Peds fellowships

[curious monkey]

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I'm considering a career in peds and have been given the idea that specializing would give a higher level of financial flexibility - is that generally true, do all peds specialists make > $200,000. One negative thing I have been told about specializing in peds is that you should tie yourself to an academic institution b/c they are generally the places that will get the majority of the "specialist's" patient population. From what infer then is that the upside with tying yourself to an institution is that you are assured patients, however the downside is that you are employed and therefore have higher risk in terms of job security (as you age, the place may desire to find a younger doctor for a cheaper salary) in comparison to private practice where you could make more money but maybe not be assured patients. Am I reading the situation correctly? Any comments anybody could add?

 

[14022]

You have been misinformed. Peds specialists are underpaid, and often make less than their generalist counterparts. The reason for this is that most general pediatricians are in private practice, which pays more than academics. On the other hand, most specialists are at large academic centers rather than in private practice. Many specialties, especially those that have no procedures, such as rheumatology, endocrinology, developmental, etc, pay very little, and I have heard of some peds endocrinologists that practice endocrine part-time and general peds part-time because the general peds can supplement their income somewhat. Even for the more procedural based fields, I would say that starting salary is almost never above $150,000. And most never make above $200,000 in the first several years of practice unless they are in a thriving private practice seeing a lot of patients and taking frequent call. In fact, I have heard that the most prestigious centers, such as Boston Children's and CHOP, start their peds subspecialists at just under $100,000 per year.

No one will ever go into peds for the money. Even surgeons and radiologists take a pay cut when deciding to do a peds fellowship within their given specialty. People do it because they love kids. If you want to make a lot of money, I would suggest doing peds ENT or Urology.

 

[Apollyon]

See, just as an aside, I thought that, in developmental peds, for double the training, you can make double the money.

Everything else in peds, though, is right on - no procedures, no money. You have to love kids (and that is something I could not get my head around where I was a resident - pedies that were NOT child advocates; I didn't know what to make of them).

 

[notstudying]

I agree with the above (except that neonatologists and critical care peds in private practice can do very well). However, I'd disagree about academic peds having less job security-after a certain point if you are productive you get tenure, and then you can't be fired, even if you become basically insane (they will take away your clinical time, however 🙂). In private practice, unless you are the partner (and taking financial risk), you can get fired more easily.

 

[14022]

I agree with the above (except that neonatologists and critical care peds in private practice can do very well).

Very true. But I would imagine that you will be working extremely hard, long hours and taking a lot of call, for NICU/PICU in private practice.

 

[blanche]

what are thoughts on going into peds and then specializing in allergy? it seems like a nice way to work with kids (and often relatively healthy ones!) but still make ok $. plus, there are so many interesting areas of research you could pursue also if you so desired.

i don't know a whole lot about allergy/immuno except you can also see adults, and it seems interesting at least in concept. trying to find out more--anyone familiar with this?

 

[curious monkey]

Can someone explain to me the difference between the two. I assume if you're not in private sector you're more of a hospitalist type, but how does one function in the private sector, why is that better from a salary and/or lifestyle?

 

[14022]

Can someone explain to me the difference between the two. I assume if you're not in private sector you're more of a hospitalist type, but how does one function in the private sector, why is that better from a salary and/or lifestyle?

not private vs public.....there's no such thing

private practice vs academics is what i meant

 

[curious monkey]

Sorry, I misspoke, I figured you were referring between private and academic but I still don't understand how they would differ in the ICU setting. Unlike adult ICU, where the physicians can practice pulm on an outpt private basis, how do peds intensivists practice in a private setting. Sorry, naive questions, but where I did my peds training, they were all hospitalists.

 

[14022]

Sorry, I misspoke, I figured you were referring between private and academic but I still don't understand how they would differ in the ICU setting. Unlike adult ICU, where the physicians can practice pulm on an outpt private basis, how do peds intensivists practice in a private setting. Sorry, naive questions, but where I did my peds training, they were all hospitalists.

