Child’s play? Pediatrics requires patience, empathy … playfulness
“Pediatrics has been my passion since I was in the seventh grade,” says Michael E. Ryan, DO. “I realized that I loved children and wanted to help them.” (Photo courtesy of Dr. Ryan)
This is the ninth in a series of articles profiling medical specialties. The others focused on anesthesiology, physical medicine and rehabilitation, osteopathic manipulative medicine, dermatology, emergency medicine, obstetrics-gynecology, general surgery and internal medicine.
As retired pediatrician Arnold Melnick, DO, observes, anyone interested in a career in pediatrics needs to have “real concern and empathy and love for kids.” These traits are intrinsic to individuals; they can’t be developed during training, he says.
“If screaming babies disturb you or you get angry when kids seem to be obnoxious, you don’t belong in pediatrics,” insists Dr. Melnick, a former president of the American College of Osteopathic Pediatricians (ACOP). “Pediatricians have to be accepting of children. They must listen to kids without contempt or ridicule, understanding that children think and speak at a different level than we do.”
Pediatricians have to be meticulous because medication doses must be calculated so carefully, points out Robert W. Hostoffer Jr., DO, another former ACOP president. Because they deal with smaller bodies and anatomical parts, physicians in this specialty require excellent fine motor skills and hand-eye coordination, he says.
“As a pediatrician, you need great patience and great humility,” adds Ronald V. Marino, DO, MPH, who directs the AOA-approved pediatrics residency at Good Samaritan Hospital in West Islip, N.Y. “If you have to start an IV on a pudgy 18-month-old, a lot of times you’re sweating bullets because it’s so hard to find a vein. You can’t be cocky as a pediatrician. Plus, you’re going to get peed on and spit up on anyway.”
Because they interact with both kids and their parents, pediatricians need especially strong interpersonal skills. “You need to bond not only with the child but also with the child’s family,” says Eileen L. Hug, DO, the director of the AOA-approved pediatrics residency at Henry Ford Macomb Hospitals in Warren, Mich. “This is challenging because when a child is sick, the family is under a lot of stress.”
Playfulness and imagination help pediatricians establish rapport with wary or frightened young children.
“My residents laugh, but I have a large repertoire of animal sounds,” Dr. Marino says. “I can laugh like a duck, honk like a goose and make elephant sounds. Kids love this. You’ve got to be a little goofy.”
But pediatrics is far from being all fun and games. From a clinical standpoint, the field is as intellectually demanding as internal medicine, Dr. Hug says. And as infants and young toddlers cannot describe their symptoms, diagnosing childhood illnesses can be particularly challenging.
What sets pediatrics apart from other specialties, however, is the huge education and advocacy role pediatricians play. On the front lines of preventive medicine, pediatricians champion immunizations, healthful eating and exercise, as well as safety precautions, such as wearing a helmet while bike riding and knowing what to do in a house fire. This often means asking difficult questions that may seem intrusive to parents.
“Because I’m in Oklahoma, where many people own guns, I ask if there are guns in the home,” says Tulsa, Okla., pediatrician Scott S. Cyrus, DO, the ACOP’s vice president. “I just stress to the parent the child safety responsibilities inherent in gun ownership. ‘If you have guns in the house, lock them up.’ ”
Pediatricians also need the courage to confront parents who exhibit poor judgment, such as not feeding their children well or letting them watch too much television. “We give parents guidance and try to increase their confidence,” Dr. Cyrus says. “But we can’t be afraid to challenge a mother and father when their parenting skills are not adequate. Many times they don’t realize that what they’re doing is not best for the child.”
With an average annual income of $156,000 a year, according to a Medscape survey, general pediatricians make less money than other medical specialists. Thus, passion rather than pay draws individuals to this field. As with internal medicine, pediatricians can increase their earnings by pursuing fellowships in subspecialties such as hematology and oncology, allergy and immunology, neonatal intensive care, and endocrinology.
Today, 14 of the 18 AOA-approved residency programs in pediatrics are also accredited by the Accreditation Council for Graduate Medical Education (ACGME). Trainees in dually accredited residencies can apply to either AOA-approved or ACGME-accredited fellowship programs. Pediatric residency and fellowship opportunities will likely increase in a couple of years, with the AOA and the ACGME working toward a common accreditation system by 2015.
Students match into pediatric residencies, which are three-year programs, in their fourth year of medical school. Not all of the 208 funded osteopathic positions fill, but some residencies are highly competitive, with dozens of applicants per opening.
The new Osteopathic GME Match Report by the American Association of Colleges of Osteopathic Medicine provides a glimpse of 2011 graduates who matched into pediatrics as their first-choice specialty. These graduates had an average score of 486 on Level 1 of the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA) and 498 on Level 2-Cognitive Evaluation (CE), while 100% passed Level 2-Performance Evaluation (PE) on the first attempt.
“I can laugh like a duck, honk like a goose and make elephant sounds. Kids love this. You’ve got to be a little goofy.” Dr. Marino
Of those pediatric candidates who matched into their first-choice program, 98% had volunteer experience, 79% had work experience and 63% had research experience.
The program directors of competitive pediatric residencies emphasize the importance of strong COMLEX scores but say that several other factors are crucial as well.
“We like candidates to have passed each component of COMLEX on the first attempt and with a solidly good score, not just by the skin of their teeth,” says Dr. Marino, who receives more than 10 applications for each of five available positions a year. “Our programs have to develop competent, credentialed pediatricians who can pass the pediatric board-certification examinations. An applicant’s COMLEX scores are a good indicator of how well he or she will do on the pediatric boards.”
With approximately 250 applications for six openings a year, the AOA-approved pediatric residency at Geisinger Health System in Danville, Pa., is very selective, says program director Michael E. Ryan, DO. He requires candidates to have scored at least in the 80th percentile on both Level 1 and Level 2-CE of COMLEX and to have passed all parts of the exam on the first attempt.
“We also look for volunteer experience related to medicine. We value this even more than research experience,” Dr. Ryan says. “But if candidates have done some research as well, that gets our attention.”
Because audition rotations are difficult to come by at Geisinger, Dr. Ryan does not require candidates to have rotated with him. Approximately half of the candidates he interviews have done a pediatrics rotation in Danville. “This gives us a chance to look at these candidates closely, but outstanding applicants are outstanding applicants, whether we’ve seen them before or not.”
In general, though, candidates who are known to program directors have an advantage over those who are not.
“You can learn a lot about candidates during elective rotations,” Dr. Marino says. “Are they team players? Do they follow through? Are they responsible? These are not traits you can gauge easily in an interview alone.”
Dr. Hostoffer, who directs an AOA-approved pediatrics residency, prefers students who have completed an intense audition rotation, known as an “acting internship,” in his program at University Hospitals Richmond Medical Center in Richmond Heights, Ohio. This allows him to observe how a student interacts with patients and their parents, as well as assess the candidate’s work ethic and clinical knowledge.