Should I do a pediatric fellowship? (given I am ~650k in debt)

[wickedprophet]

Hi everyone, I am currently a first year pediatric resident with over 650k in debt (from federal and private loans from undergrad, post-bac, and med school). It might be worth noting that my family is not well off (low-middle class) and I'm the first doctor in my family. I know pediatrics isn't the best specialty choice for someone in my situation... but if there was one thing I was sure of throughout med school, it was that I wanted to treat children.

Given the financial pickle that I will be in for many many years, would you recommend I do a fellowship to increase my overall lifetime earnings and potentially help me pay off my loans more quickly (preferably within 20 years)? The ones I'm specifically interested in at the moment include:

• Neonatology
• Pediatric Critical Care
• Pediatric Hematology/Oncology
• Child Neurology

At this point, I would be equally happy in any of these fellowships or doing general pediatrics. In terms of being financially worth it- are any of these worth doing, or should I just become a general pediatrician and start paying off my loans after my 3 years of residency?

Any advice would be much appreciated. Thanks in advance!

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[SurfingDoctor]

Do whatever interests you the most in the long run. If you choose otherwise, you will burnout by practicing what you aren’t most interested in and your personal and professional life will suffer.

 

[NurWollen]

Do whatever interests you the most in the long run. If you choose otherwise, you will burnout by practicing what you aren’t most interested in and your personal and professional life will suffer.

I agree. OP, you followed your heart into peds at a significant financial opportunity cost. Don't ruin that by pursuing something you don't love.

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[wickedprophet]

Do whatever interests you the most in the long run. If you choose otherwise, you will burnout by practicing what you aren’t most interested in and your personal and professional life will suffer.

Thanks for your reply. What if I find that I would genuinely be happy and fulfilled in any of these options? I‘ve been thinking about what I want my career to look like, and I think I’ve definitively ruled out just about all the other pediatric subspecialties based off of lack of interest or my rotation experience.

Are any of the options I listed just financially better for me?

 

[SurfingDoctor]

Thanks for your reply. What if I find that I would genuinely be happy and fulfilled in any of these options? I‘ve thought long and hard about what I want my future career to look like, and I think I’ve definitively ruled out just about all the other pediatric subspeciaties based off of lack of interest or my rotation experience.

Are any of the options I listed just financially better for me?

I guess, though if you thought long and hard about it (pros vs cons), I doubt you would find them all equally rewarding from a professional standpoint.

Based in a study from several years back, only PICU, NICU and Cards have a higher return on invest than General Peds. That being said, and only speaking from direct personal experience, some of the higher paid intensivists I know... have flamed out spectacularly like the Hindenburg.

 

[Spikebd]

Choose what you like and pray for pslf to come through for you.

 

[tantacles]

Here's the thing: If you want to make more money as a general pediatrician, you can often find a way to work more, but if you subspecialize, it may be hard to work less. My partner works in general pediatrics 4 days per week. He's happy with his salary, but our hospital system continually offers him more money to do more generalist work. He just doesn't care. So financially, probably best off staying in general peds.

 

[wickedprophet]

Here's the thing: If you want to make more money as a general pediatrician, you can often find a way to work more, but if you subspecialize, it may be hard to work less. My partner works in general pediatrics 4 days per week. He's happy with his salary, but our hospital system continually offers him more money to do more generalist work. He just doesn't care. So financially, probably best off staying in general peds.

Thank you so much for your very helpful response. May I ask where his job is located geographically (feel free to be as specific or non-specific as you’d like)

 

[tantacles]

MIdwest.

 

[sliceofbread136]

If I were in your situation I would work for a few years, pay it off and then try and go back for fellowship later. 650 would stress me out

 

[wickedprophet]

If I were in your situation I would work for a few years, pay it off and then try and go back for fellowship later. 650 would stress me out

I've thought about doing that, but would such a large gap between residency and applying for fellowship potentially rule me out of consideration/looked at as a negative thing? I'm worried that fellowship programs will question 1) if I'm willing to embrace the attitude of a learner again after having been independent for some time, and 2) if I'm truly interested in their subspecialty, and if so then why didn't I apply directly after residency? Is "financial reasons" an appropriate answer? Thanks for your input!

