To (med)peds or not to peds

[TelemarketingEnigma]

oh look another M3 asking for help with their existential crisis about specialty choice

Background: Came into med school strongly considering either IM or EM. Specific interests include ID, genetics, substance use/harm reduction. Interested in staying at least peripherally academic, maybe combo county/academic. Thought kiddos were cute but didn't think I'd want to work with them...oops
Completed rotations so far: Psych (interesting pathology, don't like the philosophy/attitudes), FM (fun, but outpatient's not for me), Ob/Gyn (fun experience but I'm over it now, not into surgery). Just finished Peds... which I somewhat unexpectedly LOVED.
Rotations yet to come: IM, Surgery, EM, Neuro, Misc electives

The Dilemma: Med Peds vs. IM (vs. EM??)
All my previous clinical experience has been with adults. Not every aspect of peds was my favorite but I had way way more fun than I expected to. I generally find at least some aspect of every rotation that I enjoy, but I just felt overall much happier during peds than previous rotations. I don't think I'd want to work only with kids (adults are cool too), but I think I'd be sad if I never got to work with kids again. I find well child visits somewhat boring (adult well visits are also boring) but I could tolerate them with the right balance of sick visits and inpatient work (my favorite so far). I also had a lot of fun in the peds ED.

Med Peds pros: work with both kids and adults, I get along well with the residents/faculty I've met, more inpatient time than something like FM, could lead into combined training in ID or genetics or just hospitalist
cons: longer training, not as many programs near my family (west coast). don't have a great vision now of where my career would go after training, maybe i'm just delaying the inevitable choice? or maybe I just need to explore the possibilities more

IM pros: shorter training, better vision of what I might do with a career afterwards
cons: haven't actually done the rotation yet lol. also no kiddos.

EM: I'm leaning away from this at the moment but there's still a nagging what if?? I enjoyed the peds ED but won't get to do adult EM until late spring at the earliest, so I may have another round of existential crisis then (not ideal). Could potentially be a route to seeing both kids and adults depending on setting.

My priorities: I want to be academically engaged in my work but still have a life outside of medicine. Enjoy working with underserved populations and social justice issues. Would like to continue doing some research/maybe teaching. Would be nice to get back near my family but I'm willing to be geographically flexible if I need to. Not concerned with making giant piles of money.

So internet people, any suggestions? advice? Snide comments? tell me what to do with my life

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[Espressso]

Why isn't Peds on the list? You clearly loved peds, and your priorities can all be met with peds. You could do a fellowship in peds ID, peds ICU and only work inpatient, there's good flexibility I think with peds.

 

[Cranjis McBasketball]

oh look another M3 asking for help with their existential crisis about specialty choice

Background: Came into med school strongly considering either IM or EM. Specific interests include ID, genetics, substance use/harm reduction. Interested in staying at least peripherally academic, maybe combo county/academic. Thought kiddos were cute but didn't think I'd want to work with them...oops
Completed rotations so far: Psych (interesting pathology, don't like the philosophy/attitudes), FM (fun, but outpatient's not for me), Ob/Gyn (fun experience but I'm over it now, not into surgery). Just finished Peds... which I somewhat unexpectedly LOVED.
Rotations yet to come: IM, Surgery, EM, Neuro, Misc electives

The Dilemma: Med Peds vs. IM (vs. EM??)
All my previous clinical experience has been with adults. Not every aspect of peds was my favorite but I had way way more fun than I expected to. I generally find at least some aspect of every rotation that I enjoy, but I just felt overall much happier during peds than previous rotations. I don't think I'd want to work only with kids (adults are cool too), but I think I'd be sad if I never got to work with kids again. I find well child visits somewhat boring (adult well visits are also boring) but I could tolerate them with the right balance of sick visits and inpatient work (my favorite so far). I also had a lot of fun in the peds ED.

Med Peds pros: work with both kids and adults, I get along well with the residents/faculty I've met, more inpatient time than something like FM, could lead into combined training in ID or genetics or just hospitalist
cons: longer training, not as many programs near my family (west coast). don't have a great vision now of where my career would go after training, maybe i'm just delaying the inevitable choice? or maybe I just need to explore the possibilities more

IM pros: shorter training, better vision of what I might do with a career afterwards
cons: haven't actually done the rotation yet lol. also no kiddos.

