Pediatric Toxicology

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PedsTox

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Is there any particular desire in the toxicology world to train/recruit pediatric toxicologists? Is there a research or clinical niche for people with that background? Or is it just another route to toxicology with no more or less marketability than any other toxicologist?

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Absolutely the desire, tox grew out of peds. Only issue is funding - most (not all) programs nowadays are funded through EM, so one needs to be able to work clinically in an ED.

Doable if the program has a PedsED, but then one has to think about post-fellowship life. A tox-only practice is a lot of work, so the economics are wonky outside of academia.

Semper Brunneis Pallium
 
What about beyond fellowship? Would programs be specifically interested in hiring a pediatric trained toxicologist to be the "peds tox" person?

I guess to be less vague, I'm trained in Peds EM. Interested in additional fellowship training, especially toxicology. I have some hesitation in pursuing it after meeting multiple tox trained people who go on to just work in an ED and only do toxicology stuff on a more or less volunteer basis rather than as an actual part of their academic duties with reasonable "buy down" in shifts. Looking at other routes that I think I would enjoy (EMS, ultrasound, etc) there seems to be a very clear clinical, educational, and research niche (i.e. EMS for children, pediatric ultrasound, etc) that seems like it would be marketable even to programs not interested in a general EMS or ultrasound person for example. I'm wondering if the same sort of opportunity exists in toxicology where programs not necessarily looking for a toxicology trained person would be interested in someone focused on pediatric toxicology.
 
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They could, absolutely. Keep in mind, though, that MedTox training prepares you for all comers regardless of age.

So, if in a children's hospital, you'd be the "tox doc" and by default caring primarily for kiddos. In another setting, you'd likely be running a tox service as part & parcel of your other duties... and can negotiate buydown accordingly.

In other words, being a Peds Toxicologist would be a good fulcrum to leverage in a pediatric setting; but may not offer the same benefits outside of that.

Semper Brunneis Pallium
 
I know this thread is 3 years old and a bit of a necro bump, but I wanted to see if anything changed.

I am currently a 2nd year fellow in PEM and I have been having a hardcore tox bug. The reality is that I just don't know if another fellowship makes any sense. I have already signed to go to a community job with a small residency and don't know if a fellowship would even be worth it for a practice in peds EM. I think it would be cool for medical toxicology consult service but the hospital I am going to has never had a toxicologist and makes do with poison control. For both adult and peds from what I can tell.

Are there models where I could practice in PEM and still do a fellowship? Is there a benefit outside of the rare academic job? Does it make more sense to just focus on tox as my niche? There is also a human toxicology masters and doctorate program at a nearby university. Is that something that may be worth considering (more likely the masters) or is that job completely different? Just trying to figure out how to satisfy the tox hunger without doing drastic things that don't make sense. I mean a 3 year residency and then 5 years of fellowship is a doozy.
 
Did you do EM or peds first? Honestly, I don't know what residency one has to do to be eligible for tox fellowship. I know that EM works, but I don't know about peds.

I did peds and according to every website on tox fellowships I can find, it can be done from EM, IM, peds, and even occupational medicine. However, what sparked my question is basically what you are saying. From what I have heard, tox programs have their fellows work some in the ED. so that isn't going to happen for me.
 
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I ended up doing the fellowship. I don't log in frequently but I lurk on SDN still so feel free to post questions here.

The graduate degree route is for something different, that's better suited to become a basic science researcher in the area of toxicology.

The fellowship is open to any specialty, the challenge sometimes becomes funding for non-EM physicians. About 50-66% of programs have some sort of shift obligation in the ED that funds the fellowship. That leaves a lot of programs open to you and even more can probably work something out with you working PEM shifts.

You asked if you can you work in PEM during fellowship, I'm not 100% sure I understand your question. Many fellows moonlight and you may be required to work some shifts. Can you keep your full-time community job and do a fellowship? I wouldn't expect that to be an option (though I believe it's technically allowed by ACGME) and I would not recommend doing so if it is.

Whether you should pursue the fellowship is a personal question. The first question is do you want to be a toxicologist? Do you want to round on toxicology patients or have a toxicology clinic or provide medical backup for a poison center? There are a lot of variations on what a toxicology career looks like but ultimately doing both PEM and toxicology (both in academics and the community) is very realistic but may mean choosing to spend some of your time being reimbursed at a lower rate than you would if you just worked in the Peds ED. Desire aside, the fellowship will generally not make you more money. It will make you more competitive for academic jobs. It will diversify your career and give you more flexibility and can be nice change of pace from the ED for the right person.
 
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I wouldn't worry about, especially with a background in PEM. Toxicology is its own body of knowledge which in many ways is independent from your primary specialty, people can come in from any specialty and do well. You would be no worse off than the adult trained toxicologists are in dealing with the frequent pediatric overdoses.
 
Is there any logical way to make toxicology lucrative? Not to get rich but to maybe help justify a fellowship?

The short answer is no. Very few people will find a way to convert any fellowship out of EM/PEM into a better financial position than if they spent two years working in a high-paying community job.

The fellowship is best justified by more intangible benefits (for the right person) like the boost in longevity and career satisfaction, being more competitive in tough markets, and the career flexibility of the various directions toxicology can take you.
 
The short answer is no. Very few people will find a way to convert any fellowship out of EM/PEM into a better financial position than if they spent two years working in a high-paying community job.

The fellowship is best justified by more intangible benefits (for the right person) like the boost in longevity and career satisfaction, being more competitive in tough markets, and the career flexibility of the various directions toxicology can take you.
Mind expanding a little on the different career paths? I've always just assumed that most toxicologists work at academic EDs +/- a tox service and take call for poison control. Are there other options?
 
Mind expanding a little on the different career paths? I've always just assumed that most toxicologists work at academic EDs +/- a tox service and take call for poison control. Are there other options?

Don't get me wrong, the most common career path definitely is a mixture of ED shifts and taking call for an academic consult service or poison control center with the majority of income coming from the ED shifts with a lucky few getting a directorship of some sort that shifts their practice to be more toxicology focused. It's worth noting that a lot of this predominance is likely driven more by socioeconomic factors.

Other options in toxicology though:
- Outpatient clinic
- Addiction medicine
- Private practice consult service
- Medicolegal work (malpractice, occupational/environmental exposures, consumer products)
- Government positions (disaster planning, regulatory, epidemiology, etc)
- Corporate work (product consulting, environmental evaluations, pharmaceuticals, etc.)

Other more supplemental income options are tangential fields (hyperbarics, personalized medicine, wilderness medicine) and teaching CME courses.

In the end, all physicians have similar options but toxicology gives you a unique niche and a less crowded job market to pursue it in.
 
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