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daleader

Pediatric subspecialties income - why lower than internal medicine

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Hey all,

I had a quick question: I keep hearing that the pediatric subspecialties offer very poor compensation compared to their adult (IM subspecialties) counterparts, even less than general pediatrician.

My question is why and how do I find out more about the subspecialty income.

1. Is the volume less? A pediatric cardiologist doesn't have as many patients

2. Billing codes offer less money? This is what my main question is. I have been told that you get paid less doing the same procedure in a kid, but when I look at the billing codes, I can't find any differences, sometimes it's even more like LP in peds vs adults. Can someone please clarify this? I can't find like endocrinology peds vs endocrinology adult OHIP codes or whatever.

 

Thanks!

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24 minutes ago, JohnGrisham said:

Its easier to be more efficient with adults then kids. You cant do flyby quick consults with kids comparatively. The personalities of the type of people going into peds is often less congruent also. 

completely agree, but would you say this is why pediatric subspecialties earn less money? Less volume as opposed to billings are less?

One of my ped staff told me that "she gets paid less for the same thing she does compared to her internist friend" but I'm confused because I don't see billings differences

Also when you check, under Cardiology consult - do peds vs internist cardiologist use the SAME billing? like 150-200$ whatever it is.

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4 hours ago, daleader said:

completely agree, but would you say this is why pediatric subspecialties earn less money? Less volume as opposed to billings are less?

One of my ped staff told me that "she gets paid less for the same thing she does compared to her internist friend" but I'm confused because I don't see billings differences

Also when you check, under Cardiology consult - do peds vs internist cardiologist use the SAME billing? like 150-200$ whatever it is.

Grass is always greener. But more likely paid less because less ability for volume and more complex cases sometimes not always in peds. And parents etc.

 

Who knows.

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8 minutes ago, PhD2MD said:

It's the volume permitted by the specialty.
It's like adult neurology vs the rest of IM. The cases don't lend themselves to the same degree of "efficiency".

 

Thanks dude! So basically they are low billing because they aren't seeing as many patients not that they are getting paid LESS per patient necessarily right? I want to make sure that I am understanding it correct that is all. So for e.g. it says Cardio consult $150, if <16 y/o $170. Peds cardiologist is billing $170 but for whatever reason they are not seeing the same volume, hence the low over all billing?

 

This is very reassuring! :)

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1 hour ago, daleader said:

 

Thanks dude! So basically they are low billing because they aren't seeing as many patients not that they are getting paid LESS per patient necessarily right? I want to make sure that I am understanding it correct that is all. So for e.g. it says Cardio consult $150, if <16 y/o $170. Peds cardiologist is billing $170 but for whatever reason they are not seeing the same volume, hence the low over all billing?

 

This is very reassuring! :)

Yeah. I don't see why that's reassuring though haha?

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1 minute ago, PhD2MD said:

Yeah. I don't see why that's reassuring though haha?

Reassuring because you can increase your billings by being more efficient + attracting a higher volume. Better than seeing 50 pts like FM and still making less than FM. 

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1 hour ago, daleader said:

Reassuring because you can increase your billings by being more efficient + attracting a higher volume. Better than seeing 50 pts like FM and still making less than FM. 

It's really hard to see as many patients in pediatrics compared to internal medicine. The cases are more complex, especially for sub-specialty peds. With anxious parents around who have a million of questions, you have to take your time. You have to consider the legal aspects of pediatrics as well. 

With the advanced prenatal screen nowadays, most of the kids are generally healthy and managed by GPs. The complex cases are often triaged by general peds first and then referred to sub-specialty. In Ontario, the pediatricians make less money than family physicians, because they can't be in a capitation model as a GP in FHT. You are billing fee for service period. 

If money is important to you, pediatrics is not that high-yield in term of income. 

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In fee-for-service models it all comes down to volume. For example, Dermatology in BC has low consult fees but the sheer volume (50+ patients a day) gets them high income.

In Peds, even for something simple like eczema, unless you are willing to say "Here's the cream, it's eczema, see me again in 1 month", you'll end up answering 15 minutes of questions on homeopathic remedies and other Dr. Google stuff. But in general peds, most of the patients aren't as complex.

For ophtho, most people assume the high billings are just from the surgeries...but I'm sure it also has something to do with 80+ patient visits per day (your techs doing the eye exams).

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9 hours ago, daleader said:

Reassuring because you can increase your billings by being more efficient + attracting a higher volume. Better than seeing 50 pts like FM and still making less than FM.  ..

If you could, people would be doing it already lol. That's the point.

