Why did you pick peds, besides liking kids?

[Sharpie1]

Hi,
I am a first year med student and have become interested in peds, mainly because I like children. However, I was wondering what other reasons one may be drawn to peds? On the other hand, why might one choose to stay away from peds?

Also, I will be graduating with the maximum amount of loans, as I'm sure many others will be too. How do you feel you will cope with the smaller salary paid to pediatricians, and paying off these ridiculous loan amounts?

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[BigNavyPedsGuy]

I think that almost any specialty you do will feel a like a bit of an assembly line after a while. With kids, there will always be that dynamic energy to keep things different and interesting.

I get to work with a fairly healthy population that gets an acute problem and then gets better (sometimes I help). There aren't very many specialties that have that. Maybe ortho, urology and I can't even think of a third choice.

The higer the highs, the lower the lows. Think of the trauma surgeon - you save a guy with your hands inside them. But then a guy dies when you've spent hours working on his insides. An internal medicine guy. High- managing his high blood pressure and DM. Low- the 84 year old died (big deal). Pediatrics is similar. A lot of people look at the negative, seeing kids pass away, the debilitated kids, etc. But I get to save kids' lives!!

Just a couple of general prinicples that led me to my choice.

 

[TexasRose]

Agree with BigNavy, apart from the fact that I really enjoy working with children, there's the ability to make a big difference in a life. Really, for a lifetime if you think about it. Sure, a lot of the illnesses we treat would get better on their own without us, or at least have no lasting negative effects. But there are time when we intervene, make a big difference and then the kid gets to go on and live a full, healthy life. Very gratifying. I also just like some of the illnesses and congenital problems that are part of Pediatrics.

(Really don't care about treating hypertension and type II DM in adult patients who don't care enough to take care of themselves but want us to prescribe something to make them feel better.)

 

[Avianburner]

For me, aside from what has been said already, kids are just happy. I'm a generally happy person, and I thought the day to day grind of chronically ill old people would depress me. Even chronically ill kids smile and want to play.

I think for a lot of people the decision comes down to parents. Many of my friends who chose against pediatrics did it simply because they didn't like dealing with the parents. I found that parents don't bother me most of the time (We'll see in July when I start intern year....)

 

[DrThom]

Alot of the zebras you learn about in medicine happen in kids, pediatric cardiology is WAY more interesting than adult cards.....ummmm, you get to play with toys?

But the big selling point for me was the patient population. If you give an adult patient a high five, its unprofessional. With a kid, its rapport building.

 

[BigRedBeta]

A lot of the things that have been said apply to me too.

Certainly have to echo what's been said about making a difference for a lifetime, as well as the fact that the goal of our treatments is much more about getting kids back to normal rather than preventing a time bomb from going off. Even our chronic conditions like CF or Sickle Cell, the main goal is to keep them up with their peers and letting them be kids.

And I'll also take the "getting to play" everyday example to the extreme...if I were to stick out my tongue at a vet at the VA, I might get punched. Do it at a three year old during an office visit and all of a sudden I'm a new best friend.

I also appreciate that there's variety that comes simply from having patients of different ages. Get the same problem in a 3 year old, an 8 year old, and a 14 year old and you have to have three different approaches. My day in Peds Pulm clinic last week was five cases of asthma, but the ages were 15 months, 3 years, 6 years, 11 and 17...very, very different visits.



As for reasons not...salary is an issue, especially if you're one of those people who very much wants to clear that debt yesterday. After going through my financial aid exit interview earlier this week, I know that my debt is going to get paid off eventually, no matter what I earn.

Parents is a big reason for a lot of people not to go into peds, though I find that it's just another person to establish rapport with (and the best place to start is to show that you care about their child).

For some people, peds can seem very limiting geographically - especially if they're considering going into a subspecialty (even a town of 500k is going to have difficulty supporting a single pediatric rheumatologist, while you'll find multiple adult rheumatologists in towns of only 30k).

Many people don't like the fact that kids don't give you a lot to work with in terms of information. You have to be a lot more developed in your sense of what's wrong. Just think about doing a lung exam with your stethoscope - with adults we have them huff and puff and breath in really deeply to hear things and obviously below a certain age, you can't get kids to do that.

 

[Doctor Bagel]

I currently hate my peds rotation with a burning passion, so I can't possibly imagine wanting to do peds. However, I never wanted to do it, so I don't know if my perspective is useful. IMO, reasons not to do it include boredom (the vast majority of patients you see in clinic and the hospital are healthy and really don't need any help), class issues (I feel like a fraud telling poor, minority people how to raise their kids when I'm some middle class white chick who doesn't have any), mean passive aggressive attendings (maybe only in my program, but yeah, it's about as bad as ob/gyn), dealing with multiple patients (parents, kids, other family members), low salary, bad schedules (peds residents here work harder than IM residents) ....

