why peds?

[villa]

it seems like an obvious question, but i would love to hear why those of you who have chosen a career in peds have done so.

i'm a 3rd year student and am trying to make the all-important decision of which specialty to apply for. i've always leaned towards peds (i really do adore kids of all ages, love the science of human development, love the idea of getting to know a family over a long period of time), and liked my peds rotation just fine. but: do you miss seeing adults? i've thought about FP for that reason, as well as for my deep interest in geriatrics. also, and this is becoming more important as i spend time with what seems like a lot of bitter burnt out doctors: pediatricians just seem a little happier and chill than those in just about any other field (except maybe psych or rads?). is this true in reality?
(i'm being only a little facetious in that question)

ok, that was a lot for a very very simple question. would appreciate any insight: why peds?

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[LadyJubilee8_18]

it seems like an obvious question, but i would love to hear why those of you who have chosen a career in peds have done so.

i'm a 3rd year student and am trying to make the all-important decision of which specialty to apply for. i've always leaned towards peds (i really do adore kids of all ages, love the science of human development, love the idea of getting to know a family over a long period of time), and liked my peds rotation just fine. but: do you miss seeing adults? i've thought about FP for that reason, as well as for my deep interest in geriatrics. also, and this is becoming more important as i spend time with what seems like a lot of bitter burnt out doctors: pediatricians just seem a little happier and chill than those in just about any other field (except maybe psych or rads?). is this true in reality?
(i'm being only a little facetious in that question)

ok, that was a lot for a very very simple question. would appreciate any insight: why peds?

1. The medicine is more interesting: Kids are more likely to present with zebras than adults are, because kids who have some rare illness are either treated for it in childhood, or don't make it to adulthood. In pediatrics, you'll see a wide variety of metabolic syndromes, seizure disorders, crazy infections, etc. etc. In adults you'll see diabetes, hypertension, alcoholism yada yada. Way less interesting.
2. Kids get better: Adults' bodies are already set in their ways, and so are way less plastic and able to adapt to disease. Their immune systems aren't quite as good, their brains aren't quite as plastic, and they've already got a myriad of chronic illnesses that prevent them from getting over problem X that you're treating. Your efforts can seem almost fruitless in an adult in kidney failure who also has cirrhosis, CHF, and a coagulopathy. One of my friends says it's like trying to rearrange furniture on the titanic. If you actually manage to bring them back from, oh say, a stroke, they will never use the damaged parts of their brains again. Kids are tough as nails and are better able to bounce back. I had a kid with Moyamoya who had a Left MCA stroke, and was kicking a ball with his right hand, walking, and giving fives with his right hand by the time he left. It's amazing and awesome.
3. History taking is WAY easier with a kid: Any meds? no. Past medical history? none. Any surgeries? no. Boom! you're done. I really don't feel like sitting there for thirty minutes trying to piece together a long and convoluted PMH. This is not the case for all kids, but for the most part.
4. Kids are easy to please and appreciate your help: If a kid is screaming and upset in your office, give him a lolly pop and a sticker. If an adult is screaming and upset in your office, you've got a law suit on your hands. Kids are happy to get better and trust you to get them there. The adults around them are ready to get their kid healthy again, and are usually compliant with treatment plans. Have you ever tried to get an adult with COPD to stop smoking? Almost impossible! They want you to fix what fifty years of smoking has done to their lungs in one visit, and they're pissed if you have the audacity to suggest they should quit their bad habits. which leads me to my next point
5. Kids have illnesses that are not their own doing. Adult A eats poorly leading to--> obesity, hypertension, diabetes, high cholesterol, strokes, heart attacks, etc. Adult B drinks like a fish leading to--> cirrhosis, alcoholic cardiomyopathy, alcoholic dementia, the DTs, vitamin deficiencies, etc. Adult C has smoked since he was 16 leading to --> lung cancer, COPD, hypertension, bladder cancer, etc. Adults A,B, and C will expect to get better really fast by only taking one pill, and are pissed when you tell them that these expectations are unrealistic. Kids get pneumonia, or septic arthritis, or have congenital heart defects, etc. All treatable, all not their faults.
6. Even when pediatrics is boring, at least you're playing with a happy, cooing baby!
7. Pedi rocks, and I could go on and on, but doing adult medicine just doesn't make sense when you could be a pediatrician.

 

[DarthNeurology]