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10 hours ago, daleader said:

Reassuring because you can increase your billings by being more efficient + attracting a higher volume. Better than seeing 50 pts like FM and still making less than FM. 

 

You want to be the one pediatrician who spends half the time with their patients that everyone else does? They're not "less efficient" because all pediatricians just happen to love chatting at the water cooler, it's the nature of peds. If you're zooming in and out you're doing a lousy job. Parents need a lot of advice and reassurance and if you don't give it to them because you're trying to fit in more patients than every other pediatrician then you're not efficient, you're a bad doctor.

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2 hours ago, PhD2MD said:

If you could, people would be doing it already lol. That's the point.

 

1 hour ago, Hellothere77 said:

 

You want to be the one pediatrician who spends half the time with their patients that everyone else does? They're not "less efficient" because all pediatricians just happen to love chatting at the water cooler, it's the nature of peds. If you're zooming in and out you're doing a lousy job. Parents need a lot of advice and reassurance and if you don't give it to them because you're trying to fit in more patients than every other pediatrician then you're not efficient, you're a bad doctor.

true... you guys are making a very fair point here

what if I like money, not competitive for derm/plastics/ophtho, hate obgyn, scared of IM residency, and I enjoyed all my other rotations.. anesthesia??

 

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4 minutes ago, daleader said:

 

true... you guys are making a very fair point here

what if I like money, not competitive for derm/plastics/ophtho, hate obgyn, scared of IM residency, and I enjoyed all my other rotations.. anesthesia??

 

Radiology. Or engineering. Or better yet, combine radiology with engineering.

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47 minutes ago, daleader said:

 

true... you guys are making a very fair point here

what if I like money, not competitive for derm/plastics/ophtho, hate obgyn, scared of IM residency, and I enjoyed all my other rotations.. anesthesia??

 

I would recommend a field where you enjoy doing the bread and butter cases and can see yourself doing for decades. My colleagues who chose fields just to chase money seem to be the ones most dissatisfied. We do well in medicine but it is not a career that is sustainable if you just look at what makes you the most money. I think that's a quick path to disappointment.

Residency alone will be soul-crushing in many fields and staff life (while usually easier) is still a demanding job. Find something that motivates you to wake up every morning. I've seen too many doctors trapped in their jobs because they need to fund their lifestyle/debt when they really want to leave instead.

 

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2 minutes ago, blah1234 said:

I would recommend a field where you enjoy doing the bread and butter cases and can see yourself doing for decades. My colleagues who chose fields just to chase money seem to be the ones most dissatisfied. We do well in medicine but it is not a career that is sustainable if you just look at what makes you the most money. I think that's a quick path to disappointment.

Residency alone will be soul-crushing in many fields and staff life (while usually easier) is still a demanding job. Find something that motivates you to wake up every morning. I've seen too many doctors trapped in their jobs because they need to fund their lifestyle/debt when they really want to leave instead.

 

 

completely agree with this but then when I talk to my mentors, some of them say remember everything will become boring and mundane at one point and not earning enough money to pay for mortgage or kids loan etc. can also be stressful esp if ur working a high number of hours... to be honest with you I can totally see myself doing almost all the non-surgical specialties as I've enjoyed them all, now because of my family and situation, I prefer to choose something that is lifestyle friendly and well compensated. 

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2 hours ago, daleader said:

 

completely agree with this but then when I talk to my mentors, some of them say remember everything will become boring and mundane at one point and not earning enough money to pay for mortgage or kids loan etc. can also be stressful esp if ur working a high number of hours... to be honest with you I can totally see myself doing almost all the non-surgical specialties as I've enjoyed them all, now because of my family and situation, I prefer to choose something that is lifestyle friendly and well compensated. 

It really depends on what you consider to be well compensated and what kind of lifestyle you want to lead. No one in medicine is going to be struggling financially unless they live irresponsible lifestyles. If you really enjoyed Peds you should 100% do it. All my friends in Peds love their jobs and love going to work despite "billing" less than some other specialties. They still live very comfortable lives even if they're not cruising around in a Ferrari.

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3 hours ago, daleader said:

 

completely agree with this but then when I talk to my mentors, some of them say remember everything will become boring and mundane at one point and not earning enough money to pay for mortgage or kids loan etc. can also be stressful esp if ur working a high number of hours... to be honest with you I can totally see myself doing almost all the non-surgical specialties as I've enjoyed them all, now because of my family and situation, I prefer to choose something that is lifestyle friendly and well compensated. 

