What medical students and other doctors should know about pediatric medicine

Since 2012, Jeffery J. Bergman, DO, FACOP, FAAP, has been practicing both pediatric hospital medicine and pediatric emergency medicine. In this edited interview, Dr. Bergman highlights the field and his experience in pediatrics, including working during a “tripledemic” and addressing vaccine hesitancy. He strongly believes that choosing to pursue a career in pediatrics is an investment in the future of our nation and the health of its children.

What should other specialties know about pediatrics?

My experience is that non-pediatric physicians often forget that children have different anatomy and physiology, depending on their age. I would also like all specialties to realize that we are all highly trained physicians and experts in our field. All too often, I have heard some specialists demean other fields of medicine, especially pediatrics. Patients benefit when we all work together and trust each other.

What are the differences between pediatric emergency medicine and pediatric hospital medicine?

Pediatric emergency medicine physicians frequently provide general care to patients who cannot get access to a primary care physician or other outpatient resources. They are also the experts in care for the acutely ill or injured pediatric patient. Pediatric emergency medicine physicians are often the first line of care for pediatric patients and frontline access to the hospital. 

On the other hand, pediatric hospital medicine involves the in-patient management of pediatric patients who require advanced medical care that cannot be managed in an outpatient setting or at home. Patients sometimes have social needs that may require time to stabilize and, in my experience, a pediatric hospitalist can help ensure that we’re not missing anything and that all the patient’s needs are being fully met.

What are some common misconceptions about your specialty?

A misconception is that pediatric hospitalists are not busy. In fact, a typical day for a pediatric hospitalist begins with handoff and rounding depends on the number of patients and acuity. We also deal with notes, admissions and discharges. Additionally, pediatric physicians typically provide either family-centered rounds, multi-disciplinary rounds or a combination of both. Pediatric hospital medicine physicians are the central spoke in the wheel of care for pediatric patients within the hospital system. 

Furthermore, we often provide care for pregnant patients as well as complicated pediatric patients, often up to age 24. Many pediatric emergency medicine providers have also been asked to see adult patients during times of high patient volume, or in mass casualty situations. During the COVID-19 pandemic, many other pediatric emergency medicine physicians and I were asked to help with adult patients.

What should medical students know about your field?

A career in pediatrics is a highly rewarding experience. There have been few moments in my life as meaningful as handing a child back to a parent who thought their child’s future was uncertain. ​‌In most cases involving pediatric patients, the patient and/or family is willing to do whatever is necessary to help the condition improve or resolve. Pediatric patients tend to be very forthright, and families are very supportive. 

Pediatric outpatient physicians have the joy of watching their patients grow up. They guide parents in the care of their children, and are experts in child development.

In terms of work schedule, outpatient pediatricians may have to take calls and be available around the clock to their patients. Pediatric hospitalists typically work 12-hour in-patient shifts or 24-hour out of house shifts. Shift work can be beneficial for work/life balance.  

There are two tracts to become a pediatric emergency medicine doctor: First, you can complete a residency in pediatrics followed by a three-year fellowship in pediatric emergency medicine.  Secondly, you can complete an emergency medicine residency followed by a two-year fellowship in pediatric emergency medicine. Pediatric emergency medicine physicians also complete 8-12 hours of shift work and often work in stressful settings with high patient volumes and acuity. 

Burnout is unfortunately very common for ER physicians. Therefore, it is important to have a good support system.

What were some of the challenges you encountered during the “tripledemic” of flu, RSV and COVID?

The initial wave of COVID was not hard on pediatric patients. This caused a lot of pediatric offices, urgent cares and even hospital and ER units to close. By the time the “tripledemic” occurred in summer of 2022, there were less pediatric resources available. This quickly overwhelmed many units. We have also seen large supply issues for important medications and items needed to treat pediatric patients in respiratory distress. 

Lastly, with masking and distancing during the early COVID pandemic, we saw a decrease in the presentation of common respiratory viruses such as influenza, RSV, human metapneumovirus and parainfluenza. This may have affected the developing immunity of young patients and may have contributed to the high numbers of hospitalizations that have occurred more recently.

How do you approach vaccine hesitancy?

We have seen an explosion of inaccurate information being promoted in the media. Sometimes, I feel like we forget how bad some of these viruses (like severe influenza, measles and polio) were, since we have not seen them in our lifetime. 

Vaccine talks are important in both the hospital and emergency room settings. However, it is not the setting to argue with someone or force them to change their viewpoints on vaccination. In these settings, you have a limited amount of time to establish trust with your patient. Spending that time trying to convince reluctant patients and their families will make it difficult to ensure quality care, as the family may not trust you or want to follow your instructions. 

I typically ask about vaccinations and note when a family states that the patient is unvaccinated. If I have several days with the patient and can build up a rapport with the family, I will re-explore why they are not vaccinated and ask them to reconsider. 

I would encourage all outpatient pediatricians to develop trust with their patient’s families and explore these tougher issues with them. At the end of the day, we can encourage vaccination, but we cannot force anyone to do it.

Related reading:

Working as a camp doctor during my pediatrics residency

How I matched into pediatrics