Thoughts on not choosing peds for financial reasons

[DO_or_Die]

I know most of you are pediatricians so this might seem like a negative statement but please hear me out.

Was a peds RN prior to med school and came in expecting to do peds and am still thinking of PICU or even peds hospitalist. I've been trying to convince myself to do an adult specialty (honestly because of the pay and benefits) and could see myself tolerating any specialty, but I just have loved my pediatrics rotation as I figured I would.

It seems unfair to have to do a peds hospitalist fellowship to come out making.. I'm not sure $150-180k if I'm being generous, when your adult counterparts make almost twice that. Pediatrics is still medically complex, it's higher stakes in terms of bad outcomes and yet you're still not compensated as you should be. I feel at the end of the day I would be happiest in peds albeit at a real financial cost. And yes I know 180k is not poor and this post wreaks of greed. It's just the principle about it and it burns me up.

It's true that you can't put a price on happiness but that price is potentially millions at the end of a career that could allow one to retire earlier. Am I looking at this the wrong way? Would you do peds if you had to make the choice again?

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[GoSpursGo]

I would choose peds again. But each person makes their own priorities. You do you

 

[SurfingDoctor]

Frankly if you can't retire comfortably as a physician in the US, no matter the specialty, you need to take a course on money management more than worrying about the patients you see.

That and, all you need is one good recession or other form of economic contraction to wreak havoc on your retirement "plans".

 

[LaughingMan]

I would not do Peds if I had the choice again. I love the field--and it's an amazing magical specialty, and I love my current practice--but the writing is on the wall. I would have done anesthesia or some procedural specialty, where someone with an online degree isn't seen as my equal by the general public, and increasingly by insurers/govt.

This field is going to be mid-level dominated.

The beauty of Pediatrics was building awesome relationships with families and watching them grow--but as we move further and further towards centralization, being able to spend time with families and actually educate them on preventative medicine is over. It's now all about churning through patients.

People talk about seeing 30+ patients per day on a 9-5 schedule and act as if that's normal. You simply cannot give the best care and counseling to families in 10-15 minute appts-absolutely no way to slice it.

You are absolutely correct to think about $$$$ and retirement. Reimbursements go down and down while costs go up and up.

 

[HemeOncHopeful19]

Not a pediatrician but you will hear people say “only do surgery if you can’t see yourself being happy doing ANYTHING ELSE” and I think it also applies to Peds unfortunately.

Consider doing something else that can still involve kids such as Anesthesia -> Peds Anesthesia for example as an alternative IMO

 

[GBurdell]

If you think you would like pediatrics, do it. If you think there's something else you would like more, do it. Reimbursement of whatever specialty may change over time. You might end up in a field that you choose for the money and forces outside of your control mean you make less than you initially thought and then you're stuck.

 

[Putkernerinthehall]

I would not do Peds if I had the choice again. I love the field--and it's an amazing magical specialty, and I love my current practice--but the writing is on the wall. I would have done anesthesia or some procedural specialty, where someone with an online degree isn't seen as my equal by the general public, and increasingly by insurers/govt.

This field is going to be mid-level dominated.

Looks like you've been a Peds attending for a few years now (I'll assume Gen Peds). Have you seen your salary decline since your first full year after residency?

Second point - why would mid-levels (NP's) be attracted to Peds when they can likely make more money in other specialties?

 

[LaughingMan]

Looks like you've been a Peds attending for a few years now (I'll assume Gen Peds). Have you seen your salary decline since your first full year after residency?

Second point - why would mid-levels (NP's) be attracted to Peds when they can likely make more money in other specialties?

No to salary decline,

I think just by the sheer number of midlevels graduating, they make their way to pedi. Lower acuity, and less burn out compared to dealing with adult medicine.

 

[DO2015CA]

Looks like you've been a Peds attending for a few years now (I'll assume Gen Peds). Have you seen your salary decline since your first full year after residency?

Second point - why would mid-levels (NP's) be attracted to Peds when they can likely make more money in other specialties?

Same reason why physicians choose peds knowing they’ll make less

 

[SurfingDoctor]

Then there’s those specialities in peds that deal with dying kids, but get paid less than dealing with dying old people.