Maybe my feelings are largely location dependent, and I really don't like kids so that's a whole other issue. It just seems like there are a lot of reasons not to do peds, but it's the right thing for some people.

Editing to add that I'm really not meaning to flame this specialty. I've just been surprised by some the stuff I've seen on my current rotation (mainly the passive aggressive stuff). But again, maybe peds is really fun at other places, and still, some people at my school really like it and want to do it.

 

[DrThom]

Post deleted

 

[BigNavyPedsGuy]

I currently hate my peds rotation with a burning passion, so I can't possibly imagine wanting to do peds. However, I never wanted to do it, so I don't know if my perspective is useful. IMO, reasons not to do it include boredom (the vast majority of patients you see in clinic and the hospital are healthy and really don't need any help), class issues (I feel like a fraud telling poor, minority people how to raise their kids when I'm some middle class white chick who doesn't have any), mean passive aggressive attendings (maybe only in my program, but yeah, it's about as bad as ob/gyn), dealing with multiple patients (parents, kids, other family members), low salary, bad schedules (peds residents here work harder than IM residents) ....

Maybe my feelings are largely location dependent, and I really don't like kids so that's a whole other issue. It just seems like there are a lot of reasons not to do peds, but it's the right thing for some people.

Editing to add that I'm really not meaning to flame this specialty. I've just been surprised by some the stuff I've seen on my current rotation (mainly the passive aggressive stuff). But again, maybe peds is really fun at other places, and still, some people at my school really like it and want to do it.

Why are you even on a peds forum if you hate it so much? The question was, "Why did you pick Peds?" Not "Tell me why you didn't like your med school's Peds rotation."

I really don't understand it. You obviously have no desire to go into that field, so why are you even on this forum?

Hijacker

 

[psychforme]

I really don't understand it. You obviously have no desire to go into that field, so why are you even on this forum?

Because it needs a dose of reality.

 

[smq123]

Why are you even on a peds forum if you hate it so much? The question was, "Why did you pick Peds?" Not "Tell me why you didn't like your med school's Peds rotation."

I think the question was ALSO partly "Tell me why I might not like peds...."

I am a first year med student and have become interested in peds, mainly because I like children. However, I was wondering what other reasons one may be drawn to peds? On the other hand, why might one choose to stay away from peds?

 

[Sharpie1]

thank you for your responses. i actually do like children very much and can see myself being happy, but am so worried about these loans! i guess next year or even the year after i can really hone in on what i love, these loans just wont pay themselves!

 

[medgator]

thank you for your responses. i actually do like children very much and can see myself being happy, but am so worried about these loans! i guess next year or even the year after i can really hone in on what i love, these loans just wont pay themselves!

That is certainly something to think about. Unfortunately, the decline in reimbursement for peds and PCP in general has swayed many to consider more lucrative specialties.

http://seattlepi.nwsource.com/local/378492_fewerdocs10.html

The salary gap may be another reason. More pay in a particular specialty tends to mean that more U.S. medical school graduates fill residencies in those fields at teaching hospitals, Dr. Mark Ebell of the University of Georgia found in a separate study.

Family medicine had the lowest average salary last year, $186,000, and the lowest share of residency slots filled by U.S. students, 42 percent. Orthopedic surgery paid $436,000, and 94 percent of residency slots were filled by U.S. students.

Meanwhile, medical school is getting more expensive. The average graduate last year had $140,000 in student debt, up nearly 8 percent from the previous year, according to the Association of American Medical Colleges.

 

[BigNavyPedsGuy]

I think the question was ALSO partly "Tell me why I might not like peds...."

oops my mistake.

 

[smq123]

thank you for your responses. i actually do like children very much and can see myself being happy, but am so worried about these loans! i guess next year or even the year after i can really hone in on what i love, these loans just wont pay themselves!

Actually, there are a few federal and state-level programs that will help physicians pay off their loans, particularly if those physicians specialize in things like family medicine, general internal medicine, and general pediatrics and practice in medically underserved areas.

No one knows what those programs will be like 5-7 years from now (what with the economy being so crappy and everything), but there will probably be SOME kind of financial help to people who do such fairly low-paying specialties. It's not all bleak.

Anyway, you'll figure out in 3rd year what you love. So keep an open mind, and I hope you find your niche.

