Why are people down on Pediatircs?

Discussion in 'Pediatrics' started by BroncosNation, Aug 15, 2018.

  1. BroncosNation

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    Every time I read something about pediatricians, there is always something about their “low pay”. I never understood this. From research, I see that pediatrician make around 180k. Compared to other doctors, this may be low, however, to the general population this is an outstanding salary. Pharmacists, which require just as much schooling (before residency) make around 60k less then a general pediatrician. Furthermore, compared to other doctors, pediatricians work relatively normal hours and can live standard lives. Because of this, I have always been confused on why people on this website are always talking down to people interested in pediatrics. Any thoughts?
     
    #1 BroncosNation, Aug 15, 2018
    Last edited: Aug 17, 2018
  2. FrkyBgStok

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    Because people suck.

    Medicine is high paying and that naturally draws people looking for money. And because of this, people equate more money with being smarter or better. Doesn’t make sense to me, but I am in pediatrics. People can talk crap about it all they want and it doesn’t bother me because I absolutely love what I do and as soon as a kid comes in they have to take care of, the start freaking out.

    And we talk about this regularly. Only in the company of other pediatricians and doctors can we complain about low pay, but we can’t do it around anyone else as they will undoubtably hate us for complaining about $200k/year.
     
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  3. physicsnerd42

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    Opportunity cost. You train until your 30s for your first job (so it’s not particularly fair to compare medicine to jobs where people get their first salary at 21; it’s more fair to compare Peds to other similar jobs, like the other ones in medicine). If, for instance, you had trained in internal medicine you would earn twice as much as a Peds hospitalist who trained for the same amount of time (or now, thanks to the ABP, two years longer). My hospital’s Peds heme/onc department is hemorrhaging oncologists and can’t easily hire new ones because they pay new, junior Peds oncologists roughly the same as what the floor nurses make (with MUCH less training) and only a little more than half of what outpatient pediatricians make. Adult oncologists make 2-3 times what Peds oncologists make.

    It’s not that pediatricians make bad money in absolute terms, they are just poorly paid compared with every other medical specialty. I think that med students should be made more aware of the true differences in compensation between specialties when choosing a career. Sure, a lot of people only want to do Peds and that’s fine. But if you like a few different specialties it might be helpful to know that by choosing inpatient Peds over inpatient medicine that you’re leaving (for example) ~$5 million on the table over the course of a career. A lot of people will say that doesn’t matter, but see how you feel when you’re trying to raise a family or buy a house.


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  4. Roadhouse

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    Mostly because of poor spelling.
     
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  5. mvenus929

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    I agree it’s about perspective. I will make more than anyone in my family has, and we had WIC when I was a kid, so I know something about economic hardship.

    But it’s sometimes a hard pill to swallow when someone with the same amount of training as you makes double what you make, just because they take care of adults instead of kids. And when you have more than 200K in loans to pay off and make 130K per year because you want to work in an academic setting, it hurts a little more.

    Still wouldn’t have chosen another specialty. I love taking care of kids, and the pathology is so much more interesting and fulfilling.
     
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  6. GoSpursGo

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    Or less training. As evidenced by the recent thread about the current state of fellowship training in pediatrics. Why an IM fellowship is 1 year vs. 3 years for pediatrics is beyond me.

    Agree with above that I wouldn't do anything differently, because I love taking care of kids and I love working with other pediatricians. I certainly am going to do just fine for myself and don't have the energy or motivation to complain too loudly. But it does feel like we get taken advantage of sometimes because we are so laid back and willing to look at how we're doing well financially relative to 99% of the population that we won't stand up and fight for better compensation.
     
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  7. Step Up

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    Medical school debt is the big problem, IMO. For potential, budding or full-blown pediatricians, it's hard not to compare salaries to other medical specialities, as many of us could have easily gone into a higher paying speciality. I'm currently a PGY-5, in a pediatric subspecialty fellowship. I'm 32 years old. I can barely make ends meet month to month with my paychecks. I can't afford to get a dog or have children right now, even though I want to. I have 250k of medical school debt (better situation than some of my former peers!) and can't even pay off my monthly interest, let alone start repaying. If it wasn't for the medical school debt, my financial situation would be so much better. But I'm 32 years old and I can't even do normal human things like have kids or get a dog. That sucks. Do I have justification to complain about my current and potential salary? You tell me.
     
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  8. NurWollen

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    It's these kind of stories that we need the ABP to hear. Pediatric training comes at an enormous personal and financial cost. I wonder how many of the powers that be had wealthy parents who paid for med school (or, more likely, went to med school back before it was so obscenely expensive) thus allowing them more freedom to pursue an academic career.

    Me, a few years from now when I finish training: Screenshot_20180816-203958_Chrome.jpeg
     
    #8 NurWollen, Aug 16, 2018
    Last edited: Aug 16, 2018
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  9. SurfingDoctor

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    Yep... their opinions are irrelevant to me. If one is in their 30s and concerned about what high school students think of their profession... they got bigger issues.