We mostly just are self-loathing…

 

[Putkernerinthehall]

Then there’s those specialities in peds that deal with dying kids, but get paid less than dealing with dying old people.

We mostly just are self-loathing…

As an aside, why is it that insurance reimbursements for children are lower than those for adults? Does this country just not value children as much ?

 

[Lexdiamondz]

As an aside, why is it that insurance reimbursements for children are lower than those for adults? Does this country just not value children as much ?

More children are covered by medicaid, thus leading to worse revenue overall.

Couple that with the reality that the kids who end up hospitalised and require expensive care tend to come from less healthy, lower SES backgrounds and you have a recipe for poor reimbursement.

Pediatric EM earns almost 100k less on average than general EM despite requiring 2-3 years more training.

 

[SurfingDoctor]

As an aside, why is it that insurance reimbursements for children are lower than those for adults? Does this country just not value children as much ?

Kids are generally healthier and therefore cost less to care for.

There’s a whole MICU of grandpas and grandmas trying to tap out, while in the PICU, the number of little ones trying to tap out is much smaller. Those illnesses are linked to DRGs which are directly related to reimbursement. The more ICD and CPT codes, the higher the DRG, the more the hospital pays you in return.

Of course, the irony of that is that a PICU doctor sleeps in the hospital to keep a close eye on those one or two sickest kids, while in the MICU doctor is asleep in their own bed and roll in the next morning to sign the death certificates.

Medicine is hilarious like that sometimes…

 

[A Salty Girl]

I know most of you are pediatricians so this might seem like a negative statement but please hear me out.

Was a peds RN prior to med school and came in expecting to do peds and am still thinking of PICU or even peds hospitalist. I've been trying to convince myself to do an adult specialty (honestly because of the pay and benefits) and could see myself tolerating any specialty, but I just have loved my pediatrics rotation as I figured I would.

It seems unfair to have to do a peds hospitalist fellowship to come out making.. I'm not sure $150-180k if I'm being generous, when your adult counterparts make almost twice that. Pediatrics is still medically complex, it's higher stakes in terms of bad outcomes and yet you're still not compensated as you should be. I feel at the end of the day I would be happiest in peds albeit at a real financial cost. And yes I know 180k is not poor and this post wreaks of greed. It's just the principle about it and it burns me up.

It's true that you can't put a price on happiness but that price is potentially millions at the end of a career that could allow one to retire earlier. Am I looking at this the wrong way? Would you do peds if you had to make the choice again?

I'm also a former peds nurse in med school and I was reading this post thinking "wait when did I write this?"

Then realized someone exactly like me wrote it.

I'm torn between PICU/NICU and derm

 

[kellsmd]

Your ultimate question: Would you do peds if you had to make the choice again?

1000% yes.

There are so many paths you can take in medicine and in each specialty.

17 years in general pediatrics, as well as academics, teaching, etc. has been incredibly rewarding and personally fulfilling for me.

I hear your financial concerns - and it really depends on where you choose to work and live. Big picture, it's very rewarding on all fronts.

 

[DO2015CA]

I'm also a former peds nurse in med school and I was reading this post thinking "wait when did I write this?"

Then realized someone exactly like me wrote it.

I'm torn between PICU/NICU and derm

You won’t be poor in any peds specialty but you will be completely fine with picu and nicu. Both don’t make as much as adult counterparts as a whole but neither fits in the poor peds stereotype that everyone goes on about. Nicu has the better job market.

 

[A Salty Girl]

You won’t be poor in any peds specialty but you will be completely fine with picu and nicu. Both don’t make as much as adult counterparts as a whole but neither fits in the poor peds stereotype that everyone goes on about. Nicu has the better job market.

What do you think is a reasonable salary a PICU and NICU doctor could hope to make at an academic center?

I keep seeing people say pediatricians make $160k, and it seems it would be hard to pay off loans for that. But I wonder if it's accurate or if PICU/NICU can ever expect to get past low $200k's? The internet is always unclear about subspecialty pay.

I totally get money is not everything. But I also don't want to train until I'm 40, to still be making what I made as a travel nurse but with physician responsibility.

