High unfilled numbers this year in pediatrics

[oldbearprofessor]

This discussion has morphed a bit into what is a very interesting discussion of academic careers and research careers in pediatrics. Speaking from my career experiences and experiences as a senior academic faculty, I can say that the rewards of academics really come from enjoying this environment and having the willingness to accept things like a lower wage, often demanding deadlines, and the real stress of funding that never stops. But the rewards of being an educator and influencer in policy and practice are real as well. Each person needs to evaluate these trade-offs and make their best decision. However, here can be no doubt that it is very difficult to maintain a long-term academic research career and getting a good start with a K award is no guarantee of long-term success in getting the funding needed to make this happen. There is no easy answer to this.

---

Members don't see this ad.

 

[SurfingDoctor]

I've posted this in other threads... but this is the gospel on the topic of academics...

Understanding Academic Medical Centers: Simone’s Maxims

Academic medical centers today represent a unique fusion of traditional academia, hospital functions, several levels of education, and, above all, patients. They are complex organizations trying to discharge an often conflicting melange of responsibilities. This complexity has grown in recent...

aacrjournals.org

Even though its 25 years old at this point, it's still 100% on point.

 

[sloh]

Thread has been a great read. Best thread on SDN right now imo

 

[Splenda88]

Yea, true research careers need addition training. And yes, true research careers need support early on. And unfortunately, neither of those things are desirable from an individual and institutional standpoint, respectively, anymore. I personally view it as a tragedy and one of the several reasons that physicians have become and will continue to be easily replaced by APRNs.

I mean, doing research makes one think critically. Not just in critical illness and acute situations, but globally. But to think critically, you need foundational knowledge. You need mechanistic expertise. All of that has been thrown out though in the modern era. You just follow the recipe (ie protocol). There’s no foundational knowledge or critical thinking skills in any of that, it’s literally following the flow diagram. The physicians’ skill (driven mostly by the business of medicine and top level ineptitude) of emphasizing Press Ganney surveys and not understanding the NADPH replenishment via Pentose Phosphate Shunt has made physicians non-cognitive operators. Maybe there is a reversal in all of that, but frankly, I mostly see physicians and institutions doubling down.

Oh well.

Can you elaborate on that?

 

[SurfingDoctor]

Can you elaborate on that?

Well, in most pediatric subspecialties, there is required scholarly activity. Unfortunately, by nature, most people don't want to do research or any sort of scholarly pursuit. If they did, they would need institutional by in and infrastructure to support it and to make it more rigorous. Often that requires financial investment for the institution and additional time from the individual to learn. However, both of those things are costly to both the individual and the institution because there are both opportunity and direct costs to both the individual and the institution. From a strictly business standpoint, it makes sense to generate money in the quickest and most cost-effective manner possible. That means, providing no institutional monetary support to the individual and in turn, the individual providing the least amount of effort to the institution. The net result is a generation of "just-qualified enough" physicians at the completion of training.

However, as was stated in Simone's Maxims number 1 and 2, the institution doesn't love you back AND has a much longer time scale for both direct and opportunity cost. At the end of the day, it’s a very slow machine designed, above all other things, to generate money for itself. Now, if the institution generates "just-qualified enough" physicians, it starts to realize that the difference between just-qualified enough physicians is similar to just-qualified enough APRNs. They both can follow the same CPG. The both can be told to order less labs. They both can be given the right text to get the maximum return on a DRG. All of those things generate the exact same revenue for the institution. In fact that skill set becomes so close, that it becomes unnecessary to pay someone more to do essentially the same thing, as the institution would rather pocket the difference, usually to build more infrastructure to repeat the same process. These also result in Maxims numbers 3 and 4, which is exactly how the first paragraph came to be in the first place and the cycle perpetuates till the wheels come off. Though again, for the institution, the wheels never really come off.

 

[DO2015CA]

Well, in most pediatric subspecialties, there is required scholarly activity. Unfortunately, by nature, most people don't want to do research or any sort of scholarly pursuit. If they did, they would need institutional by in and infrastructure to support it and to make it more rigorous. Often that requires financial investment for the institution and additional time from the individual to learn. However, both of those things are costly to both the individual and the institution because there are both opportunity and direct costs to both the individual and the institution. From a strictly business standpoint, it makes sense to generate money in the quickest and most cost-effective manner possible. That means, providing no institutional monetary support to the individual and in turn, the individual providing the least amount of effort to the institution. The net result is a generation of "just-qualified enough" physicians at the completion of training.

However, as was stated in Simone's Maxims number 1 and 2, the institution doesn't love you back AND has a much longer time scale for both direct and opportunity cost. At the end of the day, it’s a very slow machine designed, above all other things, to generate money for itself. Now, if the institution generates "just-qualified enough" physicians, it starts to realize that the difference between just-qualified enough physicians is similar to just-qualified enough APRNs. They both can follow the same CPG. The both can be told to order less labs. They both can be given the right text to get the maximum return on a DRG. All of those things generate the exact same revenue for the institution. In fact that skill set becomes so close, that it becomes unnecessary to pay someone more to do essentially the same thing, as the institution would rather pocket the difference, usually to build more infrastructure to repeat the same process. These also result in Maxims numbers 3 and 4, which is exactly how the first paragraph came to be in the first place and the cycle perpetuates till the wheels come off. Though again, for the institution, the wheels never really come off.

Meh I think it’s subspecialty dependent too. Quit making them protocol based where a cog in the wheel can be changed and encourage critical thinking. Mine (pulm) has very little and I feel confident APRNs couldn’t replace me.

 

[SurfingDoctor]

Meh I think it’s subspecialty dependent too. Quit making them protocol based where a cog in the wheel can be changed and encourage critical thinking. Mine (pulm) has very little and I feel confident APRNs couldn’t replace me.

