Shortage of pedi subspecialists

[oldbearprofessor]

http://www.telegram.com/article/20100627/NEWS/6270439/1116

Interesting about the debt relief and advocacy for it. Anyone know more about this?

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[J-Rad]

http://www.healthcare.gov/center/authorities/title_v_healthcare_workforce.pdf

1/2 way down on page 1295 is the citation. But that's all I know for now.

PS I forgot to post this article recently (the Worcester T&G is one of my "hometown" newspapers I read online every morning).

 

[blanche]

interesting. i hadn't heard of this, but it sounds like a great idea.

 

[Stitch]

Children's Hospital in Boston sees patients from several states. Many sub-specialists work there, but less than half see patients; the others teach or do research

I feel this is an issue too. Do you feel we are over emphasizing the research aspect and demanding publications at the cost of patient care? My classmate who's finishing his heme/onc fellowship this year basically felt that he had to say he was interested in doing long term research during his interviews just to get a spot.

 

[oldbearprofessor]

I feel this is an issue too. Do you feel we are over emphasizing the research aspect and demanding publications at the cost of patient care? My classmate who's finishing his heme/onc fellowship this year basically felt that he had to say he was interested in doing long term research during his interviews just to get a spot.

There are two separate issues (at least) here. One is whether all pedi fellowships should be three years and include a substantial research project. I think the answer should be "no", but the pediatric leadership does not agree.

The second is that of senior scientists who don't see patients, which is what the article was talking about I think. This is more reasonable. I know lots of folks with MDs who are primarily basic science researchers who eventually stopped (or nearly stopped) seeing patients. I think they have a right to that choice as it USUALLY occurs late in their career. For financial reasons it is uncommon for assistant profs to do this. They may be limited to 20% patient time, but rarely 0%.

 

[Stitch]

There are two separate issues (at least) here. One is whether all pedi fellowships should be three years and include a substantial research project. I think the answer should be "no", but the pediatric leadership does not agree.

The second is that of senior scientists who don't see patients, which is what the article was talking about I think. This is more reasonable. I know lots of folks with MDs who are primarily basic science researchers who eventually stopped (or nearly stopped) seeing patients. I think they have a right to that choice as it USUALLY occurs late in their career. For financial reasons it is uncommon for assistant profs to do this. They may be limited to 20% patient time, but rarely 0%.

Gotcha. I guess my feeling is that certain subspecialties might attract more interest if there wasn't such a huge push to do research and publish. Interestingly, I was looking at some of the Canadian subspecialties, and they only required a year (sometimes a year and a half) and no research requirement, though they 'encouraged.' Afterward, you'd be eligible for both the Royal Boards and the American.

 

[wml192]

Gotcha. I guess my feeling is that certain subspecialties might attract more interest if there wasn't such a huge push to do research and publish.

Agreed 100%. I'm not a guy who would be happy doing primary care, so I'm kind of stuck. But not being forced to devote 2/3 of my fellowship to an activity I have no interest in doing ever again would be a huge plus. If I'd wanted to be a full-time researcher (which, let's be honest, is what peds fellowships are designed to produce), I would've gotten a PhD.

On a related note, does anyone know how long the research emphasis in peds fellowships has been there, and why it was put in place?

 

[oldbearprofessor]

Agreed 100%. I'm not a guy who would be happy doing primary care, so I'm kind of stuck. But not being forced to devote 2/3 of my fellowship to an activity I have no interest in doing ever again would be a huge plus. If I'd wanted to be a full-time researcher (which, let's be honest, is what peds fellowships are designed to produce), I would've gotten a PhD.

On a related note, does anyone know how long the research emphasis in peds fellowships has been there, and why it was put in place?

First the historical perspective because I am, if nothing else, an OLD bear....

The transition from two year fellowships in which minimal research was expected to three year fellowships occurred in the late 1980's. I don't remember the exact entering year, but it would have been about 1988 - someone can look it up and correct me.

The reason for the switch (remember, I'm not defending, just explaining here....) is that there was a perceived lack of academic, research oriented pedi specialists and this change was believed to be a way to increase this number.

Now, fast forward 20+ years and we have a shortage of pedi specialists and the reality that, except in a few fields (e.g. pedi ID), most folks who finish a 3 year fellowship will not become researchers or even stay long if at all in academic medicine and there is a clear problem.

The solution is not all that simple. If we go back to the two year fellowship, we would really need to make sure that support was provided for a third year at a reasonable junior faculty income level (or loan payback) for those who want to do academics/research. Otherwise, we'll not have anyone willing to do the third year. Well, almost anyone. I did a voluntary third year as did a few of my colleagues, but we didn't have loans like folks do now.

