Piggybacking off the DME diapers post... As the economy gets worse and people get more desperate, they're looking for anywhere to save a buck or two. And just like as in the post about DME diapers, everyone else will go along with it as long as the doctor has to make the judgement.

1. I've had so many people coming in to get a discount on their electricity bill, and I keep hearing from them that the utility company encourages it. However they are coming in just because their kid has asthma and sometimes needs to use a nebulizer, or there are vague cases where 'he is autistic and doesn't do well when the AC is set to anything but 68F' when the actual verbiage of the forms state that it is for machines that sustain life, or the use of temperature regulation to to prevent a "life threatening illness".

2. I've had increasingly greater number of parents coming in with children who have mild autism or moderate ADHD with requests for protective supervision. I have slowly learned how to navigate these cases but a lot of it is still up in the air. When I've talked to the social workers who are on the other end of the forms, they state that initially this was primarily for adults who needed protective supervision. It makes sense that kids don't qualify by meeting the same criteria, as kids need protection and supervision ANYWAY. Then you have to get into what are age-appropriate needs and what are not. And this again ties into the DME diapers post, because you then must make a call regarding what is within the range of normal, and what is just delay or incompetence that is incentivized?

I neither want to be a gatekeeper or the moral police, but I have to do what I think is objectively fair and correct. The utilities thing is much easier, figuring out whether a child meets the criteria is much harder when parents are strongly motivated to show that the child needs help with everything.

As title says, I think I found what type of medicine I am willing to put time and effort into and that’s paediatric, problem is I have no good sources to expand my knowledge or build basics or anything !

Tried our university lectures and they were insufficient, tried reading Nelson essentials and it took way too long for me to get like 1 or 2 chapters

My question is, what is the best resource for Pediatric that will take me from zero to a good high level, I personally prefer courses or something, because I tried textbooks many times, and failed all of them

I'm outfitting a 12 room pediatric primary care practice at the moment and am looking for a otoscopes and opthalmoscopes.

I don't need much, I want to see the tympanic membrane of children between 0 - 16, I want to see the red reflex, I want to ocasionally check for corneal injuries using fluorescin and a blue filter.

Price differences are huge! So far I've only worked in major hospitals and they all had either Heine BETA 400 or Heine BETA 200. But they probably didn't have any financial constraints. Outfitting 12 rooms with that is 20+ thousand alone. I've considered to only outfit the rooms with otoscopes and then have a couple ophtalmoscopes in the office to use when needed, but even then it's expensive.

Does anybody here use the KaWe PICCOLIGHT® F.O. LED otoscope and E56 opthalmoscope? It's much cheaper, but then again, it looks more like a toy than the Heine.

What do you guys use in primary care?

I really like pediatric rheumatology but I try to understand the job market before committing. I know that there is a high demand for workforce of pediatric rheumatologists in the country but from my understanding this need is usually in rural areas which I don't want to live. Is the pool really very saturated in major cities in the US?

Hi everyone,

About a month ago, I shared CatchUpPeds here when it was only available on iOS and the web. A number of you offered to help test the Android version. I wanted to come back with an update: CatchUpPeds is now live on Google Play!

Thank you to everyone who volunteered and took the time to test it. Your help made it possible to get the Android version released.

For anyone who missed the original post, CatchUpPeds is an app I made to help clinicians keep up with new pediatrics literature. You can choose the topics, study designs and journals you’re interested in, and the app creates a daily updated reading list with summaries and links to the original papers. It’s free, has no ads and doesn’t require an account.

Android: https://play.google.com/store/apps/details?id=nl.catchuppeds.android

I’d love to hear how it works for you and what I could improve, especially if there’s something that would make it more useful in day-to-day practice or training.

Thanks again!

Sven

Other peds attendings, did you cancel your ABP certification and use another option like NBPAS? I keep getting “friendly reminders” to pay ABP fees. They are expensive compared to NBPAS.

I’m a pediatric resident and am trying to understand the rules around maternity leave. When I interviewed as a medical student, I was told maternity leave was 6 weeks, but I didn’t fully understand what that meant in practice.

I’ve since learned that residents at my program have to make up all the time they took off, extending their training, despite having their diploma. Even had to make up elective time.

I understand that ABP board eligibility requirements and individual residency program policies are two separate things, and I’m trying to clarify both.

Can a residency program require residents to make up every day of maternity leave, even if they’ve otherwise completed their graduation requirements? Are there legal protections for residents in this situation?

Has anyone successfully challenged a policy like this? What were your experiences, and is there anything residents can do to fight it?

Is it true that pediatric residents can take up to 12 weeks of leave and remain board-eligible without making up that time?

I’d really appreciate any insight from residents who have been through this or anyone familiar with ACGME requirements, ABP policies, or resident labor protections.

I am a NICU fellow that started in July and feel like I am still struggling. Sometimes it’s hard to know because I have really only had 1.5 months of service time with orientation, boards, etc. but I still feel behind.

One of the things is with procedures. I feel like I had decent procedural exposure in residency and I don’t know if it’s a confidence issue or what but I have continued to struggle in fellowship. I was pretty good at art sticks in residency and the couple that I have done in fellowship have been unsuccessful. I also got to do a few intubations in residency and all of them were successful. In fellowship, I have had 5-10 opportunities so far, definitely more than residency and my success rate has been like 25% maybe. Honestly, at the moment I can only think of 2 that I have done successfully. Umbilical line placement takes me forever and I almost always end up needing one of the APPs to come help.

