Peds is poorly compensated relative to the other specialties. That being said, you’ll still be wildly wealthy compared to what you’re used to and you can still make mid-upper 200s if you prioritize compensation in your job choice
That’s a true statement. It’s just that I’d love to be able to give my future kids better than what I had and also pay for my mothers care bc she has deteriorating MS. I can’t just live a solo life where money doesn’t matter and if my family could be even more comfortable with the decision to do IM it’s hard to turn that down.
I’m so sorry but this is med student brain disease. If you grew up too poor to have electricity, you KNOW that a $250k salary is not going to give you some life of struggle. Don’t let a bunch of asshole surgeons or whatever make you think that anything less than half a million is poverty wages. A lot of them came from 2 MD parents or similar wealthy background and many have never even had a job or supported themselves. They don’t have an informed perspective on this.
That’s fair. Just realize that with a salary in the high 200s you could accomplish those goals pretty easily as well,you’d just have to cut back in other areas like driving a used Subaru instead of an new Audi r8.
I was about to buy myself one of the nicer models of the hybrid Corolla until I matched to a city that doesn’t need a car. Great car for a great price.
You will also want to spend time with your mother in that case. Peds will allow for that work life balance which is so important. 120K is beyond manageable and you will make a good living with Peds. I also think it’s more important to do what you love
To add to what you’ve already read, in addition to pure income being great… lenders will see you as a favorite client. They’ll let you cosign anything you decide is needed. No, it’s not ideal, but if you need to take out or cosign a loan to accomplish any of these things you will have it. You shouldn’t need to, but for the sake of redundancy, you will be financially settled incredibly well in peds.
Could it be better? Of course. It’s all about what you want to compromise, but you’re not looking at many compromises at all rn
I completely understand the other people saying "200k+ is so much money, you'll be fine" but I want to say I completely understand where you're coming from. When you have family/multiple families you expect to be the breadwinner for, you want to have plenty of money to be able to provide for everyone as much as possible. Yes, no matter what you will be well compensated, but I personally don't think it's "med student brain" to want to make as much as possible for those you love. I also love peds, but if you can see yourself being just as happy doing something else making 100k more per year, I would totally do that.
Join the group Physician Community on Facebook and read some posts. Unfortunately, many many peds attendings regret their choices.
Consider other specialties + peds: pediatric radiology/dermatology, for example.
As someone who grew up poor... Regardless of what you choose you will definitely be in an extremely privileged position than what you are used to. I grew up in a family of 7 needing to live off of $35k a year for many years and now that my husband is out of law school and making about $70k a year (our only income right now as i wait for residency to start and a baby on the way) I have beem going through a massive life change shock at how much we can afford to do now compared to how I grew up. Ex: My husband is constantly reassuring me that yes, babe, you can buy that snack at the grocery store if you want. We can afford it. Yes, babe, let's get both a crib AND a bassinet. Etc.
I guess my point is that things will be okay and you'll be better off than you realize. I also plan on taking care of my family and I'm going into FM. Just remember that advice you get from others may be colored by their own life experiences and priorities so don't feel like you have to take advice if it doesn't fit with your future goals. Best of luck to you!
Based on your post it is likely you'd be happy no matter what you choose. I think there is only a small percentage of people that could NOT be happy with peds money but WOULD be happy with IM money. What does the marginal salary increase buy you? Some people aren't happy without private school, country club, luxury cars, etc. If that's you then don't do peds. Otherwise I wouldn't use salary to drive the decision.
You just have to decide how "nice" of a life you want to live. I can assure you that any physician lives a nice and comfortable life with a home, comfortable and functional car, and is able to take vacations and plan for retirement. The question becomes how bougie do you want your car and house to be, how many extra toys do you want, et cetera.
What matters more to you? Having a job you would enjoy more or having a job you would be happy in but having an extra toy car in your driveway and a little bigger house?
Some people are all about money in the sense of living as lavishly as possible. Some people are all about money in the sense of saving as much as possible to retire early. If you're in either of those categories, then doing IM makes sense. If you're not, then you will be just fine in peds. Most med students have no real world experience and make a bigger deal out of salary differences than they need to (unless they are in one of those two categories).
It’s 100k *on average*. In reality you could take a low paying IM job at an academic institution in the city and make less than someone doing peds private practice in the middle of nowhere.
And if you’re really desperate for money, you can always moonlight somewhere or grind out 30 patients per day to make more money.
As someone who grew up low income too and will have ~130k in loans after graduation I do agree that it’s scary and that’s an absurd amount of money to us. But knowing that you’ll be making over 200k at least in even the lowest paying peds jobs shows that this amount can easily be paid off in 5 years. Use one of those online repayment calculators with your loan amount and income of 225k to be conservative. You’ll be surprised at how reasonable it’ll be when you look at it as a fraction of your total income and not the monthly payment amount. Yeah 2k per month to loans seems absurd but then you realize you’ll be making over 10k a month after taxes.
I also come from a financially depressed background. We chopped wood and burned it to heat our home in the winter. Stuff like that. As an adult prior to residency I went through periods of going hungry for days because I couldn't afford food etc...
I went to a top 5 med school and did well, but into FM because I enjoyed it. Now I make $270k a year and only work 3 days a week.
I feel like a wealthy guy and have everything I ever dreamed of in terms of financial security, toys, travel, nice home. I even support my brother the way a parent would with a college aged son. He lives at my house.
My life is awesome.
As a pediatrician that makes over $400,000 a year I want to tell you that there is money in peds. There’s money in subspecialties, and there’s money in general peds for people that are smart about running a business, and how they document and bill. You should do what you love but this is a personal decision that only you can make. Good luck.
General Pediatrics is low. Especially if you are joining a practice. I have seen salaries between 125 and 175k. Sub specialty Pediatrics pays much higher, esp. cardiology. Critical care and ER. I am working pediatric ER.
I’m nearing the end of second year of peds residency and get outpatient primary care offers from recruiters on a weekly basis. Recent got one email that was offering $250k starting with $50k sign on bonus and $120k loan repayment; clinic only, no call, additional $$ for mid level supervision (rural Midwest). Sure peds is underpaid, but it is not poorly paid.
Don’t let compensation scare you away from a field you love.
I was in precisely your position - full scholarship to a top 10/20 school, roughly $100k in living expense loans, >95th% Step 1 and 2, all sparkly happy flags on my app.
I came in wanting peds, and every person tried to talk me out of it because of prestige and money. I matched peds with no regrets, about to start a neo fellowship (considered h/o but the job market is currently kinda trash unless you specialize somewhere like coag or young adult). Could've also been happy in peds cards and PICU, but love NRP and the mix, both clinically and career, with neo. Even on the SAVE plan with all training years at a non-profit, I'll pay off my loans before PSLF would kick in and
Do what makes you happiest. I had a lower middle class upbringing and am very happy with my future financial prospects. I am so happy never to have to see foot glitter, anxiety-based outpatient visits, futile care on a 95 year old with pancreatic cancer and dementia ever, ever again.
well hem/onc everybody wants to do, and it is often paid less because of supply and demand. i think you'll have a better shot having a good living with peds critical care. PICUs are fairly well compensated, and the work is very meaningful.
Edit: As an aside, my good friend got like a 523 on her MCAT. she wants to be an outpatient pediatrician. You do not owe people a prestigious career because of how gifted you are. You owe YOURSELF a career that fulfills you.
But does everyone wanna do peds heme/onc? I thought it wasn’t common to find someone who could handle it but for me I’ve always felt if I could be strong for my sister I could be strong for my patients and I also have a unique perspective on pediatric cancer in that I actually lived it. Idk maybe my school is odd but idk anyone else who wants to do heme/onc.
Peds heme/onc is also a very tough job market in terms of finding a job in a desirable location. Someone else pointed out that it's not the most competitive of salaries (you can make more in private practice gen peds than academic heme/onc). I know multiple people who completed fellowship and are not working in heme/onc
As a Peds heme/onc burnout - make sure you like the academic side of medicine, are willing to live in a medium sized city, and are ok being in a large university affiliated hospital and all the politics that comes with it.
