Picking a competitive, peds-related field...

[sdnetrocks]

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I just started third year, and don't have a particularly clear idea of what I want to do. However, I am pretty sure that I want to work with kids, though I think (please, tell me I'm wrong) that my stats so far can get me a much more competitive residency than pediatrics.

About me:

- top 10 medical school (tied for #2 by residency directors)
- 2nd year grades: 7 honors, 4 high-pass
- USMLE Step 1: 249
- 1 clinical case-report being written up now (first author)
- 2 summer-long research rotations (no publications)

While this certainly isn't "glowing" enough to get me pediatrics at MGH or Hopkins, I think it probably is decent enough to get me a competitive field like dermatology at a second-tier program, which I could follow-up with a pediatric fellowship. Is that pretty reasonable?

In general, what is the best way to use these stats to ultimately end up with a private-practice career, serving at least a 50% pediatric patient base, in a well-paid specialty with a nice lifestyle? (...one in which I could work 40-50 hrs/wk and do well, or choose to work 60-70 hrs/wk and do extremely well)

My gut feeling is cash-based fields, like derm... But are there any others?

 

[b&ierstiefel]

So far, I think your qualifications are fine for peds at MGH or Hopkins. But you're gonna have to keep up the good work and continue to do well on clinical rotations. And this can be tricky because grades on clerkships are based mostly on evaluations and evaluations are very subjective. Regardless, the trick to doing well on clerkships is kicking ass on shelf exams. Many clinical rotations will have the majority of your grade depend on these evaluations. But if everyone gets decent to great evaluations...the shelf exam scores becomes the tie-breaker which becomes especially important if only the top 5-10% of people get Honors.

 

[amojan99]

With stats like that, all you need are honors in peds and IM and good LORs from the respective chairpersons. As long as you ace the peds related fields and probably ob/gyn you'll definately be offered an interview at any and every top residency position

 

[sdnetrocks]

Correct me if I'm wrong, but I think that as far as future salary (and in some cases fellowship admissions - like peds ER or peds gas), it would be more advantageous to do a more competitive residency at a worse place rather than a less competitive residency at a top place.

However, I admit that if I intended to be in academics, I would certainly be gunning for a residency (any residency) at a TOP place.

 

[kas23]

I'm a little confused, do you want to go into a field that you love and truly enjoy? Or, do you want to get the "best" residency you can get with your stats?

2nd, MGH is not one of the very top peds residency programs.

3rd, if you want to gain a residency position (within any field, it doesn't matter) at a "top program," you will need "derm-like" stats. It is ridiculous (not to mention arrogant) to think you are "wasting" stats to get into a top peds program.

Lastly, in terms of the "stats" you think you would be wasting, come back to us after your third year, because the importance of 1st and 2nd year grades pale in comparision to your 3rd year clerkship grades.

 

[yaah]

From what I have heard, getting a good pedes residency depends mostly on your pedes grades and your evals and letter of rec. What med school you go to doesn't matter much. Board scores are good, but lots of people have high board scores. Same with publications and research.

 

[sdnetrocks]

I'm a little confused, do you want to go into a field that you love and truly enjoy? Or, do you want to get the "best" residency you can get with your stats?

Ideally, both -- so at this point I'm thinking a non-peds residency followed by a peds fellowship.

2nd, MGH is not one of the very top peds residency programs.

3rd, if you want to gain a residency position (within any field, it doesn't matter) at a "top program," you will need "derm-like" stats. It is ridiculous (not to mention arrogant) to think you are "wasting" stats to get into a top peds program.

I think I stated just the opposite -- that I DON"T have the stats for the very best peds programs, but I could possibly squeeze into a more competitive field like derm but at a low-tiered program.

Lastly, in terms of the "stats" you think you would be wasting, come back to us after your third year, because the importance of 1st and 2nd year grades pale in comparision to your 3rd year clerkship grades.

Fair enough.

 

[SmittySC]

Ideally, both -- so at this point I'm thinking a non-peds residency followed by a peds fellowship.

Correct me if I am wrong, since I am not a peds expert, but I believe that most peds fellowships require pediatric residency training first.

 

[kas23]

Ideally, both -- so at this point I'm thinking a non-peds residency followed by a peds fellowship.