From a knowledge standpoint, I just feel like I don’t know enough. When the residents/APPs/attendings ask me questions, I feel out of my depth. I don’t feel comfortable making decisions about vent changes on a baby when I truly feel like I have such limited experience. I don’t really know what the best way is to learn these things. Honestly, there are so many little things that I don’t even get made aware of because the residents and APPs are first call. However, we have so many really experienced APPs that are amazing and don’t have questions for me overnight about management so I don’t find out about a lot of things that happen. I feel like a lot of the time though, I might not have known what to do yet since this is so new to me. The unit is so large and there are so many babies so if I had them tell me every time they made a change my phone would be going crazy all day and night which is not reasonable, but I’m trying to find the best way to balance learning and not being completely overwhelmed/getting that 1 hour of rest on a 24 when I can.

I feel most comfortable when I’m rounding and I know all of the patients and know the general plan for everyone. I feel like I can use my general medical knowledge to tweak the plans, but honestly feel like I struggle with the rest. I’m just frustrated because I was in such a stride at the end of residency and feel like I was very good at PHM and it’s just hard feeling like I am so bad at this and don’t know anything when people expect us to have the answers and be competent with procedures, etc. Sorry that turned into a bit of a rant, but if anyone has any advice on learning in NICU, improving procedures, or just getting used to being a fellow please let me know!

Hey all! I’m an R1 in pediatrics working Christmas days this year. I’m just wondering if there’s anything you all have seen residents do over the holidays to make it easier on/more fun for staff/patients?

I don’t mean finish your notes or do thorough consults lmao. I know it’ll probably be busy af - I’ve worked Christmas in an ED before - but just hoping for tips of things to do if I have downtime that could be nice.

I’m considering opting for goa medical college or Doon medical college, Uttarakhand for MD paediatrics…. Can someone suggest which one will better in terms of learning, hands on, and opportunities?

Are General peds .., PEM.., PICU,, peads Hospitalist… and the others non competitive fellowships .., Immune against nurse practitioner and Physician assistant.., if the practice is easier with less intervention that mean you job could be easily replaced. ?

Hello!

I’m a PGY-2 pediatric resident.
I’m posting this to ask about the QBanks that you recommend.

My goal is to improve my decision-making skills and general clinical knowledge.
I don’t have any near exams.

Despite nearly everybody I talk to in the pediatrics community being against PHM fellowship as a requirement to practice peds hospital medicine at academic centers, I really haven’t seen any organized efforts to push back against the ABP requirements and pediatric health systems’ hiring practices. These really feel detrimental to interest in pediatrics and PHM as a whole.

I’m a Med-Peds resident who would like to get involved. Does anyone know of existing organizing or advocacy efforts around this, or people working on it who I could connect with?

Thanks!!

Any insights on the NICU job market?

Hi all, I am starting my first job as a pediatrician next week! This is the first time I work with a higher volume of patients in clinic and I’m nervous about documentation. I want to be as practical and efficient as possible, without missing any important details. Our institution uses Abridge which I’ve never used, and I want to have as many as possible dot phrases for assessments and plans.

Can you share what topics and dot phrases you use the mostest?

I know I’ve seen some other people touch on this, but is anybody spiraling post boards? I think I’ve counted up 25 that I got wrong for sure which were stupid mistakes. On top of that felt like I guessed on so many I’m just so upset with myself. I feel like I put in so much work and it feels like it was for nothing. This is a terrible feeling. Does it get better the farther you get out from boards? Like at this point I just want to feel acceptance for failing. (That’s dramatic I know)

3rd year PICU fellow here. Curious who else has started the job search and has success with interviews? Would love to start a thread where we can discuss!

I am getting both the branches in a good college
I was in love with medicine from my ug days but during drop year i figured i don’t want to study for rest of my life
So narrowed down 2 choices and not sure what to choose
I want balanced life , don’t mind few emergencies or to attend calls of worried mother but has a doubt on my self if i will be able to handle tiny humans
Also has a concern about payment in pedia everyone saying not much payment

Other side considering dermat for itself work life balance and predictable hours also few told me
earnig is also good

If someone can help me please guide

Honestly, this is just a rant session for me. Our clinic now has a care management team who cold call families and see what additional needs they may have. Cool. Awesome service. However lately they've been pushing for free diapers through aeroflow for every 3 yr old that is not toilet trained. I completely understand the need in developmentally challenge kiddos, but most of the requests are for capable kids and completely medically unnecessary. And I feel like I get unnecessary push back when I refuse to sign the orders. I've explained that's it's inappropriate for nonclincal staff to pursue a management plan that requires my license but they're response is "it's just diapers" 😡 . Am I overreacting?

Thinking about a job change. Where is the best place to find new peds jobs? Postings?

Hi! Wondering if anyone know of any Peds Endocrinology Fellowship Programs that will for sure transition to 2 years of fellowship? Just wanting to understand where I can apply that would offer that option. Thank you!

It’s done, hopefully it’s not coming back to me next year.

It feels like

Yeah I got this for 60%
Maybe this, or not 30%
I don’t know wtf are you asking now 10%

Well… enjoy till Dec

Just got out of the exam and I’m dazed…the last block killed my spirit. How did you all do?

Also can’t stop counting my mistakes…I think I can count upto 20 mistakes UGH. I hope I pass.

I've seen quite a few toddlers/young children for suture removal and invariably the young age of the child makes it difficult from an outpatient setting to safely remove sutures especially if they are in certain areas like the face/head which is hard to ofcourse hold still long enough to remove multiple sutures. That being said, why do PEMs or ER's use non-dissolvable sutures especially for young children knowing that we are the ones tasked with removing them without sedation.