Then pick something that you like the JOB, not necessarily because you like the MEDICINE. Your job IS your lifestyle because it's likely what you'll spend a major part of your time doing.

 

I don't go into peds because I don't like to talk like I'm 5 years old, and then have to try convincing the parents my medical degree > their google search.

Do you like peds just because of kids? Because not all of them are healthy or curable.

Do you like talking to people to solve their problems quickly or spending 30+ minutes with them and NOT have a solution for their problem?

Do you like working in a hospital or working in a clinic?

Do you like procedures or do you try not to get your hands dirty?

 

Etc

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6 hours ago, daleader said:

 

completely agree with this but then when I talk to my mentors, some of them say remember everything will become boring and mundane at one point and not earning enough money to pay for mortgage or kids loan etc. can also be stressful esp if ur working a high number of hours... to be honest with you I can totally see myself doing almost all the non-surgical specialties as I've enjoyed them all, now because of my family and situation, I prefer to choose something that is lifestyle friendly and well compensated. 

I agree with blah1234. Perhaps some of the mentors you mention are not the best role models for making choices with respect to job satisfaction, and you should view their perspective as more of a precautionary tale. I find medicine such a challenging and ever-evolving field, in both human and technical aspects, that if one is actively engaged in its practice, I can't imagine it ever becoming boring. Stressful and leading to burnout? Sure. But not mundane - there's so much to tackle just to be able to provide an excellent quality of care. 

With regards to lifestyle friendly and well-compensated (by this I assume you mean when compared to other physicians, not compared to the general population), these ideas are not quite compatible in a fee-for-service environment. Compensation is not generally offered without an expectation of hard work in return. I will also say that although everyone's personal situation varies, if a staff physician is working full-time and struggling to pay their mortgage, I would suspect it's the mortgage and not their remuneration that is the primary problem. Live within (preferably below) your means.

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On 6/5/2019 at 9:05 AM, daleader said:

Hey all,

I had a quick question: I keep hearing that the pediatric subspecialties offer very poor compensation compared to their adult (IM subspecialties) counterparts, even less than general pediatrician.

My question is why and how do I find out more about the subspecialty income.

1. Is the volume less? A pediatric cardiologist doesn't have as many patients

2. Billing codes offer less money? This is what my main question is. I have been told that you get paid less doing the same procedure in a kid, but when I look at the billing codes, I can't find any differences, sometimes it's even more like LP in peds vs adults. Can someone please clarify this? I can't find like endocrinology peds vs endocrinology adult OHIP codes or whatever.

 

Thanks!

Its all about the volume. When you go to a peds hospital you'll see the difference. In adult hospitals u go in and out in 10 minutes and your staff probably didn't even see the patient. In a pediatric hospital, the staff pediatrician may try to cajole a kid into swallowing his meds for 30 minutes while the entire team of residents stands still like soldiers with a big grin on the outside while mentally dying inside. 

Theres a huge thing about peds patients with chronic care needs losing access to a lot of care and funding when they turn 18. Pediatric patients get a lot better staffing and resources than adult patients. 

Compare the staffing at Sick Kids vs the number of patient beds with any adult hospital. The staff to patient ratio is by far higher than what any adult hospital will have. 

 

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48 minutes ago, Edict said:

Its all about the volume. When you go to a peds hospital you'll see the difference. In adult hospitals u go in and out in 10 minutes and your staff probably didn't even see the patient. In a pediatric hospital, the staff pediatrician may try to cajole a kid into swallowing his meds for 30 minutes while the entire team of residents stands still like soldiers with a big grin on the outside while mentally dying inside. 

Theres a huge thing about peds patients with chronic care needs losing access to a lot of care and funding when they turn 18. Pediatric patients get a lot better staffing and resources than adult patients. 

Compare the staffing at Sick Kids vs the number of patient beds with any adult hospital. The staff to patient ratio is by far higher than what any adult hospital will have. 

 

Best depiction of my peds CTU rotation experience back then, endless hours of rounding that accomplished very little. 

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Peds appointments take FOREVER, even as a surgical specialist. Annoyed me to no end as a resident.

 

And the whole peds hospital itself was a giant box of unmedicated anxiety. Drove me God damned nuts. Every single staff in the place (MDs, nurses, allied health, janitors etc.) were always on the edge of a mental breakdown. Hospital should have just put SSRIs directly into the building's water supply.

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I'd rather spend time working off-service on peds ctu than on IM mtu.

Peds in my experience was manifold less malignant than IM and was actually pretty supportive and I would routinely finish ~ 3 pm unlike IM where you were out of there by ~6-6:30 pm on a regular day.

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