1. The medicine is more interesting: Kids are more likely to present with zebras than adults are, because kids who have some rare illness are either treated for it in childhood, or don't make it to adulthood. In pediatrics, you'll see a wide variety of metabolic syndromes, seizure disorders, crazy infections, etc. etc. In adults you'll see diabetes, hypertension, alcoholism yada yada. Way less interesting.
2. Kids get better: Adults' bodies are already set in their ways, and so are way less plastic and able to adapt to disease. Their immune systems aren't quite as good, their brains aren't quite as plastic, and they've already got a myriad of chronic illnesses that prevent them from getting over problem X that you're treating. Your efforts can seem almost fruitless in an adult in kidney failure who also has cirrhosis, CHF, and a coagulopathy. One of my friends says it's like trying to rearrange furniture on the titanic. If you actually manage to bring them back from, oh say, a stroke, they will never use the damaged parts of their brains again. Kids are tough as nails and are better able to bounce back. I had a kid with Moyamoya who had a Left MCA stroke, and was kicking a ball with his right hand, walking, and giving fives with his right hand by the time he left. It's amazing and awesome.
3. History taking is WAY easier with a kid: Any meds? no. Past medical history? none. Any surgeries? no. Boom! you're done. I really don't feel like sitting there for thirty minutes trying to piece together a long and convoluted PMH. This is not the case for all kids, but for the most part.
4. Kids are easy to please and appreciate your help: If a kid is screaming and upset in your office, give him a lolly pop and a sticker. If an adult is screaming and upset in your office, you've got a law suit on your hands. Kids are happy to get better and trust you to get them there. The adults around them are ready to get their kid healthy again, and are usually compliant with treatment plans. Have you ever tried to get an adult with COPD to stop smoking? Almost impossible! They want you to fix what fifty years of smoking has done to their lungs in one visit, and they're pissed if you have the audacity to suggest they should quit their bad habits. which leads me to my next point
5. Kids have illnesses that are not their own doing. Adult A eats poorly leading to--> obesity, hypertension, diabetes, high cholesterol, strokes, heart attacks, etc. Adult B drinks like a fish leading to--> cirrhosis, alcoholic cardiomyopathy, alcoholic dementia, the DTs, vitamin deficiencies, etc. Adult C has smoked since he was 16 leading to --> lung cancer, COPD, hypertension, bladder cancer, etc. Adults A,B, and C will expect to get better really fast by only taking one pill, and are pissed when you tell them that these expectations are unrealistic. Kids get pneumonia, or septic arthritis, or have congenital heart defects, etc. All treatable, all not their faults.
6. Even when pediatrics is boring, at least you're playing with a happy, cooing baby!
7. Pedi rocks, and I could go on and on, but doing adult medicine just doesn't make sense when you could be a pediatrician.

What about the growing obesity epidemic in America? I.e. will/do pediatricians tell an 8 year who can't think abstractly that their diabetes/obesity is making them unhealthy and will make them more unhealthy as adults? There is also risky behavior in kids that is producing the most dangerous pediatric silent epidemic that continues unabated in the U.S. and affects 2 million kids:

http://video.yahoo.com/watch/1622162

I would urge you all to watch this video, and donate if you can.

 

[CrazyPeds527]

it seems like an obvious question, but i would love to hear why those of you who have chosen a career in peds have done so.

i'm a 3rd year student and am trying to make the all-important decision of which specialty to apply for. i've always leaned towards peds (i really do adore kids of all ages, love the science of human development, love the idea of getting to know a family over a long period of time), and liked my peds rotation just fine. but: do you miss seeing adults? i've thought about FP for that reason, as well as for my deep interest in geriatrics. also, and this is becoming more important as i spend time with what seems like a lot of bitter burnt out doctors: pediatricians just seem a little happier and chill than those in just about any other field (except maybe psych or rads?). is this true in reality?
(i'm being only a little facetious in that question)

ok, that was a lot for a very very simple question. would appreciate any insight: why peds?

1) Peds people have the most fun at work every day. Ask yourself this, have you ever heard an internist say "I'm really excited to go to work today and take care my patients!" No? You aren't alone. Even surgeons and Ob/Gyns seem to get excited about days at work more than internists.

2) What happens when you high five an adult patient? They look at you like you are crazy, demean you for being unprofessional, and then you feel horrible for trying to have a good day at work. With a peds patient? Instant rapport!!

3) Quick turnaround...kids can go from sick and dying to just fine in a manner of days. When was the last time you saw a vented adult walk out of the hospital 2 days later? RSV season in Peds? Happens all the time!

4) Variation in pathology (like LadyJubilee said, not kids fault!). Adult Cards: CAD, CAD, CAD, valve disease, CAD, CHF, CAD, CHF. Peds Cards: Tetralogy of Fallot, Hypoplastic L Heart, arrythmias galore, etc, etc!

I will say this, although I could go on and on and on about why peds is awesome: if you truly do have an interest in geriatrics, FP might be a good option for you to take care of a broad range of ages. Geriatric patients were definitely the most appreciative and grateful when i was a 3rd year clerk. But you have to ask yourself if that means you can deal with the 40 yr old whining about x, or treating HTN, DM, and high cholesterol is what you are truly interested in, because many of your patients will be coming in with one of those 3 (or all of above!).

Oh, and do i miss adults? NOOOOOOOOOOOOOOOOOOO!!!!!!!!!!!

 

[Bienchen]

I would just like to add another point : peds is by far the most 'preventive' specialty out there. And let's not forget that those cute kids the Pediatricians see with their acute and curable illnesses will eventually become the adults with the bad habits and obesity and hypertension if they don't form healthy habits early on. So if we do a good job, we may be able to at least partially relieve our adult doc colleagues from the burden of 'society diseases' so they have more time for other problems. And cancer can hit super-healthy people, too, as do many other 'adult' diseases...
... So for me, the question was really: At what end do I want to work ? Do I want to be at the beginning where I may at least have the illusion that I can make a difference and maybe prevent a kid from becoming morbidly obese or engaging in risky behavior, or do I want to be at the other end where I would try helping the people who are suffering from the consequences already ?
For me, that was an easy question, ultimately.
And you still have to deal with adults - the parents. As we all know, not all parents always have their kid's best interest in mind, unfortunately.

 

[Marigold]

You sound quite similar to me!

I wanted to do FM for pretty much all of my MS3 year, because I felt drawn to primary care, really enjoy continuity of care and getting to know my patients/families and taking care of them long-term, and I enjoy the variety of issues you get as a generalist. I also knew that I loved kids, but I also have a soft spot for old folks/geriatrics too. It's just all the adults in between that I don't get excited about.

THEN, at the end of third year, during my Psych rotation, I did a month of Child Psych and one day came to the realization that I was really enjoying myself...so I freaked out about my sudden career crisis and picked it apart with the help of family, close friends who know me well, and a mentor in Pediatrics, and decided that what I was really enjoying were the children.

