Choosing a Medical Specialty: Pediatrics
Highlights from AUC's recent webinar all about the medical specialty of pediatrics.
According to the AAMC, there are more than 120 specialties and medical subspecialties that students can explore during and after medical school—from sleep to sports medicine, from pulmonary disease to psychiatry. With that many specialties to choose from, it’s never too early to start exploring different areas of medicine to get a feel for which fits you best.
AUC has teamed up with our alumni to bring you the insider’s perspective on different physician careers through a series of webinars. Earlier this year, four alumni hosted a webinar to explore the specialty of pediatrics—discussing residency life, speaking about why they chose AUC, and answering specialty-specific questions like:
- What did you do as an AUC student that helped you along your career path to become a pediatrician?
- What electives would be helpful for a student applying to pediatrics residency?
- What’s the most rewarding experience you’ve had from doing pediatric medicine?
Missed it? Watch the recording or read the webinar recap below, including the presentation slideshow and Q&A with our alumni speakers.
An overview of the specialty, including factors for success, residency outlook, compensation and more
Featuring the AUC experience, clinical rotations, boosting your pediatrics application, and residency life
Laura Chalmers, MD ‘00
Assistant Professor of Pediatric and Adult Endocrinology, The University of Oklahoma
Erin Knopf, MD ‘13
Attending Physician, The Eating Recovery Center, Denver, CO
Nirmish Shah, MD ‘00
Assistant Professor and Director of Sickle Cell Transition Program, Duke University
Christopher Siracusa, MD ‘09
Assistant Professor, Division of Pediatric Pulmonology, Cincinnati Children’s Hospital
A Day in the Life of a Pediatrician
Q: What was your career path to your current role?
Laura Chalmers, MD: I graduated from AUC in 2000, and then I matched at the University of Oklahoma, which was my first choice. I did medicine pediatrics, a four year program, and then at the end of my third year I applied for fellowship, which I did at University of Oklahoma in Oklahoma City as opposed to Tulsa. Now I’m working at the University of Oklahoma in Tulsa as an Assistant Professor in Endocrine.
Nirmish Shah, MD: I graduated in 2000, then did med-peds residency at East Carolina University. I did the Couples Match with my wife. My two cents on that application is just being persistent. I actually didn’t have the interview go through at first, but I just kept calling and got my interview and matched there.
After fellowship, I did an interesting pathway in the sense that I did adult hematology-oncology fellowship first, but after a year of adult hem/onc I figured out I just wanted to do hematology. So I left fellowship after a year and became a hospitalist for a couple years. Then I went to Duke to do pediatric hem/onc fellowship and joined the faculty in 2010. I’ve been here at Duke with a joint appointment in adult and pediatric hematology ever since.
Christopher Siracusa, MD: I think I’m the only one who just did straight-up peds residency. I graduated in 2009, I matched at Akron Children’s Hospital in Ohio where I did my residency. At the beginning, I was between subspecialty interests. I knew I didn’t want to do primary care but ultimately fell in love with pulmonary medicine. I did a three year fellowship at Cincinnati Children’s Hospital, where I’ve been since my fellowship as an Assistant Professor in Pediatrics.
I initially was doing a smattering of things within pulmonary medicine, but really followed cystic fibrosis as my main interest. Currently I’m Associate Director of the Cystic Fibrosis Center. I love my job. I’m practicing 50-50 inpatient and outpatient medicine, and I’m in the OR once or twice a week doing bronchoscopies, so I feel like a surgeon. Thirty percent of my job is research, and the rest is program development and leadership. I’ve found a mix that works for me, but it took me awhile to find it.
Erin Knopf, MD: I graduated in 2013 and matched into a five year, triple board program that includes pediatric medicine, adult psychiatry and child psychiatry, all put together in a nice package. I’ve taken a position as an attending physician at Eating Recovery Center in Denver, CO. It’s residential, partial hospitalization and intensive outpatient program, all vertically integrated. It’s a private program for eating disorder patients, both children and adults.
For me as a triple boarder, liking psych and peds, I’ve always been drawn to the eating disorder population. I remember writing my application and personal statement about an eating disorder patient I met back in undergrad.
Q: What’s the most rewarding experience you’ve had from practicing in peds?
LC: One of the most rewarding instances is watching a baby who’s been really sick recover, and then follow them for 4-5 years and see them continue to do well and thrive. Also, interacting with the family and getting to know them and take care of them.
NS: The time you spend with the family and explaining in a very understandable way what’s going on with their child. It’s extremely rewarding to see that they’re so thankful, that you took the time. Obviously many of your pediatric patients are not the ones you’re always focused on explaining to—of course you want to involve them in the discussion, but if they’re sick or not old enough to understand, you’re spending a lot of time explaining to the family what’s going on, and that’s a very rewarding experience.
