My second rotation of clerkship has been Peds. I'm getting closer to the end of it, so I thought I'd continue with what I started with my OBGYN and mention a few things I've learned on the rotation. Peds I wanted to have early in my clerkship because it was fairly high on my list of potential specialties to pursue for residency, but I hadn't had much clinical exposure in the field. It's been a good rotation to clarify my clinical interests.
Here are my take-aways thus far from Peds:
1) Kids are awesome
I like working with kids, of all ages and states of health. They're interesting to talk to, fun to examine (tickling as a distraction technique just doesn't work as well in adults), and you never quite know what you're going to get meeting a new pediatric patient. The social aspect is trickier, and parents can hinder care as much as help it, but most are good and I enjoy working with even the most troublesome parents. I know a lot of physicians view parents as an annoyance, I tend to see them as just another patient in need of care. A lot of pediatrics is about caring for the family as a whole, not just the sick child, and I really like that type of comprehensive family care (though in practice, it often falls short of where it ideally should be).
2) Not a big fan of inpatient medicine
I'm increasingly realizing that I don't like working in a hospital, especially on an inpatient floor. A lot of time is spent working around the patient rather than working with them, typically involving talking to other doctors. The patient or their family may or may not be fully in the loop. Interactions with each individual patient are infrequent, a few times a day at most, oftentimes much less. I find this problematic, especially considering the disruptive nature of hospitalizations to a person's life. Too often patients do not grasp why they're there, what they're doing that day, or even who everyone is caring for them. The medical aspects of inpatient care are quite interesting and it's a good learning opportunity. However, that tends to lead to good treatments, but overall care that is often rather poor or fragmented.
Inpatient medicine is also quite detail-oriented, but the importance of those details is not always clear. As I said, a lot of time is spent with doctors talking to other doctors, usually about these details. Yet, there are rarely consistent opinions in these discussions - talk to 5 different physicians you'll get 5 different viewpoints. To me, that means either inpatient medicine frequently gets things wrong depending on which physician's opinion wins out, or it doesn't matter which opinion you take and the details probably don't matter much. I lean towards the latter and I don't get particularly excited about spending most of my time quibbling about minutiae.
I enjoy big-picture problems and patient contact. Inpatient medicine doesn't seem have enough of either for my liking.
3) Infectious diseases everywhere
I got sick this rotation. A lot. With not-so-fun illnesses. Had to take only a small amount of time off, but it ate up what few breaks I got. The residents seem to have built up more of an immunity to the common bugs, but for a first-timer working with truly sick kids, I got hit pretty hard. It's really hard to work - especially on overnight call shifts - when you're not anywhere close to 100% health-wise. I said before that long hours aren't a good fit for me and I'd rather go for specialties that have fewer hours or allow for part-time work. Having the opportunity to take time off when sick would also be a huge plus.
4) The happiness test
Taking to heart the advice "Go where the happy people are", I'm keeping a close eye on how happy the people on each rotation seem to be. Pediatricians are definitely happy people. Some are a bit more reserved, some are definitely tired (residents far more than staff) and I have met the odd unpleasant physician on this rotation, but the average pediatrician is actively smiling.
Every specialty will have some very satisfied practitioners, as well as some downright miserable ones, but where the typical physician in that specialty falls is telling me a lot about the fields of work. In OBGYN, the typical resident or staff appeared exhausted but mostly contented. In Pediatrics, the typical resident or staff appears almost joyous, with maybe a hint of fatigue. Both are largely positive states of being, but the difference is evident.
Overall, Peds is still pretty high on my list of specialties to match to, but it's slipped a bit. I had thought about doing Community Peds or Peds Emerg and those both still seem like attractive options, but it would take 3+ years of largely inpatient pediatrics to get there. I'm not sure that's a worthwhile trade-off when Family Medicine is on the table, with its similar compensation to Peds, a much better job market, shorter residencies with a focus on outpatient medicine, and much more flexibility in terms of location or practice arrangement. I like working with kids, but I also find I like working with adults. The main reason to go into Peds would be to cut out the older people from my practice, so if I don't want to do that (or I'm indifferent to it), what's the point? Won't take long to be sure where I stand though - my Internal Medicine rotation is coming up next!
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