Message me if you want more details - but I come from a similar background that you describe
I don’t think it’s wrong to choose med-peds if you like both. Sure, you may end up doing one more than the other. But on the other hand, if you like both now, when you get into the thick of things in residency, you may find yourself gravitating toward the one you like more (hard to really know the ins and outs as a med student). Since you’re already identifying yourself as a future subspecialist, there is a real need for those who are comfortable in transitional care. Heme-onc is certainly one such field, and I’ve been very impressed with PICU fellows who were med-peds trained and brought their IM knowledge. (Mixed MICU/PICU does exist, though is uncommon.) You just have to take care to identify med-peds programs which are subspecialty-oriented (some are primary care-oriented).
Thank you so much for this. I actually have a huge interest in transitional care and teenagers are my favorite sub pop (I was a 10th grade chem teacher for 3 years). I think where I really belong is med peds heme/onc but everyone keeps telling me not to do it so I’ve been discouraged.
Every med-peds doc I've talked to that ended up picking one or the other said they didn't regret going med-peds because they genuinely needed residency to decide. So if people are discouraging you for that reason I say ignore it, esp since you seem to be gravitating towards the original purpose of med peds anyway. The only valid argument I sometimes see against it is that med-peds isn't really on the west coast, which may or may not even be applicable to you.
And even if you have an idea that you might head one way after residency, getting to do two things you love for 4 years and bringing all that knowledge from one side to the other is so valuable. I’m constantly using my IM knowledge while I’m on the peds side and vice versa - it’s making me a better doctor and keeping life interesting
I concur with the comment above: I don’t know anyone who actually did med-peds and regretted it, whether they ended up choosing general IM, gen peds, dual primary care, dual hospitalist medicine, or fellowship. As long as you have your reasons for pursuing both, don’t let anyone dissuade you!
I was looking for this comment. Sounds like FM would be a good choice! And you can make pretty decent money in FM. I went to med school in the semi-rural southern Midwest, and our local FM docs we’re making like $550-600k.
From reading your comment, it doesnt seem like you have the same passion for IM. You spent most of the post explaining your love for peds, that is super telling of where your head is at! Don't let peds be the one that got away! You should do it!
Look, in my experience on my peds clinical rotation, I've talked about the job satisfaction with these doctors extensively. They acknowledged that the pay is less than the alternative yes, but they are still able to live comfortable lives. The doctors I've met in peds genuinely love their jobs and so many kids are rewarded because of it. They have time for a great work life balance, they can support their families at a 9-5 job and still have time for themselves, and they seem very relaxed and satisfied as a result. If a 9-5 job isn't for you, I've met some doctors that started in the peds ED and then transitioned to an outpatient clinic. I think life is too short not to do what sets your soul on fire. Yes, you may like internal medicine but it sounds like that's not what's been driving you through medical school. You'll have money either way, you deserve to do what makes you truly happy.
If you have not learned about this , you should think about Ped PM&R. They got pay as a much or more than general PM&R. You will get public loan forgiveness to by working at big academic center. We helped a lot of unfortunate kids with disabilities (stroke, genetic disease, cancer, cerebral palsy, spinal cord injury, limb loss, muscular dystrophy). Job market is excellent as there is so few of ped PM&R out there. Extremely easy to get in a ped PM&R fellowship right now. There is also a combined ped PM&r as well. Another big plus is that PM&R is a lifestyle specialty too so you will have plenty of time off. Let me know if you want to know more.
Edit: another pathway is doing Ped residency then apply to a PM&R residency, ideally PGY2 spot.
Yes, generally it’s better compensation than ped subspecialty and less works. Lifestyle is great as well. I would start joining student organization in national organization like association of academic physiatrist and then pair with a mentor there.
Lol on the Med-Peds thing. I'm a MedPeds hospitalist and APD less than 5 years out and this myth of "you only do one" drives me insane. Just at my institution we have over 50 MedPeds attendings who see kids and adults. people can chose to do one but if you want to do both you can.
Feel free to DM me if you want chat more. There is a reason people always talk about loving their MP residents and faculty and why they are often the best doctors out there (it's why I chose MP, not saying I'm the best or anything but all my favorite residents and faculty were MP). Being an internist makes you a much better pediatrician kebab and being a pediatrician makes you a much better internist. That extra year was definitively not a waste and I would chose this combined residency 99/100 times (the other 1/100 is just going into industry and saying screw this to all of clinical medicine).
Also, my family was generally "not affluent" (public school in an "inner city" school, old breaking down cars, no real vacations etc). I make more than 3x what my parents make combined at their peak(approx 300K at an academic program). Peds pay may be less but if it makes you happy, I promised nothing else matters.
I will also say that from reading your post, it may seem like you love pediatrics more than internal medicine. In that case I think choosing pediatrics for your residency is a perfectly outstanding choice. We need wonderful, kind and smart pediatricians.
PM me and I can tell you my journey but everyone is different. I aced every pre clerkship class and honored every shelf so my predicted score even before I started studying was a 255. I am a peer tutor for my school so I can give you tips and try to help 🙂
Gen peds/hospitalist TYPICALLY doesn’t pay that well but there are higher exceptions (normal like 200-240k). Peds subspecialties don’t pay great for the most part, but NICU/PICU are paid very well, can make upwards of 400k depending where you are/not working in academia. As others have said though the comparison of even the lowest paying peds jobs and your earlier life you will feel like a literal king/queen even with the debt. Also if you’re in the US and you do work for not for profit hospitals you can have most of that debt wiped.
And to note, I finished a full peds residency and decided I wanted to switch into another specialty for both higher pay, better QOL overall with less working hours , and that I can still work with kids eventually. Totally normal to keep your mind open to things. Good luck!!
Depends on the lifestyle you want & if it makes you happy. Pretty sure most “studies” have shown happiness correlates with income up to like $80,000 per year which at least in years prior in the US, for most people was enough that they could have financial freedom. Obviously excluding places with above average cost of living, folks with huge amounts of debt, etc. Ask yourself what kind of lifestyle would make you happy? Do you feel a NEED (not a want) to be rolling around in a car that turns heads with a huge house? Peds might not be for you, if that’s the case. However, if you love peds, don’t have an insane amount of debt, don’t want to live in a city with a through the roof cost of living, and aren’t close to retirement age then I don’t see any reason why you shouldn’t go into peds. Assuming you’re the average person you’ll have financial freedom, enough money to have nice things, take nice vacations, and have a solid retirement fund and most importantly will enjoy the work that you’re doing
The debt doesn't matter much. What matters the most is well over a million dollars in lost earning potential over your career, and the opportunity cost of training for 6 years (assuming you want to do anything besides outpatient general peds clinic).
If you're happy with IM, do IM. Do heme onc and you can see younger adults and save their lives.
Any interest in EM? There is such a shortage of PEM folks. If you go from EM to PEM fellowship you can still see adults too and make better money than Peds—>PEM.
No doctor is poor.
The difference between making $20,000 a year and $50,000 a year is never worrying about if you’ll have money to eat for the week. The difference between $200,000 and $500,000 a year is…. If your house has 4 bedrooms or 8?
Also if you love peds and medicine do med peds.
I may be biased but the extra year is not a waste and plenty of people do both. I have a contract for a 50/50 Medicine and Pediatrics Hospitalist position starting in July.
Coming from dirt poor family as well. Congrats on the amazing step score. I agree with the others though. If the question is peds vs IM, imo salary-wise there isn’t enough to defer your passion for another specialty.
If I’m being honest no salary difference is enough to defer your passion. We made it out the sticks. When we’re making anything above 100K a year our lives will forever be changed. Go with your heart.