I did several Peds electives during 4th year to make sure, and indeed, it's the perfect decision for me. I agree with everything that's been said above...I love being able to have fun and act silly with my patients, I prefer the pathology of children to that of adults (more interesting, imho), and I get passionate about giving children what they all deserve, which is the best shot at a happy and healthy life, by providing great medical care and anticipatory guidance from DOL #1. I actually enjoy educating parents (some don't), and being around kids all day just makes me happy.

I would recommend doing some peds electives if you can!! That really helped me to cement my decision to become a pediatrician.

 

[oldbearprofessor]

Great thread! I want to add a couple more that may not be quite as apparent to med students picking the field.

1. Pediatricians, both in general practice and specialists, academic and community ARE a highly respected source of advocacy for children. We are leaders in this role and it remains a very important part of what I like about caring for children. Advocating for the rights of children to receive adequate health care and be raised in a safe and nurturing environment throughout the world is one of the great benefits and responsibilities of being a pediatrician.

2. Pediatricians are leaders in conducting research, both basic science and clinical to enhance the health care of children. It is well-recognized that there is a vast gap in the research understanding of medical needs of adults and children. We are key players in conducting the research that will fill in the gap.

3. Oh yes...pediatricians ARE respected in the community. Sure we face the issues that all physicians do of malpractice risk, etc, but we have a tremendous level of respect. I've not personally seen any evidence that this has changed since I started pedi residency over 25 years ago.

and finally...for the guys out there.....

4. Have you ever spent time in a pediatric hospital and looked at your coworkers (the other residents of the other gender) and the rest of the staff? . Then go to the VA and do the same thing (well at least for the staff....).

 

[Marigold]

1. Pediatricians, both in general practice and specialists, academic and community ARE a highly respected source of advocacy for children. We are leaders in this role and it remains a very important part of what I like about caring for children. Advocating for the rights of children to receive adequate health care and be raised in a safe and nurturing environment throughout the world is one of the great benefits and responsibilities of being a pediatrician.

Amen!

 

[iatrosB]

4. Have you ever spent time in a pediatric hospital and looked at your coworkers (the other residents of the other gender) and the rest of the staff? . Then go to the VA and do the same thing (well at least for the staff....).

Just don't tell my wife

 

[DarthNeurology]

Great thread! I want to add a couple more that may not be quite as apparent to med students picking the field.

1. Pediatricians, both in general practice and specialists, academic and community ARE a highly respected source of advocacy for children. We are leaders in this role and it remains a very important part of what I like about caring for children. Advocating for the rights of children to receive adequate health care and be raised in a safe and nurturing environment throughout the world is one of the great benefits and responsibilities of being a pediatrician.

2. Pediatricians are leaders in conducting research, both basic science and clinical to enhance the health care of children. It is well-recognized that there is a vast gap in the research understanding of medical needs of adults and children. We are key players in conducting the research that will fill in the gap.

3. Oh yes...pediatricians ARE respected in the community. Sure we face the issues that all physicians do of malpractice risk, etc, but we have a tremendous level of respect. I've not personally seen any evidence that this has changed since I started pedi residency over 25 years ago.

and finally...for the guys out there.....

4. Have you ever spent time in a pediatric hospital and looked at your coworkers (the other residents of the other gender) and the rest of the staff? . Then go to the VA and do the same thing (well at least for the staff....).

Yeah, but how do pediatricians really advocate to improve health insurance for children? I don't think there have been many major breakthroughs in this realm in the U.S. . . . I guess maybe that will change with the next administration, in other words I think the politicians (some of them) are working pretty hard to get more health insurance for kids . . . I think every doctor has a responsibility to advocate for kids just going to medical school, but how some pediatricians I have interacted with acted how they and they alone were somehow saving children from the "bad adults" of the world and treated the specialty as more of an exclusive country club than just a specialty seemed deluded and a major turn-off of pediatrics for me (of which the positives outweight this negative.) A lot of pediatricians I have worked with appeared aloof and distant, and sort of condescending to students who thought they could be one of them, any similar impressions from pediatricians, i.e. Pedi-Snobs?

 

[oldbearprofessor]

Yeah, but how do pediatricians really advocate to improve health insurance for children?

http://www.aap.org/advocacy/staccess.htm

 

[edmadison]

I'll share some of my thoughts in the matter. Remember that most of the earlier posters extolling the virtues of pediatrics are medical students. It doesn't mean that they are wrong, it just means they lack the first hand experience of doing it every day. That being said, some of their comments are very insightful.

Big plusses for me have already been noted. Kids are fun. Their health problems are rarely their fault. They get better. Very few of your patients will die, while all of the internist’s patients do. You get to see a great breadth of issues, even with preventative medicine (think of how they change over 18 years). As a general pediatrician you’ll have significant variety. In one hour you’ll take care of ADHD, an ear infection and a well baby exam. You can be having an awful day turned around by a smile. I recommend scheduling at least one three or four year-old every hour.

There are downsides, as there are in every field. Many of the patients you see won’t be sick: Runny nose x 1 day or fever to 99.2. I’ve seen a ton of these. Arguing with parents about antibiotics or, worse, immunizations . How about dealing with parents who refuse to stop smoking despite their child’s third asthma exacerbation in four months? Parents who complain about behavioral problems but won’t (or "can't") take the steps necessary to fix them. Parents who come in for help with ADHD but won’t even consider medication. Then there’s the business end of the deal. Low reimbursement and the bottom of the salary scale for physicians. Then there are the people who assume you went into peds because you weren’t good enough to do anything else.

