Peds vs Child Psych?

[Pinner Doc]

Anyone else ever haggle with this decision?

I really enjoy Pediatrics, but I have heard 1,000+ reasons from everyone (and I mean everyone) why I shouldn't do it -- relatively lower pay, expendability (especially as a woman who will want to work part time for a short while in her 30s to be with the children while they are young), etc.

My school is really big on following one's heart and doing what you love, etc. I love working with children, and I think I might really enjoy being a general pediatrician. However, it's also very important to consider job security, flexibility, hours, salary, etc when choosing a career.

I really enjoyed my psych rotation, but I definitely didn't get enough exposure to child psych (one evening call in the children's CPEP). However, all the psychiatrists here at my school really talk it up- especially how child psychiatrists are in such demand, etc etc etc.

Anyone else ever consider these two fields? Thoughts?

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[potato51]

Anyone else ever haggle with this decision?

I really enjoy Pediatrics, but I have heard 1,000+ reasons from everyone (and I mean everyone) why I shouldn't do it -- relatively lower pay, expendability (especially as a woman who will want to work part time for a short while in her 30s to be with the children while they are young), etc.

My school is really big on following one's heart and doing what you love, etc. I love working with children, and I think I might really enjoy being a general pediatrician. However, it's also very important to consider job security, flexibility, hours, salary, etc when choosing a career.

I really enjoyed my psych rotation, but I definitely didn't get enough exposure to child psych (one evening call in the children's CPEP). However, all the psychiatrists here at my school really talk it up- especially how child psychiatrists are in such demand, etc etc etc.

Anyone else ever consider these two fields? Thoughts?

For child psych, wouldn't you have to do a psych residency and a subsequent fellowship in child psych, in total lasting 5-6 years? Would this extended training interfere with your family plans?

Also consider that pediatric specialists in pretty much any area of medicine are in high demand because few docs actually want to go through extra training with very little increase in salary. Someone correct me if I'm wrong there.

Good luck with your decision. I'm a MS1 so I can't offer much advice.

 

[OncoCaP]

Anyone else ever haggle with this decision?

I really enjoy Pediatrics, but I have heard 1,000+ reasons from everyone (and I mean everyone) why I shouldn't do it -- relatively lower pay, expendability (especially as a woman who will want to work part time for a short while in her 30s to be with the children while they are young), etc.

My school is really big on following one's heart and doing what you love, etc. I love working with children, and I think I might really enjoy being a general pediatrician. However, it's also very important to consider job security, flexibility, hours, salary, etc when choosing a career.

I really enjoyed my psych rotation, but I definitely didn't get enough exposure to child psych (one evening call in the children's CPEP). However, all the psychiatrists here at my school really talk it up- especially how child psychiatrists are in such demand, etc etc etc.

Anyone else ever consider these two fields? Thoughts?

From what I have read, pediatricians are some of the happiest doctors out there, and you can find job-shares (or whatever they call them) to work 20 hours per week. Psychiatry doesn't even come close in job satisfaction, but maybe child psych is different. http://www.gpscholar.uthscsa.edu/gpscholar/FacultyScholars/cr/genmed/library/aimvol162pg1577.pdf (if someone has more recent or better data, I'm interested). Everyone probably tried to talk you out of going into medicine as well, so why would you start listening to them now?

From the sound of it, other than both dealing with kids, child psych and pediatrics couldn't be more different: which one should I do: prescribing amoxicillin or ritalin? You might enjoy both equally. Something tells me you won't be holding a cardboard sign at the side of the road anytime soon as a pediatrician.

 

[LJDHC05]

I love working with kids too. Unfortunately, anything peds gets a bad rap on SDN and in academia...

As always, I'd say your decision comes down to what makes you happy: working with pint-sized psych pts (hooray teenage angst 👎) or the primary care nature of peds.