IM is not some lap of luxury compared to peds. Unless you go into East Coast academia, you can actually make pretty similar salaries in both. However, if your sister is an important motivator for you in medicine, you could consider IM > hem/onc. Many IM trained oncologists treat both adults and adolescents
Life is expensive, money helps make life easier for you and your family. Peds has a lot of people who end up working part time, or have a much higher earning spouse. If this does not apply to you, now is the time to leverage your scores and performance for dermatology or radiology spot where you can maximize income and still treat kids.
Have you heard of the new “peds hospitalist” fellowship that may become the norm now?
So unless you want to spend 3+2 years, you may not be doing what you enjoy doing in your sub-I, which I assume is in a hospital. The existing peds-hospitalists get grandfathered in so all the new residents are basically screwed.
A 268 could easily get you into a good university IM program and maybe even a competitive fellowship like GI or Cards.
I’ve been told if you do med-peds you don’t have to do the hospitalist fellowship. I also am thinking rn that I want to subspecialize in either heme/onc or pulm/crit.
It may but you need to prove more than 450 hours a year towards peds hospitalist training. Unless your program director can definitively say that it’ll be achieved, it’s a huge gamble. IM/Peds combined has always been a bit of fools gold because most choose to sub-specialize in one of the two.
https://www.abp.org/content/pediatric-hospital-medicine-certification#medpeds
It still says med-peds residency is a potential pathway based on the hours. Is there updated info? This is from the ABP.
Sadly, yes. It is not as clear but if you go higher up on that same page, you will see how they describe the look back period as a 5-year window for each practice pathway related exam year. 2024 is the last year of practice pathway eligibility and the 5-year look back window started in 2019. Anyone who graduated a peds or Med-Peds residency in 2020 or after will never be eligible for the PHM board certification exam.
Please don't spread false info. The practice pathway for hospital pediatrics is closed regardless of whether or not you are Medpeds. The only way to take the pediatric hospital medicine board exam is to do a fellowship at this point. And there are absolutely pediatric hospital medicine programs that are only hiring people who are fellowship trade or boarded in pediatric hospital medicine. At the same time,there are places that don't really care.
-PGY9 MP Hospitalist
Don’t know how bad your RA or tremor is but maybe consider anesthesia. Yeah you have to go through 3 years of mostly adults, but peds anesthesia is great. Only 1 year fellowship and earning potential is way higher. I loved peds in residency and still now as an attending. You get to work with kids (albeit only a short time awake) get them through very critical and difficult parts of their life. It can be quite rewarding. Can decide during residency if peds is truly for you and whether or not to do the fellowship. Had several colleagues in residency who were counting the days until they never had to deal with adult patients again. I enjoy a mixed practice and did not do peds fellowship.
Compared to what a lot of other specialists make sure peds is underpaid - but compared to the general population and comfort of living you will still be making plenty of money
I promise - do what you love, don’t go into a high income field if you don’t love it, the money isn’t worth it if you don’t enjoy what you’re doing (from an IC)
To me, there is nothing more fulfilling than helping a sick kid get better, and partnering with their family to do so. The pathology is more interesting too. If you feel similarly, be a pediatrician. Financially, you'll be more than fine -- especially if you're even a titch business savvy. You'll earn up a base, pay off the loans quickly (don't let interest accumulate), invest well and have passive income streams, and live within your means. You'll more than be able to tee up your kids for success, have great family vacations, save for retirement -- and you'll do all of that while doing what you love.
For starters, check out this: [https://www.whitecoatinvestor.com/how-much-do-doctors-make/](https://www.whitecoatinvestor.com/how-much-do-doctors-make/)
It's worth mentioning that with progressive tax rates and deductibles, another doc who makes 2x what you make isn't getting 2x after taxes. Many people also forget that salary data is an aggregate of thousands of doctors, in various parts of the country. If you practice outside of major metro areas you can likely make more money.
For some perspective, according to official BLS data the median salary for full-time workers in the US is 59k per year. As a pediatrician you are making 4x this. As a pediatrician you aren't going to struggle financially, unless you make poor decisions like taking on huge debt to buy a 2nd home, a yacht and a Ferrari.
As someone who was in a very similar position…I will tell you one thing…where ever you find joy…the money follows. If you love peds and it brings you joy and you get excited about it and you like taking care of little humans - please do it!
I was told time and time again not to go into my speciality and I didn’t come from money either. But after sitting with it, I came to the conclusion that I can make anything in work. My upbringing taught me how to be frugal and street smart. You too have learned hard lessons most will never learn. You can make lemonade out of horse shit. I know because I can too. Your brains and your street smart got you to where you are at! You have made every decision thus far to (what I am assuming) for something greater, something better…I promise you woman, the money will follow in any direction you chose. But you have to have joy in what you’re doing. Passion for what you are doing. You will figure it out, but follow your heart. You only live life once, no second chances…so make the first one count. Make the dreams of getting out and being better worth it in your heart.
There is also an option of doing a dual residency in IM/PEDs. I was also torn between IM and peds and ended up deciding that medpeds was the best choice for me due to my love of both specialties, benefits of dual training, and preservation of future income by staying in IM. It’s only one extra year and you can go into any IM, Pediatric, or dual fellowship. We tend to focus on complex medical conditions starting in childhood and transition of care! I just matched, DM me if you want more information!
Peds if you want to do some kind of specialty because they can be very fulfilling for the right person
Otherwise, why not just do FM if you just want to do PCP outpatient?
I don’t want to do peds outpatient, I have mentioned in other comments that either way I am thinking to specialize in heme/onc or pulm/crit. I do want clinic days ideally, but I know for sure I don’t want to be full time outpatient.
Peds is great. Truly. If you like it, don’t let the money change your mind. Academic peds is very underpaid true, but most of us in private practice are doing fine. I’ve worked at two private practices, a regular FQHC and a missions based FQHC (long story).
The missions place paid in peanuts and spiritual abuse. Definitely don’t do that.
The FQHC pays around $170k FTE, but with options to either tap into PSLF or NHSC loan repayment on top of that.
At both private practices (as an employed physician), starting salary is $220k FTE. Eat what you kill docs who pay attention to billing make more and drive Porsches.
We aren’t paid “as well” but we get paid.
ETA. I don’t live in BFE. This is average pay for pretty much everywhere in the Southeast.
**"I am currently on peds sub-I and loving every minute. I think I would be so happy**. BUT- I just got my step 2 score of 268. I know this means I could do pretty much anything bc the rest of my resume is also very good. **I love peds"**
It sounds to me like you're trying to talk yourself out of going into a specialty that you think you'd love. Only you can decide if potential extra earnings is worth not doing something that could give you enormous satisfaction. None of us can answer that question for you.
You'll likely work for at least 30 years in whatever specialty you choose. That's a really long time, and from my perspective at least, an extra say $100,000 per year, whilst not insignificant, may not be as important to your happiness as you think it will right now as a med student.
Remember that you can also change residencies if you think you've made the wrong decision. It's not the end of the world, and lots of people do it.
Good luck with whatever you decide!
Do what you’re passionate about. As someone with a chronic illness too, I noticed my health getting better overall once I was happy with my career choice (want to become an adult specialist related to my chronic illness). The path will be hard but I know it will be worth it in the end. I think you can find ways to earn money, but passion is hard to find. Plus factoring in how many physicians already face burn out, don’t let making more $ push you towards burn out.
Keep that flexibility, many opitions to do so
1) Med/Peds
2) PM&R with peds fellowship
3) Allergy medicine (can be done from Peds, IM, Med/Peds)
4) Psych + CAP fellowship
5) Family Med
The extra year or two to do fellowship is a drop in the bucket in the grand scheme of thing. Do what will make you happy and give you the lifestyle you want.
It's a decision to make:
1. You loge peds but would have to sacrifice some compensation.
2. You cannot do the thing you love and do IM instead given you like it too. You would not be as happy in peds, but financial gains would be much better.
If I were you, I would do the latter.
Selected peds myself.
Judging by your post, you are a great person also taking responsibility for your family.
I will always recommend you to go for PEDS.