Finally, I’d like to comment on the “Pedi-Snob” comment because the other thread got closed and it was brought up here. It’s real, there’s no doubt about it. There are many pediatricians who are quite sanctimonious. We see ourselves are virtuous because we defend the defenseless. We’ve forsaken large salaries for the good of the community. We give up time on Saturday’s to do camp physicals and we give talks at high schools. Most of us go into pediatrics for the right reason, we just like to let our ego inflate a bit.

Ed

 

[LadyJubilee8_18]

I'll share some of my thoughts in the matter. Remember that most of the earlier posters extolling the virtues of pediatrics are medical students. It doesn't mean that they are wrong, it just means they lack the first hand experience of doing it every day. That being said, some of their comments are very insightful.

Big plusses for me have already been noted. Kids are fun. Their health problems are rarely their fault. They get better. Very few of your patients will die, while all of the internist’s patients do. You get to see a great breadth of issues, even with preventative medicine (think of how they change over 18 years). As a general pediatrician you’ll have significant variety. In one hour you’ll take care of ADHD, an ear infection and a well baby exam. You can be having an awful day turned around by a smile. I recommend scheduling at least one three or four year-old every hour.

There are downsides, as there are in every field. Many of the patients you see won’t be sick: Runny nose x 1 day or fever to 99.2. I’ve seen a ton of these. Arguing with parents about antibiotics or, worse, immunizations . How about dealing with parents who refuse to stop smoking despite their child’s third asthma exacerbation in four months? Parents who complain about behavioral problems but won’t (or "can't") take the steps necessary to fix them. Parents who come in for help with ADHD but won’t even consider medication. Then there’s the business end of the deal. Low reimbursement and the bottom of the salary scale for physicians. Then there are the people who assume you went into peds because you weren’t good enough to do anything else.

Finally, I’d like to comment on the “Pedi-Snob” comment because the other thread got closed and it was brought up here. It’s real, there’s no doubt about it. There are many pediatricians who are quite sanctimonious. We see ourselves are virtuous because we defend the defenseless. We’ve forsaken large salaries for the good of the community. We give up time on Saturday’s to do camp physicals and we give talks at high schools. Most of us go into pediatrics for the right reason, we just like to let our ego inflate a bit.

Ed

On the pedi snobs note: I can certainly see your point about inflated egos, but don't pediatricians deserve to think highly of themselves? Someone who gives up a higher salary for the good of the community, defends the defenseless, and still gets **** on by other specialists because he is thought to have chosen his field because he wasn't good enough to do anything else gets to have bragging rights in my book. Shouldn't you feel good about being so selfless in your career choice, and about making such an important difference in the lives of children? That's not to say that other docs don't also make a huge difference in their patients' lives, or that those docs don't get to feel good about their career choices (many of them do, and will let you know). But why is it bad for a dedicated pediatrician to pat himself on the back sometimes?

 

[riverie]

IRemember that most of the earlier posters extolling the virtues of pediatrics are medical students. It doesn't mean that they are wrong, it just means they lack the first hand experience of doing it every day.

There are downsides, as there are in every field. Many of the patients you see won't be sick: Runny nose x 1 day or fever to 99.2. I've seen a ton of these. Arguing with parents about antibiotics or, worse, immunizations . How about dealing with parents who refuse to stop smoking despite their child's third asthma exacerbation in four months? Parents who complain about behavioral problems but won't (or "can't") take the steps necessary to fix them. Parents who come in for help with ADHD but won't even consider medication. Then there's the business end of the deal. Low reimbursement and the bottom of the salary scale for physicians. Then there are the people who assume you went into peds because you weren't good enough to do anything else.


Ed

Ed, I guess a question pertinent to us "idealistic" med students, given the very realistic downsides you have pointed out, is -- Is it all worth it at the end of the day?

 

[edmadison]

Ed, I guess a question pertinent to us "idealistic" med students, given the very realistic downsides you have pointed out, is -- Is it all worth it at the end of the day?

Oh absolutely -- for me. I NEVER dreaded going to work during my residency, not even in one of my 18 NICU months (it seemed like 18). Every decision should be made with full review of the pros and cons. My journey is more serpentine than most and I would have been better off to be more cognizant of some cons of my prior career(s). Peds is awesome and, to me, the pros far outweigh the cons. I certainly would rather do general peds than almost any medicine or surgery sub-specialty. That being said, I plan on escaping many of the cons I perceive in peds by going into critical care. Thus I avoid most of the office BS. On the other hand, I have a very good friend that is 9 months out of residency (just like me) and she loves general peds, but she has the personality for it. Each of us has to find the right fit.

One of the great things about doing a peds residency is that you have a great deal of flexibility. You can quasi-specialize without a fellowship: general peds vs. hospital practice or focus on adolescents (your partners won't mind you taking them off your hands). You can also bite the bullet and due a three-year fellowship and concentrate of virtually anything. No attention span? Do Peds Emergency. Great attention span? Do devo. Do you like torturing residents? Do NICU (just kidding OBP). Like taking care of chronic, but more serious issues? Do Cards or Pulm. Like GYN and sports medicine? Do an adolescent fellowship.

Regarding OBPs last comment about pediatrician's deserving to think highly of themselves, I agree. It is a "sacrifice" at least compared to other specialties. And we get secondary gain, there's no question. I could never do a job that didn't make me feel good about myself. I don't know how the dermatologist can live with themselves. And perhaps it is good that peds is on the low end of the pay scale because we don't see many people going into it for the wrong reasons. It's certainly not bad for us to "pat ourselves on the back", but I do think we exude a bit of moral superiority at times. It would be interesting to here what the med student's impression of this is as they haven't been fully indoctrinated yet.

