Peds specialites that offer good mix of oupt, inpt

[tatabox80]

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hi guys,
Right now I am in the process of trying to narrow down career choices...and peds is high on my list. I was just wondering, what are some specialites in peds that offer a good deal of continuity of care, and have a good mix of both inpatient as well as outpatient? Thanks

 

[14022]

I think specialties with a lot of outpatient are...

Heme-Onc- The majority of care is provided for outpatient chemo, infusions, transfusions, etc. in outpt day hospitals. Of coruse, the patients can get very sick and you will also spend long hours on the wards as well.

Renal- A lot of outpt follow-up for kids with chronic kidney disease and other illnesses, also lots of time in the hospital consulting on dialysis patients and taking care of acute renal failure patients

Neurology and GI are also a good balance.

Obviously PICU and NICU are all outpt, and cardiology can be either depending on your practice. In pricate practice, it is primarily outpt, but if you do interventional or cardiac ICU, you will spend most of your time in a hospital.

I would think rheum, endocrine, AI, developmental would all be mostly outpt.

 

[notstudying]

I think specialties with a lot of outpatient are...

Heme-Onc- The majority of care is provided for outpatient chemo, infusions, transfusions, etc. in outpt day hospitals. Of coruse, the patients can get very sick and you will also spend long hours on the wards as well.

Renal- A lot of outpt follow-up for kids with chronic kidney disease and other illnesses, also lots of time in the hospital consulting on dialysis patients and taking care of acute renal failure patients

Neurology and GI are also a good balance.

Obviously PICU and NICU are all outpt, and cardiology can be either depending on your practice. In pricate practice, it is primarily outpt, but if you do interventional or cardiac ICU, you will spend most of your time in a hospital.

I would think rheum, endocrine, AI, developmental would all be mostly outpt.

I agree with the above-though I think he meant that PICU and NICU are inpatient! We do have an outpatient NICU followup clinic, but it's a minor part of their time. Endocrine does a fair amount of inpatient for the DKAs, and new onset diabetics. Our general academic peds folks also do a mix-a few 1/2 days of clinic per week, plus a couple months a year on inpatient service (usually about 5-8 patients in hospital at any one time). Adolescent medicine is a mix as well depending on the setting; the inpatients are mostly EDOs and a random mix of teens with general peds problems (PID, pyelo, abdominal pain).

 

[tatabox80]

Another question, I've heard that peds specialists have to devote a great deal of their time to research. I know that fellowships require a substatial amount of research, but is this really necessary when you are done, or can you focus primarly on patient care?

 

[14022]

Another question, I've heard that peds specialists have to devote a great deal of their time to research. I know that fellowships require a substatial amount of research, but is this really necessary when you are done, or can you focus primarly on patient care?

It depends on the setting in which you practice. All fellowships will require some research, many up to 12-24 months of research. Once you are done with fellowship, you can do whatever you want.

If you decide to work in a high-powered academic center, research is often required to obtain tenure. In other words, you are required to publish a certain number of studies per year, and if you do not meet this quota, you do not obtain tenure and you most likely leave the institution.

If you work in a community hospital, research may be available to you if you choose, but will most likely not be required. In private practice, you dictate what your practice involves. For example, there are some pediatric cardiologists who do nothing but read echoes. Other practice settings, such as international medicine/doctors without borders would not require research.

In summary, you will be trained in scientific investigation during your fellowship, but your commitment to research once in practice is highly variable depending on your goals.

 

[Doc-Hollywood]

Another question, I've heard that peds specialists have to devote a great deal of their time to research. I know that fellowships require a substatial amount of research, but is this really necessary when you are done, or can you focus primarly on patient care?

It depends on the program and the specialty.
I can only tell you that in my three year Neonatal-perinatal fellowship I did a total of 13 months on the clinical service and the rest on research. I actually voluntarily took an extra month on service!! The rest of the fellows only did 12.

Clinical time on your research month consisted of 3 or 4 night calls only.
Granted this was only 1 specialty and one specific program, but I believe that it's pretty typical.

I NEVER wanted a career in research and I felt I really got the shaft in terms of the one-size fits all mentality of the people that decide how to train neonatologists.
Considering the compensation offered in many centers, there are lots of us that would love to join faculty at academic centers but find it quite impossible to repay significant med school loans and live on the $$ offered in academic neonatology.

There were 5 fellows in my class and NONE of us did academic neonatology. All went into private practice.
Was society really helped by my research projects looking at minutia?

Are my patients really served today since out of my three years of training, two of them were spent in the care of a pipette?
This underscores the importance of training in a very big and busy program so you can cram as much experience as possible into the short time frame you actually spend in the NICU

BUT this is the game you have to play to get your subspecialty training, so you grin and smile and wait until it's over.

Being a subepecialist is pretty cool. I would put up with the screwed up training scheme all over again, as would most of my friends that are practicing a pediatric subspecialty.
Like I said, some are far more clinical than others in terms of fellowship training time ( like peds ER )