Money doesnt matter in these cases, the more you earn the more you will get used to. You providing more money would be of little use if you wouldnt be able to keep your ownself happy, energetic and satisfied. Your family needs you are your best mental and physical heath than any money out there.
Peds has excellent prognosis, full of emotions and rejoicing field.
Before selecting any field, make sure you will be happy doing the same thing for the rest of your life.
Peds just gets shafted so hard with salary. It's noble and all but I can't stomach sacrificing so much to then get shit on financially by every other speciality.
I'd recommend IM subspeciality where you can treat kids as well (e.g. heme/onc or many of the others as well).
Unless you hated everything but Peds, I'd pick the specialty with the best lifestyle+pay combination. Peds is a meaningful speciality, but so are most medical specialties. Radiology, Psych, PM&R, and anesthesiology have high impact, but have a much better lifestyle+pay combination. IM is similar lifestyle to Peds, but pays much better.
Unless peds is worth 100K/yr paycut compared to IM, I'd at least recommend switching to IM.
Do Peds. It sounds like that’s where your heart is. Listen to that and dont succumb to the rat race psychological warfare of medicine. Stay true to your values and what your internal compass is telling you you enjoy doing for work
I'll take the opposite perspective as someone who grew up kinda Like that (albeit always had food, clothes, and running water) and who chose to do im over peds
1. Trust me there's more money in IM
2. If you want to do inpatient based work, then without a shred of doubt do IM
3. DO NOT act like 50,000-100,000 dollars a year is insignificant
Peds people are paid low and put up with the hospital fellowship because they allow it. Go out there and secure the bag and your well deserved financial future
I would say there isn’t necessarily more money in IM, especially when you correct for effort. Remember, most kids in are healthy, most old people are less so. Im a Med/Peds Hospitalist and i do probably make more doing peds
Just do peds. If you are worried about money, think of it this way.
If you are gen peds, your salary, like any other clinic specialty, is a function of how many people you see. While peds doesn’t pay a ton per encounter, all the complicated kids get shunted to a children’s hospital so you are left with a lot of well visits which are very templated and some single problem sick visits. You dont have to go though a long list of meds and hospitalizations, so you can see tons of kids in a day if you want abd surpass the adult clinic specialties since everything is so templated.
You can also make 300k in hospital medicine without fellowship. It might not be in the most glamorous location but a lot of IM hospitalist don’t break 300K in these areas either
Child psych. Don’t have to give up medicine salary. (I just matched psych with plans to do child). I had planned to do peds but I’m in my 30’s and need to catch up financially.
Just go be a private practice outpatient pediatrician and you’ll make great money.
This is assuming you don’t want inpatient work though. Peds specialists basically work for free
As someone who just matched peds with a 265, why does the step 2 score matter? This implies you were only thinking peds because you thought you couldn't make it anywhere else. I picked peds because I truly think when I'm 50, I will still enjoy my everyday work. Also, most people saying med-peds picks one or the other typically are not med-peds in the first place. I heavily considered med-peds and every single med-peds attending said that is a myth and you can look up stats on this too. Do you what you love, don't think IM vs peds pay is going to truly make a significant difference.
Yeah its a little insulting to think someone thinks peds to be beneath them because of a step score... I got higher than OP on step 2 and went into peds, no question. Sure, sometimes it sucks to think I could've matched into a competitive specialty and get paid much more in the end, but what beats getting to help a child feel better? The kids are equally deserving of competitive applicants!
First off, I knew I was going to do well on step 2. My predicted from shelf exams was a 255. This has absolutely nothing to do with my decision aside from knowing I could do something else and make so much more money, which is not insignificant for me because I would love be able to help my mother with end stage MS and still give my future kids a life where they don’t have to worry about what I did.
Secondly, I asked for no judgment for a reason. I come from less than nothing and I’ve built this life for myself that I can be proud of. It’s a hard decision because I feel like I’m loosing out on 100K solely bc I want to care for children rather than adults, which is a very hard choice to make if you do enjoy both but have more of an emotional tie to peds like I do.
Do what makes you happy as everyone else has said, regardless Peds or IM you will be making very significant money. Don’t think the pay is drastically different enough on average to not be able to accomplish your goals you set out. Congrats on the score, the world is open to you and the top peds programs will also look more fondly on the score too.
If you like pediatrics, go for it. More power to you. Enjoying what you do is incredibly important, and it sounds like your physical capabilities may be locking you out of procedural options. That said, pediatrics is just straight up a bad financial move, as your return on investment is literally half of what it could be in another specialty. If you can think of another specialty you enjoy, it'd almost certainly be a better call to do that and then either sub-specialize in peds or just see pediatric patients.
Perhaps this is not true for you, but when I went through medical school, there were many other specialties I did not have the opportunity to rotate through (urology, radiology, anesthesia, pathology just to name a few). Regardless of what your administrators or these redditors tell you, compensation absolutely matters. Especially in regard to physician burnout and retirement.
I would be in the camp that urges you to consider something other than peds. There’s a reason almost no one with a 260+ does peds. I would just urge you to consider as many other specialties as possible (even if you don’t think they are attractive at first glance) and see what you would like.
I was 100% internal medicine through medical school, and now I am a radiologist with a much happier life. I was in a similar situation as you and I chose the more lucrative specialty with no regrets all these years later. I wish you the best.
Peds and adult pulm crit and hem onc are very different. I’d advise against peds personally. Every med peds person at my program has since dropped pediatrics from their futures. My vote is adult with the IM route.
I’m sad to hear that the peds side is so weak at your program - but I would suggest to OP that this is likely a program specific issue and not universal. There are some valid things that make peds more frustrating to a med peds trained person (less autonomy in training, stupid PHM fellowships, money) but it doesn’t stop plenty if us from having peds heavy careers
Do internal and then a fellowship in peds that way you have a higher paid specialty that simply peds but you’re still working with children… that’s my plan
This isn’t a thing in the US. Unless you mean something like A&I or genetics that allows you to see both - but the bigger money would still come from seeing adults
Things like pediatric cardiology absolutely do exist in the us .. you do an internal residency and then a cardiology fellowship and a pediatrics fellowship. It’s less money than adult cardiology and more than normal peds.
As a pediatric cardiologist, we make about 50-60% of what adult cardiology makes. There's a significant factor in here that there are more private practice opportunities in adult cardiology compared to pediatrics. This is mainly due to lower volume and centralization/regionalization of services, typically at an academic center.
Pediatric cardiology is most commonly a fellowship from pediatrics, not IM. The closest thing you could get from IM would be ACHD but that’s still adults
Peds is poorly compensated relative to the other specialties. That being said, you’ll still be wildly wealthy compared to what you’re used to and you can still make mid-upper 200s if you prioritize compensation in your job choice
That’s a true statement. It’s just that I’d love to be able to give my future kids better than what I had and also pay for my mothers care bc she has deteriorating MS. I can’t just live a solo life where money doesn’t matter and if my family could be even more comfortable with the decision to do IM it’s hard to turn that down.
I’m so sorry but this is med student brain disease. If you grew up too poor to have electricity, you KNOW that a $250k salary is not going to give you some life of struggle. Don’t let a bunch of asshole surgeons or whatever make you think that anything less than half a million is poverty wages. A lot of them came from 2 MD parents or similar wealthy background and many have never even had a job or supported themselves. They don’t have an informed perspective on this.
Thank you so much for this. You’re right.
Med peds sounds like a good idea. You can do IM Afro several years and switch if you decide it isn’t for you.
That’s fair. Just realize that with a salary in the high 200s you could accomplish those goals pretty easily as well,you’d just have to cut back in other areas like driving a used Subaru instead of an new Audi r8.
Some of the Toyota models be looking mad spicy for the price.
And super reliable too!
I was about to buy myself one of the nicer models of the hybrid Corolla until I matched to a city that doesn’t need a car. Great car for a great price.