 

[PeepshowJohnny]

I currently hate my peds rotation with a burning passion, so I can't possibly imagine wanting to do peds. However, I never wanted to do it, so I don't know if my perspective is useful. IMO, reasons not to do it include boredom (the vast majority of patients you see in clinic and the hospital are healthy and really don't need any help), class issues (I feel like a fraud telling poor, minority people how to raise their kids when I'm some middle class white chick who doesn't have any), mean passive aggressive attendings (maybe only in my program, but yeah, it's about as bad as ob/gyn), dealing with multiple patients (parents, kids, other family members), low salary, bad schedules (peds residents here work harder than IM residents)

I had many of the same issues with peds (although the "passive-agressive" attendings were the exception, not the rule) but I had to highlight this issue.

I don't want to push this thread off topic, but you really felt this way? Hell, I'm a middle class white guy with no kids either, but I really, really disagree with this statement. I'm all for increasing enrollment of URM's, but to to think it's "wrong" for anyone other than someone from a poor, minority background to give practical advise to their peers ("Hey, maybe you should buy your kid a few books to read instead of paying for that fancy cell phone" "You know, if you smoke enough that I can smell it on you, it's probably affecting your child" "Your child is obese, maybe giving him a "big gulp" soda isn't the best idea") is silly liberal guilt.

 

[veenut]

Honestly you'll have a better idea on whether peds is for you when you do your rotation. I think one thing that made an impression on me is that pediatricians tend to be a little more needy in terms of wanting to feel like they actually have some sort of impact on their patients' lives. I'm on internal medicine now and it bothers the hell out of me that all we do is prolong the inevitable...but it doesn't seem to bother the internists I'm with. To each their own I suppose. I think in general that people who are happy doing peds will realize during their medicine rotation that they really don't like working with adults.

 

[ckbuffalo]

I also was concerned about paying off my loans....but you have to do what will make YOU happy and something tha tyou see yourself doing for the rest of your life. Loans will eventually get payed off. As suze orman says they are the best kind of loans to have.

I picked peds b/c I didn't see myself doing anything else (it was my last core), I was always happy, never complained. I also like the great variety in patients and problems. You take care of newborns, infants, kids, teens...all with different problems not only medically but socially and developmentally as well. In medicine although your patients vary in age but their problems are similar.

 

[oldbearprofessor]

Oh my, an actual thread with controversy (very very very mild controversy) in pedi. Better than the match day stuff

As a reminder, it's okay to come into a specialty forum like pedi and say what you don't like about it or your experience in pedi. Random excessive bashing of a specialty in its own forum is a no-no though. The distinction isn't always obvious of course....

Regardless, lets get the show on the road here:

Hi,
I am a first year med student and have become interested in peds, mainly because I like children. However, I was wondering what other reasons one may be drawn to peds?

Lots of folks, (but not everyone) likes kids. It's (usually) a fairly benign 3rd year rotation and playing with kids on the wards or outpatients is (generally) a good experience. So, some are drawn to pedi because they like the patient population and the type of (mostly) non-self induced diseases of the kids.

However, I have argued before that for some folks, including me, an interest in advocacy for children related to health care, both on an individual child basis and in public policy settings, is something that is very attractive about a career in pediatrics. I believe part of my role as a pediatrician in academic medicine is to take actions and guide policy that I think is to the benefit of children. This is an important reason that I like pediatrics.

IMO, reasons not to do it include boredom (the vast majority of patients you see in clinic and the hospital are healthy and really don't need any help), class issues (I feel like a fraud telling poor, minority people how to raise their kids when I'm some middle class white chick who doesn't have any), mean passive aggressive attendings (maybe only in my program, but yeah, it's about as bad as ob/gyn), dealing with multiple patients (parents, kids, other family members), low salary, bad schedules (peds residents here work harder than IM residents) ....

Boredom? - eh, come spend an hour at the bedside of a septic neonate on epi and dopamine drips, with multiple metabolic abnormalities and see if you're bored. Perhaps in your pedi core you didn't see those patients?

Class issues - The AAP goes to extra-ordinary lengths to make its policies those that are sensitive to cultural issues. As a pediatrician from any cultural group, one is primarily advocating along the lines that the AAP and other organizations have set for you (e.g. "back to sleep", bilirubin testing, breast-feeding support, etc). Not sure what the issue is here. Certainly there can be areas of difference in practice that are culturally based, but there are plenty of ways to handle this.

Dealing with multiple patients - We only have one patient, the child. Yes we interact with the family and have to deal with them and of course this is more challenging in general in pediatrics than in adult medicine. However, if the target is clear, then dealing with the peripheral sniping is tolerable. YMMV.

bad schedules - Pediatric residency is hard. For sure. There are many other threads about variations in this between places and I don't think it's, overall, much different than IM, but of course this varies between centers. Med/peds folks would be the best to make that comparision. I don't think that the life of a pediatrician - generalist or subspecialist is intolerable. But, of course, one has to talk to a lot of folks and make one's own determination.