 

[DO2015CA]

What do you think is a reasonable salary a PICU and NICU doctor could hope to make at an academic center?

I keep seeing people say pediatricians make $160k, and it seems it would be hard to pay off loans for that. But I wonder if it's accurate or if PICU/NICU can ever expect to get past low $200k's? The internet is always unclear about subspecialty pay.

I totally get money is not everything. But I also don't want to train until I'm 40, to still be making what I made as a travel nurse but with physician responsibility.

Lol. Most of my friends that are general outpatient pediatricians (resident friends ~10) are making 225+ for 4.5 days outpatient clinic with Maybe well newborn nursery rounding every 6 to 8 weeks. These are all employed positions that are not academic, and in west coast, Midwest, and south. I don’t know what the northeast looks like. These are midsize cities to rural. The only rural one that I know is making just over 250 but they also have significantly more call.

I do not know NICU or PICU salaries as idk anyone in those fields to ask. Everything you find online will be underestimates for all fields

 

[PTPoeny]

What do you think is a reasonable salary a PICU and NICU doctor could hope to make at an academic center?

I keep seeing people say pediatricians make $160k, and it seems it would be hard to pay off loans for that. But I wonder if it's accurate or if PICU/NICU can ever expect to get past low $200k's? The internet is always unclear about subspecialty pay.

I totally get money is not everything. But I also don't want to train until I'm 40, to still be making what I made as a travel nurse but with physician responsibility.

Yes, NICU and PICU can get past low 200s even in academic centers in the Northeast where salaries are generally the lowest. MGMA data gets posted on SDN on a regular basis which isn't perfect but will give you ballpark numbers.

 

[DO2015CA]

Yes, NICU and PICU can get past low 200s even in academic centers in the Northeast where salaries are generally the lowest. MGMA data gets posted on SDN on a regular basis which isn't perfect but will give you ballpark numbers.

Agreed with MGMA although the last ones I can find are 2018 are certainly dated at this point. Especially with covid and the inflation happening.

 

[GoSpursGo]

As an aside, why is it that insurance reimbursements for children are lower than those for adults? Does this country just not value children as much ?

Yes, the country just doesn't value children as much. This is why only 4% of cancer funding goes to childhood cancer, despite the fact that new treatments in pediatric cancer can often be curative (as opposed to, say, extending PFS by 4 months).

Aside from research funding, a lot of this also has to do with Medicaid reimbursement as outlined above.

 

[SurfingDoctor]

Ya know, the key to longevity in any field is about enjoying your job and not burning out. Personally, have personally known a good number of Hindenburgs... increasing salary did not prevent them from their spectacular self-destruction.

Anyway...

 

[LaughingMan]

Ya know, the key to longevity in any field is about enjoying your job and not burning out. Personally, have personally known a good number of Hindenburgs... increasing salary did not prevent them from their spectacular self-destruction.

Anyway...

I know multiple Pedi docs who are already planning their exit after 2-3 years trying to get into admin or pharma. Seeing 20+ patients a day with increasingly demanding patients with decreasing reimbursement is going to burn out even the brightest candle.

 

[SurfingDoctor]

I know multiple Pedi docs who are already planning their exit after 2-3 years trying to get into admin or pharma. Seeing 20+ patients a day with increasingly demanding patients with decreasing reimbursement is going to burn out even the brightest candle.

Hopefully, their grass is greener. Though, sometimes... it's not.

 

[calvinhobbes]

Montefiore in NYC had 10 unmatched (unfilled) peds slots this year! Damn!!

 

[calvinhobbes]

Scary

 

[SurfingDoctor]

Montefiore in NYC had 10 unmatched (unfilled) peds slots this year! Damn!!

It’s pretty interesting looking at the match lists in Medical Student forum.

Most places are matching more people to Orthopedics than Pediatrics. That’s gonna have some interesting effects of market forces in about 10 to 15 years.

 

[Oso]

Montefiore in NYC had 10 unmatched (unfilled) peds slots this year! Damn!!

Oof that’s gonna be rough!

