Peds-related specialty compensation and peds ER

[sdnetrocks]

After doing my peds clerkship, I am very interested in picking a specialty that involves the care of kids. However, from a compensation standpoint, it seems like peds is generally not very well compensated, and that even the peds fellowships of other specialties come with a pay-cut vs. staying general. I would guess that the pay ranking would go:

-Pediatric surgery
-Pediatric urology
...
-Pediatric cardiology
...
and then all the way down to general office-based pediatrics

One of the things I particularly liked was peds ER. Does anyone know:
1) how is it compensated?
2) what is the pathway to be a peds ER physician?

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[TeleoDeum]

Greetings,

I am a 3rd year Peds resident and wanting to do a Peds ER fellowship, so take all advice for what it is worth ( that a $2.50 will get you a cup of coffee at Starbucks ). You can get to Peds EM from two different paths. One is to do a full 3 or 4 year EM residency and then a Peds EM fellowship for 2 years. Most Adult EM trained people do not do this unless they want to work in academics, as Peds EM tends to pay less than adult/all-comer EM work. The other way is to do a Peds residency for 3 years and then to do a 3 years Peds EM fellowship ( the path I hope to take ). The lifestyle for Peds EM is pretty good. You can work in academic settings, again with lower pay, and work with residents, students, and do research, etc. These jobs tend to be at larger Children's Hospitals affiliated with university.medical schools ( as compared to medium sized, regional Women's and Children's Hospitals). The other alternative is to work in the private world. These jobs are straight shift work, pay by the hour. There seems to be a great demand currenly for Peds EM trained people in both settings currently - check out the job listings in Pediatrics or any other peds journal/magazine.
Now to your real question - the pay. Some Peds Em jobs are set up through EM medical groups, a combo of both adult and Peds Em people. These can have a yearly salary guarantee or a set fee-per-hour-worked, but they tend to provide some benefit packages including medical malpractice insurance. Fee-per-hour can vary depending on where in the country you are, but tends to be b/w $90 and $125 an hour. So, if you work 35-40 hour a week, you are looking at b/w 180 and 250K per year, before taxes. This is better than most general peds people make (unless you are a partner in your own sucessful practice), and about as much as other peds subspecialists make (not the peds surgical subspecialists you mentioned earlier - they are surgical speciailists, not peds specialists and the training is different).
On another note, Peds EM is a relatively hard peds fellowship to get, mainly due to the fact that there are more applicants than spots available. There are currently only something like 110 spots available nationwide per year. Only peds Cards or maybe Allergy are harder to get.
Good luck with the search, and do not forget to have fun along the way.

Peace,
Greg

 

[sdnetrocks]

Greg, thanks for the helpful reply. I hate to be crass and talk about money, but the bototm line is that after so many years of [fill in the blank], it just doesn't make a lot of sense to not come out with good compensation. Some other questions I have:

You mention that being a partner in a successful pediatrics practice can net more than 180k - 250k. Does this entail having a practice with enough non-partnered (i.e. salaried) pediatricians that a lot of your income comes from them?

In general, what are the highest paying specialties in which at least half of the patient base is pediatric?

Do you foresee the preventative medicine that happens at the level of the general pediatrician to be better compensated in the future?

Thanks again for your help.

 

[Celsus]

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm
here is a great guide to the salaries of ped specialist

 

[TeleoDeum]

Glad to help out. Again, all opinions are just that, opinion, unless I site a source.

As far as salary/compesation goes, here is something to think about. Where do you want to live and practice? That 200K will go alot further in a rural setting or in the affordable South. Demographically, physicians as a whole are compensated better in the Southeast US. This is mainly due to a lower level of HMO prevalence and a greater demand for most specialties. Also pick a place where malpratice insurance is available to your specialty at a more reasonalble price, and possibly where there has been some statewide malpractice reform. Finally pick a place you want to live and where you and your family will be happy. In medicine and in general, lots of money but hating getting up to go to work everyday will get old real quick.

