Subspecializing in Medicine vs. Peds

[ComradeDoktor]

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So, I've heard that pediatrics has the reputation of being more straightforward than IM because kids generally don't have a lot of complex co-morbidities like adult patients do. Is this still true when you compare pediatric subspecialties and their IM counterparts. Is pediatric nephrology less complex than adult nephrology? Are PICU patients easier to manage than MICU patients, or does that difference become less true when you're talking about subspecialties?

 

[Medstart108]

Dunno, but i've always thought that peds you have to deal with overanxious and concerned parents whereas in medicine you don't. Also kids can be very annoying.

The good thing is "what you see is what you get", but i'd take a little fibbing from adults over the squeals and screams of children amongst the scoldings and endless questions of parents anyday.

 

[BigRedBeta]

I'm currently a PICU fellow, so I should be able to help.

Let's break this down for general pediatricians vs your standard internist:
On the whole, yes, generally more straight forward in terms of the medical care you'll provide from one kid to the next. While there are nuances, an ear infection should usually get amoxicillin. Social situations can be VERY different however, and, at least for me, one of the things I love about peds is that the same outward problem (respiratory distress for example) has very different causes, physiology and considerations depending on the patient's age - a 2 month old is different than a 2 year old is different than a 6 year old, is different than a 12 year old is different than an 18 year old.



As for specialty care, yes, things become more complex with kids - and in some cases I'd argue more complex than their adults. I like to rib my adult cardiology friends that their job is easy - blood goes where it's supposed to which is usually not the case in peds cardiology, which explains why I end up having to take care of 40 year olds who had surgeries as infants in my Cardiac ICU at the children's hospital.

Are PICU patients easier? To some extent yes- the typical mortality rate for a PICU should be about 4%, compared to 25-40% you see in the MICU not infrequently. But again, once a patient becomes critically ill, they're going to be complex regardless if their 9 months or 90 years. And I promise you, no internist on earth wants to take care of the little 400 gram, 23 week gestation micro-preemies. I can't even imagine the look on an adult intensivists' face when you tell them they only have 60-75 ml of IV fluid to work with for the entire day!

Lastly, I'd say that the most medically complex pediatric patient can certainly eclipse the medical complexity of an adult. If you've got bad genetic substrate...well that can affect every organ system and easily involve not only numerous medical specialties but surgical services as well.

If you're trying to decide between the two fields, I'd ignore medical complexity and focus on the patients themselves. If you don't like kids (or in my case, adults), it's not going to matter what the medicine is...

 

[deleted311769]

The vast majority of children are healthy and grow up to become the average internal medicine patient. The majority of children seen in subspecialty care in large quaternary children's hospitals can be extremely complicated, and I would argue more complicated than adult patients. Our kids have metabolic/genetic/congenital/syndromic problems that lead to multiple organ systems that are impacted. And because their illnesses are life-limiting, or because they are so complicated only pediatricians feel comfortably with them, they may stay with their pediatric providers for their whole lives. Often, if they transition to adult providers, they will stay with doctors who specifically specialize in "transition." We see all the "zebra" diagnoses.

And even in primary care one of the greatest challenges is spotting the sick kid with the rare disorder in a sea of healthy children with a similar complaint. If it's one kid after another with nausea, vomiting, and a diagnosis of gastroenteritis, how do you spot the kid with new onset type 1 diabetes? In the sea of healthy children with fever, cough, and cold symptoms, how do you spot the kid with leukemia and a large mediastinal mass?

The fun in pediatric medicine is that we see all those diagnoses that you read about in text books. And then they smile and laugh and play through it all. like BigRedBeta says, you have to still love to work with kids and want to be their advocate. But the medicine sure can be fun too. Just think of the differential of the floppy baby, or try to figure out how the blood is actually flowing in post operative congenital heart disease, or contemplate how many organ systems cystic fibrosis impacts (and how many sub-specialists these patient's routinely see).

Also, anecdotally, the med/peds folks at my program say that PICU is harder than MICU. And don't even get started on NICU where the physiology is completely different.

 

[ComradeDoktor]

Thanks for the awesome answers, everyone!