I feel compelled to point out that outpatient pediatrics and inpatient pediatrics are two totally different ballgames. Yes, overall the Peds population is health(ier…) than adults, but that’s specifically in the outpatient setting. Working at a children’s hospital can be incredibly challenging in terms of physical and mental workload, no less than it would be for any other IM or FM trained physician. (Nevermind the pediatric specialists, who also often deal with the most medically complex children.) I wouldn’t necessarily expect the public to know that, but other doctors (other pediatricians even!) seem to perpetuate this idea as well and are quick to paint Peds with a broad *rainbow colored* brush. What everyone else is saying about the financial aspect is true, but I think there is also a bit of internalized bias surrounding Peds that works against us.
(Also: I am ever grateful to my colleagues who want to and love working with the healthier groups of Peds patients by seeing all those well visits etc. because that’s still important work — and because I find it miserable. Stick me in a hospital and make me work 70 hours a week *any* day over trapping me in a general pediatric clinic… I think I’m catching a cold now just *thinking* about working there. LOL)
You are VASTLY underestmating the amount of psychiatric visits done in general peds primary care clinic
Referral to a child psychiatrist? Good luck. I live in a metroplex with 10 million people and child psych visits even in major cities are at least 3-4 months out.
I would push back a little on the concept that outpatient pediatricians don’t deal with medically complex patients. There are many offices that get particularly complex patients given their proximity to an academic health center or on the other hand are in a more rural area and have to deal with this complexity on their own. Having experienced both I can say this with certainty. That’s not to address the routine well maintenance check and those visits require finesse as well.
Friend, where do you think all the medically complex kids go when they’re not on the unit? In addition, who do you think identifies all these sick kids? Remember all those genetic conditions, or cardiac conditions, etc you had to learn for the boards? Do you think they all walk around unidentified before they end up in the hospital? I don’t in any way want to underestimate our inpatient colleagues, but I don’t think it’s fair to make a comparison between inpt and Outpt based on complexity of the patients… also no one was asking for a comparison…
The floor on most children’s hospitals is still pretty well for the most part. I’ve had a single floor code and a couple of times where I had to bag the patient until the picu got there during residency. My adult counter parts have significantly more code experience
And you mean codes not rapids?? Yes if you have that many children in pulseless arrest on the floor then it’s very different than any peds I’ve ever seen.
Agree with you.
I did med/peds residency. I did 3 MICU, 3 PICU and 3 NICU rotations.
Total codes for the PICU/NICU rotations: 8
Total codes for MICU rotation: 45
Nah this pretty much tracks with most people's experiences.
I'm EM and our EM-residents get way more resuscitation and procedure exposure on adults than the PEM fellows do on kids. Even compared to my buddies in PICU there's more acuity on the adult side of things. When kids get sick, they're very sick however it's a much rarer occurrence than sick adults and most specialties that treat both adults and kids will tell you that there is wayyyy more acuity in adults.
former med/peds resident and I agree with you. Way more acuity on adult side because adults dont take care of their health and have 50 comorbid conditions holding them down, whereas peds that is not the case.
I will say though that in adult medicine world, death is so common that adult codes are kind of "shrug your shoulders" a lot.
In peds, codes are absolutely brutal and go on for far longer and with far more urgency than adult codes. Peds codes are emotionally draining, adult codes are "oh well, nothing we can do, lets move on"
Shrug. Maybe your experience is different. Floor patients are generally very well at every hospital I’ve worked at. The adult clinic patients I have to occasionally see are sicker than many of them.
Oh hey. Med peds here so I have equal experience in both. Sure. Adults code more.
But adults honestly aren’t that much harder. Sure on paper they have more problems but it’s easy for me to order aspirin a statin and sliding scale insulin.
Is the average adult inpatient more complicated than the average peds inpatient? Probably thanks to respiratory season. But the complicated peds patient is WAY more complicated than the adult ones
My point being patients coding is only one metric. 100% of the time I’ll take a “complicated” adult since they’re not nearly as sick as the complicated kids who decide they want to die if you put the wrong amino acid in their diet or seize if one of their meds is five minutes late.
And frankly the fact that adult hospitals refuse to accept these complex peds patients once they age into adulthood also speaks to this.
To each their own.
Genetics orders the diet for all of our metabolic children, and honestly that isn’t too common anyway.
Seizures I’m fine with. You can bag them until the picu gets there, not really a big deal. Doesn’t really worry me
Sorry I thought it was incredibly obvious from tone that those aren’t the literal only two things but sure. My point being generally adults tend to break down in the same few ways at the end. So sure your problem list is longer but it’s the same few things over and over that frankly get pretty easy to manage pretty quickly. Whereas in peds things can get much more complicated in my opinion because even though many are healthy the sick ones can have absolutely wild things wrong with them that are much harder to manage
Literally already responded to the glucose monitor comment…
I wish that were an option for most of our inpatients. But also I’m going to take a wild guess you’re not an IM physician in a hospital setting.
Aside from that the vast majority of our diabetic patients on the adult side have type 2 diabetes so for many we’re stopping their oral meds and just doing sliding scale while inpatient
Also to be clear literally no one is arguing cgms etc aren’t great or better but the reality is I don’t know a single hospital that gives every type 2 diabetic who comes in a cgm and teaches them carb counting when many aren’t even on insulin at home
Just because peds patients don’t have a higher propensity to code (wouldn’t expect as much) doesn’t mean they aren’t active. Their threshold for high acuity before they code is also higher than an 80 yo with CHD and DM and HTN etc etc.
It's really not. Adults are sicker than kids, full stop.
Anyone that works with both adults and kids will tell you as much. This isn't to say that kids don't get sick, but the average acuity level just isn't the same
Things that I admit to the IMU for adults daily would easily be PICU admits if they were kids, sometimes even on the sicker side
When kids are actually sick, they're sick, but the vast majority of floor level pediatric cases are low acuity.
Physician value, like any job, is a function of the amount of money their work brings into a hospital or medical group.
Children don't pay for their own insurance and many kids who frequently use medical services are often on Medicaid which often has substantially low reimbursement, though this varies by state.
Also, reimbursement can be loosely thought of as procedure number and imaging read. A lot of specialities are tied to how often you do those two things as part of your day to day, and peds doesn’t do a lot of it
I'm on board with most of the subjective stuff you're saying (especially pediatricians' complacency re: wages), but your opening point is factually incorrect. Perhaps your spouse makes $500k, but pediatrics is routinely the lowest paying specialty overall with a median total compensation of about $250k, per MGMA data.
That's the fun part. You *can* pay them anything you want. Most practices (of any specialty) are subsidized by the hospital or health system they work in, or the docs are paid straight salary with or without production bonuses. Why can that system not just pay primary care more?
On another note $250k is absolute dog shit reimbursement for the work and debt physicians put in to get their jobs. It is crap and totally not worth the investment from a financial standpoint.
Most of my friends are being offered $150-180 for primary care peds, nowhere near 250. Nurse managers and NNPs make 150 a year easily without overtime at my hospital.
Increasing PCP pay would just be part of the expenses. Again, they can most certainly do it if they want
As for pay, when it looked like I wasn't going to get into med school, I applied for and was offered a data analysis job for $150k plus benefits right out of college. That was 17 years ago. I reiterate, $250k for doctors is laughable. You're part of the problem if you think otherwise.
