r/pediatrics

Hey everyone! I'm very excited to continue with my career and eventually finish residency to pursue a very specific fellowship, but I had a rough first few days of residency. That sounds stupidly obvious given residency is a very rough experience all the way through for EVERYONE and that struggling is part of that experience, but I am really feeling a little unstable. I have autism and although I am what people would consider high-functioning (despite struggling mightily through undergrad and med school with how much harder I had to work to mask and perform at the same level as my peers), I am still finding it a little harder than usual to mask and hold back my symptoms at work. I was lucky enough to start in ambulatory clinic (even though that's not where I enjoy working) where the stakes are a tiny bit lower, but even that brought out some of the symptoms I've fought so hard to suppress. By mid-day, I was rocking and having trouble finding words with my upper-levels. I do much better with my patients and love being in the room with them, but going back to the resident workroom is such a nightmare because I know that mask is going to instantly slip and I'll start struggling with making eye contact, getting across what I want to say, and overcoming the embarrassment that I feel in front of every upper-level. I will get better with this with time and I would never consider quitting this profession, but I wanted to know if anyone else in this subreddit struggles with autism or ADHD or another neurodivergence that makes it difficult to do our job.

My goal is to become a neonatologist. I’m wondering how important it is for fellowship to do residency at a level 4 NICU compared to level 3, and similarly if I should focus my signals on level 4 NICUs? It may be worth noting that I will likely have neonatology related publications before starting residency (I am currently doing a research year in neonatology with a department chair).

Similarly, I’m wondering if PDs give priority to residents that trained at level 4 NICUs? For fellowship, I would want to train at a level 4 NICU.

*sigh*

USMLE exams are hard. All exams are hard. I was hoping for a better step 2 score. I will be a US MD applying this cycle with a step 1 fail, 2nd time pass, and now a step 2 of 225. I passed all preclinical work and shelf exams. I have glowing letters of recommendation and many amazing peds experiences, including medical missions. My entire application is well-positioned - except the USMLE scores.

I’m not aiming for major academic programs, would prefer a smaller program at a community hospital, but I’m terrified now that I won’t match because of my testing ability. I can pass, I know I can. Step 1 had a few extenuating circumstances, but I never perform amazingly well on exams.

Can I still match?

After seeing that there are new recommendations to have a SLOE in lieu of traditional letters for PDs and peds cardiologists/cards intensivists, I figured I'd just make this now since I was updating my own spreadsheet. Good luck!

https://docs.google.com/spreadsheets/d/11KszSqCsaNh6XbUfaQLzfPt6Mbz3vItwl4fgy77Dqas/edit?gid=0#gid=0

Just started my residency in pediatrics and I am honestly very worried about how to retain information. I used to study in med school with anki, before using anki I was very bad with retrieving information. I had a clinical gap of 1 year before starting this residency and I feel so behind and I forgot a lot. Now I dont know how to learn and how to improve my clinical knowledge and skills.

Help pls, should I continue anki?

New ASPHO Statement released today on delaying start of 2 year fellowship model. This will only drive applicants to other subspecialties and further decrease the peds hem/onc workforce.

There have been a number of recent articles outlining the shortage coming:
https://aspho.org/uploads/Final_Publication_2023__ASPHO_workforce_productivity_and_fellowship_assessment.pdf

https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.30830

“Pediatric hematology/oncology has long relied on the integration of rigorous clinical training, scholarship, and meaningful exposure to research to advance care and improve outcomes for children with cancer and blood disorders. As the American Board of Pediatrics (ABP) moves toward a competency-based medical education (CBME) model—with potential options for both a two-year clinically oriented pathway and a three-year scholarship-oriented pathway—the field is aligned on the need to evolve. The question is how to do so responsibly.

Following deliberate engagement with pediatric hematology/oncology (PHO) fellowship program directors, division leaders, and the broader community, the American Society of Pediatric Hematology/Oncology (ASPHO) Board of Trustees recommends that all PHO fellowship programs *delay implementation of a two-year clinically-oriented pathway and maintain the current three-year scholarship-oriented model until sufficient data are available to assess impact, no earlier than 2030.*

The community recognizes the intent behind CBME and acknowledges that a clinically focused pathway may offer value if implemented thoughtfully. However, key infrastructure needed to implement this model is not yet in place. Entrustable Professional Activities (EPAs), which are foundational to assessing readiness for independent practice, have not yet been finalized for pediatric subspecialties, nor have they been broadly integrated into fellowship programs; additional time is needed to finalize, implement, and evaluate their use consistently across training environments. Without a reliable, consistent framework for evaluating competence, it is difficult to make high-stakes decisions related to board eligibility and unsupervised care. Key operational aspects—such as alignment with undecided ACGME requirements, clarity in recruitment and Match processes, and expectations for scholarly activity, also remain undefined.

