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  • So you want to become a pediatrician. You love the idea of babies, children, and adolescents.

  • Who needs adults anyway? Let's debunk the public perception myths, and give it to you

  • straight. This is the reality of pediatrics.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in So You Want to Be. In this series, we highlight a

  • specific specialty within medicine, such as pediatrics, and help you decide if it's

  • a good fit for you. You can find the other specialties on our So You Want to Be playlist.

  • If you want to vote in upcoming polls to decide what future specialties we cover, make sure

  • you're subscribed. If you'd like to see what being a pediatrician

  • looks like, check out my second channel, Kevin Jubbal, M.D., where we'll be covering a day

  • in the life of a pediatrician in the future.

  • Pediatrics is the field of medicine providing care for babies, children, and adolescents

  • from birth up to the age of 25. The age range was capped at 18, but given our new understanding

  • of human brain development, the age range has been expanded.

  • Think of pediatrics as the equivalent of internal medicine, but for younger patients. That isn't

  • to say that children are just little adults, because they're not. Children's physiology

  • is different, and certain medications you would use for adults may have dangerous side

  • effect profiles in children.

  • Additionally, because children are more resilient than adults, they tend to crash hard and abruptly,

  • meaning they may seem relatively ok and stable, followed by a sudden decompensation requiring

  • prompt intervention.

  • Just like internal medicine, pediatrics is a massive field with a variety of subspecialties

  • such that it's difficult to generalize the field. You can take care of patients in a

  • variety of settings, from premature babies in the NICU, to healthy children at regular

  • PCP visits, to hospitalized children for various rare genetic anomalies.

  • You can view pediatrics from a generalist versus a specialist lens. As a generalist,

  • you'll be handling a wide variety of presenting pathologies that don't require sub-specialized

  • care. If you practice in the inpatient setting, this translates to being a pediatric hospitalist,

  • taking care of kiddos admitted to the hospital. This may include infectious diseases like

  • pneumonia and cellulitis, neonatal issues like hyperbilirubinemia and failure to thrive,

  • or metabolic problems like diabetes, among others. If you're an outpatient generalist,

  • you'll be seeing patients in clinic, primarily for regular checkups, vaccinations, and less

  • acute conditions, like allergies, eczema, constipation, or ADHD.

  • As a specialist, you focus on a single organ system of the body. Similar to internal medicine,

  • this could be cardiology, gastroenterology, rheumatology, endocrinology, and others. Neonatologists

  • specialize in the care of neonates, which are infants less than 4 weeks old.

  • In outpatient adult medicine, the majority of your patients have comorbidities, meaning

  • pre-existing medical conditions or risk factors. In outpatient pediatrics, the majority of

  • your patients are well children, and you'll primarily be focusing on health promotion

  • to prevent rather than manage a diagnosis. You'll build a relationship with the patient

  • and their family over time, as you may see them for up to 25 years, through all developmental

  • stages.

  • Beyond well child visits, you'll see the occasional asthma, eczema, or failure to thrive, meaning

  • poor weight gain. From time to time you'll see a rare diagnosis, like leukemia or retinoblastoma,

  • but these are exceedingly rare in primary care outpatient settings. You'll still need

  • to be alert, as kids can compensate well and look healthy until they suddenly decompensate.

  • Outpatient pediatrics has a great work-life balance, and you'll generally work 9 to 5

  • hours. It's common to have 4 days of clinic and 1 admin day per week.

  • With inpatient medicine, your focus is on kids who need to be admitted to the hospital.

  • You'll admit patients from the emergency department, working them up with labs, diagnostics, imaging,

  • and other tests. For certain conditions requiring specialized care, you'll send consults to

  • the specialists for recommendations.

  • In adult medicine, you often have disposition disasters, meaning a great deal of frustration

  • in discharging the patient and getting them to a place that can take care of them, whether

  • that's a skilled nursing facility or some place else. However, social situations can

  • still be complex with kids, such as when they aren't safe at home with their parents. In

  • these instances you'll interface with social workers and child protective services.

  • Academic pediatrics often includes 12-18 weeks of inpatient care. Beyond clinical practice,

  • there's a high amount of research and teaching, in addition to side projects of various types.

  • These are wide ranging, such as quality improvement for implementing a different electronic medical

  • record in the hospital, or partaking in advocacy and going to the capitol, lobbying for better

  • safety protections for children. Community pediatrics is the most common practice

  • setting, where you're working with a larger medical group. Private practice is the least

  • common, as it is for other specialties, in part because hospitals are buying up small

  • private practices.

