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Residency Training Program - Current Residents
The following information was compiled to assist pediatric residents in making career choices. The discussion will include items to be considered in choosing careers in practice, pediatric subspecialties, or other areas. Sources of information, including links to internet sources, are also presented and will be periodically updated
When to start planning
Career planning should begin in the PL-1 year as each rotation is checked for "goodness of fit" with one's personal goals and aspirations. The problem, of course, is that the PL-1 year begins with insecurity about basic knowledge and performance, demands a steep learning curve related to new responsibilities and environments, and requires an exploration of new relationships with fellow interns and other residents. Sleep deprivation, post-call challenges, and the overwhelming desire to avoid an onerous mistake leave little time for introspection and testing of training experiences. This is unfortunate, since half the year may go by before a new PL-1 feels comfortable enough to really explore her/his future plans, and significantly more time may transpire before anyone else begins to ask if career plans have been considered.
It is the responsibility of the training program to initiate career-planning discussions for each of its trainees. This process should begin during the PL-1 year and continue through the PL-3 year. There are numerous of ways that planning can be fostered (e.g., in semi-annual meetings with the program director to review the trainee's progress, in regular meetings with a faculty advisor, in house staff meetings that are focused on career planning, and by meetings with the Department Chair).
Making personal choices about career directions is difficult. Many residents express that they "always wanted to be a doctor" and that they "love children." There may also be siblings or parents who are physicians, making the choice of a career in medicine almost inevitable. Now, however, the individual must come to grips with the reality of exploring her/his own career direction within medicine and pediatrics. It is very important to emphasize that the individual must take control of this process. Well meaning friends, colleagues, parents, and program directors will often make suggestions about career directions that they believe are "perfect" for an individual, but which may, in fact, have nothing to do with the individual's own goals or dreams. Even though some individuals would like to see divine intervention direct them toward a specific career, they ultimately have to decide what is in their best interest, not what someone else thinks is the right thing for them to do.
Post-pediatric residency careers can take many different directions. Some of the most popular options include private practice (in all varieties from solo practice through large HMOs or other managed care organizations), further training in general academic pediatrics, Robert Wood Johnson fellowship training, pediatric subspecialty training, basic science training, Epidemic Intelligence Service, Public Health Service, Indian Health Service, advanced degrees such as a Masters of Public Health (MPH), and other specialty activities such as neurology, psychiatry, pediatric anesthesiology, radiology, and NIH fellowships.
The American Academy of Pediatrics has excellent and diverse information about pediatric careers. This site should be consulted as an essential part of career planning. It can be accessed at http://www.aap.org/profed/career.htm and http://www.aap.org/profed/gmepw.
Since the majority of pediatric residents enter practice, this will be the first area of discussion. The following data are from a random sample of 497 third-year pediatric residents completing categorical programs in 1999 (AAP News, March 2000).
"For 92% of those entering a general pediatric practice position and for 89% of those entering a subspecialty fellowship, the resident's new position was his/her first choice. The majority (59%) of those entering general pediatric practice were heading to a solo or pediatric group practice. Residents entering general pediatric practice estimated they would see 32 patients per day, and they anticipated a starting salary of $93,238. Of those entering a subspecialty, 21% chose neonatology, 13% chose hematology/oncology, and 11% chose infectious diseases. Less than 1% of residents were entering a non-pediatric fellowship."
"Residents also were asked what information or services they found helpful in their job searches. A total of 35% of residents reported that contacts they or their family had made were the most useful sources of information in their job search. An additional 18% said a residency faculty member was most useful, 14% said a peer was most useful, and 13% said direct contact from a practice was most useful. When residents were asked about other information or services that would have been helpful for their job or fellowship search, a central listing of job/fellowship opportunities was rated the highest."
See Practical Points below for how to find a job after leaving residency.
Practice opportunities are multi-faceted and range from solo practice through partnership or group practice to HMOs (staff model or group/IPA model) or various PPO arrangements. There are also additional options such as hospitalists and locum tenens arrangements. Practice environments range from the inner city to neighborhood health centers, suburban practices, and rural locations. Part-time and shared practice opportunities are often available, as well as practice in night or after-hours clinics. Issues to consider when exploring possible positions include office hours, on-call schedules and coverage, hospital responsibility for inpatients, opportunities to recruit new patients (e.g., through nursery coverage), salary, benefits, vacation and CME allowances, office management philosophy, parental leave and other special needs, licensure, cost of buy-in, partnership requirements, dissolution buy-out or restrictive clauses, and the specific expectations and philosophy of the practice. If it is a group practice, assess the stability of the group. If some physicians have left the group, find out why. It is also a good idea to spend a day or two with the practitioners at a site of interest to better understand their specific interaction, communication, and practitioner styles.
It is useful for both you and prospective employers to have a curriculum vitae or resume. In addition to the demographic material, it is particularly helpful to have a personal statement that describes your strengths and defines the kind of practice you would like to join. In describing your strengths, you will also help define the value you bring to the practice. Characterizing the kind of practice opportunity you desire will help crystallize these issues and make you more comfortable with your decisions.
There are a number of resources to use as one begins to look for private practice opportunities, including the classified advertisements in pediatric journals (like Pediatrics and Journal of Pediatrics, The New England Journal of Medicine and the Journal of the American Medical Association), postings at the various meetings sponsored by the American Academy of Pediatrics, and Web sites such as:
and many other sites related directly to regions of the country, schools, etc. There are many good "pediatric" sites to visit for a wide variety of information, including job opportunities. They include:
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