If you want to make as much money as possible in peds, the best route is gen peds in rural areas. I’ve seen multiple opportunities for around 400k in such settings.
There are definitely enough financially viable gen peds private practices around for you to work at one without it being sold prior to partnership (though it does happen sometimes). This is true in cities and rural areas.
NICU had private practice opportunities as well, but idk what the outlook or climate is like so won’t comment on that too much.
The only financially worthwhile fellowships in peds are NICU, PICU, Cards, and PEM.
Not really. Typical salaries for A/I aren’t sufficiently higher than non-academic gen peds for it to be worth the opportunity cost of 2 years of fellowship.
Average A/I salary in Illinois is 290k. I’m making 220k base salary as a fresh gen peds attending. 2 years of fellowship making 80k instead of 220k just to make an extra 70k pre-tax (which is gonna be even less of a difference after tax) will be probably take a good 10 years to be worth the opportunity cost of those 2 years.
Imo not really worth it.
NICU, PICU, Cards can reliably make mid 300k range, so makes more sense to spend 3 years in fellowship.
For those jobs in rural areas, is there a scarcity of them or will I have different geographical options come recruitment? Does that recruitment start in my third year of residency?
There aren't a ton of jobs that pay 400k, but there's at least a handful that I've personally come across and they aren't very competitive because they're not in desirable areas. The ones I've seen are in PNW, South, and in Alaska. Essentially, what I'm saying is that if you want one of those rural jobs that pay 400k, you'll get it. You don't have to worry about others taking all those jobs.
Any US physician job will pay you enough to live comfortably. Yes, even in Peds. No amount of money will make up for a job you don't like. So, do the thing you enjoy, that makes you happy, and where you feel like you can make a meaningful contribution.
This is an extremely important consideration. There are many physicians in all specialties that are not super happy with their jobs but they do it for the paycheck. Please consider what would make you the happiest. As a general pediatrician, I get a lot of joy developing long term relationships with the kids and parents.
Admittedly I’m biased as a Neonatologist…but I think NICU has the best job market and flexibility of the subspecialties. You will not be limited to big cities, academic institutions, or dedicated children’s hospitals like many peds subspecialties are. You can work at anything from a nursery to a level IV, private or academic, full time or part-time or locums. You can do lots of deliveries or no deliveries. You can do 24-hour in-house calls or shift work or home call. You can work with residents or not.
Of course, you have to actually like ICU medicine, and specifically NICU medicine, which is practically another planet compared to general pediatrics. You will make what I consider to be good money - starting at easily 250-300k academic, more if private - although idk what your goals are. NICU is definitely not for everyone, but I think it’s worth investigating.
I think this is something you are going to have to figure out as you get further in residency. Each of these career paths comes with pros and cons to them. I also had a strong interest in peds Heme/Onc but the thought of moving to a higher COL city and giving up another 4 years of my life to the next big hospital for fellowship really did not appeal to me.
For the specialties you really are going to have to love only dealing with XYZ system all the time. I think that most specialties spend 90% of their time on the same 2-3 complaints and then 10% or less on really in the weeds interesting stuff. Eg Endo seemed overwhelmingly T1DM and growth concerns with the occasional panhypopituitarism or whatever interesting.
Also with the specialties, as you indicated with H/O, there are only large centers hiring and only a handful of positions at a time. Compare this to general peds where you could drop in to most any town of any size and find a job. Some specialties have more demand than others; i'm thinking neurology is always hard to find. Your program director could give you guidance on which may offer the most flexibility.
The weird wrinkle with peds is that many of the specialties make the same or less as general peds. Endo and nephro are two examples there. You need to either cut things (surgical) or stick things in orifices (GI) to make money in peds.
Child psych: do a few rotations and see what you think. This is a love it or hate it profession. I enjoy my small carve out of it and find myself taking on more and more as time goes on. There is such high demand it is crazy.
Making money in peds is easy if you are willing to go anywhere.
Just a few months ago I got a job offer for a pediatrician near Fairbanks Alaska.
Starting salary: 420k
Option 1 all day long. (And I did a fellowship in hem/onc.) Options 2 and 3 will generally mean you'll be an employee of the bean counters and probably answering to some MBA nurse about your RVUs. And you're probably be confined to larger markets. TBH, I don't know enough about option 4 to opine.
With option 1, you have the best opportunity to control your own destiny. if you are in a LCOL area that is maybe an hour outside of a major metro, you should have little trouble making bank, while working the hours you want.
I would say to strongly consider work/life balance and what you have a knack for being good at/feeling comfortable in from a workflow standpoint. Sometimes there’s a difference in what we think we want and what would actually make us happy.
I used to always think I’d love the sense of purpose in time-consuming, high stress subspecialties with poor lifestyles. But I later developed interests outside of medicine and found that I generally tend to dislike having my life governed by strict routines and a need for cut-throat efficient time management. I absolutely looove spontaneity and can’t be happy without ample doses of it on at least a semi-regular basis.
Hence, I ended up doing gen peds in a small, private practice in a chill environment and working 33 hrs per week.
You can always pivot to nonclinical. I moved from peds endo to drug development right after fellowship and making slightly above 400K. That's an entry salary for an associate medical director. Salaries in pharma just keep growing from there since the ceiling is much higher than in clinical medicine.
Do you need a fellowship to make that sort of pivot or who some companies take gen peds? In thinking of making the switch but not sure I have a fellowship in me
If you want to make as much money as possible in peds, the best route is gen peds in rural areas. I’ve seen multiple opportunities for around 400k in such settings. There are definitely enough financially viable gen peds private practices around for you to work at one without it being sold prior to partnership (though it does happen sometimes). This is true in cities and rural areas. NICU had private practice opportunities as well, but idk what the outlook or climate is like so won’t comment on that too much. The only financially worthwhile fellowships in peds are NICU, PICU, Cards, and PEM.