CS: We as pediatricians have this privilege and responsibility of setting the stage for children and their families’ view of healthcare as they grow up. For me, one of my biggest—and oftentimes stressful, but quite rewarding—experiences is when I diagnose someone with cystic fibrosis, and it’s usually within the first few weeks of life. We’re having a conversation that’s really setting the stage for their entire life. It’s humbling and extremely important, just knowing that relationship that you can build.
Q: What’s the most challenging experience you’ve encountered while treating newborns?
EK: I will admit I’ve been very lucky that in the nursery and even NICU, I have had all good outcomes. I know that’s not typical, though.
CS: Certainly medicine has come a long way and the science now is even greater than it was even a decade ago, so we’re able to do so much more in neonatal, newborn and even prenatal periods. Having said that, there are some bad outcomes sometimes, and that is one of the hardest parts about being a pediatrician. Thankfully it doesn’t happen that often, but it does, and you have to be prepared for that.
LC: The other thing you need to think about with pediatricians is the abuse that you may see, which can be very hard when you’re taking care of a child and they either come in for abuse or you have to report abuse, whether it’s physical or mental. It can be very frustrating when you know the family isn’t capable of taking care of a child. You keep advocating for them and hopefully over time things will get better, but just know that you may have to deal with a lot.
EK: When you go into medicine, you know on an intellectual level that there’s going to be life and death, but it isn’t until you’re more in the clinical setting that you’re seeing it in real life.
NS: I think that the emotions that come into play with all these different situations, be it a very bad diagnosis or an early infant death, they do happen but they don’t happen that often. You’re taking care of a lot of really other rewarding patients.
For me, one thing I learned was something that came about when I did peds hem fellowship. In this field, you have patients similar to CF, in that you’re having to sit down and explain a really complicated, difficult situation. Fortunately, you have a really good support system within the pediatric group, meaning residents and other fellows. You know, we’re all in this together. That was extremely valuable.
My wife is an adult oncologist and we did residency at the same time. It was tough for her to hear me talking about kids with cancer, but that was okay because I had other residents and fellows that were very supportive and we were all in it together.
Q: When did you know you wanted to go into pediatrics?
CS: I think that probably I could say I always knew. I pretended I wanted to do something else through medical school, and I followed my own advice and had an open mind, and I thought I could do anything. But for me it was about every time I worked with kids and their families, it just felt so much more natural and comfortable. I would say it first popped up at the very beginning of medical school and after doing all my other rotations, it was very quickly confirmed by my third year of med school.
NS: I actually did my medicine rotation first, and then some of the other specialties. Peds was one of the last ones I did, and it convinced me that I just wasn’t a medicine person. I was kind of torn at that point about my med-peds decision because I really loved my peds experience, and it was actually at that moment that I made the decision to do pediatrics. So I did change my mind along the way a couple different times, and I absolutely love what I do now.
LC: I always wanted to do peds, and it was my last year right before applying to residency that I actually found out you could do internal medicine combined with peds for residency, which to me was the best of both worlds. I love peds, but being able to watch the kids grow up and be able to be involved in their lives was fantastic. And I also feel that, as a doctor, people are always going to be asking you different adult medicine questions in your life, and I just feel more knowledgeable in the long run and really enjoyed that program.
EK: I always wanted to go into peds—my parents can tell you I knew when I was six years old. There were some other career paths I thought of along the way, but when I went into medical school I was pretty convinced I wanted to do child psychiatry, having worked in an inpatient psych unit during undergrad. I loved the science part, I loved neuroscience—and when I got into clinicals, I’ll admit I actually loved everything. But no question, I got to my peds rotation and realized, this is absolutely where I want to be.
And it wasn’t until maybe a month or two before applying to residency that I learned through one of my attendings about the triple board program, where psych and peds were put together. For me, that just made so much sense. It’s been very rewarding for me to be able to care for the mind and body together and be a unique brand of pediatrician, if you will. I’ve noticed that when I’m on peds rotations, I bring more psych to the table, and when I’m on psych rotations, I bring more peds to the table, so it really offers a different perspective.
Preparing for a Career in Pediatrics as an AUC Student
Q: What is one piece of advice for clinical students applying to pediatric residency programs in the next two years? What clinical rotations would be useful?
LC: I definitely think an inpatient rotation would be useful, as well as finding a good outpatient clinic that you could rotate with. I think getting good outpatient skills would be necessary. It’s also important to learn to do a good newborn follow-up, a newborn exam and appropriate questions for parents after they’ve delivered their baby. Knowing what a normal healthy child is like is always very helpful, just as when you have a sick child, to know exactly how sick they are too.
