Peds versus Internal Medicine

[antoniop]

Any thoughts on the great debate between selecting pediatrics or internal medicine for a residency? I'm an MS3 debating between the two residency programs and I can't seem to come to a decision on which would fit me best. Any thoughts on this debate, especially concerning research opportunities, job satisfaction, lifestyle, respect in the medical community, salary, etc.?

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[NRAI2001]

Any thoughts on the great debate between selecting pediatrics or internal medicine for a residency? I'm an MS3 debating between the two residency programs and I can't seem to come to a decision on which would fit me best. Any thoughts on this debate, especially concerning research opportunities, job satisfaction, lifestyle, respect in the medical community, salary, etc.?

Which field has a better lifestyle? More potential for salary?

 

[deleted87716]

Any thoughts on the great debate between selecting pediatrics or internal medicine for a residency?

Why not just do IM/peds if you can't make up your mind? Or even family medicine, provided you don't want to specialize.

 

[RastaMan]

In terms of income, medicine varies greatly between the relatively lower paid general internal medicine to the very well compensated fields like cardiology and GI, especially in private practice. Peds generalists and subspecialists are typically compensated lower than the average physicians across the board.
During residency, both medicine and peds residents stick to the 80 hour rule. Medicine patients have a lot more problems, so your'e typically busier with more consults, codes, etc. The peds residents and attendings seemed very thankful not to have to deal with long problem lists with multiple issues.
After residency, lifestyle is pretty variable depending on your specific practice.

In the end, I'm not sure if you can call this a "great debate" or even a tiny little debate. If you really want to take care of kids, do peds. If you want to deal with adult issues, do medicine. If you absolutely have your heart set on taking care of adults and kids, do med/peds or family medicine.

 

[skypilot]

In the end, I'm not sure if you can call this a "great debate" or even a tiny little debate. If you really want to take care of kids, do peds. If you want to deal with adult issues, do medicine. If you absolutely have your heart set on taking care of adults and kids, do med/peds or family medicine.

Isn't peds just internal medicine for kids?

 

[Mumpu]

I was on the fence for a while too. In the end I chose IM for these reasons:
1) It is extremely important to me to relate to my patients as peers. This is virtually impossible in peds because the decision-maker is that neurotic irrational Munchhauseny freak of a parent and not my patient. I was constantly irritated by the conflict of duty to the patient and the legal need to talk to the parent.
2) I want to do hospitalist medicine. That means sicker patients. It's easy for me to genuinely commit to care, whether resuscitative or palliative, of an adult who has lived a life, made friends, laughed, loved, drank beer, whatever. I could not genuinely commit to a 6 month old with Three Dead French Guys Syndrome who I knew was going to die by 12 months of age after spending their one and only year never knowing anything but pain and suffering.
3) I thought IM diseases were more interesting.
4) IM personalities fit better with me that pediatricians.

 

[NRAI2001]

If you practice general IM, then wouldnt you see peds patients also?


Who has a more difficult/worse call at nights? IM or peds?

Can you really truely practice IM and Peds at the same time?

 

[AJM]

If you practice general IM, then wouldnt you see peds patients also?

No way! IM physicians treat adults only. That's why the slogan on the American College of Physicians website is "doctors for adults".

Once in a blue moon, I'll have to see a 16 or 17-yo patient, but that has only been while I've been in pulmonary. I almost want to ask them where the heck their pediatric pulmonologist is. 🙂 I don't think I saw a single person under 18 in general IM.

Don't know about differences in call nights between IM and peds. All I know is that the peds residents I know have to take q4 in-house call during their ENTIRE residency, including during their outpatient and elective months, where in IM we usually only have to take in-house call during a ward or ICU month. That may be program-specific, but two out of the two peds residency programs I know are like this....

 

[skypilot]

Can you really truely practice IM and Peds at the same time?

Sure, its called Family Practice! (or Med/Peds) 🙂

 

[ForeverStudent]

I was on the fence for a while too. In the end I chose IM for these reasons:
1) It is extremely important to me to relate to my patients as peers. This is virtually impossible in peds because the decision-maker is that neurotic irrational Munchhauseny freak of a parent and not my patient. I was constantly irritated by the conflict of duty to the patient and the legal need to talk to the parent.

As a parent, I just wanted to say, thank you!! I think more people should think about that aspect of Pediatrics before choosing that path. I hate Peds who think they know my child better than I do. Too many times I have had to save my own child's life because of stu-pid decisions made by Peds. ie-my dd is allergic to Amoxicillan. The nurse gives her a dose right there in the room without even asking!!! Sure enough my poor baby starts having trouble breathing, breaks out in hives and is in extreme pain. The Ped comes in and says to me, "Oh, head hurts, rash, and fever! She has mono!"
To which I am like, "No, idiot! She is having an allegic reaction!!!"

Man, you do not know what it's like to watch some idiot practically kill your kid! Especially in a friggin' hospital.

Remember, as a Peditrician, you are there for Medical advice, only. Unless you have a degree in Parenting, keep your mouth shut unless asked.

I really think parents should be able to sue Doctors for parental advice that then kills or injures their child.

