Subspecialty and Gen Peds

[deleted912547]

Hi,

I am a PGY-2 resident interested in Nephrology, Endo, and Rheum. I also enjoy Gen Peds and realize there is a strong time/monetary cost to pursuing these fellowships. Therefore, I would like to get opinions on which subspecialty training would be most helpful in Gen Peds if I were to potentially train and decide after a year or two to return to Gen Peds rather than complete the fellowship or to return/supplement my subspecialty practice with Gen Peds. Thank you.

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[GoSpursGo]

So from a cerebral perspective, if you made me pick I could see an argument for endo or nephro. But realistically this is a bad reason to choose a specialty. What are you interested in?

Also as you said there is a huge Cost in terms of time and lost earnings by pursuing any fellowship so you really should be sure before you jump in. If you’re on the fence then unless I’m mistaken, these are all sufficiently non competitive that you could easily practice for a few years and then go back if you decide it’s what you want.

 

[oldbearprofessor]

Agree with Spurs. All 3 of the ones you are interested in do a lot of care that's longitudinal and borders at time on primary care. It's certainly possible to do some primary care and some specialty time, but the fellowship is only worth it if you want to spend a good bit of your time in the specialty. Of the three, I think renal would be least compatible with that, I can see it more readily for rheum and endo. Remember that doing a fellowship requires significant research and if you aren't interested in that, it may be a frustrating 3 years.

 

[mvenus929]

I'm very clearly biased as a pediatric endocrinologist, but the bread and butter of peds endo is gen peds on steroids: growth, puberty, and obesity. Yes, there's the weird endo disorders, and there's diabetes, but the vast majority of the patients I see could be managed by a primary care doc who is interested, they just don't feel they have the time (I can spend 30-45 minutes with most of my patients without running too far behind).

Nephrology is a very interesting, very cerebral specialty. The knowledge would certainly be useful in general bc no one understands kidneys, but I don't know how much it'd help in day-to-day gen peds care.

And I don't know enough about rheum training to judge.

 

[kgamon8]

I'm very clearly biased as a pediatric endocrinologist, but the bread and butter of peds endo is gen peds on steroids: growth, puberty, and obesity. Yes, there's the weird endo disorders, and there's diabetes, but the vast majority of the patients I see could be managed by a primary care doc who is interested, they just don't feel they have the time (I can spend 30-45 minutes with most of my patients without running too far behind).

Nephrology is a very interesting, very cerebral specialty. The knowledge would certainly be useful in general bc no one understands kidneys, but I don't know how much it'd help in day-to-day gen peds care.

And I don't know enough about rheum training to judge.

what is a ballpark estimate of peds endo salary

 

[mvenus929]

what is a ballpark estimate of peds endo salary

As most peds endos are in academics, less than gen peds--I think 50%ile is around 180K. But those who are in private practice can usually clear somewhere in the 200-220K range.

 

[jarafernando]

As most peds endos are in academics, less than gen peds--I think 50%ile is around 180K. But those who are in private practice can usually clear somewhere in the 200-220K range.

in nY , its 160k

 

[jarafernando]

Peds Heme 160k, Peds Endo 160k, Peds Pulm 160k, peds rheum 85k fr part time
Neonatology 220k and Peds EM 230k

thats in my hospital

 

[atrialkickz]

Peds Heme 160k, Peds Endo 160k, Peds Pulm 160k, peds rheum 85k fr part time
Neonatology 220k and Peds EM 230k

thats in my hospital

Cards? Just curious

 

[Stone Cold]

Cards? Just curious

A fairly new attending (~2 years exp) who previously was a fellow in our hosp signed up for 320k - location is a major northeastern city

 

[atrialkickz]

A fairly new attending (~2 years exp) who previously was a fellow in our hosp signed up for 320k - location is a major northeastern city

What kind of practice style? Any sub-subspecialty? Private practice, intervenional etc? I didn't realize they were that high, most of everyone I know is making like 150-170k but my experience is all in academics

 

[Stone Cold]

What kind of practice style? Any sub-subspecialty? Private practice, intervenional etc? I didn't realize they were that high, most of everyone I know is making like 150-170k but my experience is all in academics

Fellowship in PICU followed by Cards

I've seen gen cards folks paid 160-220k in cities like Boston & NYC based on the practice style though and I don't understand why anyone with a competitive subspecialty like nicu, picu, cards, em would work for anything less than 200k in the northeast. Move elsewhere and you'd actually get paid much higher

This might give you a rough idea

 

[atrialkickz]

Fellowship in PICU followed by Cards

I've seen gen cards folks paid 160-220k in cities like Boston & NYC based on the practice style though and I don't understand why anyone with a competitive subspecialty like nicu, picu, cards, em would work for anything less than 200k in the northeast. Move elsewhere and you'd actually get paid much higher

This might give you a rough idea

Thank you for the information!! Yes, I saw that report but it's hard to figure out the breakdown when they lump all of peds Cardiology together, I would imagine that interventional, EP, cicu in cardiology probably make much more than outpatient but couldn't really find reliable estimates to support that. Thanks!!