 

[SurfingDoctor]

I've thought about doing that, but would such a large gap between residency and applying for fellowship potentially rule me out of consideration/looked at as a negative thing? I'm worried that fellowship programs will question 1) if I'm willing to embrace the attitude of a learner again after having been independent for some time, and 2) if I'm truly interested in their subspecialty, and if so then why didn't I apply directly after residency? Is "financial reasons" an appropriate answer? Thanks for your input!

Nope. Generally speaking, you look like a more mature candidate. Find some project or QI thing during that time to make yourself look better though.

 

[Goneril]

I’d stick to general pediatrics if I were you but if you don’t think you can tolerate being a general pediatrician than Neonatology would be the best option for making money to knock out that loan.

 

[FlowLimited]

Thanks for your reply. What if I find that I would genuinely be happy and fulfilled in any of these options? I‘ve thought long and hard about what I want my future career to look like, and I think I’ve definitively ruled out just about all the other pediatric subspeciaties based off of lack of interest or my rotation experience.

Are any of the options I listed just financially better for me?

Like stated above, the data is out there about what subspecialities are going to give you a financial boost. All fellowship training is going to result in a loss of 3 years of attending income and you have to decide whether that's worth it to you, especially if you pick one of the fields above where your income likely won't be much higher than a general pediatrician (all but NICU/PICU).

I have a hard time believing you when you say you know what you want your future career to look like. Your list includes the entire spectrum of pediatrics from majority outpatient to exclusively hospital based, generalist to specialist, low acuity to high acuity, and non-proceduralist to proceduralist. I'm thinking you mean that you know the subjects you're interested in but may need to think more about the lifestyle differences. Of course, as someone relatively early in residency, that's not unusual.

My recommendation would be to continue considering the little details that separate these fields. What are you okay being woken up about in the middle of the night?

 

[DeadCactus]

Subspecialty training isn't a great strategy for dealing with a tough financial situation. Your debt should guide you on lifestyle decisions not career decisions. Leverage low cost of living and high salary areas with your own spending patterns is going to have a far larger impact than the relatively minimal financial benefits of certain subspecialties. Pursue a subspecialty if it's going to make or break your career satisfaction, there really is no other good reason to.

 

[67552931811]

The median for nicu is 100k higher than gen peds. So, it’s peculiar those saying gen peds from solely a financial standpoint.

 

[wickedprophet]

The median for nicu is 100k higher than gen peds. So, it’s peculiar those saying gen peds from solely a financial standpoint.

I was thinking that while during fellowship, my debt would exponentially grow from interest and it may be best to start bringing it down asap (I was once told by a wise physician to "never underestimate the power of the exponent"). But would anyone who thinks gen peds would be best for 650k of debt like to chime in/confirm/explain? I appreciate your input.

 

[67552931811]

I was thinking that while during fellowship, my debt would exponentially grow from interest and it may be best to start bringing it down asap (I was once told by a wise physician to "never underestimate the power of the exponent"). But would anyone who thinks gen peds would be best for 650k of debt like to chime in/confirm/explain? I appreciate your input.

Are you in repaye? If not, you should be. That way you get the 50% subsidy of the difference between your monthly payment and the monthly interest.

That being said, the debt is really irrelevant to the main point that by year 5 of being an attending you would surpass whatever income gain you had as a generalist by being a neo (ergo: years 1-3 you make 230 as a generalist vs 70ish as a fellow. That’s a 480k diff, but the 100k diff between nicu median and gen peds median means by the end of the fifth year (of being a nicu doc and 8th year of being a generalist) you will make up and surpass that lost income ground). Sure, you’ll accrue interest during fellowship. But, if you’re in repaye, that can be reduced by 50%. extending your break even point between generalist/ nicu by 1 to 1.5 years max.

Over a career, it’s really a no-brainer from a monetary aspect.

