A Pediatric Emergency Medicine Physician’s Story

Session 112

Pediatric Emergency Medicine is a chance to treat diverse populations in a fast-paced setting. Dr. Donna Mendez tells us why she finds peds ER so gratifying.

Listen to all our other podcasts on the Meded Media including The Premed Years, The MCAT Podcast, The MCAT CARS Podcast, and The OldPreMeds Podcast.

If you’re interested in pediatrics or emergency medicine, check out this interview. Also, check out next week’s interview as I interview another physician as a pediatric emergency medicine physician. But he did a combined pediatrics and emergency medicine residency.

[01:41] Interest in Pediatric Emergency Medicine

Initially wanting to be a neurologist, she did Internal Medicine residency for a year. Then went for her second choice which was Pediatrics and did her residency for three years. While in residency, she did an elective in Emergency Medicine. She felt overworked and overtired and decided to do Pediatrics.

In retrospect, she could have done adult emergency medicine but ultimately, she’s happy she did Pediatrics. She believes that adults bring those different illnesses upon themselves.

In pediatrics, the patients are usually not manipulative as much as adults. They’re very fresh and happy. It’s very challenging and it can get disheartening when something goes wrong with the child.

'There's more of a chance to change the child's healthcare in the future; whereas, in adults, it's really hard to make behavioral change.'Click To Tweet

[05:15] Shift Work and Restrictions in the Emergency Room

It wasn’t until she was actually practicing Emergency Medicine that she realized she liked instant gratification. You don’t get this in Neurology because for all the chronic debilitating diseases, there’s not a quick fix.

Another thing that really drew her to Emergency Medicine was the lifestyle. A lot of people are attracted to Emergency Medicine because of shift work. In PICU, you could be on call for 48 hours. You’re not necessarily on a shift schedule because you’re on call for a long period of time.

The scenario is totally different when you’re an attending physician compared to when you’re a medical student or a resident. Many students complain about work hour restrictions or the lack of them, depending on how you look at it.

'Once you become an attending, there are no regulations. You can work as much and as long as they'll let you work.'Click To Tweet

[07:00] Traits that Lead to Becoming a Good Pediatric Emergency Medicine Physician

Multitasking is important. You have to remain calm. You also have to be a team player because you’re dealing with nurses, respiratory therapists, and other people that are not physicians. Donna says that people with ADHD love this kind of profession.

'You have to enjoy being under stress to do this kind of job.'Click To Tweet

About 75% of emergency departments now have trained Pediatric Emergency Medicine physicians. They have community physicians that are general pediatricians but are still not able to do the critically ill patients. In this case, the adult emergency medicine physician will take over. Hopefully, the percentage will rise to 95% once more programs are opened.

[09:30] Why Pediatric Emergency Medicine Is Important

They’ve done a survey looking at Emergency Medicine physicians and they don’t feel like they actually give adequate care for pediatrics because they’re not specialized. This alone says something about why Pediatric Emergency Medicine physicians are needed.

Donna did Emergency Medicine and she thinks a lot of their Emergency Medicine residents feel like they need to spend more time in Pediatrics because they didn’t do Pediatric residency.

[11:30] Types of Patients

A lot of the patients come in with upper respiratory infection, bronchiolitis, and asthma. Since she works at an academic institution, they have cases like cardiac kids with hypoplastic hearts and nephrology patients for dialysis. They also deal with rheumatology.

Working in the community, they handle bread and butter cases that are the same as Emergency Medicine minus heart attacks or strokes. So they deal with stuff like diarrhea, dehydration, fever, sepsis, and respiratory cases. They don’t usually have multiple medical problems in the community.

'You will see multiple medical problems when they come to the academic institutions because the parents already know that all the subspecialties are there to round on them.'Click To Tweet

Whereas at the academic institutions, they usually handle multiple medical conditions. They could see patients with congenital heart issues and seizures like a little adult.

[13:10] Academics vs. Community Setting

Donna chose academics primarily because she loves education and research, which are things you can’t do in the community.

In adult emergency medicine, the pay scale is a lot different if you do academics vs. community as it’s a lot higher in the community. In pediatric emergency medicine, the pay is basically the same. So you don’t lose out on any of that.

And even if it wasn’t a big discrepancy, Donna would still have chosen the academics because she gets really excited about teaching. She finds it gratifying to be interacting with residents and fellows and doing research, of which she did more of clinical educational research.

[14:10] Typical Day and Week

Donna goes to the ER 3 times a week. Their shifts vary and they changed with the 8-hour shifts. She likes the 12-hour or the 10-hour shifts because she doesn’t have to go to the ER as often. She does other things like fellowship schedules, talks, and presentations.

'There's less burnout if you do a variety of research and education rather than just go to work everyday on a shift in the ER.'Click To Tweet

Their schedule consists of 1/3 mornings, 1/3 mids, and 1/3 nights. So they have all these different types of shifts in one week. You may go from morning to the next day and then the night the next day. Then have a data turnaround and go back to the morning.

Some places do it so that if you have enough faculty, you can do all nights for one month and they do all days and mids. At their institution, they only have 12 in the faculty so it’s hard to make a schedule like that. But she gets to have all her nights together, like 3-4 nights in a row.