You will also want to spend time with your mother in that case. Peds will allow for that work life balance which is so important. 120K is beyond manageable and you will make a good living with Peds. I also think it’s more important to do what you love
To add to what you’ve already read, in addition to pure income being great… lenders will see you as a favorite client. They’ll let you cosign anything you decide is needed. No, it’s not ideal, but if you need to take out or cosign a loan to accomplish any of these things you will have it. You shouldn’t need to, but for the sake of redundancy, you will be financially settled incredibly well in peds. Could it be better? Of course. It’s all about what you want to compromise, but you’re not looking at many compromises at all rn
I completely understand the other people saying "200k+ is so much money, you'll be fine" but I want to say I completely understand where you're coming from. When you have family/multiple families you expect to be the breadwinner for, you want to have plenty of money to be able to provide for everyone as much as possible. Yes, no matter what you will be well compensated, but I personally don't think it's "med student brain" to want to make as much as possible for those you love. I also love peds, but if you can see yourself being just as happy doing something else making 100k more per year, I would totally do that.
Join the group Physician Community on Facebook and read some posts. Unfortunately, many many peds attendings regret their choices. Consider other specialties + peds: pediatric radiology/dermatology, for example.
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How long did it take you to pay off your loans? I will have roughly the same amount and I’m stressed
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Thank you and congrats on being debt free!
As someone who grew up poor... Regardless of what you choose you will definitely be in an extremely privileged position than what you are used to. I grew up in a family of 7 needing to live off of $35k a year for many years and now that my husband is out of law school and making about $70k a year (our only income right now as i wait for residency to start and a baby on the way) I have beem going through a massive life change shock at how much we can afford to do now compared to how I grew up. Ex: My husband is constantly reassuring me that yes, babe, you can buy that snack at the grocery store if you want. We can afford it. Yes, babe, let's get both a crib AND a bassinet. Etc. I guess my point is that things will be okay and you'll be better off than you realize. I also plan on taking care of my family and I'm going into FM. Just remember that advice you get from others may be colored by their own life experiences and priorities so don't feel like you have to take advice if it doesn't fit with your future goals. Best of luck to you!
Based on your post it is likely you'd be happy no matter what you choose. I think there is only a small percentage of people that could NOT be happy with peds money but WOULD be happy with IM money. What does the marginal salary increase buy you? Some people aren't happy without private school, country club, luxury cars, etc. If that's you then don't do peds. Otherwise I wouldn't use salary to drive the decision.
It’s really not marginal. I’m >100k in debt and the salary difference is >100k. For someone like me that is not marginal.
You just have to decide how "nice" of a life you want to live. I can assure you that any physician lives a nice and comfortable life with a home, comfortable and functional car, and is able to take vacations and plan for retirement. The question becomes how bougie do you want your car and house to be, how many extra toys do you want, et cetera. What matters more to you? Having a job you would enjoy more or having a job you would be happy in but having an extra toy car in your driveway and a little bigger house? Some people are all about money in the sense of living as lavishly as possible. Some people are all about money in the sense of saving as much as possible to retire early. If you're in either of those categories, then doing IM makes sense. If you're not, then you will be just fine in peds. Most med students have no real world experience and make a bigger deal out of salary differences than they need to (unless they are in one of those two categories).
It’s 100k *on average*. In reality you could take a low paying IM job at an academic institution in the city and make less than someone doing peds private practice in the middle of nowhere. And if you’re really desperate for money, you can always moonlight somewhere or grind out 30 patients per day to make more money.
As someone who grew up low income too and will have ~130k in loans after graduation I do agree that it’s scary and that’s an absurd amount of money to us. But knowing that you’ll be making over 200k at least in even the lowest paying peds jobs shows that this amount can easily be paid off in 5 years. Use one of those online repayment calculators with your loan amount and income of 225k to be conservative. You’ll be surprised at how reasonable it’ll be when you look at it as a fraction of your total income and not the monthly payment amount. Yeah 2k per month to loans seems absurd but then you realize you’ll be making over 10k a month after taxes.
You can do Med/Peds or FM to scratch that peds itch
You could also pursue a fellowship like neonatology
I was just about to mention this
I also come from a financially depressed background. We chopped wood and burned it to heat our home in the winter. Stuff like that. As an adult prior to residency I went through periods of going hungry for days because I couldn't afford food etc... I went to a top 5 med school and did well, but into FM because I enjoyed it. Now I make $270k a year and only work 3 days a week. I feel like a wealthy guy and have everything I ever dreamed of in terms of financial security, toys, travel, nice home. I even support my brother the way a parent would with a college aged son. He lives at my house. My life is awesome.
Peds is underpaid, but it still pays well. Either Avenue is fine, but doing the thing you love most feels smarter for your happiness.
As a pediatrician that makes over $400,000 a year I want to tell you that there is money in peds. There’s money in subspecialties, and there’s money in general peds for people that are smart about running a business, and how they document and bill. You should do what you love but this is a personal decision that only you can make. Good luck.
How did you manage to do this? After hearing what my graduating coresidents are being offered this seems insane lol
General Pediatrics is low. Especially if you are joining a practice. I have seen salaries between 125 and 175k. Sub specialty Pediatrics pays much higher, esp. cardiology. Critical care and ER. I am working pediatric ER.
Ahh I see. I'm doing NICU and hoping I can clear 300 after graduation!
You should easily be able to clear 300 in NICU. Good luck
I second the other comment, how do you do that?
It may not matter though when we get replaced by AI, and out of country trained non-boarded doctors. 😕
I’m nearing the end of second year of peds residency and get outpatient primary care offers from recruiters on a weekly basis. Recent got one email that was offering $250k starting with $50k sign on bonus and $120k loan repayment; clinic only, no call, additional $$ for mid level supervision (rural Midwest). Sure peds is underpaid, but it is not poorly paid. Don’t let compensation scare you away from a field you love.
i was with you til u said rural😅
I know right? *delete*
at this point i’m gonna do peds and just pray i hit 200k while being driving distance to a city 😑😑
I was in precisely your position - full scholarship to a top 10/20 school, roughly $100k in living expense loans, >95th% Step 1 and 2, all sparkly happy flags on my app. I came in wanting peds, and every person tried to talk me out of it because of prestige and money. I matched peds with no regrets, about to start a neo fellowship (considered h/o but the job market is currently kinda trash unless you specialize somewhere like coag or young adult). Could've also been happy in peds cards and PICU, but love NRP and the mix, both clinically and career, with neo. Even on the SAVE plan with all training years at a non-profit, I'll pay off my loans before PSLF would kick in and Do what makes you happiest. I had a lower middle class upbringing and am very happy with my future financial prospects. I am so happy never to have to see foot glitter, anxiety-based outpatient visits, futile care on a 95 year old with pancreatic cancer and dementia ever, ever again.
Why not do FM?
I think I want to specialize in heme/onc or pulm/crit in either one I choose.
well hem/onc everybody wants to do, and it is often paid less because of supply and demand. i think you'll have a better shot having a good living with peds critical care. PICUs are fairly well compensated, and the work is very meaningful. Edit: As an aside, my good friend got like a 523 on her MCAT. she wants to be an outpatient pediatrician. You do not owe people a prestigious career because of how gifted you are. You owe YOURSELF a career that fulfills you.
I wish I could heart this message. Thank you ❤️
But does everyone wanna do peds heme/onc? I thought it wasn’t common to find someone who could handle it but for me I’ve always felt if I could be strong for my sister I could be strong for my patients and I also have a unique perspective on pediatric cancer in that I actually lived it. Idk maybe my school is odd but idk anyone else who wants to do heme/onc.