Any other Peds programs go unfilled? Had never thought about this being an issue for peds residency…

 

[Putkernerinthehall]

Yes, the country just doesn't value children as much. This is why only 4% of cancer funding goes to childhood cancer, despite the fact that new treatments in pediatric cancer can often be curative (as opposed to, say, extending PFS by 4 months).

Aside from research funding, a lot of this also has to do with Medicaid reimbursement as outlined above.

Thanks. I'm aware of the lower Medicaid reimbursements for children but what I haven't heard is "why" they are lower for kids.

 

[allantois]

Maybe consider child psych. The pay and demand are great

 

[GoSpursGo]

Thanks. I'm aware of the lower Medicaid reimbursements for children but what I haven't heard is "why" they are lower for kids.

Same reason Medicare reimbursements are low, price is set by federal government. Difference is that many more kids are covered by Medicaid than adults are by Medicare

 

[DO2015CA]

Thanks. I'm aware of the lower Medicaid reimbursements for children but what I haven't heard is "why" they are lower for kids.

Americans dont care about their kids no matter what they say. People don’t want to put their money where their mouth is. Just look at most states education funding

 

[oldbearprofessor]

Results for the pediatric match were very similar to recent years. Residency Data & Reports

 

[SurfingDoctor]

Americans dont care about their kids no matter what they say. People don’t want to put their money where their mouth is. Just look at most states education funding

 

[A Salty Girl]

Maybe consider child psych. The pay and demand are great

What do you consider to be great pay?

And I am actually considering this! But I love babies, and babies don't get depressed. So I wonder if I would miss babies in peds psych...

Or I could just have babies at home and big kids at work.

 

[starved]

I am a former Peds resident/PICU fellow that moved to a different specialty.
Yes!! I chose to go through more years of training than practice pediatrics.

In summary :
Peds is a beautiful specialty in theory, but the actual practice of it in the US is painful and mind-numbing. Training is bad almost everywhere, leaving you scarred and ill-equipped to actually manage your patients. So, eventually you are stuck with a lot less money and a lot more frustration.
If you love working with kids in general, pick another field and subspecialize in peds, like peds anesthesia or peds surg. If you truly love a particular pediatric pathology like congenital hearts or pediatric cancer, then go for it.
Also, caring for adults is demonized by pediatricians. In my new life, I take care of a lot of old grandmas and grandpas who are scared of the hospital and don't understand what is happening to them. Taking care of them has been as emotionally rewarding as it was taking care of small kids.

Long answer:
1. The longer I worked in a generalist role ( I think PICU/Peds hospitalist are all generalists but work in a different environemnt than clinic), I realized what I was doing was not adding too much value to my patient's care but I was left handling annoying/social work things that no one else wanted to handle. Subspecialities dictate a lot of the care, and I was fed up of being a middle man managing a sick kid. If it is was well child/gen peds, so much of well-child care is protocolized and pediatricians hardly have any time to see their patients or develop the relationships they talk about.

2. After 6 yrs I felt undertrained..Yes!! Peds if done properly is very complex and rewarding, but training standards have fallen a lot in recent years. Residency training is practically useless, because residents mostly learn how to use epic to do the bidding of their attendings/fellows or do glorified social work, all while dealing with some extremely challenging/frustrated parents. In-patient peds is feast or famine, some respiratory seasons are terrible and you could learn a lot, but some are just not bad and you missed out on a lot of learning. There is no way to fix that problem easily.

2. Better trained and more experienced mid-levels than fresh grad gen peds residents.. esp true in procedure heavy NICU/PICU. It's a negative reinforcement cycle, worse training means more and more preference of the better trained/esperienced NP and this won't go away. Many NPs were former PICU/NICU nurses themselves, so they have a one-up on fresh grads already.

3. Stupid subspecialty training and ABP/ AAP's extremely poor ability to advocate for themselves . Most subspecialties are 3yrs in length but nearly 50% of that is research time..why?? so you can be cheap manpower to staff someone's research. Most other adult sub specialties make research optional but peds won't. The new hospitalist fellowship is basically a testament to the fact that residency training is bad. If you trained your residents properly, why do you need more training? So now in some areas of the country, you can't do anything other than gen peds if you didn't train more.