CS: The other thing I would consider, if you’re really gung-ho about peds and you’ve got a little time to play with, pediatric infectious disease is a great rotation for multiple reasons. It really transcends some subspecialties, it’s very high yield and could help you become a better general pediatrician or subspecialist.
Q: Any general advice for future med students dealing with patients?
NS: Working with patients is all about communication and having the empathy and desire to understand where the patient is coming from. For example, one population that is a big part of what I do is patients with sickle cell disease, a blood disorder that’s a lifelong disease. I take care of adolescents, and the big problem they have is pain. They’re often in pain, and there’s a lot of misunderstanding from many different sides as to what’s going on. As with any patient, you just need to try and put yourself in their shoes and try to do what’s best for them. My advice is to listen to them. You have to talk to them before you examine them or do anything else, and get a good history.
Q: What did you do as an AUC student, either on island or during clinical rotations, that helped you prepare for a career in pediatrics?
NS: One of the electives I was able to choose in clinicals was a pediatric rotation at Duke in the outpatient clinic, which was very rewarding. And I will advocate this for clinical students: Reach out to all the connections you have. It’s not unheard of for someone to know someone who has an ability to allow you to do these kinds of rotations. There’s letters of recommendation that made a big difference for me which came as a result of that.
Also, with more and more residency programs, when we go through candidates, we don’t necessarily expect you to already be interested in a specific subspecialty or have a detailed plan. But that said, when people do come in with a plan, and say, ‘You know, I really do love this, and that’s why I did this elective and started looking at this perspective,’ I think people really respond to that.
CS: On island, I tutored immunology and embryology, and those are essential for peds. I thought how the fetus developed seemed like a very interesting concept.
As an aside, in 2007 when I was in my clinicals in New York, I became involved in the presidential campaign. I only bring that up because I learned how to lobby, how to be an advocate and make some changes. And in reality for peds, our field does have a very strong role when it comes to advocacy and public health issues. So regardless of your side of the aisle, there is this responsibility to protect children and to advocate for children’s health. And I’ve been doing that for the last 3-4 years, working with our state and local governments to make sure our kids remain funded and have the care they need to stay healthy.
Subspecialties in Pediatrics
Q: As a Type 1 diabetic, my pediatric endocrinologist was a memorable part of my childhood. Dr. Chalmers, do you find working with kids and parents to manage chronic conditions such as diabetes to be rewarding even when you have patients/parents who are not completely compliant?
LC: I do. And I love working with Type 1 diabetes patients and families. I think the main thing is understanding that taking care of a kid with a chronic disease takes a lot of input from everyone involved and that everything’s not perfect. You can continue to work to make things better, be supportive of them and try to find things in their community or their family to help manage their disease. One of the things that’s rewarding in med peds is that I get to follow my kids into adulthood and even be able to take care of them in their pregnancies and have them deliver healthy babies.
Q: For someone interested in specializing in child/adolescent psychiatry or hem/onc, what is your favorite part in practicing your chosen specialty, and what character traits make someone a good fit for these fields?
NS: From a hem/onc standpoint, there’s definitely an emotional tug when you’re dealing with pediatric patients with cancer. But it really is the most rewarding experience to help a family and child through one of the most rough experiences they can go through. So I think that from a personality standpoint, I definitely put up a wall emotionally to get myself through that, and I had a good support group as I mentioned before. But if you can get through that emotional drain and see the positives, I would say go for it. And I think even doing a rotation helps you in making that decision because you’re in that space. I did a rotation, and it was so rewarding that I got past the fact that it was emotionally difficult to deal with.
EK: My answer is pretty similar: My favorite part is being with these patients. I usually meet them when they’re in crisis. They’ve tried to harm themselves, or they’re no longer functioning well in school or home, and I’m working with them and helping them to develop their coping skills and retraining thoughts. I especially love working with the interdisciplinary team we have as well. It’s really awesome being with the patients as you see them progressing through and turning what was one of their darkest times into a very positive experience of growth.
As for personality traits, resilience is probably the word we rely on the most in psychiatry, the ability to withstand blows and stand strong and know that you have strong roots that will carry you through. Going into psychiatry, you’re not always going to be able to keep your appointment times to 30 minutes. Sometimes patients are going to need more time, and being flexible with that and willing to lean in is important. But so is being able to identify when you need to lean on others, and being really OK with that and not beating yourself up because you are human. You’re going into a field taking care of humans and you yourself might need support. Making sure that you are really in tune with and working on your self-awareness will set you up for success.