  • Some think that pediatrics isn't that complicated, and it's just babysitting. That's certainly

  • not the case, and remember, kids actually have a unique physiology that requires careful

  • attention and nuance. Acuity and sick kids are certainly a part of pediatrics, although

  • it's fair to say on average there's a lower amount of acuity.

  • If you think pediatrics includes only talking to children, think again. There's a heavy

  • family relationship building component, and you'll essentially work with at least 2 patients

  • the kid and their parents.

  • Last, some think pediatrics is a woman's field, and while the majority are certainly women,

  • it's not as skewed as some other specialties. Approximately 70% of pediatricians are female.

  • After medical school, pediatrics residency in the U.S. is 3 years. In residency, the

  • focus is on inpatient, but there's of course continuity clinic, where you'll act as the

  • primary pediatrician for your panel of patients. You'll get new babies when starting residency

  • and have them for 3 years, offering a longitudinal relationship that many enjoy.

  • As with most residencies, the hours are challenging, usually ranging between 60 to 80 hours on

  • most weeks. It's not too far off from something like internal medicine. A chief year, meaning

  • tacking on a fourth year to your residency, is optional, and is best suited for those

  • looking at academic positions who want to strengthen their CV and leadership experience.

  • In terms of competitiveness, pediatrics is in the bottom 4, with an average USMLE Step

  • 1 of 228, USMLE Step 2CK of 245, and match rate of 98.2%. But of course, highly desirable

  • programs are more competitive, even if the overall specialty is less so.

  • Stereotypically, medical students applying to pediatrics are the soft, gentle, kind-hearted

  • students who care deeply about the community and kids. They tend to be positive, and want

  • to come to work smiling and laughing with their patients. These medical students are

  • stereotypically the "do-gooder" types.

  • After pediatrics residency, there are several subspecialties you can pursue through fellowship.

  • All of the following are 3 years in duration.

  • Hematology/Oncology, or heme/onc for short, is focused on treating kids with blood or

  • solid cancers, including leukemia, lymphoma, brain, and the like. You'll also deal with

  • non-cancerous blood disorders, like sickle cell disease. It's primarily, but not exclusively,

  • an outpatient specialty. This is for the pediatricians who are a mix

  • of brain and heart. They're able to be there for their patients on one of the worst days

  • of a parent's life, while also being highly intellectual and strategic about the best

  • approach. This also tends to be a highly academic subspecialty with many PhD's.

  • ICU is exclusively inpatient in nature, unlike the other fellowships listed here. You'll

  • be dealing with critically ill kids. Instead of focusing on diagnosing conditions, your

  • primary aim will be to stabilize and support them for other subspecialists to take over

  • and follow up with. You'll be dealing with sick kids who are intubated,

  • meaning on breathing tubes, on pressors to maintain blood pressure, and will help with

  • pre- and post-op surgical care. It's primarily acute conditions, but you'll see some frequent

  • fliers, such as patients with cerebral palsy, who are in and out of the ICU often with infections.

  • This is for the pediatricians who are the masters of physiology, remembering everything

  • from medical school and applying it the ventilator in front of them. They want to do the fun

  • stuff of treating the physiologic abnormality and then transferring to the next level of

  • care, without getting into the nitty gritty of diagnosis and follow-up.

  • Cardiology is the most competitive pediatric specialty, and many do additional fellowships

  • after to further subspecialize within cardiology, like electrophysiology.

  • You'll deal with lots of congenital abnormalities, like the tetralogy of fallot. In managing

  • these congenital conditions, you'll work closely with cardiothoracic surgeons to determine

  • optimal timing of repairs. Sometimes, it's a staged repair, requiring one surgery at

  • 6 months, another at 1 year, and so on.

  • Stereotypically, these are the pediatricians with a bit of a god complex who love managing

  • complex physiology and nerding out about physics.

  • Gastroenterology is a highly procedural subspecialty, splitting time between inpatient, clinic,

  • and the procedure suite for endoscopies and liver biopsies. They primarily deal with chronic

  • diseases, like inflammatory bowel disease, thus promoting longitudinal relationships.

  • But there's much more to it than that, such as getting into the mind-body connection,

  • as there's a large overlap with psychosomatic disorders in children, such as anxious kids

  • with abdominal pain. Nutrition is an increasingly important focus as we are in a child obesity

  • epidemic.

