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

patients – after 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 accident — we'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.