    I know... pretty deep thought...
     
  10. Oso

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    .... is this true?
     
  11. physicsnerd42

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    I’m in California, where nurses make 2-3 times (or so they tell me) what they would in other places and most of the nurses working full time make in the 6 figures. Many of the NPs in my hospital tell me they took pay cuts to work as NPs instead of as floor nurses. From what I’ve heard: a clinical instructor in Peds heme/onc starts at ~$120 k per year.

    From what people who have taken outpatient Peds jobs in the area told me, starting salary for full time is in the $200-220k range for our county hospital system, Kaiser and the biggest local private practice.


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  12. shepardsun

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    Also in California in an academic system, some of our senior recovery room nurses with overtime make mid 6 figures.
     
  13. miacomet

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    Which is insane considering how much people whine about MD salaries. It's also insane because there are plenty of competent nurses doing the same job for a quarter the pay.
     
  14. NurWollen

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    Yeah but California is extremely expensive. Full-time floor nurses at my institution make about what we do as residents. I live in an inexpensive area, wouldn't go nearly as far in California. Rent is easily 2.5x as expensive in California.

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  15. NurWollen

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    I think a lot of people are down on pediatrics because in addition to (comparatively) poor compensation, the perceive that we do nothing but well-child checks and hand out amox for questionable AOM. Which is of course not true, but there is a kernal of truth a think. Because we (as a medical society) treat kids so carefully, we often have to wait until fellowship to do some of the cool procedures and cutting edge and critical care type stuff we really have to wait until fellowship to do, compared to say EM where they learn that stuff starting intern year.

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  16. miacomet

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    Sorry, Sacramento and environs are not that expensive. SF is, but what's funny is that San Fran has notoriously low doc salaries, often lower than nursing salaries. The nurses just have a really corrupt and aggressive union in that part of California. No way is Sac more expensive than NYC or even Boston, and nurses there earn a third what NoCal nurses do. It's crazy.
     
  17. GonnaBeADoc2222

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    Because the pay sucks and parents are awful.

    200k (which is probably the high end for Pediatrics compensation) is not good compensation for a person with 7+ years of post college education and training. I don't really care what the "general population" makes.
     
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  18. SurfingDoctor

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    Sounds like you shouldn’t be in Pediatrics then.
     
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  19. GonnaBeADoc2222

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    And thus I am not

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  20. SurfingDoctor

    SurfingDoctor "Hooray, I'm useful"
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    Then why are you posting in a Pediatric forum about Pediatrics?
     
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  21. DokterMom

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    Consider also what we as a society pay other positions that take care of children: Day care workers, nannies, primary school teachers, babysitters!

    Twice the blame / liability if something goes bad and half the monetary compensation...
     
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  22. GonnaBeADoc2222

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    I'm actually on your side and an advocate of Pediatricians being paid more. Pediatricians are unfairly subject to poor Medicaid billing and suffer unfairly for it. Medical schools do a very poor job educating students on the practical realities of selecting a specialty.
     
  23. SurfingDoctor

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    I don’t think there is anyone on the world who wouldn’t want to get paid more for the work they provide. However, it’s not all about money. I’m not in the top 1% of earners, but I make a comfortable living and am satisfied. But yes if one’s primary aspiration is to be a 1% earner, then choosing Pediatrics is probably the wrong choice. Then again, I haven’t met many Pediatricians who really cared that much. There’s probably good reason Pediatrics has one of the better specialty satisifaction rates.
     
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  24. GonnaBeADoc2222

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    Really? Not according to the most recent Medscape burnout survey:

    Medscape: Medscape Access

    Peds seems to be in the middle third. Not saying Peds can't be a great and fulfilling career. Just saying medical students should be educated about practical issues about income and debt and how they interact.
     
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  25. SurfingDoctor

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    Thats fine. Again, if finances are the top priority, then they should have their life choices meet that priority. I don’t think you see anyone arguing on here otherwise.
     
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  26. NecFasc92

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    Physician career satisfaction within specialties

    Looks like peds is crushing it, actually.
     
  27. mvenus929

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    Your study is from 2009. The Medscape survey is the most recent one from 2018. There's 9 years between them. Times have changed overall, and there is more burnout.
     
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  28. NecFasc92

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    I’m aware of the time difference.

    I’d argue the statistics in what I posted are significantly more reliable, refined, and mathematical. The medscape survey doesn’t even include peds subspec who are tops in satisfaction according study I posted
     
    #28 NecFasc92, Jan 3, 2019
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  29. oldbearprofessor

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    The patients are wonderful, the parents can be difficult, but so can the families of adult patients. 200K is certainly not the high end or close to it for some pedi specialties, especially in private practice neonatology, cardiology and EM.
     
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  30. miacomet

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    I'm sure I'll get burned for this, but it's my honest opinion.