Correct me if I am wrong, since I am not a peds expert, but I believe that most peds fellowships require pediatric residency training first.

Not necessarily. I believe you can do a derm residency, then do a fellowship in peds derm.

To the OP. OK, I mistook your modesty for arrogance. The fact is, right now, your grades/scores/research are good enough for any top peds program.

You also have to think about yourself being at a low-tiered program. Would you be happy at some no name school. You do flaunt the status of your current med school. You will be unable to do that at a no-name program. And if you want to stay in academics, as someone already pointed out, you will not be able to do so at a no-name program.

Also, competitiveness of a program or a residency have little correlation with salary. The person who did derm at a no-name program and then goes into private practice will be making MUCH more than the person who graduated from Hopkins and stayed in academics. Also, ob/gyn and anesthesia are relatively noncompetitive, but get paid high salaries.

Also, think about allergy & immunology. It is a very nice lifestyle, pay is decent, very intellectually stimulating, and you get to work with both adults and children.

 

[TheThroat]

If you want to treat peds and make money, think surgical subspecialty. Peds oto, peds uro, peds ortho. You would have to limit yourself to a larger city, because smaller places don't have the referal base. There is a peds oto guy in Ft. Worth that I bet makes seven figures. Now, if you want to not work that hard, thats a different story. Maybe peds derm.

 

[Wednesday]

Do you LIKE derm? Maybe wait until you get through 3rd year and see if you even like peds. This is all theoretical at this point.

Also, derm is competitive. I don't think there are too many safety derm programs. People who actually like derm and want to go into it (as opposed to people just looking for a competitive, well paid specialty) even end up not matching. Figure out what you like to do and you can probably find a way to make lots of money if that is your goal.

 

[Florian]

Amy Paller http://www.medschool.northwestern.edu/faculty-staff/expressions/05-winter/AmyPaller.html is a pediatric dermatologist at Northwestern who is always looking for applicants with an academic interest.

 

[golgi]

Do ophthalmology and then do a one year fellowship in pediatric ophthalmology!!!!!! It meets all your criteria (competitive, prestige, good money, lifestyle, and most important FUN!!)

 

[golgi]

Let me add to my above post that a pediatric ophthalmologisit invented "botox" and that there are many peds ophthos who do cosmetic procedures like botox injections in-office and get paid handsomely for it...I think derm pales in comparison to the opportunities in ophtho plus you get to do cool (but short) eye surgeries!

 

[yaah]

I thought Clostridium botulinum invented Botox. 😛

 

[sdnetrocks]

You also have to think about yourself being at a low-tiered program. Would you be happy at some no name school. You do flaunt the status of your current med school. You will be unable to do that at a no-name program. And if you want to stay in academics, as someone already pointed out, you will not be able to do so at a no-name program.

While I enjoy the teaching aspects of academics, I am not interested in research (in fact, I am fairly certain I will want a research-free residency) nor the enormous pay-cut that accompanies an academic career. So I probably wouldn't mind being in a lesser program considering that it would be in the right field.

Also, competitiveness of a program or a residency have little correlation with salary. The person who did derm at a no-name program and then goes into private practice will be making MUCH more than the person who graduated from Hopkins and stayed in academics. Also, ob/gyn and anesthesia are relatively noncompetitive, but get paid high salaries.

Agreed!

Also, think about allergy & immunology. It is a very nice lifestyle, pay is decent, very intellectually stimulating, and you get to work with both adults and children.

I've heard some disturbing things about allergy & immunology, namely that it is oversaturated and will be much less needed in the future (except, of course, in the poorly served areas).

 

[sdnetrocks]

Do you LIKE derm? Maybe wait until you get through 3rd year and see if you even like peds. This is all theoretical at this point.

To be honest, I am not sure if I like derm... in fact, I don't know much about it at all. Obviously, there is no 3rd year rotation in derm... Maybe I could arrange to shadow some docs during the quieter 3rd year months (neuro, family, outpt medicine, psych...), although my days off will be on weekends - which is clearly not the best for shadowing lifestyle-specialty docs. Any ideas?

Also, derm is competitive. I don't think there are too many safety derm programs. People who actually like derm and want to go into it (as opposed to people just looking for a competitive, well paid specialty) even end up not matching. Figure out what you like to do and you can probably find a way to make lots of money if that is your goal.