Feedback from the training community reinforces this concern. In ASPHO’s Training Model Transition Survey, 77% of fellowship programs indicated that a transition by 2028 is too early, and only 16% reported being mostly or fully prepared to implement EPA-based assessment infrastructure. Forty percent (40%) of programs see value in a shorter, clinically focused pathway, and 60% expressed concern about whether a two-year model would adequately prepare trainees for the academic and research-oriented careers that remain central to the mission of the field.

From the perspective of ASPHO leadership, these gaps are not simply operational, they have direct implications for patient safety. Determining readiness for independent practice is a high-stakes decision, and any transition must ensure that graduates are consistently and appropriately prepared to deliver care without supervision.

Maintaining the three-year pathway during this transition period allows time to build infrastructure, collect baseline data, and evaluate outcomes. This approach positions the field to move forward deliberately, ensuring that changes strengthen training while preserving the standards of scholarship that define pediatric hematology/oncology.

Looking ahead, ASPHO will continue to engage the community, foster meaningful conversations and action, and help develop resources that support the subspecialty, future subspecialists, fellowship programs, and program and institutional leaders. Through these efforts, ASPHO aims to help ensure optimal training experiences and strengthen the future of pediatric hematology/oncology.”

Considering that this is the last fellowship match where all programs will be 3-years, should we be expecting less applicants this year overall? Are there some candidates who will wait a year to apply to 2-year programs?

My institution is starting a new peds fellowship this year so only one cohort of fellows will be on the 3-year tract. Is this a big disincentive to apply?

Has anyone quit full-time w2 work to do locums only? This job is slowly killing me, and I’m looking for a way out. I figure being willing to do hospital/call in less-than-desirable locales will minimize the total amount of work I need to do each year.

I’ve zeroed out my debt, have no dependents, and will sell everything. I have a little 4-season trailer towable by my suv, and several places to park it around the country. But am also considering a couple of towns in Mexico. I want to work just enough to pay for basic expenses and the freedom to be outside, read library books, and breathe.

My biggest questions remaining:

-healthcare: Did you manage with a marketplace plan despite moving around? I imagine that I’ll need to pick a domicile state (don’t know the proper term) and try to get most care there. I’ll need it until I’m eligible for Medicare in another 15 years. The private option in Mexico available to temporary residents also looks pretty reasonable.

-taxes: Did you handle 1099 income your own? Sending the IRS a check every month and hoping it all balances out at the end of the year.

I’d also just love to hear about personal experiences and resources you might like to share. DMs open!

Hi, just wondering if anyone has any idea for a sided gig for a general pediatrician? Clinical or non-clinical related. Can be “fun.” I work 4 days a week and am off most weekends, hoping for something that the work hours could be flexible. I enjoy meeting and talking with people. Hoping to make $100-200 dollars per week. Appreciate any ideas!

MCOL. No call, no nights, no weekends. Clinic is closed a full hour for lunch. 18-20 patients on average. 3 days per week.

Benefits are 3.5% 401k match, approx 8 paid holidays, and 12 days PTO (4 weeks).

What is a fair pay range for NP or PA in this role?

do you all recommend PBR course or medstudy videos + flashcards? i have the medstudy question bank but looking to see if i should supplement with PBR course or medstudy videos.

Do you all recommend Medstudy flashcards and videos? I have the qbank but deciding on if it’s worth the money for flash cards and videos.

Failed step 1 as a medical student, subsequently passed and passed step 2 and step 3 on first attempts. I addressed this failure during residency applications and am now applying for fellowship. Do I need to address it on my fellowship application? Do I discuss it the impactful experience section? Was >4 years ago and feels silly to discuss it but wanted to see what others thought.

As the title!

Can current attendings weigh in on what day to day for a cardiologist is like?

Every time I see our IT invoice, my first thought is how is IT this expensive? We have 2 IT, so it still surprises me every month. Before we opened the clinic, I thought just meant fixing computers when they broke and I know there's a lot more to it, but I still can't help wondering if this is just what everyone pays or has anyone found a cheaper option. any AI tools or other services that have helped cut down on costs?

I suppose the private practice folks do anything to avoid it, but for me, as an employee, slow summers are glorious. I see something like 6-10 kids a day, have all in the time in the world to catch up on reading and surfing.

Hello -
I was thinking about getting my own portable pediatrics kit that will help me perhaps participate/help in community events or simply examine relatives/friends’ children when they ask (more of a social second opinion, not as their primary). Also, it does come in handy when I’m visiting my remote town.

I’m looking for any recommendations on what to include (other than a stethoscope, ophthalmoscope, otoscope, band aids, alcohol pads..), if any of you has that, and if you have any good recommendations from amazon.

Thank you

Hi, what ranges are common for new grad post residency as a primary on the West Coast?

I am an incoming PGY1 and people keep asking what kind of fellowship I want to do, I am in between peds GI and heme onc and endo. I know they are all so different! How did you decide? When did you decide? Thank you!

Hi! Looking to make some money extra money, it seems like I am not eligible for any paid surveys I come across. General pediatrician a few years out from residency. Would appreciate if anyone has any advice on how to get into this!