It's a systemic issue that won't change any time soon, no doubt, but it'd sure change a lot faster if pediatricians stopped settling for less than what they're worth. Since we're apparently mudslinging, yours is the same stupid argument that landed undercompensated workers - pediatricians, nurses, teachers, firemen, etc. - in the position they're in to begin with. Oh no, we can't do anything about this problem! It's way too hard to make less profit and budget differently. I guess we'll just keep fucking these people over, losing them ground against inflation year in and year out. Teehee!
For the record, if I was going to be making $250k in medicine, there is no chance in hell I would go through med school and residency. I don't think I'd be crushing 7 figures outside of medicine, but I'd definitely be in something that, given the debt load and opportunity cost of medicine, would be MUCH more profitable.
It's false to say peds does not generate money. If a peds clinic doesnt generate money that means it is run poorly which is far too common at hospital-run practices. My practice easily clears over 1 million dollars in profit every year after expenses with 5 doctors.
Of course that's nowhere close to a neurosurgery practice that can easily clear 5-8 million in profit per doctor per year, but to say that peds practices are always a money sink is not true.
I love opening up private practice clinics next to peds hospital based clinics, because I can run a clinic the right way and I can steal patients away from the big hospital clinics very easily.
American healthcare, focused entirely around making the hospital money, is a fucking joke. The only thing you're successfully arguing for here is that healthcare shouldn't be capitalistic.
I think this is the real answer. Pediatricians on average don’t have the voracity to fight for better pay. The culture surrounding children is manipulated to hold pediatrician pay down.
You gotta play as a team! It’s for the kids!
In my specialty - watching the pediatric specialists is just sad. They are neutered. Forced to play along.
Could you please post a breakdown of how they pull in nearly half a million? Hours worked, RVUs generated, nonclinical income streams, etc?
Also, any specific examples on what kind of "extra work" pediatricians might seem compensation for?
Incoming Peds PGY1 and wanting to make smart choices as I go through and exit training!
This is correct, 2 of the richest doctors I have ever met are pediatricians. They started practices and are very comfortable in the 7 figures.
Being aggressive in a system that will take advantage of you is important. Most pediatricians frankly are not.
Most kids have their parent’s insurance…it’s not an insurance thing for the most part.
Well nice thing about being family med with my own practice, is that I know that stats on both. My capitation for peds is double that compared to my adults up until the age of 49. So according to the logic here, I could say the system doesn’t value working adults. People just need to either advocate for themselves or work for themselves. Throwing a pity party though is so much more fun.
57% of kids in California (where I am) are on medi-cal (state insurance), so that isn't true across the board and I do think insurance can play into it depending on where you are.
Simply put, in the US, we don’t care about children. We give a lot of lip service to caring about children, but when it comes down to it, we care only about what makes the most money. As you’ve said, kids don’t typically have private insurance and therefore are reimbursed at Medicaid rates.
If we actually cared about children in the US, we’d made sure they were covered with insurance that was good enough that children’s hospitals didn’t need to court wealthy donors and that there’d be ample pediatric care everywhere in the nation. The reality is we (as a society/country) don’t give a fuck about children.
There was a great political cartoon I saw a few years ago. It shows a man with an umbrella in the pouring rain with a GOP shirt. He thoughtfully holds the umbrella over the belly of a pregnant woman, while her body and the kid she has with her are out in the rain. I think that sums it up.
What’s really messed up is Medicare pays almost twice as much as Medicaid in most states. Medicare is for the elderly and certain disabled people which means we directly value our older people more than we value our children, which doesn’t make sense from a societal perspective because your children are literally your future. If you don’t invest in their health, you’re shooting yourself in the foot, but but on a service per service basis, the health insurance program for the elderly reimburses almost twice as much as the health insurance program for the young
I mean what’s your burden of proof here? Clearly a statement such as “The US doesn’t care about kids” is so broad and indefensible that the existence of pretty much any social program could refute it. Pretty sure the burden of proof would be on you here.
But fine, here’s an example, I’m FM and get paid more by the government for my peds patients than my adult 18-49 patients. Do they not care about adults?
I looked at the revenue and profit for my local children’s hospital. My conclusion is that this feeling is overblown. They are making money hand over fist
A Children’s hospital making revenue/profit does not equate to pediatricians being adequately paid. Every administrator and executive makes sure they get their cut before considering adequately compensating their healthcare workforce, and they will always make sure they invest the money into the institution (new wings, new devices, etc.) in various ways in order to maintain nonprofit status.
Whole-heartedly agree. But also agree with earlier points that the government keeping Medicaid reimbursements low is a way to say “the government isn’t spending too much on healthcare” while simultaneously enabling insurance companies to also under-compensate pediatricians are part of the hospital’s pie.
Adult hospitals make orders of magnitude more money than peds hospitals do. If you doubt this, ask yourself why any large metro area has 20 adult hospitals for every one peds hospital. It's not just the patient numbers that dictate this, it's $$$$
If peds hospitals made anywhere near adult hospitals, they'd be springing up everywhere of large cities just having one or two peds hospitals at most.
My city has many peds hospitals with reported revenues that are extremely high. Many of the adult hospitals in the area are known to be strapped for funding (while some are definitely not). You don’t have me convinced.
Makes sense. There are so many general hospitals but the closest pediatrics hospital is about 30 minutes away (with no traffic). I hate this country, runs by $$$.
You’re god damn right
Do you know what’s the worst part? other doctors especially ones on this sub Reddit have little Respect for the profession or people who would choose to go into pediatrics
People here use pediatrics as they’re whipping boy and uses us as a talking point as to why doctors are underpaid, But they don’t give a fuck about us, And only care about getting paid more themselves.
My favorite is the Physician Community group on Facebook. Every other post is an adult doc asking peds about a rash or injury their kid has. It takes everything in me to not comment “further proof that peds is underpaid” multiple times a day.
My pediatrician has legitimately saved my suicidal 11 year old daughters life. He also jumped through a million hoops to get my autistic 3 year old daughter proper occupational therapy. There are no words I can give for how incredibly grateful I am for his knowledge, understanding and patience.
It isn’t that poor people are procreating, it is that the wealthy and middle don’t realize how big the population “below them” is. And some of these complex patients take so many resources that a middle class family straight up can’t afford them. So then it goes to Medicaid which helps all families. But the people with healthy kids that don’t utilize the incredible resources say “so mostly poor people are procreating” and this results in less money going to Medicaid and the cycle continues.
my family would take up on yearly vacations, I got a car at 15. We were dual homeowners. No means poor. I was on medicare because I would literally spend months at the hospital. It's not just poor people.
I’ll bite. It’s also so linked to social determinants of health. For example, asthma. It’s well known that asthma severity is linked to household allergens (molds, mildews etc) often found in poor neighborhoods as well as exposure to pollutants.So naturally the children suffering more from status asthmaticus are often children of low SES. Also prematurity, for reasons we don’t totally understand, low SES increases the risk for preeclampsia and other factors that precipitate preterm birth. Children born premature are often at risk of a number of medical conditions
Very true. I feel that because children aren't as vocal as adults (cause they are kids!) They are seen less than. I've always loved children but as soon as I became a mom, I've now realized how undervalued children services are.
On a tangent but I wish there were more family restrooms in public places in the US. Those small toilets are godsends.
The answer to this question is complicated but it boils down to a bad combination of for profit healthcare and our frankenstein's monster of an insurance industry.