    I loved pediatrics, but not so much the pediatricians, which honestly led me to a different field. I was shocked by the amount of passive-aggression and righteousness in the field, and the attendings I dealt with in both medschool and in residency, and even now as an attending, just weren't nice people for the most part. Maybe the gender balance is off, I don't know, but they were far from the happy, smiley reputation pediatricians promote. Seemed like the worst personalities in all of medicine, and I'm not discounting surgeons. They also seemed mostly to be develepmentalologists, without much interest in the medicine side. I can see why the hospitalist fellowship is mandatory nowadays.

    Peds seems to be a popular field, so I don't think people are down on it, but I think the field would get more respect if it addressed these issues, and if it reworked residency so that graduates were competent for hospitalist work, not just outpatient peds.
     
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  31. solitarius

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    Pediatrics attracts a certain type of personality. If you fit, you should go into it.

    Pediatrics is primary care. A lot of outpatient peds is vanilla.

    I don't like peds because the parents are a bit much, and the gender balance is way off.
     
  32. mvenus929

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    I felt far more competent for hospitalist work graduating from residency than I did for outpatient work. But that is another discussion we’ve had many times in other threads.
     
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  33. miacomet

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    It's crazy that they came up with a three year fellowship for hospitalist work. Internal medicine is just as complicated (if not more so), yet ABIM does not feel their grads are incompetent enough to require a fellowship. Pediatrics really has no faith in their graduates. Insane. Why not restructure Peds to have a primary care, presubspecialty, and hospitalist track? So many residents can't afford three years of fellowship for a field that pays the same.
     
  34. DO2015CA

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    I have doubts it is competency driven. It was thought up by ivory tower programs where their floor patients are all zebra. This requirement has just spread to the rest like a wildfire even though it does little to increase the competency of a day-to-day general pediatric hospitalist.
     
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  35. NITRAS

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    Peds needs a three year fellowship to be hospitalist? Same for MedPeds?
    How much of yalls residency is spent inpatient? I need to ask my pediatric hospitalist friend to see about their group.
     
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  36. mvenus929

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    To be board certified, you need a two year fellowship or 4 years of half time practice by 2023.

    To actually practice, who knows. Eventually, you’ll probably need it to get a job as a hospitalist in a large children’s hospital. Which may mess up chief years for a lot of people because that’s often how they do their clinical time.

    In my program, we had 20 months, I think, of inpatient time, and we were definitely an inpatient heavy program. The board requires 10ish months of inpatient, I believe (5 months wards, 2 months NICU, 2 months PICU, and 1 month well baby nursery). I don’t remember any programs that I interviewed at that had the bare minimum of inpatient time.
     
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  37. Oso

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    We have 15 months of required inpatient.
     
  38. miacomet

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    To be a Peds hospitalist will now require as many years (five) as general surgery, two more years than EM, one more year than OB, and two more years than IM hospitalist. That seems excessive.
     
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  39. Oso

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    Yes. Seems stupid as ****.
     
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  40. calvnandhobbs68

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    Graduates are as competent for hospitalist work as IM graduates are to be hospitalists. Sounds like your med school? had a crappy peds program that you're extrapolating to all peds programs. Kinda like how I could say some of those crappy EM programs produce ED docs that can't tell the difference between asthma and bronchiolitis that would get sent our way every week.
     
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  41. miacomet

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    As I specified in my post, I have noticed this issue in medical school (less so), internship, residency, fellowship, and as an attending, all at different institutions. Maybe it's not universal, but if people are asking why people are down on peds, this is one possibility. Why so defensive? I'm not the first person to have noticed this issue.

    I agreed three years is enough for competency in both inpatient and outpatient realms, but why doesn't your Academy think so?

    As to competence in PEM- I agree many EM docs aren't comfortable with Peds. There are also many PEM folk who seem uncomfortable with sick patients, codes, and trauma.
     
    #41 miacomet, Jan 8, 2019
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  42. SurfingDoctor

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    It’s called medical jousting and it’s not unique to pediatrics in any regard. If people think so, they haven’t really been paying attention.
     
  43. Shufflin

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    To answer to OP, there are other reasons people may be knocking Peds. Money is one thing, but there's the issue of getting emotionally affected by suffering children which strikes deep, as it did for me. God bless those who can work with that, but for me I would leave clinic sad more days than not. I love love love children and can't handle seeing them suffer. The other issue was inflicting discomfort. The Peds doctor I shadowed on my Peds rotation, who thought I'd be great in Peds, forced ear exams and nose and throat exams on screaming children making them scream and cry even harder. I didn't have the stomach to do that. I just wanted to hug them all. So I figured I wasn't cut out for Peds.
     
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  44. SurfingDoctor

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    If the parents want you to examine and help the kid to rule out a throat or ear infection, they should either help calm them down (or in the case of kids moving too much, help restrain). Doesn’t really help your situation if you can’t handle kids cry, but getting the parents (or nurses) to help you get an exam and tests is a must.
     
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