Thoughts on not choosing peds for financial reasons

[Socrates25]

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.

I did med/peds in residency and the training is night and day different. Let me be frank as to why. Adult IM residents get to "practice" procedures on their patients a lot more than peds because IM attendings don't care as much if there's bad outcomes. In my MICU rotation I was thrust into procedures left and right from day one as an intern that I NEVER would have been allowed to do in PICU or NICU.

The reality is that attendings care more about their patients in the peds world than they do in the adult world. If an 85 year old decompenstates in the MICU, it's considered a typical ho hum day and the attendings dont get worked up about it. In the PICU that kind of attitude would never fly, even if it's a kid with a terminal diagnosis in which the end is obvious.

Hospital based jobs are always going to be greatly limited to compared to non-hospital jobs and that's true in both adult and peds world.

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[SurfingDoctor]

I did med/peds in residency and the training is night and day different. Let me be frank as to why. Adult IM residents get to "practice" procedures on their patients a lot more than peds because IM attendings don't care as much if there's bad outcomes. In my MICU rotation I was thrust into procedures left and right from day one as an intern that I NEVER would have been allowed to do in PICU or NICU.

The reality is that attendings care more about their patients in the peds world than they do in the adult world. If an 85 year old decompenstates in the MICU, it's considered a typical ho hum day and the attendings dont get worked up about it. In the PICU that kind of attitude would never fly, even if it's a kid with a terminal diagnosis in which the end is obvious.

Hospital based jobs are always going to be greatly limited to compared to non-hospital jobs and that's true in both adult and peds world.

Everyone expects to outlive their grandpa, no ones expects to outlive their children.

 

[LaughingMan]

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.

So you are correct, opening practices definitely can be a more viable option. I think with the trends going, I don't know how long that is going to be viable.

 

[POS23]

I would choose Peds as a specialty again if I knew that the ABP were NOT overseeing certification/ MOC.

Compared to other basic specialties, the ABP just makes life so much more complicated.

 

[Putkernerinthehall]

I would choose Peds as a specialty again if I knew that the ABP were NOT overseeing certification/ MOC.

Compared to other basic specialties, the ABP just makes life so much more complicated.

How does ABP make it difficult / more complicated ?

 

[HemeOncHopeful19]

How does ABP make it difficult / more complicated ?

The failure rate on the initial cert exam is ridiculous and (never taken it but have friends who do) questionably relevant to actual practice.

Basically the past few years ABP is claiming via their exam that 1 in 5 graduating residents is apparently not competent to practice…

 

[Putkernerinthehall]

The failure rate on the initial cert exam is ridiculous and (never taken it but have friends who do) questionably relevant to actual practice.

Basically the past few years ABP is claiming via their exam that 1 in 5 graduating residents is apparently not competent to practice…

80% first time pass rate ? Doesn't sound ideal but not horrible either.

 

[DO2015CA]

80% first time pass rate ? Doesn't sound ideal but not horrible either.

When our adult counterparts are mid 90s? I don’t think peds is so much more difficult or the peds residents are dumber compared to IM to warrant those 1st time pass rates

 

[Putkernerinthehall]

When our adult counterparts are mid 90s? I don’t think peds is so much more difficult or the peds residents are dumber compared to IM to warrant those 1st time pass rates

Yeah, that's a bigger difference than I thought. What's the reasoning behind ABP making it so difficult ?

 

[FiannaLove]

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.

Hearing you specify 17 years of doing various things is very reassuring to me. I appreciate that.

 

[SurfingDoctor]

:: thinking about when the pass rate was in the 70s ::

 

[DO2015CA]

:: thinking about when the pass rate was in the 70s ::

Lol. It was 80 this year. That’s close enough. Looks like it’s been slowly decreasing since 2018

 

[SurfingDoctor]

Lol. It was 80 this year. That’s close enough. Looks like it’s been slowly decreasing since 2018

I don’t disagree. It’s hard to imagine the incentive to let 1 in 5 pediatricians who went through the training not practice.

That being said, you also don’t want it to be too easy. I also think recertification is kinda a dumb process and idea.

 

[DO2015CA]

I don’t disagree. It’s hard to imagine the incentive to let 1 in 5 pediatricians who went through the training not practice.

That being said, you also don’t want it to be too easy. I also think recertification is kinda a dumb process and idea.

Ya somewhere in the 90s is good. Did you see the first time parse rates for fellows? PICU was also 80, hospice 85, and Pulmonology 69. Wild

 

[SurfingDoctor]

Ya somewhere in the 90s is good. Did you see the first time parse rates for fellows? PICU was also 80, hospice 85, and Pulmonology 69. Wild

Palliative care isn’t 100%? That is pretty surprising.

 

[DO2015CA]

https://www.abp.org/sites/abp/files/pdf/exam-pass-rates-init-cert.pdf

 

[oldbearprofessor]

:: thinking about when the pass rate was in the 70s ::

Hmm...my initial thought was that I didn't remember it being that low in the past, but you are right. It sat in the mid-70's until they changed the scoring methods in 2012 when it jumped into the mid-80's. I do remember that when I took neo boards for the first time (I am lifer, it was a long time ago...) the pass rate was 50% and stayed there for quite a few years before going up to current levels.

Regardless, in the current environment a 20% failure rate is unreasonable and non-productive. There is no reason to discourage people going into pediatrics this way. Children are NOT helped by it.