  • Stereotypically, these are the down to earth pediatricians who enjoy joking about poop

  • with kids and enjoy working with their hands, and maybe don't need to be as deeply intellectual

  • as some of the other subspecialties, although there is a growing need for research-minded

  • gastroenterologists with the exploding knowledge of the microbiome and intestinal immunology.

  • Pediatric emergency medicine can be approached in one of two ways - as a three year fellowship

  • after pediatrics residency, or a two year fellowship after adult emergency medicine

  • residency. There's no outpatient time, no following up on labs, and once you get your

  • shift done, you don't take any work home with you. Your job is to stabilize kids and get

  • them to the appropriate level of care. Compared to adult emergency medicine, there's less

  • acuity, but when it does escalate, it escalates quickly. If you want to know more about the

  • field of emergency medicine, we did a So You Want to Be episode on that.

  • Pediatrics is a great specialty with lots to love.

  • First, and most obviously, you're working with kids and you get to joke around with

  • them and be silly every day at work. It's unique in that you can make an impact

  • early in someone's life that can compound to yield tremendous changes over a long period.

  • It's a beautiful part of the field that's unique to working with a pediatric population.

  • This is the most powerful form of preventative medicine for the simple fact you're intervening

  • early in their life.

  • There are subspecialties of pediatrics that don't have great outcomes, like pediatric

  • oncology, but for the most part, the majority of your patients will get better. There's

  • less death compared to adult populations, and rosier outcomes are always a good thing.

  • There's a high amount of flexibility within the field, meaning it's family friendly. After

  • all, these are the doctors that prioritize children. Even in residency, your program

  • will be more understanding of maternity or paternity leave than something surgical.

  • While pediatrics is a great specialty, it's not for everyone.

  • Compensation for pediatrics is at the bottom of the list, averaging $232,000 per year.

  • Part of this is the payer mix, as many children are on medicaid, which has lower reimbursement

  • than commercial insurance. In the fee for service model of U.S. healthcare, you'll generally

  • have fewer interventions than adults, which is another reason why adult specialties often

  • make more.

  • If you love high acuity and the adrenaline rush, pediatrics has less acuity than most

  • other specialties, since kids are usually healthy and resilient.

  • As with other primary care focused specialties, there's lots of charting and computer time,

  • and you may feel like you don't get enough time with your patients.

  • Seeing child abuse and maltreatment, or seeing young children pass also never gets easier.

  • And finally, there's not as much research within pediatrics compared to adult medicine,

  • which can be frustrating since certain drugs haven't yet been tested in kids for efficacy

  • and safety profiles.

  • How can you decide if pediatrics is a good fit for you?

  • While you should certainly love children, you shouldn't mind having essentially two

  • patientsafter all, you're dealing with not only the kids but also their parents,

  • who may be more concerned or neurotic with their child's health than with their own.

  • Pediatricians also tend to think about the health of the whole child, including nutrition,

  • living situation, families, and thinking broadly about what health means more so than just

  • diagnosing and treating conditions.

  • Many pediatricians find enjoyment with the data, puzzles, and detail required of the

  • field. They tend to be interested in public health and advocacy work, and are focused

  • on more than just the medicine aspect, but also the context in which the child grows.

  • In doing so, they hope to build a better system to promote children's health.

  • And finally, the happiest pediatricians tend to be mission driven. After all, it's not

  • a lucrative specialty, and many who go into this field do so because they love kids and

  • want to take care of them at the end of the day.

  • Special thanks to Dr. Erin Elbel Mauney, current Insider at Med School Insiders, for helping

  • me in the creation of this video. Are you hoping to become a pediatrician? To

  • get into medical school and match into a desirable pediatrics residency, you'll need to not

  • only crush your MCAT and USMLE, but also shine on your personal statement, secondaries, interviews,

  • and other soft components of your application. At Med School Insiders, our pediatricians

  • can help you get there. We've had over 3,000 customers so far and have an industry leading

  • 99% customer satisfaction rating. That's not an accidentwe've obsessed and invested

  • heavily over the past few years in creating our proprietary systems that allow us to consistently

  • provide excellent service and deliver stellar results. That's the Med School Insiders difference.

  • Learn more about why our customers love us at MedSchoolInsiders.com.

  • Thank you all so much for watching! If you enjoyed this video, check out another specialty

  • on our So You Want to Be playlist. Much love, and I'll see you guys there.

So you want to become a pediatrician. You love the idea of babies, children, and adolescents.

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So You Want to Be a PEDIATRICIAN [Ep. 24]

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    Summer posted on 2021/05/08
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