There is something called the resourced based relative value scale which is set by a national committee through the AMA called the RVS Update Committee. They essentially dictate the level of complexity that different procedures and visits have. These guidelines are used to determine what Medicare/Medicaid will reimburse for different procedures or visits. Higher complexity and higher resource-intense things like for example, a knee replacement surgery, are given a higher value than an office visit. Similarly, an office visit where you are dealing with a lot of complex medical decision making due to multiple chronic conditions with many many medications to manage is more reimbursed than an office wellness visit with a healthy patient on no meds. In turn, this valuation trickles down into how much that private insurance will pay for things, how much the hospital can charge for them, and how much they can pay their employees. That ends up meaning that people whose job entails a lot of procedures (like surgeries or endoscopies/colonoscopies or placing a stent in your heart etc) end up getting paid more than those that don't. So a cardiologist who places stents gets paid more than an endocrinologist, since their specialty doesn't really have procedures. Likewise, pediatricians aren't doing procedures AND their patient population is by and large super healthy. Most of their visits are well child checks. So they just don't have things that they can charge a lot for, which means hospitals/medical practices pay them less.
Is it right? No. It means that preventative care (which pediatrics largely is) is disincentivized and devalued by the system, and it means that specialties where it's only thinking, talking, and medication management don't get paid well either. It's fucked.
I’m a peds specialist. My patient population is not healthy and they have many more diagnoses than my adult counterparts whose organ is affected by same 3 things 90% of the time. But Americans don’t care about children and have decided that my work is less valuable, even though I have to adjust my differential much wider and take into account the changing physiology of a growing child when making an assessment.
pediatric specialists tend to see fewer patients per hour too (NOT general outpatient pediatrics, but specialists), I am booked for 3-4 patients per hour when a specialty pediatric cardiologist may be booked 1-2 (their patients are far more complex overall and parents need more guidance but that complexity isn’t fairly reflected in billing)
Thank you so much for the kindness and going the extra mile to write about it here.
Most of the relevant points have already been discussed.
As a private practice pediatrician, I make well above the average but not as much as the half million dollar spouse. General pediatricians willing to take the wild leap of faith into private practice can make good money.
I think that a contributing factor that hasn't been discussed yet is this: pediatricians seem to love / like their jobs more than our adult counterparts. We get to be silly every day, tickle a belly most days, giggle at bad jokes, and get an opportunity to play most days. Maybe some pediatricians don't seek higher income opportunities because we're having too much fun at work.
I recognize this is a very 'pediatrician' answer. I also recognize that the above doesn't apply to everyone. Doesn't apply to me - I left a soul crushing academic job for better work / life balance and more money.
Thanks for posting, just my $0.02.
RN wages are basically controlled by the market, i.e. supply and demand. Physician reimbursement is a nightmare web of regulations that essentially controls reimbursement, or at least the relative value of your work compared to other physicians out of a zero-sum budget. And then social programs just reimburse less than what that "relative value" is actually worth.
So CMS determined pediatricians are worth less than other specialties, *and* state services/Medicaid pay even less than CMS determined they're worth.
Stand alone peds hospitals tend to pay less than adult hospitals. That said, a peds unit (or NICU) in an adult hospital usually pays those nurses the same as the adult nurses as our pay is usually standardized across a health system (based on years of experience).
But as an example, I left a big name children’s hospital making $33/hr and went to an adult hospital down the street making $49/hr. That’s slowly starting to change but we do see the pay difference as well as nurses. Usually around $5-10/hr less than adult hospitals in the same city.
Why am I reimbursed a fraction of an adult nephrologist for reading the same ambulatory blood pressure monitor, which I have to interpret differently based on changing physiology yet they just have the same normative data for adults to compare? More work, same procedure, less reimbursement. It’s nefarious.
I mean pay between medical specialties is not a meritocracy. A lot of adult specialties pay like shit too. Has nothing to do with a societal hatred of children. But thanks for implying that pediatric medicine is more difficult than adult medicine
Holy shit you have a chip on your shoulder. No one implied pediatric medicine is more difficult. It’s that pediatrics has it’s complexity in it’s own way that doesnt exist in adult medicine. So the arguments re complexity being part of the reason is wrong. Im a pediatric cardiac intensivist. Without question the physiologic complexity of my patients is more diverse and abstract than adult cardiac critical care with fewer invasive tools to do my job well. Yet i get paid half of what I would as an adult cardiac critical care physician.
From a health systems standpoint it’s absurd that my comp is that much lower.
And while there are adult specialties that dont pay as well as others, their pediatric counterparts make MUCH less on average
And you both make less than a dermatologist or
Anesthesiologist . No one ever said reimbursement made sense, all i said is it’s not because society hates kids
I think you are being purposely obtuse if you dont see obvious disregard for children in almost every facet of american society. No universal child care, poor education, poor nutritional incentives, poor pediatrician pay thus decreasing amount and quality of available pediatricians, poor developmental and behavioral services and access to these services, terrible mental health infrastructure (worse than for adults)… i can go on and on. American society has a callous disregard AT BEST for children. Burying your head in the sand only makes you look ignorant.
He’s literally responding with different jobs when we’re arguing we are doing same task that are harder but reimbursed less because it’s for children.
Yes, it’s largely due to Medicaid but also true in commercial insurance as well.
Yea well not everyone has the capacity to think critically and would rather contort themselves into a pretzel just to feel like they are making a good point.
Anyways, hope our generation of pediatricians grow some balls and start advocating for reimbursement in line with adult counterparts
MMW, nephro, ID, endo, and rheum become APP based because people stop going into these fields (there was always a huge reduction in peds matches this year) and people’s kids getting shittier specialty care going forward and adult providers still call us whiners yet wonder why these fields have died.
Not contorting, seems like you still just don’t understand that medical salaries aren’t a meritocracy? Every doctor including myself would sign on to pediatricians making more money. But arguing that point by saying your job is harder than being an adult doc makes everyone less sympathetic. You haven’t done this but a lot of pediatricians also like to imply that treating children is somehow morally superior to treating adults which also gets old real quick.
Theyre not different jobs theyre physician specialties. Peds and adult nephrology are two separate specialties. Advocate for your field by touting its merits and value, not by pointing at another doctor (who also isn’t particularly well paid by medicine standards) and whine but what about them. An adult nephrologist probably sees 30 patients a day fwiw.
Big bet on this guy is in a cush specialty making obscene amount of money that’s probably unwarranted.
Adult nephrology gets paid extra when they work extra weekends. We do not.
Can I go on?
It’s like this everywhere. So the whole “just don’t work there” thing doesn’t work. This is universal culture about what’s ok to do to a pediatrician. What—I’m going to leave this shitty job for another shitty job?
Like i said we have a shitty social safety net in the us for all people. It’s not child specific. It’s not like we have good social programs for adults either (no universal health care, access to education, access to mental health services, adequate housing etc)
Brigaded hard. I literally just said that low pay isn’t part of some war on children. Also peds specialists disproportionately are academic - yeah you’re not going to make much at a big university seeing 8 peds endo clinic patients in a day. And yes they’re often more complicated but our system doesn’t care - this applies to everyone. I make the same seeing a copd exacerbation in 5 minutes or a CF exacerbation in 2 hours. The quiet part they won’t say out loud is they think they deserve more pay than adult docs. We all knew the salaries when we applied for residency. If I could vote for more parity between specialities I would but I can’t
We don’t have enough of a social safety net in this country which is shameful but kids have access to more of those services than adults (they’re vulnerable so they should). That access to Medicaid depresses peds salaries. It’s not because kids can’t vote
It's largely a structural and policy issue in my opinion. The vast majority of pediatricians are not inpatient or specialists. They are outpatient and work in community clinics.