Ed

 

[riverie]

On the other hand, I have a very good friend that is 9 months out of residency (just like me) and she loves general peds, but she has the personality for it. Each of us has to find the right fit.

how would you describe a personality suited for general peds? i'm trying to decide between that and subspecialties at this point.

It would be interesting to here what the med student's impression of this is as they haven't been fully indoctrinated yet.

Ed

i actually haven't come across self-righteous pediatricians yet, but i do think i'd have an extra pat on the back for myself in the future for eschewing a larger paycheck and a presumably better lifestyle.

 

[oldbearprofessor]

Regarding OBPs last comment about pediatrician's deserving to think highly of themselves, I agree. It is a "sacrifice" at least compared to other specialties.

Ed

For the record, that was Lady Jubilee, not me, who said that. I wouldn't have quite said it that way, I would have focused on a word like "proud". However, I certainly think that these people, DESERVE to think highly of themselves for what they are doing (note that not all are pediatricians), as do the many other pediatricians serving the global community of children.

With regard to specialty vs general, a lot of folks change their mind in both directions during their PL-1 and PL-2 year. Have an open mind, talk with lots of folks like me , and see where your interests take you. Don't worry too much about primary care vs specialty "tracks" as you enter residency.

 

[riverie]

With regard to specialty vs general, a lot of folks change their mind in both directions during their PL-1 and PL-2 year. Have an open mind, talk with lots of folks like me , and see where your interests take you. Don't worry too much about primary care vs specialty "tracks" as you enter residency.

yeah i'm definitely leaving the option of fellowships wide open. however, i'm trying to decide between pedi neuro (early match) and gen peds/other subspecialties right now. i guess it boils down to how much interest in pedi neuro i have and that's why i'm in the elective now! hehe. then i do a month of gen peds to really feel that out too. i was just wondering if Ed had a specific personality in mind that i might find describes me too.

 

[edmadison]

For the record, that was Lady Jubilee, not me, who said that. I wouldn't have quite said it that way, I would have focused on a word like "proud". However, I certainly think that these people, DESERVE to be think highly of themselves for what they are doing (note that not all are pediatricians), as do the many other pediatricians serving the global community of children.

Sorry about that -- I confused the picture of the bear and the cat. I do think that "proud" is a good way to describe how many off us feel. There certainly is enough arrogance to go around in the medical field -- thank goodness that surgeons use up most of the supply. There are still a few pediatricians that are a little over the top. I'm glad we can discuss the issue in a civil fashion because the previous thread got closed to stop a brewing flame war (I assume).

As for riverie's question -- there's no magic formula to find out what you will like. Just try to get some good exposure to what any given specialist and subspecialist does on a daily basis. Every field has pros and cons, it's just a question of which pros mean the most to you and which cons you can live with. I like treating sick patients, I get bored with treating patients that aren't sick. Thus, ICU is a good fit for me (and for a bunch of other reasons too). My friend really likes counseling and interacting with patient's and families; on the other hand, she doesn't get as much satisfaction with dealing with emergencies and sick patients; for her general peds is a better fit. As OBP said (and I hope I got it right this time) you needn't worry about picking your final destination at this time as long as you know that you want to work with kids (well, unless you want to do child psych or child neuro). In my previous post I was just noting that there opportunities for a great breadth of personalities in peds.

ed

 

[generic]

I'm in the same boat as Riverie.

I have seen the stats that suggest that most Pedi residents (and especially most AMG's at "well-ranked" residencies, FWIW) will match into their chosen fellowship. However, there are a few "more competitive" ones, such as Neo, Cards, ER, etc. for which many go unmatched each year.

So is it really feasible to wait til residency (PL1/2) to "feel these out" and still be able to apply and successfully match? Does one need to already be doing research as an early PGY2 in order to get a fellowship spot?

Seems like as a med student, those who haven't already hit the ground running are looking at long odds if they wish to do something very competitive like surgical subspecialities, derm, whatever...I think that's why I'm scared about it.

 

[oldbearprofessor]

I'm in the same boat as Riverie.

I have seen the stats that suggest that most Pedi residents (and especially most AMG's at "well-ranked" residencies, FWIW) will match into their chosen fellowship. However, there are a few "more competitive" ones, such as Neo, Cards, ER, etc. for which many go unmatched each year.

So is it really feasible to wait til residency (PL1/2) to "feel these out" and still be able to apply and successfully match? Does one need to already be doing research as an early PGY2 in order to get a fellowship spot?

Seems like as a med student, those who haven't already hit the ground running are looking at long odds if they wish to do something very competitive like surgical subspecialities, derm, whatever...I think that's why I'm scared about it.

This is neo's first year in the match, so no one knows what will happen, but in the past, there have been "unfilled" slots, although the biggest and best-known programs find good fellows easily. There are others here who are more familiar with cards and pediEM, but I've certainly known lots of folks who decided on these during their residency. If you are going the "usual" route (i.e. not doing an extra year as a chief or in Africa, etc) then you need to decide by about middle of the second year - a bit earlier for early match fellowships (eg cards) a bit later for late match fellowships (eg neo).

Many fellowship applicants have little or no residency research. Who has time for that during internship?

