

i dunno, for a cool mil i'd go awol to the carribean and work there. i'm getting aout asap, which unfortunately isn't until the middle of the next decade.

-your friendly neighborhood 7-4-19 to go caveman

 

[a1qwerty55]

i dunno, for a cool mil i'd go awol to the carribean and work there. i'm getting aout asap, which unfortunately isn't until the middle of the next decade.

-your friendly neighborhood 7-4-19 to go caveman

I heard we retained 1 out of 13 pediatricians who could exit the Army last year. Is that true? I suspect it is.

According to TSG.... all is well.

 

[Homunculus]

I heard we retained 1 out of 13 pediatricians who could exit the Army last year. Is that true? I suspect it is.

According to TSG.... all is well.

sounds about right. and the one that stayed was probably a 15 yr who is safe from deployment and wants to finish off their career.

the real number to look at (if they'll disclose it) is how many people are retained the first time they are eligible to get out. there's a selection bias if you take into account lifers already in the system. the retention rate for CPT and MAJ after their first ADSO and not continuing on to military fellowship training has to be zero.

--your friendly neighborhood 7-4-18 caveman

 

[IgD]

The only thing worse than being a pediatrician is trying to get medical care for your children from the peds clinic. Once we were supposed to come in for a school physical at the family practice clinic. The clinic said they wouldn't sign the paperwork because my kid had asthma. They kept bouncing us back and forth between peds and FP. Finally we got the situation addressed. My neighbor who is also a Navy physician has similar stories. Our kids are lucky to see a nurse practitioner if we can cut through the red tape.

Another of my kids had a couple cavities. After the dentist filled the teeth, I asked for a follow-up. He explained they if they were in private practice they would do it but because they were so short staffed they were handling crises only. I about blew my top.

 

[dtn3t]

.

 

[BigNavyPedsGuy]

Not to sound sarcastic, but isn't it just common sense to think that you shouldn't join the military if you want to do pediatrics? Most of us just kind of fell into liking peds and nothing else.

You got it! That's my point. I'm happy with my program, but if were to choose today, knowing htat I want to do peds I would not have chosen the military. No more no less, just stating the facts.

 

[edmadison]

side bar: anyone else hearing the rumor that the Army is filling all Brigade surgeon slots before Flight Surgeon spots even if it means leaving FS slots unfilled?

I don't know if this is true, but it certainly makes sense. In our CAB, we have 10 docs for 4000 soldiers. It's ridiculous. My problem isn't that I'm here not doing peds, its that I'm not really doing anything! I see about 4 patients each day. In my 4 months here I have yet to see a patient that could not have been handled by a well trained medic with a telephone. Of course we have level II and level III here. If I were actually saving lives, I'd feel much better about being here. What I'm really doing is saving junior enlisted from PT and details. Joy.

Ed

 

[BlueIsis]

DON'T CALL CPS FRIVOLOUSLY.

Whiskey-tango-foxtrot? Over.

 

[BigNavyPedsGuy]

Whiskey-tango-foxtrot? Over.

No kidding. Homonculus can we get Post #23 through this one removed? This was a good logical thread until now.

 

[DrBloodmoney]

Congrats to the peds guys (as well as the rest of us - nonsurgery/anesthesia folks) - FY09 proposed ISP for all the specialties that were sub-20k are all now going to be 20k. Woohoo!

 

[dtn3t]

.

 

[J-Rad]

The PDF that got sent to me from a group-mail from the consultant to the (AF)SG for pediatrics is too large to upload here. It's a memorandum to the services about the increased ISP/MSPs. It's the real deal.

 

[Scooby007]

I'm like some of the other people and found an interest in Peds during medical school after taking the HPSP.

How many people (and ratio of applicants) successfully match Peds in the Army? Also, what are the chances of getting a Neonatology fellowship in the Army? Can you do it right after residency or do you have to serve your 3 years as a general pediatrician first? Is there anything that I should be doing as a MS3 (or any place I should try to do my residency) to increase the chances of getting the fellowship?

Thanks!

 

[dtn3t]

I'm like some of the other people and found an interest in Peds during medical school after taking the HPSP.

How many people (and ratio of applicants) successfully match Peds in the Army? Also, what are the chances of getting a Neonatology fellowship in the Army? Can you do it right after residency or do you have to serve your 3 years as a general pediatrician first? Is there anything that I should be doing as a MS3 (or any place I should try to do my residency) to increase the chances of getting the fellowship?

Thanks!

The ratio varies every year, but usually the number of applicants is close to the number of spots (26?), give or take a few each year. A NICU fellowship right after residency is definitely possible and happens, but most do a tour as a BDE or flight surgeon (or peds if you're lucky) for a year or two before getting the spot. There is always someone waiting in the wings in operational land to get the spot. Things you can do now to improve your chances of fellowship is to improve your chances at getting the residency. First things first. You'll have plenty of chances to build your CV for fellowship during residency. Doesn't really matter where you do residency, although you might want to look at residency locations where the fellowships are so you have feel of what it's like there.

 

[rotatores]

Hey Hey...slow down. Take it easy. First priority is to do an internship/residency in pediatrics then decide if you want to do a fellowship. The NICU is a special place and requires a special person to do it as a career. When I was a MSIII I was all about the NICU...but trust me...when you spend several years in it as a resident your eyes open. My advice now...pass your step 2 and 3 with style and continue to make good grades.

Rotatores
PGY-3 Pediatrics