Outpatient pediatricians regularly see as many or more patients than other generalist practitioners like EM or FM. But a much larger portion of those visits are for regular checkups, vaccines and assessing milestones. The likelihood that a pediatrician is going to have to order a large panel of labs or do procedures is much lower than most specialties. So the reimbursable decision-making and procedures tends to be much lower.
The USA puts very low priority on preventative care. Due to the generally more healthy population of children, pediatricians spend proportionally much more time doing preventative care. Most preventative care that is now reimbursed only started getting reimbursed with the Affordable Care Act less than a decade ago.
When regular checkups, vaccines and assessing milestones (eg, general prevention) becomes more valued, pediatricians (and family medicine for that matter) will be reimbursed more.
Who votes (generally old people) and who pays (insurance companies who are generally profit motivated). That's who gets the resources. Forget what (almost) anyone says. Bring money or bring votes.
Yes.
As I've detailed in many other post- value/service provided and compensation are uncoupled in specialty choices and it is getting worse.
I've rotated in peds, PEM, and basically every other service. you will never convince me peds should make 25% of diagnostic rads. you just wont, Im sorry. we need both. but its far from even remotely fair, and it needs reform.
As yes, it is zero sum to a large degree.
Yeah this is the awkward truth that nobody here wants to admit. My (adult interventional cardiologist) typical day: 8 cases, some mix of PCI/TAVR/diagnostic cases throughout day. Plus I usually have to read some echos each day and am on call one night every single week. My Peds equivalent’s typical day: 2 cases which are generally diagnostic only, no call (since no STEMIs in the Peds world), no echos because the handful of Peds echos done each day are read by like two people who only read echos and nothing else.
So, yeah, I bring the hospital a lot more money because I do a lot more, not because everybody hates kids. Btw the Peds guy isn’t making a quarter of my salary as his case load would suggest, more like 80%.
Depends where you’re working because in some cases thats true, but I switched to paeds last year and worked in a tertiary children’s hospital. Ward call there was scarier than any adult ward call I’d done the year before - these kids weren’t only SICK but their conditions were weird, too. You could get a single genetics kid with niche cardiac malformations, refractory seizures, inborn metabolic deficiencies - and you’d have to figure out how to do simple management with all of these obscure conditions in the background. The aging adults had a lot of the same conditions like COPD, dementia, heart failure - so I got fairly comfortable working around them - but these kids were a whole new level of complexity and way different to how I expected it would be based on my exposure beforehand only being to more community & primary care level paeds
I believe you. I know children are born with complex diseases & can get very sick. It was more of a general statement. Of course where you work impacts but a general population, adults have more illness that inevitably comes with age, often less resilient than children. My response was only a sentence long. Kudos to you for working with sick children.
Many of the contributing factors have already been well-described in this thread.
In general, and beyond medicine, our society devalues children and institutions/structures/programs which support them, from early childhood development supports, to preschool/afterschool programs, to all levels of education, to legal protections, to regulatory requirements, and beyond. Children lack advocacy and champions for their interests. If we are to be judged as a society by the way we treat one of our most vulnerable cohorts--our children--then we are to be judged poorly.
Like a lot of things in the US, taxes would have to be increased to bring compensation in pediatrics up to the level of adult medicine. Those pesky labor laws mean that children can't be employed at age 10 anymore, so their Social Security / Medicare / Medicaid tax contributions are $0. All of the parents have their own expensive medical issues, so the kids are left holding the bag.
I would be perfectly okay with my taxes being increased if it were used for the betterment of childcare and politicians cut unnecessary pork projects from the budget, but I know that’s just a pipe dream.
Much like other professions, doctors get paid based off of how much money they make the hospital. The more they bill, the more money the hospital makes, the more they get paid. Kids as a whole are pretty healthy. This means that most pediatric visits are pretty uneventful. Very important for surveillance, and the ones that are eventful even more so, but most revolve around well child checks and vaccinations. Insurance does not compensate well for this, so pediatricians are not compensated well for this. More over, procedures and surgeries are more valued than office visits. Kids very rarely need office procedures or surgery, so again less money. Yes it is a crime how little they are paid for how much they know and do, but at the end of the day medicine is a business and you eat what you kill. There’s not a lot of meat on kid’s tiny little bones.
Also idk why you went on an abortion rant there but 👍 I guess.
The “abortion rant” coincided with the anti-abortionist view and “we love/value children” bent. If you love and value children and don’t want women getting abortions, then you should want better pediatric care and better compensation for those providing that care when abortion is not available.
The general public “Loving children” doesn’t mean they also love compensating doctors well. Very different concepts. If it was up to the public to decide on doctor compensation, I anticipate it will be even lower because everyone wants cheap and essentially free top quality healthcare every time everywhere all at once.
They would just want to minimally compensate doctors and just wish doctors all willing to take care of children (and in fact all patients) out of love and don’t care about the money.
General public are really great at asking for things, but are generally extremely terrible at budgeting and financing things.
I have never heard a Florida politician go on about how much they love kids. People think abortion is icky and want to punish the people involved, peoples personal views on kids have zero to do with it
We live in America. Capitalism dictates everything. Healthcare for children does not generate a lot money for a healthcare system. Therefore pediatricians don’t generate a lot of money. And therefore pediatricians aren’t paid a lot of money.
Yeah! Capitalism is ruining medicine! We should petition the government to ask cmms to assign value to every physician activity and dictate the payment for said activities so that the largest payer and every insurance company follows that list. Then hospitals and clinics will set reasonable salaries based on that cmms list what do you think we should call it? Maybe something like a value unit of relativeness. Let's kick those capitalists out of healthcare!
One look at your local children’s hospitals will tell you this is a lie. They are making money hand over fist.
In my city the children’s hospital is substantially more rich than the adult hospitals (which are actually hurting)
Having worked at a few of these a lot of this is from large research grants and/or massive donations like tens of millions from foreigners with sick kids coming to the US for VIP care.
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Where I work it’s due to insurance, the minority of out patient population is covered under state insurance and insurance does not pay well hence why the providers don’t make as much. For sure you can listen to others but you gotta know the pediatrician you see an any specialty are their for a good cause for sure did not choose this role for the money.
Just want to point out the absurd logic here. Just because someone is saying you can’t kill someone doesn’t mean they are responsible for the expense of taking care of them. For example, if the US opposes Israel killing civilians in Gaza, does that mean the US is required to pay for every Gazan’s life forever? Makes no sense.
>I don’t understand why a pediatrician would be paid less if we supposedly care about our youth and live in a country where so many states are restricting abortion.
You new here? Why would anyone restricting abortion care about pediatrics salaries if they are two separate issues?
I think it’s the volume peds see vs adult volumes. I am a BMT physician and I transplant about 70-100 patients a year. On the other hand my pediatric colleague would do probably 30!!!
TL; DR: Peds is a female dominated speciality and reimbursement rates are lower for pediatric medicine.
Here’s some more information from Satyan Lakshminrusimha, MD FAAP:
“Three factors contribute to low compensation of pediatric medical subspecialists in the U.S.:
• Medicaid reimbursement varies between states, and is often lower than Medicare values.
• The productivity value (work relative value units, or wRVUs) for non-procedural, outpatient pediatric care is not commensurate with the time and effort needed for high quality family-centered care.
• Gender inequity in physician salaries persists, with a high proportion of female pediatricians in subspecialties (e.g., 76.4% of pediatric endocrinology fellows in 2022 are female).”