 

[riverie]

As for riverie's question -- there's no magic formula to find out what you will like. Just try to get some good exposure to what any given specialist and subspecialist does on a daily basis. Every field has pros and cons, it's just a question of which pros mean the most to you and which cons you can live with. I like treating sick patients, I get bored with treating patients that aren't sick. Thus, ICU is a good fit for me (and for a bunch of other reasons too). My friend really likes counseling and interacting with patient's and families; on the other hand, she doesn't get as much satisfaction with dealing with emergencies and sick patients; for her general peds is a better fit. As OBP said (and I hope I got it right this time) you needn't worry about picking your final destination at this time as long as you know that you want to work with kids (well, unless you want to do child psych or child neuro). In my previous post I was just noting that there opportunities for a great breadth of personalities in peds.

ed

Thanks for sharing your observations, Ed. I do think the words in bold describe me well. I love interacting with playful kids and also reassuring parents.

 

[DarthNeurology]

For the record, that was Lady Jubilee, not me, who said that. I wouldn't have quite said it that way, I would have focused on a word like "proud". However, I certainly think that these people, DESERVE to be think highly of themselves for what they are doing (note that not all are pediatricians), as do the many other pediatricians serving the global community of children.

With regard to specialty vs general, a lot of folks change their mind in both directions during their PL-1 and PL-2 year. Have an open mind, talk with lots of folks like me , and see where your interests take you. Don't worry too much about primary care vs specialty "tracks" as you enter residency.

I've worked on global health projects focusing on helping children and while you do think very highly of the work you do and the organization does, . . . you usually leave with a sense of gratitude and don't think especially highly of yourself. There is a subtle but important distinction in terms of expectations of what you get out of an experience.

 

[umass rower]

Yeah, but how do pediatricians really advocate to improve health insurance for children? I don't think there have been many major breakthroughs in this realm in the U.S.

Uh.... what? In spite of the fact that children, on the whole, exert very little political power, they have fairly generous criteria for eligibility in public health insurance programs. Uninsured rates are drastically lower among children than adults, and approximately 7 out of 10 uninsured children are eligible for services (source: http://www.rwjf.org/files/newsroom/ckfresearchreportfinal.pdf ). Who do you think have been the driving forces behind these measures?

A lot of pediatricians I have worked with appeared aloof and distant, and sort of condescending to students who thought they could be one of them, any similar impressions from pediatricians, i.e. Pedi-Snobs?

I have never once seen this kind of attitude, and suspect that your characterization of "a lot of pediatricians" being like this is probably exaggerated. In fact, I haven't seen the kind of attitude you describe (feeling that a student isn't good enough for their specialty) ANYWHERE so far; much to the contrary, most physicians I've met like to tout the positives of their field, and seemed to want me to join them in their specialty.

 

[umass rower]

I've worked on global health projects focusing on helping children and while you do think very highly of the work you do and the organization does, . . . you usually leave with a sense of gratitude and don't think especially highly of yourself. There is a subtle but important distinction in terms of expectations of what you get out of an experience.

So it's OK to be proud of the work you do, and the organization you support, and the difference you make, but isn't OK to be proud of yourself for doing these things? I'm not talking about pride in the 7 deadly sins sense; I'm talking about the feeling of satisfaction one gets when accomplishing goals that feel truly worthwhile. I think that if you're truly acting in a selfless manner to accomplish meaningful goals, it is almost impossible not to be proud of yourself to some extent for what you've done.

 

[DarthNeurology]

So it's OK to be proud of the work you do, and the organization you support, and the difference you make, but isn't OK to be proud of yourself for doing these things? I'm not talking about pride in the 7 deadly sins sense; I'm talking about the feeling of satisfaction one gets when accomplishing goals that feel truly worthwhile. I think that if you're truly acting in a selfless manner to accomplish meaningful goals, it is almost impossible not to be proud of yourself to some extent for what you've done.

I think to be pleased with the work you have accomplished is normal and good, i.e. most gain satisfaction from helping other people. I think it is also good to pleased with an organization that promotes helping others such as children in need in developing countries. I think by definition that if you are acting in a selfless manner you won't be overly proud of yourself.

Being proud of what you are doing, or feeling that you deserve to be proud sort of blinds yourself to what more you should/could be doing and inhibits future personal growth I think. People who are overly proud of themselves I feel have a sense to discount the good that others are doing, i.e. "We are pediatricians and are very proud of that I am very proud to be pediatrician, (even though I don't actually do large amounts of volunteer work, but basically do the work of an average pediatrician), being proud sort of says that you are happy with your level of giving back to the community, i.e. "I've done my share", or "I work for less than most doctors to take care of kids, (even though pediatricians maybe financial make more than 85% of Americans) . . . being proud allows you to make all sort of rationalizations about why you are special. I find that most people who are involved in what the rest of us would consider selfless acts are not "proud", but wish that they could do more, are happy to be Americans and have good jobs and education and want to give something back, i.e. and actual sense of guilt instead of being "proud". Honeslty, being proud I think means comparing yourself to others in your situation to raise yourself above them, we all do it, I could say (for example if these were facts I have no way of knowing, but could guess): "I am proud that I study more than 80% of medical students to be a better doctor, and I am proud that I volunteer more than 75% of people every did in medical school and I am proud that I will be involved in global health more than 98% of physicians, i.e. I am planning on doing Medicine Sans Frontieres for 2-3 i.e. a tour of duty, How proud I am! I am so much more dedicated than most aspiring pediatricians" Have I thought these thoughts before? Yes actually! But when I ponder what I am thinking I wonder what I am really thinking, . . . I will enjoy doing global health, but I won't be proud about it and probably complain I can't buy a fancy house or pay off loans (but probably think it was worth it, and like making joking complaints better than fancy stuff), but what matters is that the work gets done. Being proud sounds self-centered I guess. I may be wrong, I have been before.

