Peds NP: the importance of "big names"

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Puzzle Pieces

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Hi all, thanks in advance for weighing in on this! I've haven't gotten a clear consensus among my former and current supervisors so I thought I'd post here to get some additional thoughts.

How important is brand name for pediatric neuropsychology fellowships? I've heard that this matters much less at the internship stage, but during the fellowship stage, brand name is more important given that it can be a bridge to job opportunities. When ranking, how heavily would you weigh brand name vs. fit?

My top two sites are pretty similar with respect to clinical and research opportunities, geographic location isn't a factor for me, but one is for sure a bigger brand name with a more well known supervisor. I don't yet have a clear number 1 post interviewing with both sites soooo any thoughts would be appreciated!

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Jobs-wise, at least in certain areas, I wouldn't worry too much as long as you get solid training and board cert. The peds waiting list in my metro area are insane. A PP could step in and get a full caseload pretty easily. Also several institutional hirings in the last couple months. This is one area in psych that does not appear to be super saturated yet.
 
If no clear number one fit wise and location not a factor, why not go with the big name?

That said, I'll echo Wisneuro's comment. I do peds assessment, limited to kiddos under 4, and don't have an opening until August. I refer out older kids, and they need to travel 1.5 hours to the "big city" if they even hope to get out on a 3-6 month wait list. I stay reasonably abreast of the research, and couldn't really tell you who the big names are. Get solid experience pre- and post-doc, and the names really won't matter as far as getting a clinical position.
 
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Peds neuro is significantly underserved. Solid peds neuro ppl have wait lists of many months. Hacks can still be busy. It depends on what setting you want and what population(s) you want to serve.

I’d recommend going to the best name place (likely an AMC) so you can get access to the best didactics and lineage of training mentors. There is enough need that it isn’t required to be successful, but I think training-wise you want as much as you can get from the best ppl before you are fully independent.

Fit matters, particularly if you want to work w a niche area within the speciality, though i’d be very hesitant to consider a private practice option over an AMC or formal fellowship program.

Good luck!
 
Peds NP here.

There are a few sites with more name recognition, where it's widely expected that people will get good training and varied experiences. But those are not the only good programs nor do their graduates automatically have an advantage for jobs. I agree that sticking to a hospital is probably your best bet, particularly if you want to work with medical populations later on. It also helps to work with someone ABPPed who may have connections within the field.

I would think about where you might want to work longterm... a program might have a strong regional reputation, even if it is less well known nationally. But I also know several people who did fellowship somewhere and moved for jobs, so YMMV.

Personally, I'd go where you think you'd be happiest and/or where you want to live.
 
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Peds neuro is significantly underserved.

Are there enough internship and post-doc sites for trainees that want to get into peds neuro? How does this compare in general to neuro for older adults, and rehab neuro? As in, are those 2 areas not underserved like peds?
 
Are there enough internship and post-doc sites for trainees that want to get into peds neuro? How does this compare in general to neuro for older adults, and rehab neuro? As in, are those 2 areas not underserved like peds?

There is generally a good job market for adult neuro people, much more so if you are boarded. Almost every job I see wants the person boarded or has a stipulation for boarding within several years. But, it's tightening somewhat. At least in the areas I've been at, Peds neuro has been much more in demand with lots of open positions/need.
 
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IMO:

There seem to be two categories or trajectories in peds neuro: Hospital based, and PP.

The PP seem to make a lot of money selling very extensive LD batteries to people who have the cash to buy these services. Often it seems that the batteries have a customer service, "get us the accommodations we want" approach. I can see the pressure to diagnose something for a $5k battery. But I've seen ridiculous things, like saying a private school in Zurich is the least restrictive environment for a kid so the public school system needs to pay for it.

The hospital based people tend to deal with extremely sick kids, with epilepsy being their bread and butter. There seems to be a fair amount of education in genetic based disorders. That's probably necessary if you're going into hospital practice. If you want to go into ped neuro PP, it's not very likely that you'll see a ton of rarer genetic disorders.
 
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This is all super helpful. Thank you all so much! I'm particularly interested in pediatric brain injury so I applied only to sites with concussion clinics/rotations.
 
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Spot on posts.

One thing I noticed with peds is something PSYDR touched on...it can be a very “Have” and “Have Nots”, which happens in both the peds and adults worlds....but it seems compounded in the peds world. Those most in need have the least resources, so there needs to be consideration about how to bill (e.g. full fee cash pay v. sliding scale v taking insurance), what to bill for (e.g. phone conferences, meetings w the school, etc), etc. The other side is recognizing the dynamics of expensive evals and pushy parents.

Everyone is free to setup their private practice however they want, though I personally take the approach of full-fee cash pay and medico-legal work so I can afford to do bro-bono work as I want, while also avoiding time-suck paperwork and hoop jumping. It limits who I can see bc I refuse to deal with any commercial health insurance or gov’t (Medicare & Medicaid) insurance, but I can spend more time with my patients.

Some ppl find a solid biller and that can *really* help if you elect to take insurance. ALWAYS negotiate rates w insurance companies, as you should have a ton of leverage doing peds neuro. They need you WAY more than you need them. If you take insurance, negotiate one contract at a time, as jumping on a bunch all at once can increase the learning curve and level of frustration.

You can also do 1 patient contracts where you negotiate your rates (I never accept less than 85% of my full fee, and usually I required 100% of my fee) just to see one specific patient. These typically occur when they have a plan member who needs to see someone and they can’t get in to be seen by an in-network provider, and that plan member has leverage so the carrier needs to find a solution. This can be a way to “test drive” the company and process.

Make sure to read the contract bc you don’t want to agree to opt into their network. Always get everything in writing. I used to require an rider/clause that set payment requirements of either up front payment or payment within 15 days of receipt of report and bill. There would be a (significant) % late fee charge if outside of the payment window. None of the companies liked this, but most acquiesced bc they needed it done. Know your market.
 
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I'm particularly interested in pediatric brain injury so I applied only to sites with concussion clinics/rotations.

This is an interest of mine as well (well, debating between adults and peds). It wouldn't be for a few years for me, but would you mind PMing me your list of sites? Would be helpful to know what to shoot for :)
 
This is an interest of mine as well (well, debating between adults and peds). It wouldn't be for a few years for me, but would you mind PMing me your list of sites? Would be helpful to know what to shoot for :)

Happy to help! I'll PM you.
 
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