Both fields are fairly flexible, especially in private practice. If you get in with a good peds practice I'm fairly certain that you'd be able to reduce your work load with when you have a baby or two. In either case, there's only occasional call (if any at all), most weekends off (occasional saturday/sunday emergency duty), and work starts and ends when you schedule patients. (Leaving you plenty of time with the kids/earning some turns before work...if there's snow). No physician, pediatrician or not, has ever starved to death...money shouldn't be too much of the equation, but in private practice it's not too bad.

 

[rpkall]

For the OP: I'm also in a place where the psych dept really talks up Child Psych (maybe the same place--there's a "CPEP" here in Syracuse). From what I can tell from research into this area (I've wanted to do psych for a while), child psych is in high demand in most areas. How true this is in places like Boston or NYC (as far as academic appointments and opportunities for growth professionally) I'm not sure, but when you talk about a clinical need in these areas or across most of the country, I've been told numerous times that it's there.

I've also heard of child psych residents coming out of programs into positions whose salary/benefits are around 200k (including some consult/shift work but not working more than 55 hrs/week). And as we all know, when psychiatrists "work," it's more like mental/verbal gymnastics rather than standing for hours while doing a procedure, getting sprayed with blood or other gunk, etc, etc. 😉

P.S. The psych residency (depending on where you go) can be a lot less demanding than other fields. For example, 3rd and 4th years of psych, there's usually less and less call responsibility. I'm not sure what the workload is for an adult/child psych combined program compared to regular psych or other specialties. My gut tells me that it's more hairy than regular adult psych but still less than general medicine...

A lot of people don't realize that psych is really a lifestyle specialty. Most psychiatrists work normal hours and find chunks of time to consult (telepsych or school/juvenile court stuff/rehab programs) to make some extra money sometimes. It's not physically demanding work, but it's interesting and regular, netting money that will be more than enough when talking about a family (especially if your partner works, even part time). 200k is great, I think--even 180 or 160--if you really like working with the kids and you wake up every morning excited to go in to work...

Good luck to ya, anyway!

 

[simplicity256]

FYI... I'm also interested in both fields, more so pediatrics than psychiatry though. There is actually a Triple Board Program in 10 schools across the US that consists of a 5 year program, combining Pediatrics, Psychiatry and Child Psychiatry.

here's a link to the site if this sparked your interest.

http://www.tripleboard.org/

 

[snapdad]

FYI... I'm also interested in both fields, more so pediatrics than psychiatry though. There is actually a Triple Board Program in 10 schools across the US that consists of a 5 year program, combining Pediatrics, Psychiatry and Child Psychiatry.

here's a link to the site if this sparked your interest.

http://www.tripleboard.org/

I was actually about to mention this same thing. The child psychiatrist at my school's children's hospital is triple boarded. She talked it up quite a bit, actually -- she went through the residency program and at the end, could have gone into practice doing any of those three specialties. Seems like the best of all possible worlds.

 

[baya]

I was actually about to mention this same thing. The child psychiatrist at my school's children's hospital is triple boarded. She talked it up quite a bit, actually -- she went through the residency program and at the end, could have gone into practice doing any of those three specialties. Seems like the best of all possible worlds.

I'm interested in the triple board programs too. Like the other posters, I LOVED peds and really liked psych. I think if I had to choose I'd go for peds, but I'd be sad about leaving psych behind. And I know that if I do general peds I'll be seeing a lot of kids with mental health issues anyway, so why not be good at it?

Anyone got thoughts on the potential difference in income as a general pediatrician vs. a child psychiatrist vs. a general pediatrician who sees some outpatient child psych patients as part of her practice?

 

[HyperDoctor]

One of the (pretty obvious!) things I noticed about peds is there are tons of babies. They scream and cry. They dont interact. They dont answer questions or tell you whats going on. (A bit like teens in some ways. 😀 ) I think child psych by nature tends to have slightly older kids who can at least communicate a bit. A lot more teen and school-aged than pre-school and baby-aged. So if you want to work with screaming babies who spit up on you, peds is a better fit.

