Peds w/o clinic

[StarboardMD]

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In a couple of years, I will be getting out of the Army and doing a civilian peds residency (assuming I get picked up). In my current job, I work exclusively in the clinic doing super basic primary care (adult only) medicine, and I am not sure how much more clinic time I can handle before I rip out all my hair in frustration. I am absolutely dying to get back into the hospital and do some "real" medicine. I definitely cannot see myself sitting in a clinic all day for the rest of my life.

However, my husband and kids live over an hour from the nearest academic medicine center and cannot move (this is non-negotiable), so I will have to live apart from them for the entire duration of my training. Thus, I don't really see myself doing a fellowship (they all last 3 years?!?! What's up with that???). So my question is, if I don't do a fellowship, am I doomed to a life of clinic forever? Are there non-clinic jobs that would hire someone without fellowship training? Maybe as a hospitalist or something?

Thanks in advance for the help.

 

[Rutgers06]

In a couple of years, I will be getting out of the Army and doing a civilian peds residency (assuming I get picked up). In my current job, I work exclusively in the clinic doing super basic primary care (adult only) medicine, and I am not sure how much more clinic time I can handle before I rip out all my hair in frustration. I am absolutely dying to get back into the hospital and do some "real" medicine. I definitely cannot see myself sitting in a clinic all day for the rest of my life.

However, my husband and kids live over an hour from the nearest academic medicine center and cannot move (this is non-negotiable), so I will have to live apart from them for the entire duration of my training. Thus, I don't really see myself doing a fellowship (they all last 3 years?!?! What's up with that???). So my question is, if I don't do a fellowship, am I doomed to a life of clinic forever? Are there non-clinic jobs that would hire someone without fellowship training? Maybe as a hospitalist or something?

Thanks in advance for the help.

Yeah, there are definitely pediatric hospitalist jobs that are out there. At some of the children's hospitals, there are also fast track positions in the ED. Just keep an open mind and figure out what works for you.

 

[Socrates25]

In a couple of years, I will be getting out of the Army and doing a civilian peds residency (assuming I get picked up). In my current job, I work exclusively in the clinic doing super basic primary care (adult only) medicine, and I am not sure how much more clinic time I can handle before I rip out all my hair in frustration. I am absolutely dying to get back into the hospital and do some "real" medicine. I definitely cannot see myself sitting in a clinic all day for the rest of my life.

However, my husband and kids live over an hour from the nearest academic medicine center and cannot move (this is non-negotiable), so I will have to live apart from them for the entire duration of my training. Thus, I don't really see myself doing a fellowship (they all last 3 years?!?! What's up with that???). So my question is, if I don't do a fellowship, am I doomed to a life of clinic forever? Are there non-clinic jobs that would hire someone without fellowship training? Maybe as a hospitalist or something?

Thanks in advance for the help.

1. Clinic-based medicine is in fact, "real" medicine. Peds hospitalist is just one step up from outpatient, and kids get admitted all the time to hospitalist services for "babysitting" stuff like RSV in the winter where all you are doing is monitoring vitals. If you need something more intense, then even peds hospitalist would probably be "boring" to you. You need to consider PICU, NICU, or peds cardiology/CVICU.

2. If you are absolutely sure that your family cant move at any time in the future, then I'd make sure that there's a childrens hospital or a mixed use hospital nearby that actually hires peds hospitalists. They are not as widespread as adult hospitalists.

3. Sadly, I suspect that in the future a fellowship will become the de facto credential to get a peds hospitalist position. But thats at least 15-20 years down the line IMHO. You should be fine.

 

[BigRedBeta]

1. Clinic-based medicine is in fact, "real" medicine. Peds hospitalist is just one step up from outpatient, and kids get admitted all the time to hospitalist services for "babysitting" stuff like RSV in the winter where all you are doing is monitoring vitals. If you need something more intense, then even peds hospitalist would probably be "boring" to you. You need to consider PICU, NICU, or peds cardiology/CVICU.

2. If you are absolutely sure that your family cant move at any time in the future, then I'd make sure that there's a childrens hospital or a mixed use hospital nearby that actually hires peds hospitalists. They are not as widespread as adult hospitalists.

3. Sadly, I suspect that in the future a fellowship will become the de facto credential to get a peds hospitalist position. But thats at least 15-20 years down the line IMHO. You should be fine.

Due to a relative paucity of fully fellowship trained Peds EM physicians, there's a market for general pediatricians who want to do acute care in the ED. Depending on the market this may actually be relatively high acuity (with back up from formally trained PEM folks). My residency program had an extremely high volume ED that was staffed by 2 attending physicians - 24/7 staffing from a PEM or PCCM doc, with a general pediatrician who depending on volume was there 20-24 hours a day (obviously shift work, our attendings worked 8 hour shifts). Of course, sometimes low acuity ED work is no better than general peds clinic, except without the well child checks and immunizations. If you really crave the adrenaline rush of more critical care situations or even just the rhythm of hospital based medicine (I personally find comfort in the process of pre-rounds, rounds, work rounds, afternoon progress and checkout that comes from being in the hospital...it probably icalms my mild OCD), then this sort of acute care peds might not be enough...

 

[StarboardMD]

Thanks for all the above info. Sounds like the answer is that it can be done, if the situation is right, but it might not be what I'm after anyway. Hmmm. Lots of things to think about. If only peds fellowships weren't so LONG!!! Thanks for the help!

 

[No1Cub17]

Some places also hire "critical care hospitalists" so you'd basically work in the PICU, function semi-autonomously, but have backup from an attending. So if general hospitalist is too boring and you don't want to do a PICU/NICU fellowship, this is another option. I'm not exactly sure why you hate clinic so much though - I'm currently a hospitalist but moonlight as much as I can for area docs who need clinic coverage. It helps to keep current with the outpatient world too.

 

[StarboardMD]

That does sound interesting. I think my loathing for clinic work comes from the nature of the work that I do right now. It is entirely possible that once I get into residency and start doing real clinic medicine, I will decide I like it. Here's hoping!