As an Emergency Medicine physician, their calls are non-existent although they’re on backup. This would be in cases such as when somebody gets sick or when necessary such as when there’s a mass shooting. But they’re not basically “on-call” so they won’t be called in.

[17:00] Work-Life Balance

Donna thinks she has a life outside of the hospital. She tells people that her hobby is her children. She also exercises once or twice a week and reads. They also make one big trip every two years.

[18:00] The Training Path

There are two routes you can take, either through Emergency Medicine or Pediatrics.

For Emergency Medicine, they do a residency. Some of those take four years while others take three years. For fellowship, they spend two extra years. But in some programs, they do three extra years even if you did Emergency Medicine.

For Pediatrics, you do three years of Pediatric residency. Then you’re required by the American Academy of Pediatrics to do three years of fellowship.

This has gone down to the Emergency Medicine residents that apply. Most of them are pediatric residents.

She thinks the reason for this is that in Emergency Medicine, your salary can be pretty good after getting out of residency. So they really don’t want to do more training because they want to pay off their loans.

Whereas in Pediatrics, the people that really like excitement in the ICU, there’s a lot more of them they’re willing to spend three extra years. But the pay is not as good for general pediatrics.

'The decision of specialty which shouldn't be based on pay, oftentimes is, just because of the debt load nowadays.'Click To Tweet

Donna adds, however, that the residents are now more mature about how they’re going to pay back their loans. It sounds like potentially they have people who are self-selecting into high-intensity specialties right away.

For those that don’t like to do procedures, Donna doesn’t think Emergency Medicine is a good path for them. This is also not the specialty for those people who can get really scared with stress. Ultrasound has become so prevalent now so you would want to do procedures.

[21:35] How to Be a Competetive Applicant for Residency

If their medical school is not associated with an Emergency Medicine department, they can rotate to an Emergency Room. You need letters of recommendation so it’s better to get letters (or at least one) from a Pediatric Emergency Medicine doctor than just a pediatric attending.

'Do your away rotations, if possible, even if you do have a Pediatric Emergency Medicine Department in your hospital.'Click To Tweet

Doing away rotations even if you have a pediatric emergency medicine department improves your chances because you get to get a letter of recommendation from them. Also, you get exposed and you get to show that you’re a good worker.

Research is a big part of your application. Donna recommends doing at least one case. It doesn’t have to be Emergency Medicine. Just look for any scholarly activity. Grants aren’t expected but it always looks great if you get a grant.

[23:55] Overcoming Bias Against DOs

Donna has been in programs where there wasn’t any negative bias towards them. That said, she still recommends that they get a lot of research or that you’ve given lectures.

Just make sure there are some scholarly activities disseminated on your resume. For fellowship, it’s moreso scholarly activity. It also helps if you’re a member or an officer in some of these academic committees,

[25:05] What She Wished Pediatricians Knew About Pediatric Emergency Medicine

Pediatricians don’t have a lab or Xrays in their clinics so they often send their patients to them for the services. It’s like people are using ERs as their clinic and people just want to get things done quickly. They don’t have as much patience so they come to the ER because

'People don't have as much patience so they come to the ER because they wouldn't wait to see their doctor in the morning.'Click To Tweet

Urgent Care is so popular now too so the co-pay is so much less. For pediatricians, most of them know that Pediatric Emergency Medicine can do all the services. But a lot of them know that they have a nephrologist, a cardiologist, and dental. So they call them all the tie just asking for their opinion or whether they have these certain services.

[26:55] Special Opportunities Outside of Clinical Medicine

You can do a purely academic role or you can work as a pediatrician in Urgent Care or as a general pediatrician. For Emergency Medicine, it’s harder because a lot of them try to go to Physical Medicine or Ultrasound, or something where it won’t be so stressful on their body.

[28:11] The Most and Least Liked Things

What Donna likes the most about being a Pediatric Emergency Medicine physician is the action. She still likes doing CPR and enjoys doing procedures. She also does most of her teaching on those subjects. She does a lot of simulation in the simulation center for procedures.

On the flip side, what she likes the least is when rescusications go bad and she’d have to tell the family that their loved one has died. You’re going to have to be used to spending time with the family.

'It's really hard. There's a lot of drama behind every illness in the emergency room.'Click To Tweet

[30:00] Major Future Changes in Pediatric Emergency Medicine

Donna thinks we have to be more cost-effective because of the cost of Emergency Medicine care.

Luckily, she was taught by a residency program director who is a Canadian and he wouldn’t let them order anything until they asked him and justified it with literature. So she also teaches her students not to order a bunch of labs and really decide what they need to order.

'That's what's killing us nowadays with the cost of health care just ordering too many things.'Click To Tweet

However, ordering a ton of stuff would mean revenue for the hospital so there can be a potential pushback on this from the side of the hospital. Donna believes that we have to practice good medicine because it’s hard on the patient.

[31:37] Final Words of Wisdom

If she had to do it all over again, she would still have chosen the same specialty.

Finally, what she wishes to tell everyone who might be interested in Pediatric Emergency Medicine is that it’s a great life. It’s very gratifying. It’s a diverse population. You will never get bored.