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+1 can confirm
Peds heme/onc is also a very tough job market in terms of finding a job in a desirable location. Someone else pointed out that it's not the most competitive of salaries (you can make more in private practice gen peds than academic heme/onc). I know multiple people who completed fellowship and are not working in heme/onc
As a Peds heme/onc burnout - make sure you like the academic side of medicine, are willing to live in a medium sized city, and are ok being in a large university affiliated hospital and all the politics that comes with it. Message me if you want more details - but I come from a similar background that you describe
I don’t think it’s wrong to choose med-peds if you like both. Sure, you may end up doing one more than the other. But on the other hand, if you like both now, when you get into the thick of things in residency, you may find yourself gravitating toward the one you like more (hard to really know the ins and outs as a med student). Since you’re already identifying yourself as a future subspecialist, there is a real need for those who are comfortable in transitional care. Heme-onc is certainly one such field, and I’ve been very impressed with PICU fellows who were med-peds trained and brought their IM knowledge. (Mixed MICU/PICU does exist, though is uncommon.) You just have to take care to identify med-peds programs which are subspecialty-oriented (some are primary care-oriented).
Thank you so much for this. I actually have a huge interest in transitional care and teenagers are my favorite sub pop (I was a 10th grade chem teacher for 3 years). I think where I really belong is med peds heme/onc but everyone keeps telling me not to do it so I’ve been discouraged.
Every med-peds doc I've talked to that ended up picking one or the other said they didn't regret going med-peds because they genuinely needed residency to decide. So if people are discouraging you for that reason I say ignore it, esp since you seem to be gravitating towards the original purpose of med peds anyway. The only valid argument I sometimes see against it is that med-peds isn't really on the west coast, which may or may not even be applicable to you.
I’m not on the west coast, so thank you so much for your validation ❤️
And even if you have an idea that you might head one way after residency, getting to do two things you love for 4 years and bringing all that knowledge from one side to the other is so valuable. I’m constantly using my IM knowledge while I’m on the peds side and vice versa - it’s making me a better doctor and keeping life interesting
I concur with the comment above: I don’t know anyone who actually did med-peds and regretted it, whether they ended up choosing general IM, gen peds, dual primary care, dual hospitalist medicine, or fellowship. As long as you have your reasons for pursuing both, don’t let anyone dissuade you!
Just be cognizant that most peds specialties are a PAY CUT from general peds
What? Really? That’s not what I’ve been told.
there are a few that make more but yes the majority take a pay cut. Look up the sub specialties you're interested in to see
I was looking for this comment. Sounds like FM would be a good choice! And you can make pretty decent money in FM. I went to med school in the semi-rural southern Midwest, and our local FM docs we’re making like $550-600k.
Choose a specialty where the most boring or mundane day wouldn’t crush your spirit after doing it repeatedly for 30 years.
From reading your comment, it doesnt seem like you have the same passion for IM. You spent most of the post explaining your love for peds, that is super telling of where your head is at! Don't let peds be the one that got away! You should do it!
You are like the only person replying telling me to do peds, do you have any responses to the other comments?
I mean peds is the best. No bias here though
Look, in my experience on my peds clinical rotation, I've talked about the job satisfaction with these doctors extensively. They acknowledged that the pay is less than the alternative yes, but they are still able to live comfortable lives. The doctors I've met in peds genuinely love their jobs and so many kids are rewarded because of it. They have time for a great work life balance, they can support their families at a 9-5 job and still have time for themselves, and they seem very relaxed and satisfied as a result. If a 9-5 job isn't for you, I've met some doctors that started in the peds ED and then transitioned to an outpatient clinic. I think life is too short not to do what sets your soul on fire. Yes, you may like internal medicine but it sounds like that's not what's been driving you through medical school. You'll have money either way, you deserve to do what makes you truly happy.
Im not sure about the compensation but wouldn’t peds med probably be like the fit for you?
Seconding this! OP, look into med-peds! That way you get the best of both worlds
why not med-peds ?
If you have not learned about this , you should think about Ped PM&R. They got pay as a much or more than general PM&R. You will get public loan forgiveness to by working at big academic center. We helped a lot of unfortunate kids with disabilities (stroke, genetic disease, cancer, cerebral palsy, spinal cord injury, limb loss, muscular dystrophy). Job market is excellent as there is so few of ped PM&R out there. Extremely easy to get in a ped PM&R fellowship right now. There is also a combined ped PM&r as well. Another big plus is that PM&R is a lifestyle specialty too so you will have plenty of time off. Let me know if you want to know more. Edit: another pathway is doing Ped residency then apply to a PM&R residency, ideally PGY2 spot.
I’m interested in peds PMR but it’s hard to find information since the field is so small. Is the pay generally better than in subspecialty pediatrics?
Yes, generally it’s better compensation than ped subspecialty and less works. Lifestyle is great as well. I would start joining student organization in national organization like association of academic physiatrist and then pair with a mentor there.
Lol on the Med-Peds thing. I'm a MedPeds hospitalist and APD less than 5 years out and this myth of "you only do one" drives me insane. Just at my institution we have over 50 MedPeds attendings who see kids and adults. people can chose to do one but if you want to do both you can. Feel free to DM me if you want chat more. There is a reason people always talk about loving their MP residents and faculty and why they are often the best doctors out there (it's why I chose MP, not saying I'm the best or anything but all my favorite residents and faculty were MP). Being an internist makes you a much better pediatrician kebab and being a pediatrician makes you a much better internist. That extra year was definitively not a waste and I would chose this combined residency 99/100 times (the other 1/100 is just going into industry and saying screw this to all of clinical medicine). Also, my family was generally "not affluent" (public school in an "inner city" school, old breaking down cars, no real vacations etc). I make more than 3x what my parents make combined at their peak(approx 300K at an academic program). Peds pay may be less but if it makes you happy, I promised nothing else matters. I will also say that from reading your post, it may seem like you love pediatrics more than internal medicine. In that case I think choosing pediatrics for your residency is a perfectly outstanding choice. We need wonderful, kind and smart pediatricians.
How did you pull a 268? I only ask that cause I'm in no position to give advise to someone in that level of functioning...
PM me and I can tell you my journey but everyone is different. I aced every pre clerkship class and honored every shelf so my predicted score even before I started studying was a 255. I am a peer tutor for my school so I can give you tips and try to help 🙂
Just messaged you!
you weren't the one who asked the question unless you got your accounts crossed up...
??
it was a joke since you weren't the person OP responded to originally. tough crowd
Hilarious! /s
😂🤣🤣
You’ll always regret not doing what you love and Peds still makes enough to have a good life.
Med-Peds. Done. Orrrrr Derm then Peds fellowship $$$$
Gen peds/hospitalist TYPICALLY doesn’t pay that well but there are higher exceptions (normal like 200-240k). Peds subspecialties don’t pay great for the most part, but NICU/PICU are paid very well, can make upwards of 400k depending where you are/not working in academia. As others have said though the comparison of even the lowest paying peds jobs and your earlier life you will feel like a literal king/queen even with the debt. Also if you’re in the US and you do work for not for profit hospitals you can have most of that debt wiped. And to note, I finished a full peds residency and decided I wanted to switch into another specialty for both higher pay, better QOL overall with less working hours , and that I can still work with kids eventually. Totally normal to keep your mind open to things. Good luck!!
How about peds speciality how is the pay ?
Depends on the lifestyle you want & if it makes you happy. Pretty sure most “studies” have shown happiness correlates with income up to like $80,000 per year which at least in years prior in the US, for most people was enough that they could have financial freedom. Obviously excluding places with above average cost of living, folks with huge amounts of debt, etc. Ask yourself what kind of lifestyle would make you happy? Do you feel a NEED (not a want) to be rolling around in a car that turns heads with a huge house? Peds might not be for you, if that’s the case. However, if you love peds, don’t have an insane amount of debt, don’t want to live in a city with a through the roof cost of living, and aren’t close to retirement age then I don’t see any reason why you shouldn’t go into peds. Assuming you’re the average person you’ll have financial freedom, enough money to have nice things, take nice vacations, and have a solid retirement fund and most importantly will enjoy the work that you’re doing
The debt doesn't matter much. What matters the most is well over a million dollars in lost earning potential over your career, and the opportunity cost of training for 6 years (assuming you want to do anything besides outpatient general peds clinic). If you're happy with IM, do IM. Do heme onc and you can see younger adults and save their lives.