Your question was which specialties will allow you to work mostly with kids and get paid well. As I alluded to earlier, pediatric surgical subspecialties get paid the real jack. But these require you do a surgical residency then subspecialize. IE general surg 5 years --> peds fellowship 2 years = $500K
Urology/ENT 5 years + 2 years fellowship = $3-500K.
The other question is what pediatric specialties can make money. As a general pediatician the average pay is about $140-160K, working a reasonable 4.5 days per week schedule. I expect this to stay about the same. You asked about changes in general peds and reimbursements. Most insurance plans and Medicaid do not reimburse well for kids or preventative health (ie, if you want to make $$$ find a good billable procedure - GI scopes, surgery, PE tubes, etc.). What this means is that whereas the IM doc sees 3-4 pts per hour, the Peds guy must see 4-5 per hour to make the same cash. The problem in gen peds right now is that more and more parents are wanting more of your time to talk about social, behavioural and nutritional issues, shots and autism, etc, ie "non-medicine" things. So they take more time for the same billing. We as pediatricians are notoriously bad billers. We feel "bad" for charging for more than one code. The sucessfull peds practices I alluded to earlier have a designatred billing person whose job it is to maximize billing. So, when at the end of the acute "check my ear" 5 min visit, mom asks about constipation or sleep habits, the good doc will say " I am really busy today, but would love for you to come back next week to talk about just that for a full 15 minutes" abd bill for BOTH visits. Anyway, sorry, I digress. So, it is possible to make $200-250K as a general peds person if you are a partner of a well run practice who uses good billing people, and who might use a good NP/PA for patient education, and who has an in office lab/xray (you get a portion of the bill for every test you order).
Peds subspecialists tend to be required to live in proximity to a Childrens Hospital or in a city large enough to support a private practice. The best paid is hands down private Neonatology - all intensive care billing and a pretty good life if set up right. The private guys where I am from in south Louisiana are making $400-600K per year. But you have to like Neo, which is another whole discussion. Next is prob Allergy/Immuno - again, they have the good old allergy testing and shots for procedures to bill for. Most other peds subspecialists work in the Children's Hospital/academic world and live in the $150 - 250K range.
Again, talking about money and compensation is NOT crass. It is realistic. We all want to be paid well for our time and education. BUT, making life decisions based solely on money will ultimately leave you unhappy. Live life to the fullest, have a family and spend time with them, travel, and enjoy what you do for a living. Those are the real things I like about medicine - if you set things up correctly, you can do all those things.

 

[drv]

One of the most honest and best posts seen by me. Thanks man

 

[sdnetrocks]

BUT, making life decisions based solely on money will ultimately leave you unhappy. Live life to the fullest, have a family and spend time with them, travel, and enjoy what you do for a living. Those are the real things I like about medicine - if you set things up correctly, you can do all those things.

I completely agree. For me, making a decision based solely on money would mean ruling out pediatrics, which would be a shame because I really enjoy working with kids. I am glad that there are options in peds that can meet several of my goals.

I never knew that private neonatology is so well compensated... A few more questions that I have:

What about the adolescent medicine / child psychiatry route? I think I remember vaguely hearing that child psychiatry is compensated quite well.

Also, I think I read in the popular press about "executive" or "boutique-type" practices, where basically the patients pay a membership fee (i.e. $2k/yr), and in return get awesome service, such as same-day appointments. Any thoughts on this?

Thanks so much for your responses.

 

[ekydrd]

Teleodeum left out another possible pathway... Med/Peds combined residency then Peds EM fellowship. It is a year longer (Med/Peds is 4 yr program), but you will also be trained in taking care of adults, which can be important in a rural setting where you may be the only doc on duty in the ER at times.

 

[peptidoglycan]

There are also peds/EM combined residencies, but there are only 2 in the country, and each only takes 2 people -- 4 spots in total. They are 5 years long and get you boarded in both peds and EM. Remember, though, this EM is adult EM, so you are then trained and qualified to work at any ER seeing all-comers (more $$$ for you). They are at University of Maryland (well known for shock trauma in the ER) and Indiana University (good peds program) (and FREIDA says U of Arizona, but when I looked a couple years ago, they weren't actually taking applications - check for yourself this year). It's a good route, and slightly shorter. Your training will be broader than the guys who go a fellowship route, but you will be well-prepared to make more $$$.

 

[14022]

TeleoDeum...any knowledge on financial aspects of peds cardiology?

I have heard salaries consistently under $200K (~140-170K) which doesnt make much sense, since I would think billing for echos and EKG's would generate significantly more cash flow than preventive medicine by general peds or skin testing by A/I. They also have post-surgical management and ICU care, as well as cath and fetal echo, which all would be expected to reimburse nicely.

So what is with the low salary?

 

[14022]

What about the adolescent medicine / child psychiatry route? I think I remember vaguely hearing that child psychiatry is compensated quite well.

Child psych is in high demand, especially in academic settings. Problem is (well...problem for university hospitals...good for child psych docs) is that private practice can be a cash based specialty, so salaries are much much higher in private practice.

 

[Apollyon]

One is to do a full 3 or 4 year EM residency and then a Peds EM fellowship for 2 years.

About half of the Peds EM programs make EM grads do 3 years like the Peds grads (for equity).