Both have pros and cons. You really get to know some of your psych pts and their families. But then again, most of them you only see for a bit, and then a couple times a year and they see a SW or therapist the rest of the time. I dont have a sense how well pediatricians know their patients these days.

 

[TexasRose]

Anyone else ever haggle with this decision?

I really enjoy Pediatrics, but I have heard 1,000+ reasons from everyone (and I mean everyone) why I shouldn't do it -- relatively lower pay, expendability (especially as a woman who will want to work part time for a short while in her 30s to be with the children while they are young), etc.

My school is really big on following one's heart and doing what you love, etc. I love working with children, and I think I might really enjoy being a general pediatrician. However, it's also very important to consider job security, flexibility, hours, salary, etc when choosing a career.

I really enjoyed my psych rotation, but I definitely didn't get enough exposure to child psych (one evening call in the children's CPEP). However, all the psychiatrists here at my school really talk it up- especially how child psychiatrists are in such demand, etc etc etc.

Anyone else ever consider these two fields? Thoughts?

Sounds like you need more exposure to both fields. Can you do a child psych elective?

I considered child psych and peds. I spent some time researching the training, etc. Then, I spent some time shadowing a child psychiatrist in clinic. Ultimately, I realized I prefer pediatrics.

I think you can have a decent working life in either specialty, though you may find it easier to make $$ and keep your hours down in Psych because there's so much demand.

 

[Packamylase]

From what I have read, pediatricians are some of the happiest doctors out there, and you can find job-shares (or whatever they call them) to work 20 hours per week. Psychiatry doesn't even come close in job satisfaction, but maybe child psych is different. http://www.gpscholar.uthscsa.edu/gpscholar/FacultyScholars/cr/genmed/library/aimvol162pg1577.pdf (if someone has more recent or better data, I'm interested). Everyone probably tried to talk you out of going into medicine as well, so why would you start listening to them now?

From the sound of it, other than both dealing with kids, child psych and pediatrics couldn't be more different: which one should I do: prescribing amoxicillin or ritalin? You might enjoy both equally. Something tells me you won't be holding a cardboard sign at the side of the road anytime soon as a pediatrician.

Thanks for that link, OncocaP. Here's a line that I found intriguing.

"The largest odds ratio in this "positive association" group belongs to income between $250,000 - 300,000. Persons in this earnings bracket are 98% more likely to report being very satisfied than persons in the $100,000 - 150,000 bracket."

 

[Wizard of Oz]

Thanks for that link, OncocaP. Here's a line that I found intriguing.

"The largest odds ratio in this "positive association" group belongs to income between $250,000 - 300,000. Persons in this earnings bracket are 98% more likely to report being very satisfied than persons in the $100,000 - 150,000 bracket."

Funny how that works...

OP--refreshing to see that this thread was started by an M3 and not a pre-med.

 

[lilnoelle]

For those who have done psych rotations.... what does a psychiatrist actually do? Before I decided to go to med school I was VERY interested in psychology. I still like it a lot. So I know what a psychologist does. I know that a psychiatrist is a more "medical" than a psychologist, prescribing prescriptions for mental conditions and are more likely to deal with more difficult conditions (schizophrenia, bipolar, etc). But what does a psychiatrist do on a normal day? Do they do any counseling, or is it mostly meds related?
As mentioned before, I'm really interested in the human psyche, but wonder if I wouldn't like psychiatry since I tend to enjoy the counseling side of the picture more than the medical side.

I know most of my questions can be answered by shadowing a psychiatrist. I plan to, as soon as I can make time. Time is, however, hard to find.

So the pay ranges mentioned above, are they accurate? I thought a psychiatrist got paid more along the same range as a primary care doc.

 

[oldbearprofessor]

One of the (pretty obvious!) things I noticed about peds is there are tons of babies. They dont interact.