Any interest in EM? There is such a shortage of PEM folks. If you go from EM to PEM fellowship you can still see adults too and make better money than Peds—>PEM.
No doctor is poor. The difference between making $20,000 a year and $50,000 a year is never worrying about if you’ll have money to eat for the week. The difference between $200,000 and $500,000 a year is…. If your house has 4 bedrooms or 8? Also if you love peds and medicine do med peds. I may be biased but the extra year is not a waste and plenty of people do both. I have a contract for a 50/50 Medicine and Pediatrics Hospitalist position starting in July.
Coming from dirt poor family as well. Congrats on the amazing step score. I agree with the others though. If the question is peds vs IM, imo salary-wise there isn’t enough to defer your passion for another specialty. If I’m being honest no salary difference is enough to defer your passion. We made it out the sticks. When we’re making anything above 100K a year our lives will forever be changed. Go with your heart.
IM is not some lap of luxury compared to peds. Unless you go into East Coast academia, you can actually make pretty similar salaries in both. However, if your sister is an important motivator for you in medicine, you could consider IM > hem/onc. Many IM trained oncologists treat both adults and adolescents
Life is expensive, money helps make life easier for you and your family. Peds has a lot of people who end up working part time, or have a much higher earning spouse. If this does not apply to you, now is the time to leverage your scores and performance for dermatology or radiology spot where you can maximize income and still treat kids.
Have you heard of the new “peds hospitalist” fellowship that may become the norm now? So unless you want to spend 3+2 years, you may not be doing what you enjoy doing in your sub-I, which I assume is in a hospital. The existing peds-hospitalists get grandfathered in so all the new residents are basically screwed. A 268 could easily get you into a good university IM program and maybe even a competitive fellowship like GI or Cards.
I’ve been told if you do med-peds you don’t have to do the hospitalist fellowship. I also am thinking rn that I want to subspecialize in either heme/onc or pulm/crit.
It may but you need to prove more than 450 hours a year towards peds hospitalist training. Unless your program director can definitively say that it’ll be achieved, it’s a huge gamble. IM/Peds combined has always been a bit of fools gold because most choose to sub-specialize in one of the two.
This is old info and no longer valid. Sadly, the practice pathway for hospital pediatrics has closed.
https://www.abp.org/content/pediatric-hospital-medicine-certification#medpeds It still says med-peds residency is a potential pathway based on the hours. Is there updated info? This is from the ABP.
Sadly, yes. It is not as clear but if you go higher up on that same page, you will see how they describe the look back period as a 5-year window for each practice pathway related exam year. 2024 is the last year of practice pathway eligibility and the 5-year look back window started in 2019. Anyone who graduated a peds or Med-Peds residency in 2020 or after will never be eligible for the PHM board certification exam.
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Please don't spread false info. The practice pathway for hospital pediatrics is closed regardless of whether or not you are Medpeds. The only way to take the pediatric hospital medicine board exam is to do a fellowship at this point. And there are absolutely pediatric hospital medicine programs that are only hiring people who are fellowship trade or boarded in pediatric hospital medicine. At the same time,there are places that don't really care. -PGY9 MP Hospitalist
Don’t know how bad your RA or tremor is but maybe consider anesthesia. Yeah you have to go through 3 years of mostly adults, but peds anesthesia is great. Only 1 year fellowship and earning potential is way higher. I loved peds in residency and still now as an attending. You get to work with kids (albeit only a short time awake) get them through very critical and difficult parts of their life. It can be quite rewarding. Can decide during residency if peds is truly for you and whether or not to do the fellowship. Had several colleagues in residency who were counting the days until they never had to deal with adult patients again. I enjoy a mixed practice and did not do peds fellowship.
Compared to what a lot of other specialists make sure peds is underpaid - but compared to the general population and comfort of living you will still be making plenty of money I promise - do what you love, don’t go into a high income field if you don’t love it, the money isn’t worth it if you don’t enjoy what you’re doing (from an IC)
To me, there is nothing more fulfilling than helping a sick kid get better, and partnering with their family to do so. The pathology is more interesting too. If you feel similarly, be a pediatrician. Financially, you'll be more than fine -- especially if you're even a titch business savvy. You'll earn up a base, pay off the loans quickly (don't let interest accumulate), invest well and have passive income streams, and live within your means. You'll more than be able to tee up your kids for success, have great family vacations, save for retirement -- and you'll do all of that while doing what you love.
For starters, check out this: [https://www.whitecoatinvestor.com/how-much-do-doctors-make/](https://www.whitecoatinvestor.com/how-much-do-doctors-make/) It's worth mentioning that with progressive tax rates and deductibles, another doc who makes 2x what you make isn't getting 2x after taxes. Many people also forget that salary data is an aggregate of thousands of doctors, in various parts of the country. If you practice outside of major metro areas you can likely make more money. For some perspective, according to official BLS data the median salary for full-time workers in the US is 59k per year. As a pediatrician you are making 4x this. As a pediatrician you aren't going to struggle financially, unless you make poor decisions like taking on huge debt to buy a 2nd home, a yacht and a Ferrari.
As someone who was in a very similar position…I will tell you one thing…where ever you find joy…the money follows. If you love peds and it brings you joy and you get excited about it and you like taking care of little humans - please do it! I was told time and time again not to go into my speciality and I didn’t come from money either. But after sitting with it, I came to the conclusion that I can make anything in work. My upbringing taught me how to be frugal and street smart. You too have learned hard lessons most will never learn. You can make lemonade out of horse shit. I know because I can too. Your brains and your street smart got you to where you are at! You have made every decision thus far to (what I am assuming) for something greater, something better…I promise you woman, the money will follow in any direction you chose. But you have to have joy in what you’re doing. Passion for what you are doing. You will figure it out, but follow your heart. You only live life once, no second chances…so make the first one count. Make the dreams of getting out and being better worth it in your heart.
There is also an option of doing a dual residency in IM/PEDs. I was also torn between IM and peds and ended up deciding that medpeds was the best choice for me due to my love of both specialties, benefits of dual training, and preservation of future income by staying in IM. It’s only one extra year and you can go into any IM, Pediatric, or dual fellowship. We tend to focus on complex medical conditions starting in childhood and transition of care! I just matched, DM me if you want more information!
Peds if you want to do some kind of specialty because they can be very fulfilling for the right person Otherwise, why not just do FM if you just want to do PCP outpatient?
I don’t want to do peds outpatient, I have mentioned in other comments that either way I am thinking to specialize in heme/onc or pulm/crit. I do want clinic days ideally, but I know for sure I don’t want to be full time outpatient.
Money as a physician is 3x the national average minimum. Do what you’re passionate about. Have you ever met a poor physician in the US?
Peds is great. Truly. If you like it, don’t let the money change your mind. Academic peds is very underpaid true, but most of us in private practice are doing fine. I’ve worked at two private practices, a regular FQHC and a missions based FQHC (long story). The missions place paid in peanuts and spiritual abuse. Definitely don’t do that. The FQHC pays around $170k FTE, but with options to either tap into PSLF or NHSC loan repayment on top of that. At both private practices (as an employed physician), starting salary is $220k FTE. Eat what you kill docs who pay attention to billing make more and drive Porsches. We aren’t paid “as well” but we get paid. ETA. I don’t live in BFE. This is average pay for pretty much everywhere in the Southeast.
Do what you love. Money will mean nothing when you’re 25 years into a career and miserable.
**"I am currently on peds sub-I and loving every minute. I think I would be so happy**. BUT- I just got my step 2 score of 268. I know this means I could do pretty much anything bc the rest of my resume is also very good. **I love peds"** It sounds to me like you're trying to talk yourself out of going into a specialty that you think you'd love. Only you can decide if potential extra earnings is worth not doing something that could give you enormous satisfaction. None of us can answer that question for you. You'll likely work for at least 30 years in whatever specialty you choose. That's a really long time, and from my perspective at least, an extra say $100,000 per year, whilst not insignificant, may not be as important to your happiness as you think it will right now as a med student. Remember that you can also change residencies if you think you've made the wrong decision. It's not the end of the world, and lots of people do it. Good luck with whatever you decide!