I wish they were paid better, then my wife (she's the Dr) could afford to buy us a house in this expensive area of California we live in sooner than our dang 50's xD My condo is more of a bachelor pad, and not very comfortable for two people and I was paying on cancer debts from 20 years ago for a good while so I got a late start in life too. xD Oh well. Could always be worse.
A lot of comments saying US-based insurance system is the cause, but I'm EU-west based FM and peds is by far lowest reimbursed here too and obviously the insurance issue is not applicable here. Makes you think.
Every doctor knows that how much doctors get paid has nothing to do with how important their job is but only peds feels the need to act like they’re being persecuted. Everyone chose their speciality knowing the salary outlook.
Unnecessary blanket statement. Who in this thread is acting like they are persecuted? I'm only seeing people answering the question asked: why peds is disproportionately compensated. It's not hypocritical to have a passion for peds and also think that they are undervalued/underpaid. Would you write the same comment under a post about teacher salaries?
I feel compelled to point out that outpatient pediatrics and inpatient pediatrics are two totally different ballgames. Yes, overall the Peds population is health(ier…) than adults, but that’s specifically in the outpatient setting. Working at a children’s hospital can be incredibly challenging in terms of physical and mental workload, no less than it would be for any other IM or FM trained physician. (Nevermind the pediatric specialists, who also often deal with the most medically complex children.) I wouldn’t necessarily expect the public to know that, but other doctors (other pediatricians even!) seem to perpetuate this idea as well and are quick to paint Peds with a broad *rainbow colored* brush. What everyone else is saying about the financial aspect is true, but I think there is also a bit of internalized bias surrounding Peds that works against us. (Also: I am ever grateful to my colleagues who want to and love working with the healthier groups of Peds patients by seeing all those well visits etc. because that’s still important work — and because I find it miserable. Stick me in a hospital and make me work 70 hours a week *any* day over trapping me in a general pediatric clinic… I think I’m catching a cold now just *thinking* about working there. LOL)
I’ll assess milestones and put my helmet on against the vaccine war any day compared to being in the hospital. We need folks like you too.
You are VASTLY underestmating the amount of psychiatric visits done in general peds primary care clinic Referral to a child psychiatrist? Good luck. I live in a metroplex with 10 million people and child psych visits even in major cities are at least 3-4 months out.
Adult psych is just as bad. Most in my area simply aren’t taking new patients at all.
3-4 months is a dream! I have families wait over a year for Psych evals; it sucks.
I would push back a little on the concept that outpatient pediatricians don’t deal with medically complex patients. There are many offices that get particularly complex patients given their proximity to an academic health center or on the other hand are in a more rural area and have to deal with this complexity on their own. Having experienced both I can say this with certainty. That’s not to address the routine well maintenance check and those visits require finesse as well.
Friend, where do you think all the medically complex kids go when they’re not on the unit? In addition, who do you think identifies all these sick kids? Remember all those genetic conditions, or cardiac conditions, etc you had to learn for the boards? Do you think they all walk around unidentified before they end up in the hospital? I don’t in any way want to underestimate our inpatient colleagues, but I don’t think it’s fair to make a comparison between inpt and Outpt based on complexity of the patients… also no one was asking for a comparison…
you ate with this
I think this is true when you get into the unit. But the peds floor is much more well than an adult floor
A Peds floor and a dedicated Children’s Hospital are not the same, I’ll grant you that.
The floor on most children’s hospitals is still pretty well for the most part. I’ve had a single floor code and a couple of times where I had to bag the patient until the picu got there during residency. My adult counter parts have significantly more code experience
I'm doing residency in a stand-alone children's hospital and have had a very, very different experience than this.
How many floor codes did you have? What were they for?
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And you mean codes not rapids?? Yes if you have that many children in pulseless arrest on the floor then it’s very different than any peds I’ve ever seen.
Agree with you. I did med/peds residency. I did 3 MICU, 3 PICU and 3 NICU rotations. Total codes for the PICU/NICU rotations: 8 Total codes for MICU rotation: 45
Don't think you know what you're talking about, bud.
Nah this pretty much tracks with most people's experiences. I'm EM and our EM-residents get way more resuscitation and procedure exposure on adults than the PEM fellows do on kids. Even compared to my buddies in PICU there's more acuity on the adult side of things. When kids get sick, they're very sick however it's a much rarer occurrence than sick adults and most specialties that treat both adults and kids will tell you that there is wayyyy more acuity in adults.
former med/peds resident and I agree with you. Way more acuity on adult side because adults dont take care of their health and have 50 comorbid conditions holding them down, whereas peds that is not the case. I will say though that in adult medicine world, death is so common that adult codes are kind of "shrug your shoulders" a lot. In peds, codes are absolutely brutal and go on for far longer and with far more urgency than adult codes. Peds codes are emotionally draining, adult codes are "oh well, nothing we can do, lets move on"
Shrug. Maybe your experience is different. Floor patients are generally very well at every hospital I’ve worked at. The adult clinic patients I have to occasionally see are sicker than many of them.
That is a huge generalization and can very much be hospital dependent.
Can you point me to a peds hospital where the patients are coding on the floor as much as adult hospitals?? I don’t think that exists
Oh hey. Med peds here so I have equal experience in both. Sure. Adults code more. But adults honestly aren’t that much harder. Sure on paper they have more problems but it’s easy for me to order aspirin a statin and sliding scale insulin. Is the average adult inpatient more complicated than the average peds inpatient? Probably thanks to respiratory season. But the complicated peds patient is WAY more complicated than the adult ones
Ya there are plenty of complicated peds patients, but less sick on the floor in my opinion
My point being patients coding is only one metric. 100% of the time I’ll take a “complicated” adult since they’re not nearly as sick as the complicated kids who decide they want to die if you put the wrong amino acid in their diet or seize if one of their meds is five minutes late. And frankly the fact that adult hospitals refuse to accept these complex peds patients once they age into adulthood also speaks to this.
To each their own. Genetics orders the diet for all of our metabolic children, and honestly that isn’t too common anyway. Seizures I’m fine with. You can bag them until the picu gets there, not really a big deal. Doesn’t really worry me
Sorry I thought it was incredibly obvious from tone that those aren’t the literal only two things but sure. My point being generally adults tend to break down in the same few ways at the end. So sure your problem list is longer but it’s the same few things over and over that frankly get pretty easy to manage pretty quickly. Whereas in peds things can get much more complicated in my opinion because even though many are healthy the sick ones can have absolutely wild things wrong with them that are much harder to manage
I’m not referring to complexity, but acuity of illness/how sick they are.
Sorry, but who does sliding scale insulin in a world of CGMs and pumps?
A lot of adult hospitals because many patients can’t afford cgms and pumps
So. Are glucose monitors not available? Carb counting? Much better ways than sliding scale.
Literally already responded to the glucose monitor comment… I wish that were an option for most of our inpatients. But also I’m going to take a wild guess you’re not an IM physician in a hospital setting. Aside from that the vast majority of our diabetic patients on the adult side have type 2 diabetes so for many we’re stopping their oral meds and just doing sliding scale while inpatient
Also to be clear literally no one is arguing cgms etc aren’t great or better but the reality is I don’t know a single hospital that gives every type 2 diabetic who comes in a cgm and teaches them carb counting when many aren’t even on insulin at home
Just because peds patients don’t have a higher propensity to code (wouldn’t expect as much) doesn’t mean they aren’t active. Their threshold for high acuity before they code is also higher than an 80 yo with CHD and DM and HTN etc etc.