 

[SurfingDoctor]

Thank you for the information!! Yes, I saw that report but it's hard to figure out the breakdown when they lump all of peds Cardiology together, I would imagine that interventional, EP, cicu in cardiology probably make much more than outpatient but couldn't really find reliable estimates to support that. Thanks!!

Cardiac ICU typically falls under Critical Care, not Cardiology FYI.

 

[Stone Cold]

Thank you for the information!! Yes, I saw that report but it's hard to figure out the breakdown when they lump all of peds Cardiology together, I would imagine that interventional, EP, cicu in cardiology probably make much more than outpatient but couldn't really find reliable estimates to support that. Thanks!!

I've hardly interacted with any peds EP or IC physicians or definitely not to the point of discussing compensations. It's uncommon for peds cards folks to further specialize since you don't see the case load or the comp figures as compared to their adult counterparts where they make anywhere between $500k-1m based on type of practice and location

Until a few years ago, most cicu positions only required just 1 year of additional cards (cicu) training post picu fellowship but I believe they're asking for two years in cards as well. I heard some programs offer a 2 year peds cards fellowship program enabling you to get board certified if you're already done with picu fellowship but need to find out more in that regard

As for picu comps, two picu physicians (5+ & 10+ yrs exp) in our hosp make over 300k with no further specialization which is in line with 2018's MGMA data as posted above...one of them gave me an LOR as well

Maybe some practicing physician or someone who recently did a job search can provide more data on cicu/ep/ic compensations

 

[ghostbaby]

Until a few years ago, most cicu positions only required just 1 year of additional cards (cicu) training post picu fellowship but I believe they're asking for two years in cards as well. I heard some programs offer a 2 year peds cards fellowship program enabling you to get board certified if you're already done with picu fellowship but need to find out more in that regard

Would one would need to go through the ERAS interview cycle again if they wanted to do those two extra years of CICU? Seems like limited programs allow you to stay for CICU training.

Do you think the 1-year CICU fellowships are gonna go away, or here to stay (despite the movement towards 2-year)? Would hate for one to do the 1-year then not be able to get a job afterwards.

 

[mvenus929]

I heard some programs offer a 2 year peds cards fellowship program enabling you to get board certified if you're already done with picu fellowship but need to find out more in that regard

FWIW, the ABP allows this for any second fellowship. So if you did 3 years of Cards first and then wanted to do PICU, you could become board eligible after two years with the right support. Any program can arrange it that way.

Works the same way for Med-Peds fellowships. They can do 2 years instead of 3 if doing another fellowship as long as there is a scholarly project at the end.

 

[SurfingDoctor]

I've hardly interacted with any peds EP or IC physicians or definitely not to the point of discussing compensations. It's uncommon for peds cards folks to further specialize since you don't see the case load or the comp figures as compared to their adult counterparts where they make anywhere between $500k-1m based on type of practice and location

Until a few years ago, most cicu positions only required just 1 year of additional cards (cicu) training post picu fellowship but I believe they're asking for two years in cards as well. I heard some programs offer a 2 year peds cards fellowship program enabling you to get board certified if you're already done with picu fellowship but need to find out more in that regard

As for picu comps, two picu physicians (5+ & 10+ yrs exp) in our hosp make over 300k with no further specialization which is in line with 2018's MGMA data as posted above...one of them gave me an LOR as well

Maybe some practicing physician or someone who recently did a job search can provide more data on cicu/ep/ic compensations

Yes, there are many places that offer a 1 year fellowship on an Instructor position. Cincinnati, Baylor, but that's generally more for PICU fellows. That path is less common for Cards fellows who typically don't do enough ICU during fellowship and then do a shortened 2 year fellowship. We've had both in our training program. The finding a 2 year PICU fellowship is hard because it screws up the applicant pool, but we've started offering 2 year PICU fellowship spots to Cards fellows outside the MATCH because the job market in that field is still good.

 

[Stone Cold]

FWIW, the ABP allows this for any second fellowship. So if you did 3 years of Cards first and then wanted to do PICU, you could become board eligible after two years with the right support. Any program can arrange it that way.

Works the same way for Med-Peds fellowships. They can do 2 years instead of 3 if doing another fellowship as long as there is a scholarly project at the end.

Yes, there are many places that offer a 1 year fellowship on an Instructor position. Cincinnati, Baylor, but that's generally more for PICU fellows. That path is less common for Cards fellows who typically don't do enough ICU during fellowship and then do a shortened 2 year fellowship. We've had both in our training program. The finding a 2 year PICU fellowship is hard because it screws up the applicant pool, but we've started offering 2 year PICU fellowship spots to Cards fellows outside the MATCH because the job market in that field is still good.

Thanks for that information. Any idea what the compensation looks like in your region for CICU physicians (PICU+2 yrs cards)?

 

[SurfingDoctor]

Thanks for that information. Any idea what the compensation looks like in your region for CICU physicians (PICU+2 yrs cards)?

Typically starting about $30K/year to $40K/year more to work in the CVICU than to work in the PICU based on regional compensations. Of course, there are exceptions to that and certainly unit needs dictate prices, but that is a general estimate.