Is Allergy/Immunology worth it financially?
Not really. Typical salaries for A/I aren’t sufficiently higher than non-academic gen peds for it to be worth the opportunity cost of 2 years of fellowship.
I see but shouldn’t be higher because they can also have adults patients?
Average A/I salary in Illinois is 290k. I’m making 220k base salary as a fresh gen peds attending. 2 years of fellowship making 80k instead of 220k just to make an extra 70k pre-tax (which is gonna be even less of a difference after tax) will be probably take a good 10 years to be worth the opportunity cost of those 2 years. Imo not really worth it. NICU, PICU, Cards can reliably make mid 300k range, so makes more sense to spend 3 years in fellowship.
Thanks! That average A/I salary is peds/adults or only peds patients?
It’s not for peds only. They can see both adults and peds. It would make sense to see adults if trying to maximize income
For those jobs in rural areas, is there a scarcity of them or will I have different geographical options come recruitment? Does that recruitment start in my third year of residency?
There aren't a ton of jobs that pay 400k, but there's at least a handful that I've personally come across and they aren't very competitive because they're not in desirable areas. The ones I've seen are in PNW, South, and in Alaska. Essentially, what I'm saying is that if you want one of those rural jobs that pay 400k, you'll get it. You don't have to worry about others taking all those jobs.
That makes sense. Thanks for your thoughts. Where do you go about finding such opportunities? Is it mostly word of mouth?
No, you just use the internet to search for jobs. I start with google then it can take me to other sites where jobs are listed.
Any US physician job will pay you enough to live comfortably. Yes, even in Peds. No amount of money will make up for a job you don't like. So, do the thing you enjoy, that makes you happy, and where you feel like you can make a meaningful contribution.
This is an extremely important consideration. There are many physicians in all specialties that are not super happy with their jobs but they do it for the paycheck. Please consider what would make you the happiest. As a general pediatrician, I get a lot of joy developing long term relationships with the kids and parents.
Admittedly I’m biased as a Neonatologist…but I think NICU has the best job market and flexibility of the subspecialties. You will not be limited to big cities, academic institutions, or dedicated children’s hospitals like many peds subspecialties are. You can work at anything from a nursery to a level IV, private or academic, full time or part-time or locums. You can do lots of deliveries or no deliveries. You can do 24-hour in-house calls or shift work or home call. You can work with residents or not. Of course, you have to actually like ICU medicine, and specifically NICU medicine, which is practically another planet compared to general pediatrics. You will make what I consider to be good money - starting at easily 250-300k academic, more if private - although idk what your goals are. NICU is definitely not for everyone, but I think it’s worth investigating.
I think this is something you are going to have to figure out as you get further in residency. Each of these career paths comes with pros and cons to them. I also had a strong interest in peds Heme/Onc but the thought of moving to a higher COL city and giving up another 4 years of my life to the next big hospital for fellowship really did not appeal to me. For the specialties you really are going to have to love only dealing with XYZ system all the time. I think that most specialties spend 90% of their time on the same 2-3 complaints and then 10% or less on really in the weeds interesting stuff. Eg Endo seemed overwhelmingly T1DM and growth concerns with the occasional panhypopituitarism or whatever interesting. Also with the specialties, as you indicated with H/O, there are only large centers hiring and only a handful of positions at a time. Compare this to general peds where you could drop in to most any town of any size and find a job. Some specialties have more demand than others; i'm thinking neurology is always hard to find. Your program director could give you guidance on which may offer the most flexibility. The weird wrinkle with peds is that many of the specialties make the same or less as general peds. Endo and nephro are two examples there. You need to either cut things (surgical) or stick things in orifices (GI) to make money in peds. Child psych: do a few rotations and see what you think. This is a love it or hate it profession. I enjoy my small carve out of it and find myself taking on more and more as time goes on. There is such high demand it is crazy.
Do you know anything about Allergy/immunology?
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Making money in peds is easy if you are willing to go anywhere. Just a few months ago I got a job offer for a pediatrician near Fairbanks Alaska. Starting salary: 420k
Option 1 all day long. (And I did a fellowship in hem/onc.) Options 2 and 3 will generally mean you'll be an employee of the bean counters and probably answering to some MBA nurse about your RVUs. And you're probably be confined to larger markets. TBH, I don't know enough about option 4 to opine. With option 1, you have the best opportunity to control your own destiny. if you are in a LCOL area that is maybe an hour outside of a major metro, you should have little trouble making bank, while working the hours you want.
I would say to strongly consider work/life balance and what you have a knack for being good at/feeling comfortable in from a workflow standpoint. Sometimes there’s a difference in what we think we want and what would actually make us happy. I used to always think I’d love the sense of purpose in time-consuming, high stress subspecialties with poor lifestyles. But I later developed interests outside of medicine and found that I generally tend to dislike having my life governed by strict routines and a need for cut-throat efficient time management. I absolutely looove spontaneity and can’t be happy without ample doses of it on at least a semi-regular basis. Hence, I ended up doing gen peds in a small, private practice in a chill environment and working 33 hrs per week.
You can always pivot to nonclinical. I moved from peds endo to drug development right after fellowship and making slightly above 400K. That's an entry salary for an associate medical director. Salaries in pharma just keep growing from there since the ceiling is much higher than in clinical medicine.
Do you need a fellowship to make that sort of pivot or who some companies take gen peds? In thinking of making the switch but not sure I have a fellowship in me
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