EM: I'm leaning away from this at the moment but there's still a nagging what if?? I enjoyed the peds ED but won't get to do adult EM until late spring at the earliest, so I may have another round of existential crisis then (not ideal). Could potentially be a route to seeing both kids and adults depending on setting.

My priorities: I want to be academically engaged in my work but still have a life outside of medicine. Enjoy working with underserved populations and social justice issues. Would like to continue doing some research/maybe teaching. Would be nice to get back near my family but I'm willing to be geographically flexible if I need to. Not concerned with making giant piles of money.

So internet people, any suggestions? advice? Snide comments? tell me what to do with my life

I could be very wrong, but dont most people that go into med-peds have to eventually choose one or the other to focus on, unless you go rural?

 

[Vyzzle]

I could be very wrong, but dont most people that go into med-peds have to eventually choose one or the other to focus on, unless you go rural?

Not necessarily, I know some physicians will enter a niche where they can follow people throughout the lifespan (congenital heart conditions, blood disorders, etc) and/or focus their care on young adults who fall between ped and adult care. A lot if not most do fall to one side or the other, though.

And this may just be my take, but choosing a specialty is not only about the patients and type of stuff you wanna see, but the general culture of a specialty can have a huge impact. Good luck OP, I'm in the same boat as you.

 

[TelemarketingEnigma]

Why isn't Peds on the list? You clearly loved peds, and your priorities can all be met with peds. You could do a fellowship in peds ID, peds ICU and only work inpatient, there's good flexibility I think with peds.

I've done a lot of work with adults (before rotations) that i've really enjoyed and could see myself focusing on (especially working with people who inject drugs, infectious consequences of addiction), and I don't know that I'm ready to give that up. Some of that can be done with adolescents but that's not really a niche that peds hits as well by itself. I'm expecting that some of what I loved about peds (it was my first time really working on the wards) will carry over to IM (which I have next), while other aspects won't (the patients, obviously). At the moment, I think if it came down to it I'd prefer to be a general internist than a general pediatrician - but the peds interest is also a lot newer, so I will definitely be thinking about it more. Some of it may depend on how I feel in a few weeks/months once I'm past the honeymoon phase with peds and back to working with adults.

I could be very wrong, but dont most people that go into med-peds have to eventually choose one or the other to focus on, unless you go rural?

Not necessarily, I know some physicians will enter a niche where they can follow people throughout the lifespan (congenital heart conditions, blood disorders, etc) and/or focus their care on young adults who fall between ped and adult care. A lot if not most do fall to one side or the other, though.

And this may just be my take, but choosing a specialty is not only about the patients and type of stuff you wanna see, but the general culture of a specialty can have a huge impact. Good luck OP, I'm in the same boat as you.

Yeah, as I've been exploring there's been a surprising variety of combined med peds practice options I've come across! I think it's more common in academic settings as well, which is fine with me. So far I like what I've seen of the med peds culture. I also think that in the end, I may be okay with using this training to kick the decision further down the road - even if i end up choosing one or the other eventually, I would get 4 additional years of working with both.

 

[Kgizzle]

You sound like a prototypical EM/Gas applicant. Calling it now. You seem like you working with all ages but prefer a mix of acuity. Sounds like you also hate clinic so thats just my guess.

 

[TelemarketingEnigma]

You sound like a prototypical EM/Gas applicant. Calling it now. You seem like you working with all ages but prefer a mix of acuity. Sounds like you also hate clinic so thats just my guess.

That's a pretty fair assessment, but so far I don't love the OR so I don't see Gas in my future. I don't know that I hate clinic but I find the workflow a lot more tiring/less engaging than other settings, and general well visits are definitely not my fav. I could see doing something with like a more specialized clinic a couple days a week, but definitely not as my main setting

 

[mvenus929]

I could be very wrong, but dont most people that go into med-peds have to eventually choose one or the other to focus on, unless you go rural?

If the idea is to stay in academics, then it's definitely possible to do both. I'm at a Children's Hospital that has a med-peds program associated with it, and we have several faculty that are med-peds trained and work in a variety of settings. I've also been interviewing for faculty positions and there is a surprising number of med/peds trained specialists (the obvious ones are cardiology because you can do adult congenital easily, but I'm endo and I've met at least two med/peds endos who spend time in both the adult and peds worlds). Finding the job that will allow you to do both is a little harder because a lot of places have stand alone children's hospitals that aren't looking for part-time people (so you can do part-time in the adult world), but there are lots of hospital within a hospital that you could easily develop a niche in both worlds.