Well, I suppose this is crass, but what gets you in is not how much you like a field, but how appetizing of a candidate (whatever that means) you are to the admissions committee.

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So I guess the "differential" at this point is:

peds derm
peds gas
peds ophthy

Unfortunately, each of those fields has a substantially more lucrative fellowship (mohs, pain, retina) that will be very tempting.... Oh, why must pediatricians be paid so poorly? 😉

 

[TheThroat]

You really need to find what you like and not think about money too much at this point. The real money-makers in medicine are making outside the field. You can make money doing a lot of things, but if you don't enjoy your work, you won't be content. Do you like to operate: get into something that will let you operate. Do you like the operating room, but not operating? Anesthesia might be your stuff.

 

[TheThroat]

By the way, I wouldn't go into interviews and tell the truth about yourself. It will turn the interviewers off in a big way. I can just imagine it:

Interviewer: "So, why did you decide to go into derm?"

Candidate: "Well, I just wanted to get into something to make some serious money without having to work too hard. And I like kids, and I hear that peds derms make monster cash. Oh, and by the way, I am not into research and would never consider academics because you make beans compared to what I'll make in private practice."

Interviewer: "Great, we'll see you never."

 

[Smurfette]

Hmm...if you want a research free residency, derm is likely not for you (from what I've heard, it's pretty intellectual....many have publication requirements). Cross rad-onc off your list too. Wait six months and see what your interests are then. Maybe you're not a clinic person...in which case derm is definitely not the field for you.

I agree with an above poster---derm is VERY hard to get into. As in AOA with publications and letter writers with connections. Don't just assume you can match into a 2nd tier program. Plus, you've got a whole year of rotations to do and grades to receive. 3rd year grades matter a lot, and you didn't mention what your 1st year grades are.

 

[sdnetrocks]

Hmm...if you want a research free residency, derm is likely not for you (from what I've heard, it's pretty intellectual....many have publication requirements). Cross rad-onc off your list too. Wait six months and see what your interests are then. Maybe you're not a clinic person...in which case derm is definitely not the field for you.

I agree with an above poster---derm is VERY hard to get into. As in AOA with publications and letter writers with connections. Don't just assume you can match into a 2nd tier program. Plus, you've got a whole year of rotations to do and grades to receive. 3rd year grades matter a lot, and you didn't mention what your 1st year grades are.

I've heard some talk about this rad-onc, but I don't know too much about it. The big concern I have with it is that the protocols for treating cancers may change (for example, as a result of new drugs, etc.) such that radiation is used much much less....

 

[TheThroat]

I've heard some talk about this rad-onc, but I don't know too much about it. The big concern I have with it is that the protocols for treating cancers may change (for example, as a result of new drugs, etc.) such that radiation is used much much less....

You've gotta be kidding me. If anything, xrt is being use more and more, especially in head and neck ca's. There is nothing as far as chemo is concerned that is even in the pipeline that is anywhere close to xrt or surgery for almost any upper aerodigestive tract ca. almost all advanced scc of the head/neck is treated with either surgery and xrt or chemoxrt. I don't know about other ca's (breast/lung/prostate/colon), but head and neck get treated with xrt all the time.

 

[NinerNiner999]

While this certainly isn't "glowing" enough to get me pediatrics at MGH or Hopkins

Don't be too sure about that...

 

[sdnetrocks]

You've gotta be kidding me. If anything, xrt is being use more and more, especially in head and neck ca's. There is nothing as far as chemo is concerned that is even in the pipeline that is anywhere close to xrt or surgery for almost any upper aerodigestive tract ca. almost all advanced scc of the head/neck is treated with either surgery and xrt or chemoxrt. I don't know about other ca's (breast/lung/prostate/colon), but head and neck get treated with xrt all the time.

Fair enough. I guess I'm just thinking of worst-case scenario. Kind of like becoming a "leech-specialist" and then suddenly being made useless with the development of warfarin...

 

[TheThroat]

To the "lay population" the idea of a "cure for cancer" is some type of magic pill that will cure all types of cancers. The fact is that cancer is a incredibly complex field that requires multiple therapies. The field of rad-onc is alive and well and is an expanding field. Even if it became obsolete for one type of cancer, it would still be used for mulitple other types, and even in some benign disease states (eg: acoustic neuroma).