peds vs IM

[jannahz]

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i'm trying to decide between peds and IM. i know i dont want to pursue the med/peds program. i listed pro/cons for each. if any of you are in a similar situation or have advice, i'd really appreciate it.. i would like to subspecialize in possibly endo/renal/ID

peds:
+working with kids is more fun
+develop long relationships as you see the kids get older
+outpt peds is more fun than outpt med
-pediatricians are viewed as not real docs in certain places
-kids come with mainly one problem that you deal with, it's rare to deal with multiple problems

med:
+mult problems, solving puzzles, especially in inpatient settings
+viewed as more hard core
+better pay
-whiny adults are not fun
-i dont like htn/dm
-i dont like working with very old patients because they're so fragile

 

[oldbearprofessor]

-pediatricians are viewed as not real docs in certain places
-kids come with mainly one problem that you deal with, it's rare to deal with multiple problems

1. EVERY medical specialty has practitioners who disrespect every other field. So what? BTW, I assure you, that when these same folks have their own child in a NICU or a PICU, they change their mind very rapidly.

2. It is simply not true that in pediatric subspecialty medicine, kids rarely have multiple health problems. This may be relatively accurate in some general pedi practices, but not in subspecialty clinic practice. For sure, kids have fewer comorbidities than most adults, but management of renal and endocrine patients will require all of your knowledge base and a need to integrate diverse fields.

 

[BigRedBeta]

I think it's going to come down to the relative importance of each of those points for you. Which of the negatives are you most able to live with and which of the positives can you not live without?

I agree with OBP that you can find complexity in pediatric situations, especially NICU/PICU, but also with your CF kiddos, CP patients, in the genetic anomaly kids and pretty much any other chronic condition. What separates peds from IM in this is that usually there's one underlying cause that links everything together whereas in IM, they're distinct conditions. In that sense I do think that peds has a lot of problem solving that's just as interesting as any diagnostic dilemma in IM.

I'm not sure what being viewed as "more hard core" has to do with anything. I will say that I have a couple friends who did transitional years (one for rads, a couple for anesthesia) which required peds months and they were all blown away by all the congenital defects/genetics/development stuff the peds residents knew. They've all told me they felt really comfortable that they knew just as much as the IM residents, but had large gaps in their knowledge when it came to big portions of peds. Take that for what it's worth.

Also, in terms of being "hard core" I've heard that the peds boards are MUCH harder than the IM boards.

 

[CrazyPeds527]

Agree with all noted above. I have yet to meet anyone who believes pediatricians are not "real docs" (including med school).

The rarity of dealing with multiple problems you speak of may be a function of where you go to med school (maybe not). If your peds rotations are at community hospitals where they do not see a lot of pediatric pathology, then you are not seeing the multiple problems because those patients may be going elsewhere. If you decide to do a peds residency at a large academic center (and some community hospitals too!) you will be seeing lots and lots of "MMP" patients and do.ing plenty of puzzle solving

If you say below that you don't like hypertension and you don't like diabetes, i highly doubt you will enjoy being an IM doc, let alone an adult nephrologist or endocrinologist. And you don't like old people? Think about these things long and hard.

The better pay thing can also be solved by subspecialty (although if you decide ID, whether adult OR pediatric, there will be many docs making more $ than you - my question is, does it matter that much if you make $120,000 per year or $140,000?

There are parts of pediatrics I don't enjoy either...my subspecialty choice will weed out a lot of it, but not all of it. The simple fact is that it is difficult to like every patient's every issue...you need to figure out, as BigRed said above, which negatives you can put up with.

 

[jannahz]

thanks for your replies guys.. i've been hard core about peds until people tried to talk me out of it. so it was nice to hear what you all had to say..

so someone recommended i think i'm in a certain field for a day and see how it goes. so for the past two days, i have been thinking about being an internist. and for some reason i have been really depressed. then i realized that the thought of treating adults, and not seeing kids made me sad.. i know it sounds silly but it was weird.