Category Archive: Pediatrics

Best Books and Resources for the Pediatrics Rotation

 

This post is part of our series on the best books and resources to help you perform well on your third year rotations and shelf exams. Also check out our lists for clerkships in Internal MedicineFamily MedicineOB/GYNGeneral SurgeryNeurologyPsychiatryPediatrics, and Emergency Medicine. You can also check out our complete list of "Best Books" lists for medical students here

Background: Clerkship Grades

At the beginning of each of these clerkship lists there are a few things I must say. First, your grade on clinical rotations will depend on both your clinical performance and your performance on a shelf exam at the end of the rotation. While it is true that how you work with your teams and patients will play into your evaluation, there is no denying that your knowledge of the subject matter is, by far, the most important part of your final grade because it directly affects both of these two areas of evaluation. As a resident, I currently find myself filling out medical student evaluations every week. There are very few 'incredible' medical students and very few 'terrible' medical students. The vast majority of you (~95%) fit into the "good and easy to work with" group; the only thing you have to set you apart from others is your knowledge base. You have no alternative but to study! First Aid for the Wards is a great resource to understand the dynamics of your clinical rotations, I highly recommend it.

Essential Resources

The resources I will describe in the clerkship lists are books and online question banks. From the onset let me point out two indespesible resources that I will not list for each rotation individually.

  • First, I consider a great online question bank essential. Both Kaplan and USMLE World are very good products. I highly recommend purchasing a one year subscription to one of these USMLE Step 2 question banks. As you complete your third year rotations, these question banks will prepare you for 1- your clinical duties, 2- your rotation shelf exam, and 3- the USMLE Step 2 during your fourth year.  
  • Second, online review materials (e.g. Medscape, UpToDate, etc.) are essential resources to prepare for your patients in the hospital. The books and question banks can never provide the type of in-depth detail about disease processes that you will need to learn how to properly take care of your specific patients. To be a great medical student, you must prepare more profoundly for the diseases you are encountering personally in the hospital.

Book Series for Third Year

Medical students are not all made the same; we are all very different learners. There are a number of companies producing review materials for third year medical students, each with a slightly different focus. Each of these companies produce a different book for each clerkship. Interestingly, some companies' books are rated higher in some clerkships than others. If you find a product that works for you, consider sticking with it during your third year even if that product is not 'rated' as highly for a specific clerkship. Below are a few of the review products and their features.

  1. The Case Files Series: A unique teaching model; the Case Files series introduces a number of important clinical cases and follows them up with clinical pearls and important concepts. For students who need vivid clinical situations to remember factoids and concepts, this is a great series. (Case Files Pediatrics)
  2. The PreTest Series: The PreTest series is a classic question bank format with questions and detailed explanations. As I previously mentioned, I believe there is no substitute for a great question bank. While an online resource (USMLE World or Kaplan) can be more robust and mobile, a good question book is still a great option. The PreTest series produces a couple fantastic question banks. (PreTest Pediatrics).
  3. The BluePrints Series: The BluePrints series has a beautiful format that is very easy to read. The text is laid out in a bulleted lists, but with more details and descriptions than the First Aid series with which most students are familiar. I think very highly of these review books. (Blueprints Pediatrics).
  4. First Aid Clerkship Series: The First Aid series well known to most students also produces review books for third year clerkships. The content is similar to what students are used to, bulleted lists of high yield information. While I highly recommend many of the First Aid review books for USMLE Step preparation, the books are not quite as widely read and recommended for clerkships. (First Aid for the Pediatrics Clerkship).

Best Books for Pediatrics Rotation

So, we can agree that books are not sufficient for success on your clerkships, but they are still an incredible resource that you should tap into. Let's review the best books and resources for your Pediatrics rotation. These lists come from both my experience and also from one medical school's annual survey of its 250 graduating medical students who try to detail which resources were the most useful on their rotations.

Studying for the pediatrics rotation is not nearly as daunting as other rotations because the material is better partitioned than the more broad rotations. You will have to know both inpatient and outpatient peds very well, but do not spend all your time memorizing milestones, vaccine schedules, and inpatient conversions. There are quite a large number of highly rated books for this rotation, so choose one that fits your learning style. 

 

1. PreTest Pediatrics:

Probably the best in the PreTest series, the PreTest Pediatrics book is well rated by every metric. I remember 3-4 questions on my shelf that were near duplicates of PreTest questions; this is high yeild material. It is not, however, sufficient for your shelf. You must find a more complete text to study from as well.


 

2. Blueprints Pediatrics:

This is a very complete text and highlights well both the inpatient and outpatient concepts in pediatric medicine. If you have time to get through and remember the information in this text it will lead to a good score on the shelf.

3. Case Files Pediatrics:

A well written book that is highly regarded by students. There is nothing special about this particular volume of the Case Files Series, but if you like the series this is a good bet.


 

4. BRS Pediatrics:

This is an interesting addition to our Best Books list. Students in my medical school and on annual book surveys rave about this book. It is a bit outdated (last edition printed in 2004) so I did not read it, but even though it is older, students still swear by it.


 

Physician Satisfaction by Specialty

The most recent installment of the Medscape Physician Compensation Report was recently published. Along with some of the best information on the web about physician salaries by specialty, the new Medscape report also reports which specialties are the most satisfied with their jobs (click here to view the entire Medscape Report). The results may surprise you. There is no correlation with salary and satisfaction.  The highest paid specialties (orthopedics and anesthesia for example) are found in the middle of the list while pediatrics, ID/HIV, and pathology are all found at the top of the list.  Interestingly, plastic surgery is–by far–the least satisfying specialty. So, the most competitive specialty is by far the least satisfying…that’s odd!