A group of physicians get together and decide that they are going to offer their services to a particular community hospital. The group decides upon the coverage needs and creates a schedule. The key difference is that they do not have residents or medical students. Therefore they do everything themselves...write notes, deal with families, take care of social issues, etc. The key difference is that they have no residents to cover their patients, therefore someone from the group is always in the hosptial or on call. If you have a small group (eg, 4 people), then you cover every fourth night, which is not fun as a 40 year old with a spouse and 3 children. But you read the awards of splitting all your group's income among 4 people only.

Your misunderstanding I think comes from the fact that you are equating private practice to outpatient and academics to hospitalists. Both private practice and academics have both outpatient and inpatient docs.

 

[oldbearprofessor]

Sorry, I misspoke, I figured you were referring between private and academic but I still don't understand how they would differ in the ICU setting. Unlike adult ICU, where the physicians can practice pulm on an outpt private basis, how do peds intensivists practice in a private setting. Sorry, naive questions, but where I did my peds training, they were all hospitalists.

look up Pediatrix (www.pediatrix.com)

http://www.neonatology.org/jobs/job5889.html is an example

lots of private practicing PICU docs out there. Some in community hospitals, some in much bigger "academic" hospitals. These lines are very much blurred for NICU and PICU docs as many work for private groups in Children's Hospitals or other teaching hospitals throughout the US.

 

[yoni13]

In addition to critical care, pediatric GI and cardio generally make more than 200,000K when in a private practice.. and most of these physicians work in a private practice.

 

[oldbearprofessor]

In addition to critical care, pediatric GI and cardio generally make more than 200,000K when in a private practice.. and most of these physicians work in a private practice.

Do you have a reference for the statement that > 50% of pediatric cardiologists are in private practice. I am not saying you are wrong, but it would be a surprise to me.

 

[yoni13]

Do you have a reference for the statement that > 50% of pediatric cardiologists are in private practice. I am not saying you are wrong, but it would be a surprise to me.

I am actually not sure about pediatric cardiololgists.. I apologize... I am certain however that most pediatric gastroenterologists are part of a private/solo practice. I am about to start a fellowship in peds GI... and I interviewed/spoke with people across the country. You can also check NASPGAN, the AAP, and an excellent article in JPGN that essentially surveyed todays pediatric GIs. Not sure about peds cardio.. that was merely an assumption.

 

[oldbearprofessor]

You can also check NASPGAN, the AAP, and an excellent article in JPGN that essentially surveyed todays pediatric GIs.

I was curious so I looked it up. JPGN April 2005 I assume is the one you mean. According to Table 2, 56% of Pedi GI are in University/Academic practice, 23% private practice, 16% hospital/clinic and 2% HMO. Of note is that only 32% of the academics are on the tenure track whereas 83% have an academic appointment.

The lines between academic and private are very blurred. Even among "academics" in pedi specialties, many are principally clinicians and do little or no research. However, they are still academic faculty as described above.

I have no doubt that there are a greater percentage of private pedi GI than private pedi cardiology although certainly there are plenty of private pedi cardiology. The equipment needs for pedi cards make it more difficult to establish stand-alone private practice, although it is possible via several mechanisms. Again, these lines are extremely blurred as it isn't clear how to define those who are primarily employed by a hospital who have an academic appointment but spend all their time doing clinical work.

My point isn't to disagree, as I don't disagree with the idea behind your posts, but to try to clarify that the concept of academic and private as two distinct entities is not a real distinction in most cases. Many posts on SDN, especially in the pre and allo boards try to make it seem like academics are another breed of doctor separate from their private brethren. Nothing like that really exists for the most part in pedi specialties, even in the largest children's hospitals.

Regards

OBP

 

[yoni13]

excellent post!! thank you for taking the time to look that up... as you suggested, many "academic" ped subspecialists are reallly privates with a faculty appointment.. I sense that this is particularly true for pediatric gastroenterologists. It is certainly the case in South Florida where I am currently a pediatric resident. We'll see what the landscape is like in 4 years when I complete my GI fellowship..

regards..