 

[DarealThang]

If I were you, I would consider going into gen peds and join a loan forgiveness program with the fed government and work in an underserved area, or consider military career, they also have loan repayment programs.

 

[Dr. Wexler]

would you recommend I do a fellowship to increase my overall lifetime earnings

No.

But. If you're considering 3 more years of GME to earn more $ might as well contemplate doing an EM residency or anesthesiology residency.

 

[wickedprophet]

No.

But. If you're considering 3 more years of GME to earn more $ might as well contemplate doing an EM residency or anesthesiology residency.

Thanks for your response. May I ask why you wouldn’t recommend me doing a pediatric fellowship such as Neonatology? (I‘m unfortunately not interested in EM or anesthesiology at the moment)

 

[NITRAS]

The median for nicu is 100k higher than gen peds. So, it’s peculiar those saying gen peds from solely a financial standpoint.

Its not quite so simple. There is a time value to money. I'm an internist, and it would actually take me a long time to break even to go back and do fellowship. Even a better paying fellowship would take me probably ten years of working to break even. Longer if you consider now is the best buying opportunity for retirement accounts that have come around in over a decade.

The OP has got himself/herself in a big pickle. He/She needs to do a lot better job going forward than they have up to this point, otherwise the OP will struggle financially.

 

[Stone Cold]

Hi everyone, I am currently a first year pediatric resident with over 650k in debt (from federal and private loans from undergrad, post-bac, and med school). It might be worth noting that my family is not well off (low-middle class) and I'm the first doctor in my family. I know pediatrics isn't the best specialty choice for someone in my situation... but if there was one thing I was sure of throughout med school, it was that I wanted to treat children.

Given the financial pickle that I will be in for many many years, would you recommend I do a fellowship to increase my overall lifetime earnings and potentially help me pay off my loans more quickly (preferably within 20 years)? The ones I'm specifically interested in at the moment include:

• Neonatology
• Pediatric Critical Care
• Pediatric Hematology/Oncology
• Child Neurology

At this point, I would be equally happy in any of these fellowships or doing general pediatrics. In terms of being financially worth it- are any of these worth doing, or should I just become a general pediatrician and start paying off my loans after my 3 years of residency?

Any advice would be much appreciated. Thanks in advance!

I was pretty much in the same dilemma but my options were PICU, NICU, Cards and EM initially. I did rule out EM after 2 rotations since I couldn't take the high stress lifestyle. I'm an IMG and would want to eventually move back. Peds Cards doesn't have much scope in my home country and hence, I ruled out that as well though I did like Cards

Spoke with a few PICU/NICU folks in my program recently and all of them make >300k being in an academic setup closely followed by EM and Cards (not in any particular order). I also live in NYC which is the among the lowest paying regions. Recently, a cousin of mine took up a Peds hospitalist position in upstate new york for $230k but typically in NYC, peds hospitalists are paid $190-215k from what I've heard but it looks like NICU market is kinda saturated.

Try to access MGMA data if possible for more accurate comp reports. I know the adult CCM median comp is around $450-500k but unsure about peds data.

Again, you need to make a call if you're inclined to inpatient or outpatient. There's a major trade-off on the location as well and rural areas definitely pay more. If I were you, I just can't see myself in gen peds and I'd suggest take up something that you'd truly like, take a rural position in some flyover state which pays relatively way higher while live as if you're making no more than $100k to pay of your debt

 

[Oso]

I was pretty much in the same dilemma but my options were PICU, NICU, Cards and EM initially. I did rule out EM after 2 rotations since I couldn't take the high stress lifestyle. I'm an IMG and would want to eventually move back. Peds Cards doesn't have much scope in my home country and hence, I ruled out that as well though I did like Cards

Spoke with a few PICU/NICU folks in my program recently and all of them make >300k being in an academic setup closely followed by EM and Cards (not in any particular order). I also live in NYC which is the among the lowest paying regions. Recently, a cousin of mine took up a Peds hospitalist position in upstate new york for $230k but typically in NYC, peds hospitalists are paid $190-215k from what I've seen. Again, you need to make a call if you're inclined to inpatient or outpatient. There's a major trade-off on the location as well and rural areas definitely pay more

Interesting. So what did you decide on? If you didn't like the high stress lifestyle of EM then I'm assuming you also did not go into NICU or PICU?