 

[Sheon]

Not discounting your story, but I've seen far too many parents thinking like you without the slightest idea what is going on and making things worse rather than better using stupid wives tales (i.e., "starve a fever feed a cold") and come in with a child that is damn near comatose from dehydration. Far too many parents come in demanding antibiotics because they are so sure that their 3 year old with the fever and the sniffles needs them.

Parents that know something about parenting isn't as common as you think, and parents that know something about medicine is rare.

Pediatricians are not here for "medical advice" we are here to provide medical care. If all we were here for was advice ANYONE could write perscriptions for that amoxicillin your kid was allergic too.

I can appreciate that your situation was different, but you also need to appreciate that most nurses won't do what that nurse did, and most pediatric residents can tell mono from anaphylaxis/urticaria.

 

[neutropenic]

If you practice general IM, then wouldnt you see peds patients also?


Who has a more difficult/worse call at nights? IM or peds?

Can you really truely practice IM and Peds at the same time?

Dude you need to learn more about specialties.
Are you just looking for the easiest specialty on G-d's green earth? With lots of dollars?
May I suggest radiation oncology, sir!

 

[NRAI2001]

Dude you need to learn more about specialties.
Are you just looking for the easiest specialty on G-d's green earth? With lots of dollars?
May I suggest radiation oncology, sir!

I m just trying to get a sense of what the different specialties entail. To just consider one aspect would be equally as dumb as only considering money when looking into specialties.

 

[Benzo4every1]

Any thoughts on the great debate between selecting pediatrics or internal medicine for a residency? I'm an MS3 debating between the two residency programs and I can't seem to come to a decision on which would fit me best. Any thoughts on this debate, especially concerning research opportunities, job satisfaction, lifestyle, respect in the medical community, salary, etc.?

Heh. I had this problem myself. I eventually picked medicine because I wanted to do inpatient stuff. Peds has a lot of outpatient and the peds hospitalist thing - i couldnt see myself doing that ...

 

[mysophobe]

And parents are stupid.

 

[Hova2005]

I was on the fence for a while too. In the end I chose IM for these reasons:
1) It is extremely important to me to relate to my patients as peers. This is virtually impossible in peds because the decision-maker is that neurotic irrational Munchhauseny freak of a parent and not my patient. I was constantly irritated by the conflict of duty to the patient and the legal need to talk to the parent.
2) I want to do hospitalist medicine. That means sicker patients. It's easy for me to genuinely commit to care, whether resuscitative or palliative, of an adult who has lived a life, made friends, laughed, loved, drank beer, whatever. I could not genuinely commit to a 6 month old with Three Dead French Guys Syndrome who I knew was going to die by 12 months of age after spending their one and only year never knowing anything but pain and suffering.
3) I thought IM diseases were more interesting.
4) IM personalities fit better with me that pediatricians.

I ended up choosing medicine for many of the same reasons. I also realized that what I liked most about Peds was playing with the kids, holding the babies, etc etc, not so much the actual practice of Pediatrics.

 

[NYC rat]

Beyond child versus adult, for which I agree with the statement above about treating your peers, is one-patient-one-problem versus one-patient-problem-list. I feel that with adults, each patient is more likely to represent a novel clinical challenge in that they can have any combination of comorbidities to their chief complaint. The child, on the other hand, has one problem usually, and quite frankly it's asthma 99% of the time.

 

[novacek88]

Peds:

Pros
1 Patients are usually not responsible for their conditions unlike adult patients who smoke are obese etc.

2 Kids are fun

3 Peds residency can be fun. Peds residents are pretty happy people for the most part. You see a lot of pathology. You will literally save many lives with premies in the NICU etc.

Cons

1. Peds fellowships pay far less than adult fellowship such as Peds cardiology vs Adult Cardiology

2. Kids are fun but their parents aren't

3. Peds residency may be fun but practicing general peds is a lot more difficult than practicing general IM. You will have to a lot of consoling of parents about issues that are non-emergency. A lot of parents call for reassurance and that can be annoying at times.

 

[novacek88]

Internal Medicine

Pros

1 You can directly communicate with your patients and relate to them. It's more difficult to communicate with children even though they are fun.

2 IM has many fellowships associated with it and there are more opportunities in IM

3 It's far easier to practice general IM vs general Peds if you choose not to do fellowship

Cons

1 IM residency is more difficult. IM residents aren't as happy as Peds residents but they are not anywhere close to being nasty like surgery residents. The hours are tougher too

2 Most of your patients will be non-compliant and responsible for their condition aka the smoker with emphysema. It's much easier to treat a child who has a congenital disease vs an adult who acquired their condition due to poor lifestyle

3 Your patients will mostly comprise of the elderly so that can be a difficult issue at times.

 

[Clemson Doc]

I do not see how you can say that general IM is "easier" than general pediatrics. Internists handle ~95% of the cases they see (i.e., they have the knowledge base to do so). The residency wouldn't be so tough and grueling if the daily practice of IM didn't require so much background knowledge and mastery of medicine. I realize that peds has its challenges, which are somewhat different from IM, but to say that the daily practice of peds is harder than IM is a stretch if you ask me. Both are quite important!

