Peds & Genetics

[doctorE2010]

I'm still in my preclinical years but I'm pretty sure I want to do peds (or possibly OBGYN). I'm really interested in pediatric genetic disorders...is there a fellowship that relates to this? I don't want to do solely genetic counseling--I'd like to have clinical patient time too. Maybe I'm just making up a new specialty? Anyone know if there's a pediatric genetic specialty?

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[chhsu]

Yes, there certainly is a pediatric genetics specialty. I did an elective at Children's Memorial Chicago and it was awsome! You can either go directly into pediatric medical genetics or you can do a general peds residency followed by a genetics "fellowship" which isn't really a certified fellowship and I think it does not allow for you to sit for board certification but does allow you to have some expertise in genetics. I worked with MD's who had had gone either routes but it seems that the ones who go directly into genetics after med school get a more intesive genetics training and are the ones who run the practice.

 

[doctorE2010]

Thanks! I'm gad I didn't make this up! Anyone else know much about this field?

 

[BigNavyPedsGuy]

I have a classmate that just matched into a categorical pediatric genetics program (meaning one 5yr residency to replace 3yr residency adn 3yr fellowship). She told me that there were about 12 spots nationwide and 10 applicants.

 

[J-Rad]

Per the American Board of Medical Genetics
http://www.abmg.org/genetics/abmg/cert-2007/requirements.htm

TRAINING REQUIREMENTS FOR CERTIFICATION

Individuals seeking certification by the ABMG must fulfill all requirements for certification as detailed in this document. For an individual who has a doctoral degree earned outside of the US, Canada or Puerto Rico, or graduate medical training outside of the US or Puerto Rico, additional requirements may pertain.

Doctoral Degree requirements:

Clinical Genetics: MD or DO
PhD Medical Genetics: PhD*
Clinical Cytogenetics: MD, DO, or PhD*
Clinical Biochemical Genetics: MD, DO, or PhD*
Clinical Molecular Genetics: MD, DO, or PhD*

*PhD must be in genetics, human genetics or a related field, as determined by the ABMG.
For applicants for the Clinical Genetics specialty only, training requirements are either:

24 months of satisfactorily completed full-time training in an ACGME-accredited residency program in a specialty (other than clinical genetics) that is recognized by the ABMS (e.g., pediatrics, ob-gyn, internal medicine) and an additional 24 months of satisfactorily completed full-time training in an ACGME-accredited clinical genetics residency program;

OR
48 months of satisfactorily completed full-time training in an ACGME-accredited 4-year clinical genetics residency. (Note: In this instance the 48 months of training satisfy both the graduate medical training requirement and the medical genetics training requirement);

OR
60 months of satisfactorily completed full-time training in an ACGME-accredited combined pediatrics / medical genetics or internal medicine / medical genetics residency. Upon successful completion of all requirements of the combined residency, a trainee is qualified to apply for certification by either or both the American Board of Pediatrics (ABP) and the ABMG OR either or both the American Board of Internal Medicine (ABIM) and the ABMG. Applicants must satisfactorily complete the specific credentialing requirements of each Board to be eligible to sit for the examination of that Board. Certification in one specialty is not contingent upon certification in the other.



BTW Genetics is pretty clinically oriented, esp. when the kids roll in in whatever metabolic crisis they're prone to and the Geneticist is the metabolic expert. Also there are often genetic counselors (with a Masters level education in gentic counseling) who do much of the counseling portion of the work in a genetics dept.

 

[doctorE2010]

Could anyone tell me what exactly a genetic pediatrician does? Do you treat kids with all sorts of genetic diseases or just a subset? Are you their primary pediatrician and handle basically all of their medical care, or do you just oversee it? I'm just trying to get an idea (before rotations) if this is something I'd really be happy doing. Thanks!

 

[Haemulon]

Could anyone tell me what exactly a genetic pediatrician does? Do you treat kids with all sorts of genetic diseases or just a subset? Are you their primary pediatrician and handle basically all of their medical care, or do you just oversee it? I'm just trying to get an idea (before rotations) if this is something I'd really be happy doing. Thanks!

Dude, I just typed like a huge response to your question and by the time I submitted it, my login had expired and the whole message was lost. Grrrrrr. That is so frustrating.

Anyway, I'l recap a truncated version. Yes, a medical geneticist may practice in all of the ways that you have asked about. Many see patients and manage general care, with varying degrees of time devoted to this. However, research and teaching is usually a large component as well. I think something like 90% of med gen specialists work in an academic setting/academic hospital. Much of the emphasis in pediatric med gen is focused on evaluating and diagnosing unusual and rare conditions (or just difficult cases). Something like Down Syndrome, for instance, while falling within the real of med gen, would not necessarily require a referral to such a specialist. However, infants with unusual presentations of tri-18 or tri-13 may. Other fairly common things like Angelman's or del(5p) might be of interest to med gen. Certainly any unusual translocations or inherited metabolic disorders may be of interest as well. Med gen specialists may also offer consults for neoplastic disease, as many genetic markers are of both diagnostic and prognostic value and may impact treatment decisions. There are many possibilities for exploring a diversity of interests. I think part of the appeal of this specialty is the involvement with diagnosing and managing conditions that are very rare or are just unfamiliar to most other physicians, and in contributing to research and education.

The down side of course is pay. Med Gen is among the lowest paid specialty, partly because it is largely academic, but also because the focus is on the "thinking"/diagnostic aspects rather than on technology/procedures. Many times, patient sessions may take 30 minute to an hour, instead of the standard 15 min visit. This reduces throughput. Also, there is a lot of time spent researching implications of various physical and lab findings (since many conditions are so rare).

Hey, I just noticed: This is my 3000th post!!!!! Yeh me!!!!!!!!!!!!!!!!!
Woo hoo!!!!!!! 😀

 

[acedens]

^ fabulous answer! Other interesting roles of the geneticist would be NICU consults for babies with unique findings, and definitely a lot of education of PCPs about the specific future needs for patients with rare conditions. Some consult on ultrasound findings - i.e., a skeletal dysplasia is seen on u/s, what could it be, what are the chances it is lethal, how should pt. be managed?

A lot of the geneticists I have worked with have said pay/reimbursement are big issues. Most are paid less than they were as a pediatrician (all the ones I have worked for have taken the peds->fellowship route) largely because medicaid and insurance companies don't always recognize the need of genetic testing, and most are supported by an in-house lab. It's next-to-financially-impossible to start your own private practice genetics clinic without some type of lab working to meet the day-to-day funding needs, so there are not tons of jobs available.

But there is a real need for these physicians and the ACMG even spoke about how to recruit more people into the field at a recent meeting.

 

[doctorE2010]

hmmmm...If I wanted to do research, teach, and be grossly underpaid I would have gone for PhD! I was sort of hoping there was more of a treatment component in addition to the dianostic part...why is it so hard deciding what you want to do with the rest of your life??? Any good peds genetics programs people know of? Or good places to do rotations?

 

[Haemulon]

hmmmm...If I wanted to do research, teach, and be grossly underpaid I would have gone for PhD! I was sort of hoping there was more of a treatment component in addition to the dianostic part...why is it so hard deciding what you want to do with the rest of your life??? Any good peds genetics programs people know of? Or good places to do rotations?

Ha! Nice. 👍

Yeh. they clinical stuff is really what I am interested in too. It is still worth looking into and learning more about, ut I have definitely been discouraged by what I have learned so far. But I don't know, maybe there is a good track out there.