Babies don't interact? 🙄 Interacting with babies is one of the best things about pediatrics.

Please note that the legendary article quoted in this thread specifically pointed to neonatologists as among the most satisfied docs. 😀

If I hadn't done pedi and if it weren't necessary to do adult psych to get to child psych I would have strongly considered it - I did a two month rotation in it and liked it and thought there was real potential to help a lot of kids via child psych in a meaningful way. There is considerable crossover with pedi as has been discussed on other threads (e.g. developmental pedi, pedi neuro), but still it is a very different model of patient interaction.

If your (the OP's) faculty REALLY have emphasized that you should "follow your heart", then you have exceptional faculty and I encourage you to listen to them.

Regards

OBP

 

[Biscuit799]

From what I have read, pediatricians are some of the happiest doctors out there...

agreed. In fact every time I hear a stat about Dr depression rates, suicides, divorce, etc, it's always augmented by the statement "except pediatricians." Studies show they have an overall job satisfaction significantly higher than other dr's. And when ppl say they have low $$$, it's still low for a doc (low avg is still 90K).

Sounds like a "do what I really love or do what I like but gets better pay" type question

 

[baya]

Sounds like a "do what I really love or do what I like but gets better pay" type question

Well, I can't speak for the OP, but that's definitely not the dilemma I'm in.

In peds, I really loved the kids, and I found the medicine at my tertiary-care inpatient facility interesting, but I wasn't all that thrilled about rash after ear-ache after rash after ear-ache after rash in the outpatient setting. Since I want to live in a rural setting somewhere on the west coast, tertiary-care pediatric centers are likely to be in short supply for me.

OBP: if I did peds, I might specialize in neonatology. Do you have any idea if I could live in a rural-ish area of the west coast and work as a baby-doc? Or do they ship most babies straight out to big urban hospitals for their care?

In psych, I found the disorders fascinating, and actually wanted to learn more about the differences in meds and other treatments, as opposed to on peds where I felt that I really ought to memorize all the antibiotics and which bugs are sensitive to what, but it definitely sounded like a chore.

So basically, I'm thinking I could put the population I love working with together with the interesting medicine and be even happier that I would be in either separately. Problem is just that I keep getting warned about how emotionally draining child psych and how people get secondary PTSD from it, and the legal nightmares, etc., etc.

So I need to do an elective rotation in it and gage my own emotional reaction, and then I'll have a better idea.

 

[Pinner Doc]

Funny how that works...

OP--refreshing to see that this thread was started by an M3 and not a pre-med.

And yet... isn't it funny? I'm now thinking about EM in terms of interests. (Peds and Psych are still in the running, though.) I guess this is the beauty of third year... trying everything on for size! I just hope I make up my mind, though. 🙂

 

[baya]

And yet... isn't it funny? I've moved on to EM in terms of interests. (Peds and Psych are still in the running, though.) I guess this is the beauty of third year... trying everything on for size! I just hope I make up my mind, though. 🙂

EM is the other thing on my list of 3, but it's moved down to about 10% for me. It seemed like an odd list of three possible specialties, but maybe it's not as unusual as I thought. What do peds, child psych, and EM have in common...?

 

[Tired]

I really enjoyed my psych rotation, but I definitely didn't get enough exposure to child psych (one evening call in the children's CPEP). However, all the psychiatrists here at my school really talk it up- especially how child psychiatrists are in such demand, etc etc etc.

Personally I hate Peds (the medical crap, anyway), and was only marginally interested in Psych. But I did have a chief who was lined up for Child Psych, and she couldn't stop talking about it. Here's what she impressed on us.

They are in huge demand, and even more importantly, there aren't all that many residents in the pipeline, meaning the shortage is only going to get worse. General psych is increasingly covering cases that should rightly go to Child Psych, if there were any available. The starting salary is significantly higher than either Peds or General Psych. And, unlike Pediatrics, you can probably get away with setting up a boutique practice, if you are so inclined.

