Subspecialties

[veenut]

I'm an M3 and have recently gotten interested in Peds Cardiology as a possible career. However, I don't really have an interest in doing general pediatrics. Would it be a mistake for me to pursue a Peds residency? I guess my question is: Is it a bad idea to go into Pediatrics if you know for sure that you want to subspecialize? Is this investing too much on the hope that future plans - getting into that subspecialty - will work out? Thanks

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[J-Rad]

It depends on your passion for the career. It's a little hard to decide in your M3 year. But lots of people know they want to subspecialize prior to residency (myself included). But to be a good peds subspecialist, you really need to be a good pediatrician first. Three years of aiming to that goal is tolerable. The downside is if you are not a competative candidate for the subspecialty and you're stuck practicing as a general pediatrician, assuming that you truly won't like it (I've been surprised that I've actually been missing general somewhat as my fellowship has commenced. That being said, I'm still doing plenty of [mostly inpatient] peds with our patients). Good luck.

 

[oldbearprofessor]

I guess my question is: Is it a bad idea to go into Pediatrics if you know for sure that you want to subspecialize?

No as this is the only way to get to a pediatric subspecialty (more or less....). In general, pedi subspecialties are not exceptionally competitive, although some, including cards and EM are moderately competitive.

Have confidence in yourself, commit yourself during your residency BOTH to becoming a good pediatrician and spending extra effort in your desired subspecialty area and you'll almost always do fine.

There are always risks, but this is a small one to do what you want to do with your life. If you enjoy working with children and their families, then go for it.

BTW, there is a shortage of virtually all pedi subspecialties and this is not expected to go away anytime soon.

And pedi cards is fun. Not as fun as neonatology, but pretty fun.😀

 

[Amoeba]

No as this is the only way to get to a pediatric subspecialty (more or less....). In general, pedi subspecialties are not exceptionally competitive, although some, including cards and EM are moderately competitive.

Have confidence in yourself, commit yourself during your residency BOTH to becoming a good pediatrician and spending extra effort in your desired subspecialty area and you'll almost always do fine.

There are always risks, but this is a small one to do what you want to do with your life. If you enjoy working with children and their families, then go for it.

BTW, there is a shortage of virtually all pedi subspecialties and this is not expected to go away anytime soon.

And pedi cards is fun. Not as fun as neonatology, but pretty fun.😀

Thanks for the post -- very helpful...Just wondering if you'd say there are any specific exceptions to this to be aware of...any areas where the specialists are overabundant?

 

[edmadison]

But to be a good peds subspecialist, you really need to be a good pediatrician first.

This is right on the money. If you want to see an example in action, compare Peds ER docs. The ones that do Peds -> ER are very different from ER -> Peds.

I'm in the same boat as J-Rad, I came into peds intending on doing a CCU fellowship. I'm just biding my Army time until I can do it.

One of the biggest things causing the relative subspecialist shortage is the insane requirement for three year fellowships. Several of the ICU fellowships I have looked at have 21 months of research time! Some peds subspecialties greatly increases your income (GI, NICU, PICU), others are more modest (endo, pulm) and some get you a lower income (adolescent). Why would you spend 3 years to earn less money?

Ed

 

[veenut]

Thanks for the replies, everyone. J-Rad, I can appreciate that you need to have a strong foundation in general Peds. I don't dislike general pediatrics per se, I just am more interested in subspecializing. It sounds like that shouldn't be a problem from what you all are saying though.

One thing I'm certain about is that I really like working with kids - I like that they are not responsible for their diseases (not too many kids with CHF due to 75 yr pack histories), and I like that they can be very resilient and actually fixed a great deal of the time. And they can sometimes be kinda cute and fun too. 😉

 

[oldbearprofessor]

Thanks for the post -- very helpful...Just wondering if you'd say there are any specific exceptions to this to be aware of...any areas where the specialists are overabundant?

As with anything in medicine, if your goal is to practice within 20 miles of Fenway Park or similar major medical landmarks, there might be a bit of a crunch of subspecialists in some fields, but in general, on a national basis, the answer is "no".

 

[CrazyPeds527]

Thread Hijack: OBP, are you saying Fenway Park is a major medical landmark?? I mean, outside of the famous "foreign body in airway" studies lasting from 1918-2004, I am not certain of other major medical breakthroughs from that institution.

Back to the thread: I started residency 99% certain I wanted to be a subspecialist (i think the start of this year has made me 100%), and that was OK with me. As noted, if you apply and don't get a subspecialty spot, you may find out you are OK doing hospitalist medicine, which is different enough from outpt gen peds for some to be happy. I certainly know current 3rd year residents who have hated their clinic and are still doing "general peds" only as a hospitalist instead.

As much as I dislike some of the fields we rotate though (see J-rad's post on "What I hate about Pediatric Specialties"), i do feel it is important to learn from them. If I do CCM for instance, as much as I hate pulm as a subspeciality, i better be damn good at managing RSV or Asthma, as those are bread and butter CCM diagnoses.

Veenut you seem to be interested in peds for many of the reasons why a lot of us became pediatricians. You will find your niche, whether cardiology or not...there are plenty of non-general peds jobs to get to by doing a pediatric residency, and who knows...you might even find you like something you previously would have thought you hated... 🙂

Good luck!

 

[UMED122]

As with anything in medicine, if your goal is to practice within 20 miles of Fenway Park or similar major medical landmarks, there might be a bit of a crunch of subspecialists in some fields, but in general, on a national basis, the answer is "no".

I've been wondering about this. I've heard that there is often a glut of subspecialists in major cities. On the other hand, I've also heard that to be a peds subspecialist, you need to be around a fairly large population center. So, what is the optimal place to practice? I know the answer probably varies by subspecialty and other factors, but how about for example, a pediatric endocrinologist or cardiologist? Is demand higher in a city like Chicago, or a medium sized city?

 

[oldbearprofessor]

I've been wondering about this. I've heard that there is often a glut of subspecialists in major cities. On the other hand, I've also heard that to be a peds subspecialist, you need to be around a fairly large population center. So, what is the optimal place to practice? I know the answer probably varies by subspecialty and other factors, but how about for example, a pediatric endocrinologist or cardiologist? Is demand higher in a city like Chicago, or a medium sized city?

Depends on whether you are interested in academics or private practice. There are opportunities for most pedi specialists in most "major" cities and for most areas that goes down to cities in the 250,000-500,000 size range (for neo even smaller). But, some fields in some towns will have a glut - that is inevitable. At the phase of deciding on a specialty, this isn't a big issue though.

 

[oldbearprofessor]

Thread Hijack: OBP, are you saying Fenway Park is a major medical landmark?? I mean, outside of the famous "foreign body in airway" studies lasting from 1918-2004, I am not certain of other major medical breakthroughs from that institution.

Nah, I just heard there are a couple of medical centers located near Fenway Park.😉

Speaking of which, last chance for anyone going to AAP (which will be held a short distance from Fenway!) to PM me if you want to meet.

End of hijack.