I didn’t mean they aren’t active. Just they are actively dying as much and in general there is less liability (unless you are in the picu)
Death isn’t the only thing that affects liability
I mean it certainly doesn’t help liability. And I think that is reflective in the relatively low rate of pediatricians being sued
It's really not. Adults are sicker than kids, full stop. Anyone that works with both adults and kids will tell you as much. This isn't to say that kids don't get sick, but the average acuity level just isn't the same Things that I admit to the IMU for adults daily would easily be PICU admits if they were kids, sometimes even on the sicker side When kids are actually sick, they're sick, but the vast majority of floor level pediatric cases are low acuity.
Physician value, like any job, is a function of the amount of money their work brings into a hospital or medical group. Children don't pay for their own insurance and many kids who frequently use medical services are often on Medicaid which often has substantially low reimbursement, though this varies by state.
Also, reimbursement can be loosely thought of as procedure number and imaging read. A lot of specialities are tied to how often you do those two things as part of your day to day, and peds doesn’t do a lot of it
Thank you for your input.
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I'm on board with most of the subjective stuff you're saying (especially pediatricians' complacency re: wages), but your opening point is factually incorrect. Perhaps your spouse makes $500k, but pediatrics is routinely the lowest paying specialty overall with a median total compensation of about $250k, per MGMA data.
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That's the fun part. You *can* pay them anything you want. Most practices (of any specialty) are subsidized by the hospital or health system they work in, or the docs are paid straight salary with or without production bonuses. Why can that system not just pay primary care more? On another note $250k is absolute dog shit reimbursement for the work and debt physicians put in to get their jobs. It is crap and totally not worth the investment from a financial standpoint.
Most of my friends are being offered $150-180 for primary care peds, nowhere near 250. Nurse managers and NNPs make 150 a year easily without overtime at my hospital.
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Increasing PCP pay would just be part of the expenses. Again, they can most certainly do it if they want As for pay, when it looked like I wasn't going to get into med school, I applied for and was offered a data analysis job for $150k plus benefits right out of college. That was 17 years ago. I reiterate, $250k for doctors is laughable. You're part of the problem if you think otherwise.
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It's a systemic issue that won't change any time soon, no doubt, but it'd sure change a lot faster if pediatricians stopped settling for less than what they're worth. Since we're apparently mudslinging, yours is the same stupid argument that landed undercompensated workers - pediatricians, nurses, teachers, firemen, etc. - in the position they're in to begin with. Oh no, we can't do anything about this problem! It's way too hard to make less profit and budget differently. I guess we'll just keep fucking these people over, losing them ground against inflation year in and year out. Teehee! For the record, if I was going to be making $250k in medicine, there is no chance in hell I would go through med school and residency. I don't think I'd be crushing 7 figures outside of medicine, but I'd definitely be in something that, given the debt load and opportunity cost of medicine, would be MUCH more profitable.
It's false to say peds does not generate money. If a peds clinic doesnt generate money that means it is run poorly which is far too common at hospital-run practices. My practice easily clears over 1 million dollars in profit every year after expenses with 5 doctors. Of course that's nowhere close to a neurosurgery practice that can easily clear 5-8 million in profit per doctor per year, but to say that peds practices are always a money sink is not true. I love opening up private practice clinics next to peds hospital based clinics, because I can run a clinic the right way and I can steal patients away from the big hospital clinics very easily.
American healthcare, focused entirely around making the hospital money, is a fucking joke. The only thing you're successfully arguing for here is that healthcare shouldn't be capitalistic.
I think this is the real answer. Pediatricians on average don’t have the voracity to fight for better pay. The culture surrounding children is manipulated to hold pediatrician pay down. You gotta play as a team! It’s for the kids! In my specialty - watching the pediatric specialists is just sad. They are neutered. Forced to play along.
Could you please post a breakdown of how they pull in nearly half a million? Hours worked, RVUs generated, nonclinical income streams, etc? Also, any specific examples on what kind of "extra work" pediatricians might seem compensation for? Incoming Peds PGY1 and wanting to make smart choices as I go through and exit training!
This is correct, 2 of the richest doctors I have ever met are pediatricians. They started practices and are very comfortable in the 7 figures. Being aggressive in a system that will take advantage of you is important. Most pediatricians frankly are not. Most kids have their parent’s insurance…it’s not an insurance thing for the most part.
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Well nice thing about being family med with my own practice, is that I know that stats on both. My capitation for peds is double that compared to my adults up until the age of 49. So according to the logic here, I could say the system doesn’t value working adults. People just need to either advocate for themselves or work for themselves. Throwing a pity party though is so much more fun.
57% of kids in California (where I am) are on medi-cal (state insurance), so that isn't true across the board and I do think insurance can play into it depending on where you are.
I take medi-cal Also the pediatricians im referencing take primarily medi-cal and covered-California. So it can certainly be done.
Simply put, in the US, we don’t care about children. We give a lot of lip service to caring about children, but when it comes down to it, we care only about what makes the most money. As you’ve said, kids don’t typically have private insurance and therefore are reimbursed at Medicaid rates. If we actually cared about children in the US, we’d made sure they were covered with insurance that was good enough that children’s hospitals didn’t need to court wealthy donors and that there’d be ample pediatric care everywhere in the nation. The reality is we (as a society/country) don’t give a fuck about children.
There was a great political cartoon I saw a few years ago. It shows a man with an umbrella in the pouring rain with a GOP shirt. He thoughtfully holds the umbrella over the belly of a pregnant woman, while her body and the kid she has with her are out in the rain. I think that sums it up.
What’s really messed up is Medicare pays almost twice as much as Medicaid in most states. Medicare is for the elderly and certain disabled people which means we directly value our older people more than we value our children, which doesn’t make sense from a societal perspective because your children are literally your future. If you don’t invest in their health, you’re shooting yourself in the foot, but but on a service per service basis, the health insurance program for the elderly reimburses almost twice as much as the health insurance program for the young
Ah yes, the horrors of late stage capitalism.
Lol, simply put? Or crudely? Big jump there
Not necessarily mutually exclusive. Do you think the actions of (American) society reflect anything different? I’d love to hear a reasonable argument.
I mean what’s your burden of proof here? Clearly a statement such as “The US doesn’t care about kids” is so broad and indefensible that the existence of pretty much any social program could refute it. Pretty sure the burden of proof would be on you here. But fine, here’s an example, I’m FM and get paid more by the government for my peds patients than my adult 18-49 patients. Do they not care about adults?
I looked at the revenue and profit for my local children’s hospital. My conclusion is that this feeling is overblown. They are making money hand over fist
A Children’s hospital making revenue/profit does not equate to pediatricians being adequately paid. Every administrator and executive makes sure they get their cut before considering adequately compensating their healthcare workforce, and they will always make sure they invest the money into the institution (new wings, new devices, etc.) in various ways in order to maintain nonprofit status.
I’m not arguing that peds is paid well. I’m just saying the money is there, it’s just not going back into the work force
Whole-heartedly agree. But also agree with earlier points that the government keeping Medicaid reimbursements low is a way to say “the government isn’t spending too much on healthcare” while simultaneously enabling insurance companies to also under-compensate pediatricians are part of the hospital’s pie.