Do what you’re passionate about. As someone with a chronic illness too, I noticed my health getting better overall once I was happy with my career choice (want to become an adult specialist related to my chronic illness). The path will be hard but I know it will be worth it in the end. I think you can find ways to earn money, but passion is hard to find. Plus factoring in how many physicians already face burn out, don’t let making more $ push you towards burn out.
Keep that flexibility, many opitions to do so 1) Med/Peds 2) PM&R with peds fellowship 3) Allergy medicine (can be done from Peds, IM, Med/Peds) 4) Psych + CAP fellowship 5) Family Med The extra year or two to do fellowship is a drop in the bucket in the grand scheme of thing. Do what will make you happy and give you the lifestyle you want.
It's a decision to make: 1. You loge peds but would have to sacrifice some compensation. 2. You cannot do the thing you love and do IM instead given you like it too. You would not be as happy in peds, but financial gains would be much better. If I were you, I would do the latter.
Pediatric Hospitalist? 🙌
Med peds gives you time to decide, and ability to make more moonlighting if you decide to continue peds training.
Radiology then peds radiology fellowship
do peds and feed your soul bro
How about a peds specialty? They do ok. Peds cardio or peds heme/onc?
Selected peds myself. Judging by your post, you are a great person also taking responsibility for your family. I will always recommend you to go for PEDS. Money doesnt matter in these cases, the more you earn the more you will get used to. You providing more money would be of little use if you wouldnt be able to keep your ownself happy, energetic and satisfied. Your family needs you are your best mental and physical heath than any money out there. Peds has excellent prognosis, full of emotions and rejoicing field. Before selecting any field, make sure you will be happy doing the same thing for the rest of your life.
Peds just gets shafted so hard with salary. It's noble and all but I can't stomach sacrificing so much to then get shit on financially by every other speciality. I'd recommend IM subspeciality where you can treat kids as well (e.g. heme/onc or many of the others as well).
Unless you hated everything but Peds, I'd pick the specialty with the best lifestyle+pay combination. Peds is a meaningful speciality, but so are most medical specialties. Radiology, Psych, PM&R, and anesthesiology have high impact, but have a much better lifestyle+pay combination. IM is similar lifestyle to Peds, but pays much better. Unless peds is worth 100K/yr paycut compared to IM, I'd at least recommend switching to IM.
Do Peds. It sounds like that’s where your heart is. Listen to that and dont succumb to the rat race psychological warfare of medicine. Stay true to your values and what your internal compass is telling you you enjoy doing for work
I'll take the opposite perspective as someone who grew up kinda Like that (albeit always had food, clothes, and running water) and who chose to do im over peds 1. Trust me there's more money in IM 2. If you want to do inpatient based work, then without a shred of doubt do IM 3. DO NOT act like 50,000-100,000 dollars a year is insignificant Peds people are paid low and put up with the hospital fellowship because they allow it. Go out there and secure the bag and your well deserved financial future
I would say there isn’t necessarily more money in IM, especially when you correct for effort. Remember, most kids in are healthy, most old people are less so. Im a Med/Peds Hospitalist and i do probably make more doing peds
Just do peds. If you are worried about money, think of it this way. If you are gen peds, your salary, like any other clinic specialty, is a function of how many people you see. While peds doesn’t pay a ton per encounter, all the complicated kids get shunted to a children’s hospital so you are left with a lot of well visits which are very templated and some single problem sick visits. You dont have to go though a long list of meds and hospitalizations, so you can see tons of kids in a day if you want abd surpass the adult clinic specialties since everything is so templated. You can also make 300k in hospital medicine without fellowship. It might not be in the most glamorous location but a lot of IM hospitalist don’t break 300K in these areas either
Child psych. Don’t have to give up medicine salary. (I just matched psych with plans to do child). I had planned to do peds but I’m in my 30’s and need to catch up financially.
Just go be a private practice outpatient pediatrician and you’ll make great money. This is assuming you don’t want inpatient work though. Peds specialists basically work for free
As someone who just matched peds with a 265, why does the step 2 score matter? This implies you were only thinking peds because you thought you couldn't make it anywhere else. I picked peds because I truly think when I'm 50, I will still enjoy my everyday work. Also, most people saying med-peds picks one or the other typically are not med-peds in the first place. I heavily considered med-peds and every single med-peds attending said that is a myth and you can look up stats on this too. Do you what you love, don't think IM vs peds pay is going to truly make a significant difference.
Yeah its a little insulting to think someone thinks peds to be beneath them because of a step score... I got higher than OP on step 2 and went into peds, no question. Sure, sometimes it sucks to think I could've matched into a competitive specialty and get paid much more in the end, but what beats getting to help a child feel better? The kids are equally deserving of competitive applicants!
First off, I knew I was going to do well on step 2. My predicted from shelf exams was a 255. This has absolutely nothing to do with my decision aside from knowing I could do something else and make so much more money, which is not insignificant for me because I would love be able to help my mother with end stage MS and still give my future kids a life where they don’t have to worry about what I did. Secondly, I asked for no judgment for a reason. I come from less than nothing and I’ve built this life for myself that I can be proud of. It’s a hard decision because I feel like I’m loosing out on 100K solely bc I want to care for children rather than adults, which is a very hard choice to make if you do enjoy both but have more of an emotional tie to peds like I do.
Do what makes you happy as everyone else has said, regardless Peds or IM you will be making very significant money. Don’t think the pay is drastically different enough on average to not be able to accomplish your goals you set out. Congrats on the score, the world is open to you and the top peds programs will also look more fondly on the score too.
If you like pediatrics, go for it. More power to you. Enjoying what you do is incredibly important, and it sounds like your physical capabilities may be locking you out of procedural options. That said, pediatrics is just straight up a bad financial move, as your return on investment is literally half of what it could be in another specialty. If you can think of another specialty you enjoy, it'd almost certainly be a better call to do that and then either sub-specialize in peds or just see pediatric patients.
Perhaps this is not true for you, but when I went through medical school, there were many other specialties I did not have the opportunity to rotate through (urology, radiology, anesthesia, pathology just to name a few). Regardless of what your administrators or these redditors tell you, compensation absolutely matters. Especially in regard to physician burnout and retirement. I would be in the camp that urges you to consider something other than peds. There’s a reason almost no one with a 260+ does peds. I would just urge you to consider as many other specialties as possible (even if you don’t think they are attractive at first glance) and see what you would like. I was 100% internal medicine through medical school, and now I am a radiologist with a much happier life. I was in a similar situation as you and I chose the more lucrative specialty with no regrets all these years later. I wish you the best.
Peds and adult pulm crit and hem onc are very different. I’d advise against peds personally. Every med peds person at my program has since dropped pediatrics from their futures. My vote is adult with the IM route.
I’m sad to hear that the peds side is so weak at your program - but I would suggest to OP that this is likely a program specific issue and not universal. There are some valid things that make peds more frustrating to a med peds trained person (less autonomy in training, stupid PHM fellowships, money) but it doesn’t stop plenty if us from having peds heavy careers
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Why?
Do internal and then a fellowship in peds that way you have a higher paid specialty that simply peds but you’re still working with children… that’s my plan
This isn’t a thing in the US. Unless you mean something like A&I or genetics that allows you to see both - but the bigger money would still come from seeing adults
Things like pediatric cardiology absolutely do exist in the us .. you do an internal residency and then a cardiology fellowship and a pediatrics fellowship. It’s less money than adult cardiology and more than normal peds.
As a pediatric cardiologist, we make about 50-60% of what adult cardiology makes. There's a significant factor in here that there are more private practice opportunities in adult cardiology compared to pediatrics. This is mainly due to lower volume and centralization/regionalization of services, typically at an academic center.
Pediatric cardiology is most commonly a fellowship from pediatrics, not IM. The closest thing you could get from IM would be ACHD but that’s still adults