FM with Child Health +1 vs Pediatrics

[northo60]

Hi all, 

I am interested in doing either Family Medicine or a residency in Pediatrics. I recently found out that Western has a +1 in Child Health. Has anyone done a Child Health +1 who can compare it to a peds residency? If a FMD can tailor their practice and only see peds pts, what would be the main difference between the +1 and an actual residency in peds? Thanks!

[NeuroD]

1 hour ago, northo60 said:

Hi all, 

I am interested in doing either Family Medicine or a residency in Pediatrics. I recently found out that Western has a +1 in Child Health. Has anyone done a Child Health +1 who can compare it to a peds residency? If a FMD can tailor their practice and only see peds pts, what would be the main difference between the +1 and an actual residency in peds? Thanks!

It would probably similar to working as an out patient community peds consultant, as opposed to hospital peds.

Edit: 100% speculation

[freewheeler]

Never heard of the child +1 until now. Honestly not sure. The intent behind the +1 may be for rural physicians seeking more training in peds, who work in areas where peds access may not be prevalent. To my knowledge western is the only school with a +1 in rheumatology and I believe the reason for that is similar to that above. 

[bananabread]

it is not comparable at all to doing a peds residency/being a pediatrician. What freewheeler said is correct, it is meant to give more knowledge in peds for those working in underserviced areas/would like to become more proficient to better serve their patient population. As far as I know doesn't allow working as a 'peds only' FM who sees only kids. If you want to see only kids and no adults I think peds is the only way to do that, in fm you can try to tailor your practice to a lot of young families but I think all fm practices end up with a mix of patients. 

[JohnGrisham]

Billing codes. 

You could probably suffice as an outpatient pediatrics analogue, but you just wont get paid nearly as much for consults. Wouldn't be worth it at all.  

[LittleDaisy]

On 8/30/2018 at 10:39 AM, northo60 said:

Hi all, 

I am interested in doing either Family Medicine or a residency in Pediatrics. I recently found out that Western has a +1 in Child Health. Has anyone done a Child Health +1 who can compare it to a peds residency? If a FMD can tailor their practice and only see peds pts, what would be the main difference between the +1 and an actual residency in peds? Thanks!

I don't think that you could do just pediatrics as a family physician. Most of the pediatrics care that I provide is well-baby care, and some AOM, UTI, GERD, etc..We would generally refer to general pediatrics for developmental delay, ADHD, asthma etc (perhaps it's different in smaller cities) ...

In Toronto, the primary care pediatrics is very saturated, where a lot of general pediatricians do well-baby checks for a living. Patients could often pick if they want their GPs to follow their newborns or Pediatrician. It makes sense, as the advanced prenatal screening, and the advances in pediatrics, make the younger patients much healthier. 

If you want to take care of sick children, I would recommend pursue a residency in pediatrics. 

With the aging population, you will end up seeing more complex elderly patients than a healthy well-baby in your day-to-day family practice. 

[freewheeler]

Also keep in mind that pediatrics is basically internal medicine for kids, while family medicine is largely looking after 'the worried well' and helping coordinate specialist involvement in patient care with some preventative healthcare added in. There is a difference in the presentations you will see and feel comfortable managing. If you really want to focus on working with children, pursue a career in pediatrics. 

 

[JohnGrisham]

27 minutes ago, freewheeler said:

Also keep in mind that pediatrics is basically internal medicine for kids, while family medicine is largely looking after 'the worried well' and helping coordinate specialist involvement in patient care with some preventative healthcare added in. There is a difference in the presentations you will see and feel comfortable managing. If you really want to focus on working with children, pursue a career in pediatrics. 

 

Very true.

That said, most of outpatients peads still is fairly common and bread butter things that most family docs could manage just fine. It's the fact that they couldn't spend the hour with the patient due to lack of billing codes.  

[JohnGrisham]

45 minutes ago, LittleDaisy said:

developmental delay, ADHD, asthma etc

Arguably a GP could do these no problem either, but most in big cities would have no way of spending the required time due to lack of billing codes. ADHD and asthma especially are not hard to manage, just takes time and counselling. If you have peds billing codes you have bit more luxury of time to spend, (or delegate to a nurse who you may employ in your clinic).

[LittleDaisy]

19 minutes ago, JohnGrisham said:

Arguably a GP could do these no problem either, but most in big cities would have no way of spending the required time due to lack of billing codes. ADHD and asthma especially are not hard to manage, just takes time and counselling. If you have peds billing codes you have bit more luxury of time to spend, (or delegate to a nurse who you may employ in your clinic).

I actually have started treating kids with asthma, but then my staff preferred to general pediatrics after. The wait time to see general pediatrics in GTA is quite short, some patients just self-refer and even for developmental pediatrics, the wait time is < 1 months; perhaps a good sign to cut down the number of pediatric residency spots.  

For ADHD, definitely a GP would feel comfortable managing, the lack of PEDS billing codes in primary care could definitely why we over-refer. 

If the MOH develops GP pediatric billing codes ( you definitely spend a fair a bit more time with pediatric population, especially counselling on anxious parents, and more thorough physical exam and history given medical-legality aspect), I suspect that there will be even less need for general pediatrics in urban area