 

[DarthNeurology]

Uh.... what?. . .[edit] suspect that your characterization of "a lot of pediatricians" being like this is probably exaggerated. In fact, I haven't seen the kind of attitude you describe (feeling that a student isn't good enough for their specialty) ANYWHERE so far [edit]; .

Well, ah, this is my experience with some pediatricians and how I describe I think anybody would describe it, classmates of mine observed this and thought it was funny that I actually wanted to do pediatrics and didn't understand why I was treated that way.

 

[DarthNeurology]

. . . they have fairly generous criteria for eligibility in public health insurance programs. Uninsured rates are drastically lower among children than adults, and approximately 7 out of 10 uninsured children are eligible for services

The U.S. is really a wonderfully generous nation such that approximately 7 out of 10 uninsured children are eligible for services. I would be upset that 3 out of 10 uninsured children are not eligible for services and that children remain disenfranchised as a group in the U.S. That any children go hungry, or do get adequate health care while the majority do is not exactly something I would be proud of, especially since the U.S. has known about under and un-insured people and the impact on their health and lives for decades.

 

[johnnywalker]

ok your message about being proud was just rambling. not sure what the point was. regardless, you had a bad pediatric experience, got it, but not all experiences are like this obviously, otherwise there would not be threads (some closed) devoted to pediatrics.

 

[TexasRose]

Okay, there have been several comments on the closed thread so I will assume I didn't make it evident enough why that happened. There were several TOS violations on the thread and things were deteriorating into personal snipes and insults. Since the discussion was being held in a more civil manner in other threads, it was decided that the thread should be closed.

Please carry on.

 

[AF_PedsBoy]

Four words: "Stuffed Animals" and "Giving Shots"

 

[drpediatrician]

if you had asked a question to yourself, why into medicines.. may be you had not asked this question.

its fun and challenge .. to interpret something one cannnot understand... easily.

if you got brains! think peds!!
http://www.pediatricianonline.in

 

[Leukocyte]

I was one of those who was very interested in pediatrics, but ended up choosing Family Medicine. My reasons.

1-Liked Peds, but also like OB/GYN. In my residency, as a FM, we get to take care of mom, mom during pregnancy, deliver mom, and take care of the baby.

This weekend I delivered one of my continuity patients. Every thing was fine and dandy, the monitors are all OK, mother pushing well, head just w'ont come out. I decided to use a vaccum. Head came out with vaccum. Then the baby's head started turning blue. Very blue. Mother pushing, but baby is stuck...I was very scared, but tried to calm down and did my maneuvers with episiotomy (McRoberts, Rubin, Wood, Reverse Woods) Then finaly baby came out after I told mom to be on all fours. I was very happy, but I had to repair the episiotomy and the torn anal sphincter.

2-In my experience, FMs are more comfortable with invasive procedures than general pediatricians. We do procedures on a daily basis in our FM clinic. Last month on my out-patient peds rotation, a kid came in with an abcess. My attending pediatrician was not comfortable doing a I&D, and decided to send the patient to the Family Practice Clinic for the "procedure"...I was shocked.

3-Sightly better pay as a FM than general Pediatrician.

 

[tawanda]

I didn't choose peds until September of my fourth year. I loved many of my rotations, including OBGYN (gasp) and Internal Medicine and of course Peds. I debated over Family Medicine since I had a variety of interests, but finally I thought to myself, "would I be more likely to take my child to a Pediatrician or a Family doc?" "Would I be more likely to deliver my baby with an OB or a family doc?" All of my personal choices led towards the more specialized physician. Not to say that Family docs don't do a great job. I myself wanted to feel more like that "expert" in a field with way more opportunities to specialize. I found Peds to give me a similar satisfaction I had in Family Med--a wide variety of patients, lots of contact with families, opportunity for preventative medicine. Also, I really admired a lot of the pediatricians I had worked with. They had a lot of pride in their field, were hard-working, and actually cared about their patients.

I also considered Anesthesia (hey, they deal with OB, Adults, and kids) but I found Anesthesiologists tended to look at me like I had two heads when I told them this reasoning. I also found that many of the residents seemed to be in it for the money (just a personal observation). I actually decided to do peds while on an anesthesia rotation. I loved talking to the families before a procedure that a child was about to undergo, reassuring them. I didn't like sending the child away afterwards, never to see them again. The next month I did a rotation in Neonatology and this sealed the deal. I loved the combination of chronic care of an extremely preterm neonate, talking to the families on a daily basis, as well as opportunities for acute management and procedures (intubation, lines, etc.)

I am entering internship this June, and I still wonder if I might miss adults. Sometimes I like the complexity of medical problems, having patients you can carry on an adult conversation with, and having a patient who actually cooperates with your physical exam. I think in Peds I'll still be able to fulfill these needs with the child with chronic, complex problems, and adolescent patients who can have some adult illnesses. For me the negatives in adult medicine outweigh the positives. I grew tired of treating problems that were brought on by the patients themselves, treating patients who were drug-seeking, and patients who were faking.

I'm considering Neonatology but I am not totally sure. I think some other fields like Heme-Onc and Pulm might appeal to me too. I highly recommend Peds. Just because you can do a more competitive field like Rads, Derm, etc because you have awesome board scores doesn't mean you should. Do what is right for you.

 

[mytirf]

I also considered Anesthesia (hey, they deal with OB, Adults, and kids) but I found Anesthesiologists tended to look at me like I had two heads when I told them this reasoning. I also found that many of the residents seemed to be in it for the money (just a personal observation). I actually decided to do peds while on an anesthesia rotation. I loved talking to the families before a procedure that a child was about to undergo, reassuring them. I didn't like sending the child away afterwards, never to see them again. The next month I did a rotation in Neonatology and this sealed the deal. I loved the combination of chronic care of an extremely preterm neonate, talking to the families on a daily basis, as well as opportunities for acute management and procedures (intubation, lines, etc.)