So, I think that creating a clinical track is a good idea, but it needs some thought and some funding support for those who want to do longer projects. I think a 2 year fellowship track should include mandatory education in study design, etc so that fellows are fully prepared to properly assess the medical literature and participate in clinical studies. But, I don't think a real research project should be required.

I have no expectation that this change will occur soon.

 

[generic]

I agree. That sounds like something I would be much more interested in than the current fellowships. Heme/Onc seems especially painful for non-research types. Looks like they've taken your idea and put it into practice--only making their 3 year fellowship into FOUR years (instead of 2-->3). Argh.

On the other hand, Allergy/Immunology is 2 years.

Sports Medicine is only 1 year!

 

[VanDiemen]

I think another thing to look at would be that pediatrics residencies are primarily filled with women, who may be under a lot of pressure to deal with partners who still expect them to handle almost all of the childcare duties. This also makes it hard to progress in academic medicine, which is where alot of subspecialists have to practice.
So, if women are less inclined to become subspecialists, that means most peds residents are not likely to choose subspecialty training.

 

[surftheiop]

As someone getting ready to start going on medschool interviews, I would be absolutely thrilled if the debt forgiveness went into effect and sitting where I am now, I think it could definitely have a big effect on what I choose to do with my career. Even my public state schools will set me back 200k total by the time I graduate

 

[surftheiop]

Do 2nd or 3rd year peds specialist fellows qualify for this sort of repayment?

Has 20hr/week research requirement

http://services.aamc.org/fed_loan_pub/index.cfm?fuseaction=public.program&program_id=99

 

[oldbearprofessor]

Do 2nd or 3rd year peds specialist fellows qualify for this sort of repayment?

Has 20hr/week research requirement

http://services.aamc.org/fed_loan_pub/index.cfm?fuseaction=public.program&program_id=99

Yes, they do, but these have become much more competitive lately and generally are being obtained by junior faculty. A third year fellow with a good plan to move to a faculty position in the next year could give it a shot though and some of these are successful.

 

[vancouvergeorge]

Meanwhile a pharmacists makes $110k right out of pharm school.

Look at the University of Michigan faculty salaries:
http://www.collegiatetimes.com/databases/salaries/university-of-michigan-ann-arbor

Pediatric faculty salaries are in the 80k's, 20k less than the lowest paid pharmacist.

Meanwhile law profs at UMich are making $700k. The highest paid neurosurgeon at Michigan makes half as much as the law professors.

And people wonder why there is a shortage....

 

[uncndn]

700k is a lot of money, but you would have to be a lawyer...

 

[oldbearprofessor]

Look at the University of Michigan faculty salaries:
http://www.collegiatetimes.com/databases/salaries/university-of-michigan-ann-arbor

Pediatric faculty salaries are in the 80k's, 20k less than the lowest paid pharmacist.

Just a reminder:

1. Many of those salaries do not include a clinical second check which can be all or a majority of the pay.
2. Lots of the folks in pediatrics were making > $150,000 even ignoring #1 above.
3. Lots were making "0" too as they are voluntary faculty not taking money from the Univ.
4. Although there are some folks at some academic places that start <100K, this simply isn't common for full-time faculty, despite what's written on SDN. One is welcome to believe whatever one wants to believe about this.
5. Go Buckeyes.

 

[radtopedi]

looked at the salaries at they were mostly >180K, but those were all pedi specialists, compared to radiology (my alma mater) and they were in the 190k range, where are the 80k?

OBP, what is a "clinical second check"? just out of curiosity, I am leaning towards doing academics and would like to know what I'm in for .

 

[oldbearprofessor]

OBP, what is a "clinical second check"? just out of curiosity, I am leaning towards doing academics and would like to know what I'm in for .

Many specialists, especially neonatologists, critical care docs and pedi cards will have a paycheck separate from what is their institutional salary. This may be due to night-call duties in-house, or just be how they do it. Moonlighting, etc, are often handled as a second check. One benefit is related to retirement income, but I'm not the expert here.

Salary surveys that only look at academic faculty salaries are unlikely to be even remotely accurate. I'm not saying that academic pedi specialists are getting rich, and there are definitely a FEW high powered academic places that really underpay their specialist, but for the most part, it isn't that bad as is portrayed. Also, keep in mind that an increasing number of pedi specialists are in private practice as there are multiple private practice pedi hospitals or pedi hospitals that have private practice specialists. There salaries are often (but not always) higher than the academic folks, and they aren't published.

 

[radtopedi]

so for the high acuity specialists (PICU/NICU/Cards) working 60+hrs a week is it more like 200K-300K rather then 80K?