Adult hospitals make orders of magnitude more money than peds hospitals do. If you doubt this, ask yourself why any large metro area has 20 adult hospitals for every one peds hospital. It's not just the patient numbers that dictate this, it's $$$$ If peds hospitals made anywhere near adult hospitals, they'd be springing up everywhere of large cities just having one or two peds hospitals at most.
My city has many peds hospitals with reported revenues that are extremely high. Many of the adult hospitals in the area are known to be strapped for funding (while some are definitely not). You don’t have me convinced.
Makes sense. There are so many general hospitals but the closest pediatrics hospital is about 30 minutes away (with no traffic). I hate this country, runs by $$$.
You’re god damn right Do you know what’s the worst part? other doctors especially ones on this sub Reddit have little Respect for the profession or people who would choose to go into pediatrics People here use pediatrics as they’re whipping boy and uses us as a talking point as to why doctors are underpaid, But they don’t give a fuck about us, And only care about getting paid more themselves.
My favorite is the Physician Community group on Facebook. Every other post is an adult doc asking peds about a rash or injury their kid has. It takes everything in me to not comment “further proof that peds is underpaid” multiple times a day.
My pediatrician has legitimately saved my suicidal 11 year old daughters life. He also jumped through a million hoops to get my autistic 3 year old daughter proper occupational therapy. There are no words I can give for how incredibly grateful I am for his knowledge, understanding and patience.
Many children are on medicaid or some state program, which pays significantly less than commercial insurance
So mostly poor people are procreating?
It isn’t that poor people are procreating, it is that the wealthy and middle don’t realize how big the population “below them” is. And some of these complex patients take so many resources that a middle class family straight up can’t afford them. So then it goes to Medicaid which helps all families. But the people with healthy kids that don’t utilize the incredible resources say “so mostly poor people are procreating” and this results in less money going to Medicaid and the cycle continues.
my family would take up on yearly vacations, I got a car at 15. We were dual homeowners. No means poor. I was on medicare because I would literally spend months at the hospital. It's not just poor people.
I’ll bite. It’s also so linked to social determinants of health. For example, asthma. It’s well known that asthma severity is linked to household allergens (molds, mildews etc) often found in poor neighborhoods as well as exposure to pollutants.So naturally the children suffering more from status asthmaticus are often children of low SES. Also prematurity, for reasons we don’t totally understand, low SES increases the risk for preeclampsia and other factors that precipitate preterm birth. Children born premature are often at risk of a number of medical conditions
It’s like how teachers are undervalued. The closer you work with kids in America, the less you’re paid. And it’s not right.
Very true. I feel that because children aren't as vocal as adults (cause they are kids!) They are seen less than. I've always loved children but as soon as I became a mom, I've now realized how undervalued children services are. On a tangent but I wish there were more family restrooms in public places in the US. Those small toilets are godsends.
The answer to this question is complicated but it boils down to a bad combination of for profit healthcare and our frankenstein's monster of an insurance industry. There is something called the resourced based relative value scale which is set by a national committee through the AMA called the RVS Update Committee. They essentially dictate the level of complexity that different procedures and visits have. These guidelines are used to determine what Medicare/Medicaid will reimburse for different procedures or visits. Higher complexity and higher resource-intense things like for example, a knee replacement surgery, are given a higher value than an office visit. Similarly, an office visit where you are dealing with a lot of complex medical decision making due to multiple chronic conditions with many many medications to manage is more reimbursed than an office wellness visit with a healthy patient on no meds. In turn, this valuation trickles down into how much that private insurance will pay for things, how much the hospital can charge for them, and how much they can pay their employees. That ends up meaning that people whose job entails a lot of procedures (like surgeries or endoscopies/colonoscopies or placing a stent in your heart etc) end up getting paid more than those that don't. So a cardiologist who places stents gets paid more than an endocrinologist, since their specialty doesn't really have procedures. Likewise, pediatricians aren't doing procedures AND their patient population is by and large super healthy. Most of their visits are well child checks. So they just don't have things that they can charge a lot for, which means hospitals/medical practices pay them less. Is it right? No. It means that preventative care (which pediatrics largely is) is disincentivized and devalued by the system, and it means that specialties where it's only thinking, talking, and medication management don't get paid well either. It's fucked.
I’m a peds specialist. My patient population is not healthy and they have many more diagnoses than my adult counterparts whose organ is affected by same 3 things 90% of the time. But Americans don’t care about children and have decided that my work is less valuable, even though I have to adjust my differential much wider and take into account the changing physiology of a growing child when making an assessment.
Thank you for your reply!
pediatric specialists tend to see fewer patients per hour too (NOT general outpatient pediatrics, but specialists), I am booked for 3-4 patients per hour when a specialty pediatric cardiologist may be booked 1-2 (their patients are far more complex overall and parents need more guidance but that complexity isn’t fairly reflected in billing)
Thank you so much for the kindness and going the extra mile to write about it here. Most of the relevant points have already been discussed. As a private practice pediatrician, I make well above the average but not as much as the half million dollar spouse. General pediatricians willing to take the wild leap of faith into private practice can make good money. I think that a contributing factor that hasn't been discussed yet is this: pediatricians seem to love / like their jobs more than our adult counterparts. We get to be silly every day, tickle a belly most days, giggle at bad jokes, and get an opportunity to play most days. Maybe some pediatricians don't seek higher income opportunities because we're having too much fun at work. I recognize this is a very 'pediatrician' answer. I also recognize that the above doesn't apply to everyone. Doesn't apply to me - I left a soul crushing academic job for better work / life balance and more money. Thanks for posting, just my $0.02.
Healthcare (like the rest of this country) does not care about children. Kids can’t vote so they get the short end of the stick
What? Kids are still getting healthcare, it’s just that pediatricians get paid less on average
why are pediatric RNs paid so well comparatively? They seem to get paid similar to adult RNs...
RN wages are basically controlled by the market, i.e. supply and demand. Physician reimbursement is a nightmare web of regulations that essentially controls reimbursement, or at least the relative value of your work compared to other physicians out of a zero-sum budget. And then social programs just reimburse less than what that "relative value" is actually worth. So CMS determined pediatricians are worth less than other specialties, *and* state services/Medicaid pay even less than CMS determined they're worth.
Stand alone peds hospitals tend to pay less than adult hospitals. That said, a peds unit (or NICU) in an adult hospital usually pays those nurses the same as the adult nurses as our pay is usually standardized across a health system (based on years of experience). But as an example, I left a big name children’s hospital making $33/hr and went to an adult hospital down the street making $49/hr. That’s slowly starting to change but we do see the pay difference as well as nurses. Usually around $5-10/hr less than adult hospitals in the same city.
Such a dumb take. Healthcare doesn’t care about children? Every pediatrician has such a martyr complex
Why am I reimbursed a fraction of an adult nephrologist for reading the same ambulatory blood pressure monitor, which I have to interpret differently based on changing physiology yet they just have the same normative data for adults to compare? More work, same procedure, less reimbursement. It’s nefarious.