I took the exact same path as you did choosing pediatrics later and making that decision while on my anesthesia rotation. I'm currently a PL-2 almost a PL-3 and really love my job. I actually love almost everything about it...of course I love kids, but I also love working with the parents, nursing staff, child-life people, respiratory therapists etc...I feel that we are all on the same team, together taking care of the patient. The variety is also tremendous, with both critical care, chronic care, complex patients and office-based medicine. You can really get to know the families that you care for and provide excellent medical care for the under-served. Yes, you won't make quite as much money as your adult counterparts, but let me tell you, when your friends start having kids and one of them is sick, the amount of respect you will get is incredible.

It is a great field, and I wouldn't change it for really anything. And remember, who would you rather wake up for...an obnoxious adult wanting sleeping meds, or a miserable child with a fever.

-MT

 

[smq123]

On the pedi snobs note: I can certainly see your point about inflated egos, but don't pediatricians deserve to think highly of themselves? Someone who gives up a higher salary for the good of the community, defends the defenseless, and still gets **** on by other specialists because he is thought to have chosen his field because he wasn't good enough to do anything else gets to have bragging rights in my book. Shouldn't you feel good about being so selfless in your career choice, and about making such an important difference in the lives of children? That's not to say that other docs don't also make a huge difference in their patients' lives, or that those docs don't get to feel good about their career choices (many of them do, and will let you know). But why is it bad for a dedicated pediatrician to pat himself on the back sometimes?

Regarding OBPs last comment about pediatrician's deserving to think highly of themselves, I agree. It is a "sacrifice" at least compared to other specialties. And we get secondary gain, there's no question. I could never do a job that didn't make me feel good about myself. I don't know how the dermatologist can live with themselves. And perhaps it is good that peds is on the low end of the pay scale because we don't see many people going into it for the wrong reasons. It's certainly not bad for us to "pat ourselves on the back", but I do think we exude a bit of moral superiority at times. It would be interesting to here what the med student's impression of this is as they haven't been fully indoctrinated yet.

The "pedi snobs" phenomenon has actually really turned me off from peds.

I think that pediatricians do a GREAT service. I admire their ability to relate to children of all ages, and at all stages of health. It's easy to play with a charming, cute 3 year old with a stellar smile...but not so easy to relate to a kid on a vent or who's dehydrated, etc.

But - wow, I'd never heard so much bashing of other specialties as I've heard on peds. Even the OB/gyns had smaller inferiority complexes.

The OBs don't know anything about babies, so they get unnecessarily worried about the neonates.

The family med guys don't know enough about peds.

The surgeons are too lazy to come down and do the consult RIGHT NOW.

Etc.

It's a little off-putting, I have to say.

I've worked with some FANTASTIC attendings. The hospitalists that I worked with on inpatient peds and NICU...the attendings that I'm working with on outpatient...all incredible. But none have shown this kind of snobbery. They love their job, and that's enough for them. They don't need to pat themselves on the back, or talk down other specialties, to get that sense of satisfaction.

You SHOULD be proud of your work - otherwise there's no point in getting out of bed each morning. But for some people, it seems like they can only get satisfaction out of their work by running down what other people do...and that's a huge turn off.

 

[LADoc00]

it seems like an obvious question, but i would love to hear why those of you who have chosen a career in peds have done so.

i'm a 3rd year student and am trying to make the all-important decision of which specialty to apply for. i've always leaned towards peds (i really do adore kids of all ages, love the science of human development, love the idea of getting to know a family over a long period of time), and liked my peds rotation just fine. but: do you miss seeing adults? i've thought about FP for that reason, as well as for my deep interest in geriatrics. also, and this is becoming more important as i spend time with what seems like a lot of bitter burnt out doctors: pediatricians just seem a little happier and chill than those in just about any other field (except maybe psych or rads?). is this true in reality?
(i'm being only a little facetious in that question)

ok, that was a lot for a very very simple question. would appreciate any insight: why peds?

Good ?, I would think because the generous salary allows you lots of choices when shopping for all your needs at the local Dollar Store.

 

[pathfme30]

That is so strange. My experience at NYP, CHOP, OKlahoma Med CTr, and Childrens of Boston is that the pediatricians are some of the most easy going, kind, non-snobby individuals I have met. I guess it varies from place to place.

The "pedi snobs" phenomenon has actually really turned me off from peds.

I think that pediatricians do a GREAT service. I admire their ability to relate to children of all ages, and at all stages of health. It's easy to play with a charming, cute 3 year old with a stellar smile...but not so easy to relate to a kid on a vent or who's dehydrated, etc.

But - wow, I'd never heard so much bashing of other specialties as I've heard on peds. Even the OB/gyns had smaller inferiority complexes.

The OBs don't know anything about babies, so they get unnecessarily worried about the neonates.

The family med guys don't know enough about peds.

The surgeons are too lazy to come down and do the consult RIGHT NOW.

Etc.

It's a little off-putting, I have to say.

I've worked with some FANTASTIC attendings. The hospitalists that I worked with on inpatient peds and NICU...the attendings that I'm working with on outpatient...all incredible. But none have shown this kind of snobbery. They love their job, and that's enough for them. They don't need to pat themselves on the back, or talk down other specialties, to get that sense of satisfaction.

You SHOULD be proud of your work - otherwise there's no point in getting out of bed each morning. But for some people, it seems like they can only get satisfaction out of their work by running down what other people do...and that's a huge turn off.