 

[gutonc]

I do not see how you can say that general IM is "easier" than general pediatrics. Internists handle ~95% of the cases they see (i.e., they have the knowledge base to do so). The residency wouldn't be so tough and grueling if the daily practice of IM didn't require so much background knowledge and mastery of medicine. I realize that peds has its challenges, which are somewhat different from IM, but to say that the daily practice of peds is harder than IM is a stretch if you ask me. Both are quite important!

I don't want to put words in his mouth but I think he meant that there are more jobs for general internists out there than there are generalist pediatricians, not that the actual practice of adult medicine was easier than that of pediatric medicine.

But I've been wrong before. Once.

BE

 

[novacek88]

I do not see how you can say that general IM is "easier" than general pediatrics. Internists handle ~95% of the cases they see (i.e., they have the knowledge base to do so). The residency wouldn't be so tough and grueling if the daily practice of IM didn't require so much background knowledge and mastery of medicine. I realize that peds has its challenges, which are somewhat different from IM, but to say that the daily practice of peds is harder than IM is a stretch if you ask me. Both are quite important!

That depends on what type of internal medicine you will be practicing. If you are going to function as a hospitalist or an attending, that is quite different from functioning in a private practice clinic. I'm assuming you are a medical student because every IM resident or doc can tell you there is a significant difference between the two and wouldn't even question this. Private practice deals with an outpatient setting in which you will be seeing common pathology. Most of your difficult patients will be managed by hospitalists that your group employs. That is significantly different than being on the wards and seeing multiple patients like this yourself, which is what residents do.

I'm an IM resident. IM in private practice is much easier to practice in terms of lifestyle than general peds private practice. Pediatricians get called a LOT. Most of their phone calls are reassurance calls from worried parents as opposed to true emergencies. You might think a simple 3 minute phone call is nothing but trust me, it can disrupt your day when you are getting 10-20 of those as soon as you come home from work especially more than half of those are simply reassuring the mother. It can be very unsettling especially at night. IM docs do not have to bother with a ton of phone calls like this at every hour of the day. Adults are far less demanding in this regard. Furthermore, talk to any pediatrician and they will tell you they have to see a lot of patients to financially sustain themselves.

I never said one field is more important than the other. Furthemore, I never claimed that one field required more expertise than the other. I fail to see how you read into that

 

[Benzo4every1]

Why not just do IM/peds if you can't make up your mind? Or even family medicine, provided you don't want to specialize.

Bad advice!!! LOL Dont pick IM/Peds because you can't make up your mind. Pick it because you see yourself doing both or the inbetweens, adolescents medicine etc.

 

[carpe diem]

Bad advice!!! LOL Dont pick IM/Peds because you can't make up your mind. Pick it because you see yourself doing both or the inbetweens, adolescents medicine etc.

Go Med/Peds 👍 If you don't mind the extra year, you can then potentially enter any IM or Peds fellowship, and , of course, the increasing number of combined fellowships being offered, or Med/Peds primary care.

Carpe
Med-Peds PGY-1 almost

 

[Adcadet]

I'm only a medical student, so what do I know. But from my pediatrics and medicine rotations I've figure out that for me:

sick adult = fun
really sick adult = really fun
dying adult = fun but tolerable

sick kid = boring
really sick kid = sad
dying kid = sad and barely tolerable

 

[NRAI2001]

I'm only a medical student, so what do I know. But from my pediatrics and medicine rotations I've figure out that for me:

sick adult = fun
really sick adult = really fun
dying adult = fun but tolerable

sick kid = boring
really sick kid = sad
dying kid = sad and barely tolerable

A sick adult to you is fun? 🙁

 

[Adcadet]

A sick adult to you is fun? 🙁

Well, I'm not happy that they're sick and I feel bad for them, but I find taking care of sick people to be very enjoyable, yes. I take great satisfaction in taking away pain, in relieving distressing symptoms, and even in just providing what comfort I can. And I also get a kick out of applying what I know, and of using the latest scientific advances to help my patients.

 

[NRAI2001]

Well, I'm not happy that they're sick and I feel bad for them, but I find taking care of sick people to be very enjoyable, yes. I take great satisfaction in taking away pain, in relieving distressing symptoms, and even in just providing what comfort I can. And I also get a kick out of applying what I know, and of using the latest scientific advances to help my patients.

👍

 

[oracle2]

I'm an IM resident. IM in private practice is much easier to practice in terms of lifestyle than general peds private practice. Pediatricians get called a LOT. Most of their phone calls are reassurance calls from worried parents as opposed to true emergencies. You might think a simple 3 minute phone call is nothing but trust me, it can disrupt your day when you are getting 10-20 of those as soon as you come home from work especially more than half of those are simply reassuring the mother. It can be very unsettling especially at night. IM docs do not have to bother with a ton of phone calls like this at every hour of the day. Adults are far less demanding in this regard. Furthermore, talk to any pediatrician and they will tell you they have to see a lot of patients to financially sustain themselves.

Hate to revive this ancient thread, but I happened across it and found this quote interesting. For those interested in primary care... any thoughts on this?