4. Job opportunities and flexibility: There are maybe 10-15 adult gigs in town for every 1 or 2 peds facility. That one peds place now has absolute negotiating power over you, esp if they know that you don't want to move elsewhere. most of my former PICU co-fellows had real trouble finding jobs and mostly settled for something they weren't truly looking for.

 

[DO2015CA]

I am a former Peds resident/PICU fellow that moved to a different specialty.
Yes!! I chose to go through more years of training than practice pediatrics.

In summary :
Peds is a beautiful specialty in theory, but the actual practice of it in the US is painful and mind-numbing. Training is bad almost everywhere, leaving you scarred and ill-equipped to actually manage your patients. So, eventually you are stuck with a lot less money and a lot more frustration.
If you love working with kids in general, pick another field and subspecialize in peds, like peds anesthesia or peds surg. If you truly love a particular pediatric pathology like congenital hearts or pediatric cancer, then go for it.
Also, caring for adults is demonized by pediatricians. In my new life, I take care of a lot of old grandmas and grandpas who are scared of the hospital and don't understand what is happening to them. Taking care of them has been as emotionally rewarding as it was taking care of small kids.

Long answer:
1. The longer I worked in a generalist role ( I think PICU/Peds hospitalist are all generalists but work in a different environemnt than clinic), I realized what I was doing was not adding too much value to my patient's care but I was left handling annoying/social work things that no one else wanted to handle. Subspecialities dictate a lot of the care, and I was fed up of being a middle man managing a sick kid. If it is was well child/gen peds, so much of well-child care is protocolized and pediatricians hardly have any time to see their patients or develop the relationships they talk about.

2. After 6 yrs I felt undertrained..Yes!! Peds if done properly is very complex and rewarding, but training standards have fallen a lot in recent years. Residency training is practically useless, because residents mostly learn how to use epic to do the bidding of their attendings/fellows or do glorified social work, all while dealing with some extremely challenging/frustrated parents. In-patient peds is feast or famine, some respiratory seasons are terrible and you could learn a lot, but some are just not bad and you missed out on a lot of learning. There is no way to fix that problem easily.

2. Better trained and more experienced mid-levels than fresh grad gen peds residents.. esp true in procedure heavy NICU/PICU. It's a negative reinforcement cycle, worse training means more and more preference of the better trained/esperienced NP and this won't go away. Many NPs were former PICU/NICU nurses themselves, so they have a one-up on fresh grads already.

3. Stupid subspecialty training and ABP/ AAP's extremely poor ability to advocate for themselves . Most subspecialties are 3yrs in length but nearly 50% of that is research time..why?? so you can be cheap manpower to staff someone's research. Most other adult sub specialties make research optional but peds won't. The new hospitalist fellowship is basically a testament to the fact that residency training is bad. If you trained your residents properly, why do you need more training? So now in some areas of the country, you can't do anything other than gen peds if you didn't train more.

4. Job opportunities and flexibility: There are maybe 10-15 adult gigs in town for every 1 or 2 peds facility. That one peds place now has absolute negotiating power over you, esp if they know that you don't want to move elsewhere. most of my former PICU co-fellows had real trouble finding jobs and mostly settled for something they weren't truly looking for.

Did you get any time shaved off for the second residency?

 

[bronx43]

It’s pretty interesting looking at the match lists in Medical Student forum.

Most places are matching more people to Orthopedics than Pediatrics. That’s gonna have some interesting effects of market forces in about 10 to 15 years.

Orthos are basically used car salesmen these days due to their oversupply. I've worked in many different geographic locales from urban to semirural to rural, and there are ALWAYS multiple competing groups of orthos.
If you see ortho these days, they'll try to sell you a surgery no matter what MSK ailment you have.

On the other hand, if one needs to see an endocrinologist for some non-DM endocrine disease, you're gonna wait 9 months.
I guess this is what happens when CMS decides to pay 10-15k in facility fees for a 90 minute knee replacement and not enough for a non-proceduralist to even pay rent seeing complex clinic patients.

 

[starved]

Did you get any time shaved off for the second residency?