 

From the 2012 Medscape Compensation Report

 

My conclusions from the Physician Satisfaction Survey:

  1. The age old adage is correct: Money does NOT buy happiness.
  2. Just because a specialty is desirable to match into does not mean it is desirable to practice in [plastics].
  3. I can find only one thing that links the most satisfying specialties: LIFESTYLE.  If you look at dermatology, psychiatry, emergency medicine, infectious disease, pathology, and ophthalmology they have a great lifestyle in common. They all have minimal call, good salary (but they are not the big earners), and few emergencies.  They all lend themselves well to family, recreation, and other hobbies outside of medicine.

 

My unsolicited advice:

  • I am sure there are my internists and plastic surgeons who are very satisfied with their jobs. I would bet that they knew exactly what there were getting into before they choose their specialty. Satisfaction in the workplace has lots to do with managing your expectations (and the expectations of your family and friends!)  If you really love some of the specialties that do not have the best lifestyle, that is great, just make sure you know that this will be an issue before you go into he specialty. Once you have made that decision, you will not be shocked (and neither will your family/friends) when you work a lot more than those around you.

Allied Health Salaries

The new Medscape Physician Compensation Report identified internal medicine, family medicine, and pediatrics as the lowest earners in medicine (each with an average of less than $165,000 per year).  I wanted to compare these results to the updated information from the Cejka Search group who publish data on the salaries of allied health professionals. The Cejka Database is the best place I have found for reliable information about the salaries of allied health practitioners. The list of allied health workers is long and includes:

  • Nurse Practitioners (NP)
  • Certified Nurse Aneasthatists (CRNA)
  • Physicians Assistant (PA)
  • Podiatrist (DPM)
  • Occupational Therapist (OT)
  • Physical Therapist (PT)
  • Optomotrist (OD)
  • Psychologist (PhD)
  • Dentist (DMD or DDS)
  • Midwife

Cejka reports the following salary information for these allied health professionals.  As you can see, CRNAs and Dentists earn more money than our country’s primary care physicians (pediatricians, family physicians, general internists).  This is just the yearly salary information, not taking into account the number of hours worked. Very few allied health professionals work the average hours per week worked by primary care physicians in the US (60 hours is a very conservative estimate for our PCPs). This means the dollars per hour is vastly different between some allied health practitioners and our primary care doctors. How do you feel about this?

From Cejka Search

The Most Recruited Medical Specialties

Now that I am in the first year of residency I am beginning to think about landing that first real job.  As a Transitional Year resident I am heavily involved with the Internal Medicine residents at my hospital.  I found out very quickly that these internal medicine residents are HIGHLY sought after. In fact, many of them receive job offers on a weekly, or even daily basis.  The jobs that are in highest demand for internists are outpatient primary care and inpatient hospitality.  Many of my senior residents are being offered salaries between $200,000 and $300,000 along with many benefits including loan repayment. There are even some offers higher than $300,000 for less desirable locations! This is in a stark contrast to the ophthalmology job market that I will face, where starting salaries are low and it is terribly difficult to get your foot in the door.

Recently, I came across the Merritt Hawkins database.  Merritt Hawkins obtains information about starting salaries and benefits for newly graduated residents. I speak about their great physician salary database in my Ultimate Guide to Physician Salaries. However, their database also contains a list of the 20 most recruited specialties in medicine. The list may shock you!  The ability to find a well paying job right out of residency is NOT AT ALL correlated with the competitiveness of the specialty.  Case in point: family physicians and general internists are the two most highly recruited specialists in medicine!

From Merritt Hawkins

 

This list represents the Top 20 most ‘requested physician searches by medical specialty.’ The numbers represent the number of times Merritt Hawkins was used to recruit a person from the respective specialties (Merritt Hawkins full PDF including physician compensation data is available here for free). So, when you are deciding on a specialty, don’t forget that competitive does not equal good job placement.  In fact, many of the least competitive specialties are very high on this list (pediatrics, psychiatry, family medicine)

Which doctors get sued the most?

Have you ever wondered which physician specialties deal with the most malpractice lawsuits? While I was in medical school I often heard physicians discuss the rising costs of malpractice insurance and the lack of tort reform.  I knew that OB/GYN doctors had to deal with a lot of lawsuits, but I had no knowledge of which other specialties faced frequent lawsuits.  The New England Journal of Medicine recently published a great paper identifying which medical specialties are sued the most frequently.  The paper can be freely accessed by anyone (click here to see the full article).

The most interesting results can be summarized by the graph below, which demonstrates the percentage of physicians sued in a calendar year, separated by specialty. As you can see, neurosurgeons and cardio-thoracic surgeons lead the list with nearly 20% of all physicians in these specialties sued each year.  Wow, that seems excessive!  On the other side of the graph, only about 3% of psychiatry and pediatric physicians deal with lawsuits each year.

Taken from NEJM, click the link below to see the full article

See the full article here

The article also presents data that demonstrate the cumulative probability of being sued during your career.  They find that by the time physicians in ‘high risk’ malpractice fields, such as general surgery and neurosurgery, reach 55 years of age nearly every singly physician has been sued at least once (95-99%).

Malpractice lawsuits are an important topic, especially when choosing a medical specialty during medical school.  Students need to know what problems the every-day doctors face so that we can make informed decisions.  If someone went into neurosurgery without knowing that nearly 100% of all neurosurgeons will be sued by the age of 55, this might result in a very unhappy professional life.  On the other hand, if you love neurosurgery and you are informed about this problem, you will be able to weigh all the pros and the cons of the specialty before making your decision.  When you know what you are getting into, you always have a higher chance of success.