Others can cover the salary issues. I have no complaints and never have. But I'm a neonatologist and very very old.

 

[smq123]

Boredom? - eh, come spend an hour at the bedside of a septic neonate on epi and dopamine drips, with multiple metabolic abnormalities and see if you're bored. Perhaps in your pedi core you didn't see those patients?

You have MS3s rotate through the NICU with you?

On my peds rotation, I spent (maybe) a grand total of 4 hours in the NICU - and most of it was spent listening to the neonatology fellow outline the fetal circulation for me. I've actually spent MORE time in the NICU/with neonatologists on my OB and MFM rotations.

That being said, I agree that peds had a wider range of "zebras" than almost any other rotation. A simple cough could either be asthma or some bizarre exotic pulmonary disease that only the peds pulmonologist had heard of. Peds was also the only time in med school I've ever seen a patient who actually DID have Guillain-Barre.

As a reminder, it's okay to come into a specialty forum like pedi and say what you don't like about it or your experience in pedi. Random excessive bashing of a specialty in its own forum is a no-no though. The distinction isn't always obvious of course....

While that's true, I do feel for Doctor Bagel. I was sorely disappointed by my peds rotation, because I had strongly considered peds or med/peds when starting MS3.

Like her, though, I had a really bad experience with a few of the residents, and I've since struggled not to let their malicious harpy-like personalities negatively color my view of the field. (It's a bad sign, I think, when other med students on my peds rotation would randomly pull me aside to give me a hug and say, "I am so grateful that I don't have to work with your resident." )

Oh well - I look at it as a good lesson to learn for when I become a resident, and work with students who may not be interested into going into my particular specialty. At least I can try not to be malignant, and toxic, and color their views of my specialty.

 

[oldbearprofessor]

You have MS3s rotate through the NICU with you?

No, that was my point. It isn't reasonable to say that pedi is a boring field based on a core rotation. Core rotation med students don't often see the most interesting things.

:
While that's true, I do feel for Doctor Bagel.

I didn't single her post out nor did I indicate (or think) that it was problematic. Just clarifying for everyone. We don't get much controversy in the pedi forum.

 

[smq123]

No, that was my point. It isn't reasonable to say that pedi is a boring field based on a core rotation. Core rotation med students don't often see the most interesting things.

Ah, I see. That's fair.

Like I said, though, I didn't have a particularly boring core rotation. There was much more variety than I had on inpatient IM. Kawasaki, Fifth disease, osteo, Guillain Barre, a couple of kids with Turners, one kid with Graves....crazy stuff.

 

[BigNavyPedsGuy]

A couple of good points above that could stand to be underscored

1) Residents very a lot from program to program and (obviously) from specialty to specialty. One of the big challenges throughout all of third year is to see past that to what the actual practice would be like someday.

2) If every medical student rotated through the NICU there would be a VERY different perspective of pediatricians. It's a serious place with serious acuity.

3) Agree with OldBear: it's great to finally have something besides interview and rank list threads.

 

[TexasRose]

Yesterday on my ER shift we resuscitated a septic child with multiple congenital abnormalities, an infant with Jeune Syndrome in respiratory distress and I diagnosed an appy in a 2 yr old that had been missed the previous day in an urgent care clinic. Oh yes, and then there were the asthmatics and the gastros. Pediatrics has never been dull for me.

 

[kristing]

I agree with the positives everyone has said above, and I am glad someone pointed out the negatives they found. As in all specialties, you have to like the work more than you like the negatives, so we in peds think those negatives are minimal, or don't see them because the positive outshine it!

I like dealing with the whole family. If you want to make an impact on a person, affect their community. A kid's community is partially made up of the people he/she lives with, so you get to talk to the big people and the little people. This also keeps me sane. If I only enjoyed dealing with children, I would have become an elementary school teacher, not a pediatrician.

I like being an advocate for a person/group that does not have a voice. It gves meaning to my life and makes me feel I am doing something worthwhile with my life.

Most parents love their children. Even the abusive ones who are whacked. I can often work with this love to get a better outcome for my patients.

 

[Doctor Bagel]

Bumping an old thread where I really didn't mean to flame. I just walked away from my peds rotation not understanding why anybody would want to do it unless they absolutely hated adult medicine, and sadly that seemed to be the main answer I got from people here when answering why peds. One thing to note about my experiences -- the peds program here is small, we don't have any fellowships and we're pretty limited in specialists, so all the interesting patients that we started to work up in the hospital got sent out of town. Consequently, the hospital patients that we worked up and kept were pretty much all RSV, asthma exacerbations and rota. In clinic, the students were pretty much stuck doing well child checks and doing ear checks, so I really was pretty bored. We didn't get any NICU or PICU experience.