Yes, I did..still in my second residency, have been promised 6 months off if I can get my numbers and required rotations on time..but it was something I got at this program, and not something that I could get at other places I interviewed..
I loved congenital hearts, but realized I would have to do yet another fellowship to be a CICU attending. Some places have a 1 yr fellowship, but that is not always accepted all over the country. Many academic ivory towers demand a whole second cardiology fellowship of 2yrs (which unfortunately is where most of the complex congenital heart kids are cared for anyways). So, when I did the math and realized that at 2.5 yrs more training I had the opportunity to practice a far higher paying, administratively easier specialty that I knew I also liked medically speaking, the choice was easy. DM me if you have more questions

 

[Staphylococcus Aureus]

Yes, I did..still in my second residency, have been promised 6 months off if I can get my numbers and required rotations on time..but it was something I got at this program, and not something that I could get at other places I interviewed..
I loved congenital hearts, but realized I would have to do yet another fellowship to be a CICU attending. Some places have a 1 yr fellowship, but that is not always accepted all over the country. Many academic ivory towers demand a whole second cardiology fellowship of 2yrs (which unfortunately is where most of the complex congenital heart kids are cared for anyways). So, when I did the math and realized that at 2.5 yrs more training I had the opportunity to practice a far higher paying, administratively easier specialty that I knew I also liked medically speaking, the choice was easy. DM me if you have more questions

What specialty did you switch to?

 

[Oso]

I am a former Peds resident/PICU fellow that moved to a different specialty.
Yes!! I chose to go through more years of training than practice pediatrics.

In summary :
Peds is a beautiful specialty in theory, but the actual practice of it in the US is painful and mind-numbing. Training is bad almost everywhere, leaving you scarred and ill-equipped to actually manage your patients. So, eventually you are stuck with a lot less money and a lot more frustration.
If you love working with kids in general, pick another field and subspecialize in peds, like peds anesthesia or peds surg. If you truly love a particular pediatric pathology like congenital hearts or pediatric cancer, then go for it.
Also, caring for adults is demonized by pediatricians. In my new life, I take care of a lot of old grandmas and grandpas who are scared of the hospital and don't understand what is happening to them. Taking care of them has been as emotionally rewarding as it was taking care of small kids.

Long answer:
1. The longer I worked in a generalist role ( I think PICU/Peds hospitalist are all generalists but work in a different environemnt than clinic), I realized what I was doing was not adding too much value to my patient's care but I was left handling annoying/social work things that no one else wanted to handle. Subspecialities dictate a lot of the care, and I was fed up of being a middle man managing a sick kid. If it is was well child/gen peds, so much of well-child care is protocolized and pediatricians hardly have any time to see their patients or develop the relationships they talk about.

2. After 6 yrs I felt undertrained..Yes!! Peds if done properly is very complex and rewarding, but training standards have fallen a lot in recent years. Residency training is practically useless, because residents mostly learn how to use epic to do the bidding of their attendings/fellows or do glorified social work, all while dealing with some extremely challenging/frustrated parents. In-patient peds is feast or famine, some respiratory seasons are terrible and you could learn a lot, but some are just not bad and you missed out on a lot of learning. There is no way to fix that problem easily.

2. Better trained and more experienced mid-levels than fresh grad gen peds residents.. esp true in procedure heavy NICU/PICU. It's a negative reinforcement cycle, worse training means more and more preference of the better trained/esperienced NP and this won't go away. Many NPs were former PICU/NICU nurses themselves, so they have a one-up on fresh grads already.

3. Stupid subspecialty training and ABP/ AAP's extremely poor ability to advocate for themselves . Most subspecialties are 3yrs in length but nearly 50% of that is research time..why?? so you can be cheap manpower to staff someone's research. Most other adult sub specialties make research optional but peds won't. The new hospitalist fellowship is basically a testament to the fact that residency training is bad. If you trained your residents properly, why do you need more training? So now in some areas of the country, you can't do anything other than gen peds if you didn't train more.

4. Job opportunities and flexibility: There are maybe 10-15 adult gigs in town for every 1 or 2 peds facility. That one peds place now has absolute negotiating power over you, esp if they know that you don't want to move elsewhere. most of my former PICU co-fellows had real trouble finding jobs and mostly settled for something they weren't truly looking for.