The downside, and I don't know how much of it you got to see on Psych, is the actual patients themselves. The kids run the range of mild behavior problems to profoundly disturbed little freaks. They frequently have legal problems, and even more disturbing for a lot of people, they are very very often the products of sexual and physical abuse. The real question is, can you handle hearing from the 9-year old girl about being anally raped by her father and uncle? Can you be non-judgemental when the 12-year old boy tells you about beating his classmate over the head with a chair because he looked at him funny?

If you think you could take it, God knows you're needed, and you should definetely give it serious thought. Most of us . . . well, suffice it to say I, at least, couldn't get away from there fast enough.

 

[Jejton]

How much overlap is there between neurology and psychiatry ? I once was told ( back in my undergrad days ) that psychiatry is being phased out, and the work is being divied up by psychology and neurology. Is there any truth to this ?

 

[Tired]

How much overlap is there between neurology and psychiatry ? I once was told ( back in my undergrad days ) that psychiatry is being phased out, and the work is being divied up by psychology and neurology. Is there any truth to this ?

There was zero overlap on my rotations. Psych would do the initial workup to rule out "medical" causes of psychiatric disorders (ie - syphillis, thyrotoxicosis, brain tumor, etc) and then treat when everything else came back negative. If anything was positive, then immediate turf to the appropriate medical team. Neurology and Psych didn't even talk.

 

[Pinner Doc]

Neurology was never directly involved, but at my institution, things are very research-heavy, with brain imaging/mapping and the like. Of course, they also teach psychopharmacology, psychoanalysis, etc... but I think if you're into research into how the brain works, you can still do this through psychiatry.

 

[OldPsychDoc]

How much overlap is there between neurology and psychiatry ? I once was told ( back in my undergrad days ) that psychiatry is being phased out, and the work is being divied up by psychology and neurology. Is there any truth to this ?

Neurologists can't stand crazy people--they turf them to us as soon as (sometimes before!) a "real" neurologic cause is ruled out.

 

[oldbearprofessor]

OBP: if I did peds, I might specialize in neonatology. Do you have any idea if I could live in a rural-ish area of the west coast and work as a baby-doc? Or do they ship most babies straight out to big urban hospitals for their care?

Depends how rural and depends on how far you're willing to commute. Moderate sized communities will often have a small level 2 nursery with a neonatologist but not very rural areas. To work in those areas you'd need to be within reasonable range of a big city. Since most intensive care in neonatology for ventilator-dependent babies is headed towards 24 hrs in-patient and shift work for attendings, there are a variety of ways to make this work without actually living in the city.

Feel free to follow up in the pedi forum if you have more Q about this

OBP

 

[edmadison]

Interesting discussion, I too considered child psych. My big problem with it is that in real practice you make your money on the Q15 minute med checks. Psychotherapy doesn't reemburse well so it gets punted to the cousellors. The other big problem is that for the vast majority of your patients, you are not permitted to do the definitive procedure that can fix the problem: the Parentectomy. That's very frustrating.

Ed

 

[baya]

Interesting discussion, I too considered child psych. My big problem with it is that in real practice you make your money on the Q15 minute med checks. Psychotherapy doesn't reemburse well so it gets punted to the cousellors.

Do you have an idea of what the financial consequences of this choice are? ie, if you choose to not punt to the counsellors, you make more in the ~150 K range, but if you do punt, you're more in the ~250 K range? (Those numbers are completely made up -- I have no idea, which is why I'm asking.)

The other big problem is that for the vast majority of your patients, you are not permitted to do the definitive procedure that can fix the problem: the Parentectomy. That's very frustrating.

Yeah, that's the one that worries me the most. And having been a teacher, tutor, and nanny, I've seen situations that I just know would frustrate the baloney out of me if it were my job to fix it but I couldn't due to parental issues that they were unwilling to address.