For the OP: agree with others who've mentioned that choosing a specialty mostly based on income seems less than ideal. If you really are not leaning towards a particular fellowship, then I agree with doing gen peds in an underserved area as part of a loan forgiveness program, as mentioned by @DarealThang . After a couple of years you could still do fellowship if interested. Just my 2 cents.

 

[Stone Cold]

Interesting. So what did you decide on? If you didn't like the high stress lifestyle of EM then I'm assuming you also did not go into NICU or PICU?

For the OP: agree with others who've mentioned that choosing a specialty mostly based on income seems less than ideal. If you really are not leaning towards a particular fellowship, then I agree with doing gen peds in an underserved area as part of a loan forgiveness program, as mentioned by @DarealThang . After a couple of years you could still do fellowship if interested. Just my 2 cents.

I'm still in my residency and will need to choose between PICU and NICU given their similarities in lifestyle, compensation etc. EM being high stress as in I haven't been learning a lot and felt it was more like a grind whereas both NICU and PICU being my most liked rotations. For a while, I was really keen on cards but lack of cards opportunities in my home country made me opt that out. I might consider an extra year in CICU if I decide to go for PICU but that's still a long way to go

 

[Oso]

I'm still in my residency and will need to choose between PICU and NICU given their similarities in lifestyle, compensation etc. EM being high stress as in I haven't been learning a lot and felt it was more like a grind whereas both NICU and PICU being my most liked rotations. For a while, I was really keen on cards but lack of cards opportunities in my home country made me opt that out. I might consider an extra year in CICU if I decide to go for PICU but that's still a long way to go

Gotcha, cool. Good luck!!

 

[Obnoxious Dad]

I wouldn't count on PSLF. Get a job now in the Midwest.

Pediatricians, General

www.bls.gov

Live like a monk and pay off your debt ASAP. Then do a fellowship. Most pediatric fellowships aren't competitive. See page 11

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/02/Results-and-Data-SMS-2020.pdf

 

[pediadocto]

I wouldn't count on PSLF. Get a job now in the Midwest.

Pediatricians, General

www.bls.gov

Live like a monk and pay off your debt ASAP. Then do a fellowship. Most pediatric fellowships aren't competitive. See page 11

https://mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/uploads/2020/02/Results-and-Data-SMS-2020.pdf

how much do they offer in midwest?

 

[Obnoxious Dad]

how much do they offer in midwest?

The Bureau of Labor Statistics collects wage data across the country and publishes annual salaries based on a 2,080 work year. In ascending order here are the states with 2018 average annual pediatricians' salaries exceeding $200,000 per year:

Connecticut(0900000)	200090
California(0600000)	200270
Rhode Island(4400000)	200300
Arkansas(0500000)	201280
Delaware(1000000)	205390
Missouri(2900000)	210320
Alabama(0100000)	214220
New Jersey(3400000)	215040
Wyoming(5600000)	215250
Minnesota(2700000)	217450
Utah(4900000)	228440
New Hampshire(3300000)	236670
Iowa(1900000)	238990
Montana(3000000)	245090
Nevada(3200000)	247360
Mississippi(2800000)	249270
North Dakota(3800000)	258680
Wisconsin(5500000)	258850

 

[pediadocto]

Connecticut(0900000) 200090

North Dakota, here i come.

 

[NurWollen]

There are probably lots of places outside of those states where you can make good money in peds. Think about states with large metro areas surrounded by vast, mostly rural countryside. The large metros bring the average down. Think Texas, New York, Illinois.

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[Stone Cold]

North Dakota, here i come.

Wisconsin is still a better place in that regard. You could find a gig somewhere around Milwaukee which is a decent sized city and you're only 90min from Chicago