Did you finish PICU fellowship or switch before graduating? If you don’t mind sharing, which specialty did you switch to/practice in?

 

[Yale Medicine]

I know most of you are pediatricians so this might seem like a negative statement but please hear me out.

Was a peds RN prior to med school and came in expecting to do peds and am still thinking of PICU or even peds hospitalist. I've been trying to convince myself to do an adult specialty (honestly because of the pay and benefits) and could see myself tolerating any specialty, but I just have loved my pediatrics rotation as I figured I would.

It seems unfair to have to do a peds hospitalist fellowship to come out making.. I'm not sure $150-180k if I'm being generous, when your adult counterparts make almost twice that. Pediatrics is still medically complex, it's higher stakes in terms of bad outcomes and yet you're still not compensated as you should be. I feel at the end of the day I would be happiest in peds albeit at a real financial cost. And yes I know 180k is not poor and this post wreaks of greed. It's just the principle about it and it burns me up.

It's true that you can't put a price on happiness but that price is potentially millions at the end of a career that could allow one to retire earlier. Am I looking at this the wrong way? Would you do peds if you had to make the choice again?

As you get older, get a family going, mortgage, etc, money becomes not only more important but a key to happiness the cliché is true. It is prudent to factor this in.

 

[SurfingDoctor]

As you get older, get a family going, mortgage, etc, money becomes not only more important but a key to happiness the cliché is true. It is prudent to factor this in.

Interestingly... my colleagues who complain the most about money are the most burntout...

They also are just the most unsatisfied in life in general... like they hope the grass is greener... but they piss on the lawn.

 

[finalpsychyear]

It's not right at all that peds is so poorly compensated. When you have Nps approaching the 120-150 range it is beyond ridiculous.
I think you have to be ok with the salary hit or have a spouse where it makes financial sense. I think you guys have trained way to long and deserve much more.

 

[Putkernerinthehall]

Same reason Medicare reimbursements are low, price is set by federal government. Difference is that many more kids are covered by Medicaid than adults are by Medicare

Do you have insight as to why the federal government sets Medicaid reimbursements for children so low? Lower than for adults on Medicaid I assume, and lower than for those on Medicare.

 

[HemeOncHopeful19]

Do you have insight as to why the federal government sets Medicaid reimbursements for children so low? Lower than for adults on Medicaid I assume, and lower than for those on Medicare.

Adults on Medicaid also pays like crap. The only way to make money with Medicaid patients is to do some sort of PCMH FQHC BBQ type thing where they give you bonus payments.

 

[GoSpursGo]

Do you have insight as to why the federal government sets Medicaid reimbursements for children so low? Lower than for adults on Medicaid I assume, and lower than for those on Medicare.

As above. And because Medicaid is underfunded in the federal budget. You can’t pay money you don’t have

 

[Putkernerinthehall]

As above. And because Medicaid is underfunded in the federal budget. You can’t pay money you don’t have

Ok, got it. So it's purely an abject failure on the part of some of our legislators to prioritize Medicaid and fund it adequately.

 

[DO2015CA]

Ok, got it. So it's purely an abject failure on the part of some of our legislators to prioritize Medicaid and fund it adequately.

Not purely but it’s a significant portion. Citizens don’t press lawmakers to make children a priority. Lastly, and I can’t state this enough, a large portion of parents don’t prioritize their children either. It doesn’t take long in pediatric practice to come across many parents that will choose the lesser treatment option because one is covered by insurance and the other would have an out of pocket expense. (It would be a different story if cost was the issue but it happens even with affluent parents as well). Usually it’s medicines which doesn’t equate to more money in the physicians pocket (but an example that affects money would be dealing with prior auths to try and get the better medicine approved which will take time away from seeing patients).

 

[Socrates25]

This field is going to be mid-level dominated.

Disagree, I can open a practice right down the block from an NP factory and within weeks start stealing their patients. I've already done that three times in 3 separate areas of the country. I LOVE opening practices in areas that are dominated by NPs.

Hell I love opening practices in areas that have only hospital based practices because I can steal their patients too.

You guys are looking at this the wrong way. NPs and hospital based peds practices lower the level of your competition substantially and make it a lot easier to distinguish yourself in the marketplace.