I’ve been doing this for 20 years and I see no reverse in the trend.

Our children’s hospital’s Pulmonary service is ranked in the Top 20 for US News (for whatever that’s worth) and the entire Pulmonary Hypertension service is run by an APRN. Of course, there’s a MD in the Director position, but that’s all for show as they don’t do any clinical time. It’s the APRN that runs the show and everyone knows it, because at the end of the day, it’s about following the CPG. Just FYI.

 

[DO2015CA]

I’ve been doing this for 20 years and I see no reverse in the trend.

Our children’s hospital’s Pulmonary service is ranked in the Top 20 for US News (for whatever that’s worth) and the entire Pulmonary Hypertension service is run by an APRN. Of course, there’s a MD in the Director position, but that’s all for show as they don’t do any clinical time. It’s the APRN that runs the show and everyone knows it, because at the end of the day, it’s about following the CPG. Just FYI.

Meh PH is mainly controlled by cardio in a lot of places which is fine. It’s extremely boring. I’m referring to most bread-and-butter pulmonary diseases. The chronic coughers, gray zone asthmatics, aspirators, even trach-vent, rheumatologic disease affect on lungs, etc. All of these shouldn’t run off protocols because they have fine details that determine the etiology. Many well trained pediatricians can’t distinguish these. If there is a world where hospital system force midlevels because they’re cheaper and pts get worse care then that’s one thing but to say they can replace and do a great job is wrong. Too many steroids for not actual steroid responsive pulmonary diseases has been my experience with even the pulm APRNs.

 

[SurfingDoctor]

Meh PH is mainly controlled by cardio in a lot of places which is fine. It’s extremely boring. I’m referring to most bread-and-butter pulmonary diseases. The chronic coughers, gray zone asthmatics, aspirators, even trach-vent, rheumatologic disease affect on lungs, etc. All of these shouldn’t run off protocols because they have fine details that determine the etiology. Many well trained pediatricians can’t distinguish these. If there is a world where hospital system force midlevels because they’re cheaper and pts get worse care then that’s one thing but to say they can replace and do a great job is wrong. Too many steroids for not actual steroid responsive pulmonary diseases has been my experience with even the pulm APRNs.

Ok

 

[dozitgetchahi]

Now I’m going to vent. There was an MD/PhD in the lab. They had no school debt. It was paid off to by their PhD department.

This person was brought into the lab and handed a great project. They submitted a K-grant (junior faculty award) with no data they personally generated and it got scored pretty well, but not funded. The biggest driver against the grant was not the science (which is a rarity for a K) but the candidate. That person, instead of improving themselves and their candidacy, left to go into private practice.

I’m not faulting them because frankly, they sucked at research, but they were given an opportunity and pissed it away. And they did it not because they needed the money, but because they wanted more money.

Just another reason this field doesn’t incentivize good citizens and screws it up for those who follow.

/vent

Meh. I’m betting there was a lot of silly political BS involved here that we’re not hearing about.

Can’t blame anyone for bailing out of academia. I trained in very “high academic” places for residency/fellowship and left for PP after burning out as a fellow under all the pressure to produce, dealing with gigantic attending egos, etc. My wife is a “recovering academic” who left a psych PhD program after having her PhD dragged out by something like 8 years because a micromanaging advisor wanted her to keep re-editing her thesis a bazillion times and moving commas around etc (she gave up dealing with the woman, got a masters and got the hell out - she was just cheap labor to them and everyone knew it by the end).

Academia is laden with BS. I can’t blame anyone for having enough of it and moving on.

 

[SurfingDoctor]

Meh. I’m betting there was a lot of silly political BS involved here that we’re not hearing about.

Can’t blame anyone for bailing out of academia. I trained in very “high academic” places for residency/fellowship and left for PP after burning out as a fellow under all the pressure to produce. My wife is a “recovering academic” who left a psych PhD program after having her PhD dragged out by something like 8 years because a micromanaging PD wanted her to keep re-editing her thesis a bazillion times and moving commas around etc (she got a masters and got the hell out).

Academia is laden with BS. I can’t blame anyone for having enough of it and moving on.

Maybe. I guess they can speak for themselves in 20 years when they are being called by the bedside nurse at home that a child’s BP is undectable.

 

[Putkernerinthehall]

I’ve been doing this for 20 years and I see no reverse in the trend.

Our children’s hospital’s Pulmonary service is ranked in the Top 20 for US News (for whatever that’s worth) and the entire Pulmonary Hypertension service is run by an APRN. Of course, there’s a MD in the Director position, but that’s all for show as they don’t do any clinical time. It’s the APRN that runs the show and everyone knows it, because at the end of the day, it’s about following the CPG. Just FYI.

Remind me not to seek care for PH at your facility. I make it a point to, every time I need to be seen, ask for an MD. Why pay for a NP/PA if it costs the same as an MD? The public needs to push back.

 

[DarkBluMage]

Remind me not to seek care for PH at your facility. I make it a point to, every time I need to be seen, ask for an MD. Why pay for a NP/PA if it costs the same as an MD? The public needs to push back.

I never see NPs/PAs. I don’t play with my health. I’m paying to see an expert in medicine.

 

[SurfingDoctor]

Remind me not to seek care for PH at your facility. I make it a point to, every time I need to be seen, ask for an MD. Why pay for a NP/PA if it costs the same as an MD? The public needs to push back.

Personally, I'd be okay with that. Refractory PH is an awful death.

 

[dozitgetchahi]

Maybe. I guess they can speak for themselves in 20 years when they are being called by the bedside nurse at home that a child’s BP is undectable.

My worst day in PP was better than my best day in academic medicine.

 

[SurfingDoctor]

My worst day in PP was better than my best day in academic medicine.

Congrats I guess.