Peds compensation?

[mercaptovizadeh]

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Why is peds substantially less well compensated than IM? Is it because the disease burden in medicine is greater or are the same procedures/treatments for the same or very similar conditions in children vs. adults actually reimbursed differently?

 

[BigNavyPedsGuy]

It was once explained to me that people want every kid to have access to care and that's why compensation rates are lower. I don't know if it's true but it makes me less annoyed about the pay gap.

 

[edmadison]

Why is peds substantially less well compensated than IM? Is it because the disease burden in medicine is greater or are the same procedures/treatments for the same or very similar conditions in children vs. adults actually reimbursed differently?

It's because our society places no value on children

Ed

 

[generic]

reimbursement is lower per patient.

fewer procedures and high-dollar specialties...even if a child needs a cardiologist, a much smaller percentage of them need catheterization or multiple invasive procedures.

same for endoscopy in GI medicine--sure Crohn's patients get scoped whether they are children or adults, but peds GI will never have something like a recommendation that every single adult over the age of 50 gets colonoscopy every 10 years...

 

[Stitch]

It's because our society places no value on children

Ed

I agree. They're basically property in the eyes of the law.

In terms of primary care, remember that most of the PCPs are doing well child checks and anticipatory guidance. This is extremely important to prevent problems (and also makes identifying the few 'sick' ones more difficult), however there's little reimbursment for it. Procedures are valued more than preventative care. So for example that mom who comes in with a million questions and worries. You may spend half an hour with her and reassuring her that the child is normal, but you'll get paid very little for that expert consult.

Although children certainly get chronic disease requiring complex management (think of the former 24 week premie now with chronic lung disease, allergies and mental ******ation with behavioral problems), you don't get the end stage organ disease associated with the 90 year old who's had disease for 50 years. Even the diabetics and fat hypertensives haven't had the time to ruin their bodies yet. So even compared to internists taking care of the same disease, we get less.

 

[scotsdoc54]

you don't get the end stage organ disease associated with the 90 year old who's had disease for 50 years. Even the diabetics and fat hypertensives haven't had the time to ruin their bodies yet. So even compared to internists taking care of the same disease, we get less.

I understand how this can be a factor in lower compensation, but isn't this also a positive as far as patient composition? I'm just a lowly pre-med (but I've been accepted!), but to me it seems it would be infinitely more satisfying to treat kids with disease than adults with disease that was largely preventable? Again, I don't know, but it's one naive reason I have for looking at peds and peds specialties.

 

[BigNavyPedsGuy]

I understand how this can be a factor in lower compensation, but isn't this also a positive as far as patient composition? I'm just a lowly pre-med (but I've been accepted!), but to me it seems it would be infinitely more satisfying to treat kids with disease than adults with disease that was largely preventable? Again, I don't know, but it's one naive reason I have for looking at peds and peds specialties.

That's why we go into pediatrics. Not for the money.

 

[WestcoastMedicine]

Two doctors are hired at an academic medical center in July, one month after completing all of their training.

Doctor A did a 3 year peds residency and is starting as an associate professor as a hospitalist for Z State University Medical Center. Doctor B did a peds residency and then completed a peds fellowship. He is starting as an associate professor in his respective subspecialty at Z State Univ MC.

Do they get paid the same with everything the same except one is fellowship trained and the other is not?

 

[BigNavyPedsGuy]

Do they get paid the same with everything the same except one is fellowship trained and the other is not?

It depends on the fellowship. If it's Cards then probably not. If it's ID or Nephro their pay is probably pretty equivalent.

Fellowship or not, they pay you to do, not to think. Those of us that want to do ID won't do it for the money.

 

[oldbearprofessor]

Two doctors are hired at an academic medical center in July, one month after completing all of their training.

Doctor A did a 3 year peds residency and is starting as an associate professor as a hospitalist for Z State University Medical Center. Doctor B did a peds residency and then completed a peds fellowship. He is starting as an associate professor in his respective subspecialty at Z State Univ MC.

Do they get paid the same with everything the same except one is fellowship trained and the other is not?

Hard to say since no one starts at "associate professor" right after residency or fellowship. That takes an average of 5-8 years after training is completed.

As to the core of your question, it depends on the field, the institution, etc. There is no way to generalize. Having said that, critical care fields (NICU/PICU/cards) will likely have a financial benefit from doing a fellowship in the long run (not necessarily in the short run), whether academic of private. Other fields are more variable and depend on the practice environment and type of practice vs research arrangement.

 

[twilightdoc]

Do they get paid the same with everything the same except one is fellowship trained and the other is not?

As "OldBearProfessor" said, your very first faculty job would not be as an Associate Professor. Some places start their new faculty as instructors, while others start new faculty as Assistant Professors. In general, a faculty member with residency training and no fellowship training is not as likely to advance academically (or financially) at the same rate as one with fellowship training and subspecialty boards. The way departments (and even med schools) are structured financially varies widely, sometimes in inexplicable ways. And just because two individuals have the same faculty rank (Assistant Professor, for instance) usually doesn't mean that they have the same salary. And "incentive plans" complicate the picture even more.
At the risk of sounding too "old school", you should do what you love, which will hopefully be something for which you have an aptitude. I couldn't imagine many things worse than hating your job and dreading your upcoming work day, even if you were well-remunerated.

 

[MOHS_01]

Physician compensation is neither mysterious, mystical, nor complicated -- it simply is not adequately explained to (or understood by) students, residents, and even many attendings.

In the current environment you can either have a salaried, non-clinical career or one that directly or indirectly production / profit based. Even most "salaried" clinical positions are ultimately production driven -- if you a replaceable drain on the system, expect to be replaced. Unfortunately the converse is not always true -- hence the high rate of (productive) physician turnover at many institutions.

(Revenue - costs) = total compensation.

You have to take each factor separately in order to understand how the system works. Revenue is driven by volume, payor mix, and CPT mix. Peds suffers from social welfare blight (SCHIP, medicaid) and the undervaluation* of cognitive services; taken together, even with the high volume that many pediatricians see, the top line revenue numbers suffer. Costs are high due to the high volume nature of the specialty as well as some potential costly and low profit operations (vaccinations is the first thing that comes to mind).

*Notice that I did not say "relative" undervaluation -- many procedures are not "overvalued" despite the current drumbeat; the problem is simply that physician time and intellectual property are undervalued.

 

[michaelrack]

Why is peds substantially less well compensated than IM? ?

I think that part of the reason is that vaccinations, which tend to be unprofitable, are a bigger part of peds than general IM.