General pediatrics is a fantastically diverse field that reflects the "bread and butter" of pediatric diagnoses and issues. For many general pediatricians, it is highly satisfying be able to see a newborn in the hospital nursery within the first few hours of life and continue to see that same baby develop throughout each stage of life. General pediatrics provides the satisfaction and the challenge of understanding the whole child. It also provides the opportunity to be a thoughtful provider of continuous, compassionate and comprehensive care to healthy and ill children. To your patients, you are the master coordinator of care. To your colleagues, you must be the master processor of information.
- Some of a general pediatrician's responsibilities include:
- Management of serious and life-threatening illnesses
- Diagnosis and treatment of acute and chronic disorders
- Monitoring physical and psychosocial growth and development
- Age-appropriate screening
- Health supervision (health promotion and disease prevention activities to enable each child to reach full potential)
- Anticipatory guidance (advice and education for patients and parents regarding appropriate preparation for predictable developmental challenges)
- Referral of more complex conditions as needed
- Consultative partnerships with other care providers, such as family practitioners, nurse practitioners, and surgeons Community-based activities in sports medicine, school health, and public health.
- Creating and Informing pediatric public health policy
- Career tracks from general pediatricians include ambulatory care (outpatient based), hospitalists, med-peds or academic general pediatrics. Depending on the setting in which you are most comfortable, each of these tracks allows you to continue to see a variety of diagnoses. If a higher-level of acuity of care is preferable, choosing a hospitalist track is a fantastic career path for many generalists. Academic general pediatrics provides the amazing opportunity to combine patient care with a focus on teaching students and residents while also pursuing interests in research. General academic pediatric fellowship are typically 3 years in length and include master's level coursework with the goal to gain greater investigative and leadership skills.
Below is a graph depicting the general distribution of general pediatric tracks in 2011:
While many physicians decide to pursue general pediatrics, there are diverse options for further specialization. The decision to pursue specialty training should involve consideration of many factors. Some include the types of patient populations involved as well as length of training, lifestyle and salary.
Chart: Length of Fellowship Inpatient Experience Outpatient Experience Procedural Focus
According to the American Board of Pediatrics (ABP), among those taking the general pediatrics examination for the first time in 2009, the five subspecialties most frequently selected by those planning to pursue fellowship training in an ABP-boarded pediatric subspecialty were neonatal perinatal medicine, pediatric hematology-oncology, pediatric emergency medicine, pediatric cardiology, and pediatric critical care. Click here to see a trends in the number of fellows by specialty over the years (Source: the American Board of Pediatrics) .
Access to certain pediatric subspecialists is also a growing national concern that perpetuates interest in recruiting and training excellent fellows. A 2007 survey of active-practice, United States-based AAP Fellows in general pediatrics identified dissatisfaction with wait time for appointments and availability of many pediatric medical subspecialties and several pediatric surgical specialties. Ninety-six percent of surveyed primary care pediatricians said there were too few local child/adolescent psychiatrist to meet referral needs; 87% cited a shortage of developmental-behavioral pediatricians; and 82% reported insufficient pediatric dermatologists. More than half of those surveyed reported shortages of pediatric medical subspecialists in rheumatology, neurology, adolescent health, endocrinology, and gastroenterology. When these same physicians were surveyed about local access to pediatric surgical specialists, the most acute shortages were in orthopedics, neurosurgery and urology. Workforce experts have suggested that public policy related to funding for subspecialty training should be carefully researched and subspecialty-specific.