And the residents here work really hard when they're on wards with considerably worse hours than IM residents. Going over 80 hours seemed to be a normal experience, and there's no real cap on admissions unlike in IM here. And our program expects students to be there all the time even when nothing's happening and requires more overnight calls/week than surgery.

So my program is probably weird, and someone made a good point above that it's hard as a 3rd year to see beyond the particulars of a program to know whether or not you'd like a specialty.

 

[Sharpie1]

I just read an article on the aap website that said, "The average starting salary for residents who accepted part-time jobs was almost $34,000 less than that for residents working full-time (part-time: $71,615; full-time: $105,598). Residents who accepted part-time positions expected to work 15 hours less per week in practice (38 vs 23 hours)".

These salaries are a lot lower than I was expecting. I obviously know that pediatricians make the lower end of the spectrum of physicians and thats okay with me, but I would not be able to afford to live (after loan payments and taxes) off of $105,000. I thought average starting salaries in new york were around $140,000... are the above numbers true??

 

[BigNavyPedsGuy]

I just read an article on the aap website that said, "The average starting salary for residents who accepted part-time jobs was almost $34,000 less than that for residents working full-time (part-time: $71,615; full-time: $105,598). Residents who accepted part-time positions expected to work 15 hours less per week in practice (38 vs 23 hours)".

These salaries are a lot lower than I was expecting. I obviously know that pediatricians make the lower end of the spectrum of physicians and thats okay with me, but I would not be able to afford to live (after loan payments and taxes) off of $105,000. I thought average starting salaries in new york were around $140,000... are the above numbers true??

It varies a lot by region. Within regions it varies a lot from city to city. I would try to get in touch with a pediatrician either somewhere near your goal practice or in a peds residency program and they could fill you in.

 

[montessori2md]

I just read an article on the aap website that said, "The average starting salary for residents who accepted part-time jobs was almost $34,000 less than that for residents working full-time (part-time: $71,615; full-time: $105,598). Residents who accepted part-time positions expected to work 15 hours less per week in practice (38 vs 23 hours)".

These salaries are a lot lower than I was expecting. I obviously know that pediatricians make the lower end of the spectrum of physicians and thats okay with me, but I would not be able to afford to live (after loan payments and taxes) off of $105,000. I thought average starting salaries in new york were around $140,000... are the above numbers true??

This is sort of off-topic, but I'd do some more digging by region on those numbers (try using the labor dept, they keep data sorted that way). By way of example, if I go see my FP for sinusitis, she gets reimbursed $118 (this is the visit, does not include labs), but if I take my son to the pediatrician for sinusitis, they get reimbursed $72. Same problem, same time, same insurance co. What's worse is, if I took him to the ENT ("tubes"), the visit would be reimbursed $200, and he prob. would see the NP, not the ENT himself.

With peds, CHIP and medicaid can be sig in some areas, and reimbursement for medicaid varies wildly state-to-state.

Also, for your federal loans, you're only req'd to pay 15% of your income, and at 105k/yr, I think you're below the margin and can continue to write off loan interest. But I'm with you, it's still painful.

 

[Sharpie1]

Also, for your federal loans, you're only req'd to pay 15% of your income, and at 105k/yr, I think you're below the margin and can continue to write off loan interest. But I'm with you, it's still painful.

I had no idea about this... is this even after residency? And is Grad plus considered a federal loan as well or is that private?

 

[twilburys]

And is Grad plus considered a federal loan as well or is that private?

Grad PLUS is a Federal loan.

 

[smq123]

I had no idea about this... is this even after residency? And is Grad plus considered a federal loan as well or is that private?

Technically, GradPlus loans are federal loans. But, in practice, I tend to think of GradPlus as sort of "in-between" a federal loan and a private loan. They are unsubsidized loans that accumulate interest at an extremely high rate - higher than even unsubsidized Stafford. (I think the current rate is ~8.5%.) They're sort of a last-ditch resort for people who have run out of Stafford loans, but need more money.

 

[Seriouslynot]

I prefer peds as I would much rather deal with a whining child than a whining adult, and quite honestly, as long as the parents are given good rationale for treatment and follow up, I find that they are very appreciative of their child's treatment.

Peds is a place where you can really affect the health outcomes of an individual. I find that most of the kids are very compliant with their treatment..whereas quite a few adults tend to "forget" their diets and/or medication regime.