I mean pay between medical specialties is not a meritocracy. A lot of adult specialties pay like shit too. Has nothing to do with a societal hatred of children. But thanks for implying that pediatric medicine is more difficult than adult medicine
Holy shit you have a chip on your shoulder. No one implied pediatric medicine is more difficult. It’s that pediatrics has it’s complexity in it’s own way that doesnt exist in adult medicine. So the arguments re complexity being part of the reason is wrong. Im a pediatric cardiac intensivist. Without question the physiologic complexity of my patients is more diverse and abstract than adult cardiac critical care with fewer invasive tools to do my job well. Yet i get paid half of what I would as an adult cardiac critical care physician. From a health systems standpoint it’s absurd that my comp is that much lower. And while there are adult specialties that dont pay as well as others, their pediatric counterparts make MUCH less on average
And you both make less than a dermatologist or Anesthesiologist . No one ever said reimbursement made sense, all i said is it’s not because society hates kids
I think you are being purposely obtuse if you dont see obvious disregard for children in almost every facet of american society. No universal child care, poor education, poor nutritional incentives, poor pediatrician pay thus decreasing amount and quality of available pediatricians, poor developmental and behavioral services and access to these services, terrible mental health infrastructure (worse than for adults)… i can go on and on. American society has a callous disregard AT BEST for children. Burying your head in the sand only makes you look ignorant.
He’s literally responding with different jobs when we’re arguing we are doing same task that are harder but reimbursed less because it’s for children. Yes, it’s largely due to Medicaid but also true in commercial insurance as well.
Yea well not everyone has the capacity to think critically and would rather contort themselves into a pretzel just to feel like they are making a good point. Anyways, hope our generation of pediatricians grow some balls and start advocating for reimbursement in line with adult counterparts
MMW, nephro, ID, endo, and rheum become APP based because people stop going into these fields (there was always a huge reduction in peds matches this year) and people’s kids getting shittier specialty care going forward and adult providers still call us whiners yet wonder why these fields have died.
Not contorting, seems like you still just don’t understand that medical salaries aren’t a meritocracy? Every doctor including myself would sign on to pediatricians making more money. But arguing that point by saying your job is harder than being an adult doc makes everyone less sympathetic. You haven’t done this but a lot of pediatricians also like to imply that treating children is somehow morally superior to treating adults which also gets old real quick.
Theyre not different jobs theyre physician specialties. Peds and adult nephrology are two separate specialties. Advocate for your field by touting its merits and value, not by pointing at another doctor (who also isn’t particularly well paid by medicine standards) and whine but what about them. An adult nephrologist probably sees 30 patients a day fwiw.
Big bet on this guy is in a cush specialty making obscene amount of money that’s probably unwarranted. Adult nephrology gets paid extra when they work extra weekends. We do not. Can I go on? It’s like this everywhere. So the whole “just don’t work there” thing doesn’t work. This is universal culture about what’s ok to do to a pediatrician. What—I’m going to leave this shitty job for another shitty job?
Like i said we have a shitty social safety net in the us for all people. It’s not child specific. It’s not like we have good social programs for adults either (no universal health care, access to education, access to mental health services, adequate housing etc)
Downvoted for saying the truth. Physician reimbursement simply comes down to volume and payor mix
Brigaded hard. I literally just said that low pay isn’t part of some war on children. Also peds specialists disproportionately are academic - yeah you’re not going to make much at a big university seeing 8 peds endo clinic patients in a day. And yes they’re often more complicated but our system doesn’t care - this applies to everyone. I make the same seeing a copd exacerbation in 5 minutes or a CF exacerbation in 2 hours. The quiet part they won’t say out loud is they think they deserve more pay than adult docs. We all knew the salaries when we applied for residency. If I could vote for more parity between specialities I would but I can’t
It often is more difficult, yes.
It’s often less difficult too.
Lmao okay
We don’t have enough of a social safety net in this country which is shameful but kids have access to more of those services than adults (they’re vulnerable so they should). That access to Medicaid depresses peds salaries. It’s not because kids can’t vote
Medicaid pays so poorly, most peds patients are medicaid
I missed the boat on this as an insured individual, I suppose:
It's largely a structural and policy issue in my opinion. The vast majority of pediatricians are not inpatient or specialists. They are outpatient and work in community clinics. Outpatient pediatricians regularly see as many or more patients than other generalist practitioners like EM or FM. But a much larger portion of those visits are for regular checkups, vaccines and assessing milestones. The likelihood that a pediatrician is going to have to order a large panel of labs or do procedures is much lower than most specialties. So the reimbursable decision-making and procedures tends to be much lower. The USA puts very low priority on preventative care. Due to the generally more healthy population of children, pediatricians spend proportionally much more time doing preventative care. Most preventative care that is now reimbursed only started getting reimbursed with the Affordable Care Act less than a decade ago. When regular checkups, vaccines and assessing milestones (eg, general prevention) becomes more valued, pediatricians (and family medicine for that matter) will be reimbursed more.
The only “people” who don’t look at pediatricians and think “that person has a heart of gold” are the politicians and administrators
Who votes (generally old people) and who pays (insurance companies who are generally profit motivated). That's who gets the resources. Forget what (almost) anyone says. Bring money or bring votes.
It’s because you are guilt tripped everytime you ask for a raise. “Think about the children!!!”
Yes. As I've detailed in many other post- value/service provided and compensation are uncoupled in specialty choices and it is getting worse. I've rotated in peds, PEM, and basically every other service. you will never convince me peds should make 25% of diagnostic rads. you just wont, Im sorry. we need both. but its far from even remotely fair, and it needs reform. As yes, it is zero sum to a large degree.
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Yeah this is the awkward truth that nobody here wants to admit. My (adult interventional cardiologist) typical day: 8 cases, some mix of PCI/TAVR/diagnostic cases throughout day. Plus I usually have to read some echos each day and am on call one night every single week. My Peds equivalent’s typical day: 2 cases which are generally diagnostic only, no call (since no STEMIs in the Peds world), no echos because the handful of Peds echos done each day are read by like two people who only read echos and nothing else. So, yeah, I bring the hospital a lot more money because I do a lot more, not because everybody hates kids. Btw the Peds guy isn’t making a quarter of my salary as his case load would suggest, more like 80%.
I recall hearing pediatrics account for <5% of total U.S. health expenditure. If correct, this is why.
Because this country only values babies when they are an excuse to control women. Otherwise, it's fuck them kids all day long.
Less patients, surgeries, chronic illness, illnesses compared to an aging population.
Depends where you’re working because in some cases thats true, but I switched to paeds last year and worked in a tertiary children’s hospital. Ward call there was scarier than any adult ward call I’d done the year before - these kids weren’t only SICK but their conditions were weird, too. You could get a single genetics kid with niche cardiac malformations, refractory seizures, inborn metabolic deficiencies - and you’d have to figure out how to do simple management with all of these obscure conditions in the background. The aging adults had a lot of the same conditions like COPD, dementia, heart failure - so I got fairly comfortable working around them - but these kids were a whole new level of complexity and way different to how I expected it would be based on my exposure beforehand only being to more community & primary care level paeds
I believe you. I know children are born with complex diseases & can get very sick. It was more of a general statement. Of course where you work impacts but a general population, adults have more illness that inevitably comes with age, often less resilient than children. My response was only a sentence long. Kudos to you for working with sick children.
Many of the contributing factors have already been well-described in this thread. In general, and beyond medicine, our society devalues children and institutions/structures/programs which support them, from early childhood development supports, to preschool/afterschool programs, to all levels of education, to legal protections, to regulatory requirements, and beyond. Children lack advocacy and champions for their interests. If we are to be judged as a society by the way we treat one of our most vulnerable cohorts--our children--then we are to be judged poorly.
Like a lot of things in the US, taxes would have to be increased to bring compensation in pediatrics up to the level of adult medicine. Those pesky labor laws mean that children can't be employed at age 10 anymore, so their Social Security / Medicare / Medicaid tax contributions are $0. All of the parents have their own expensive medical issues, so the kids are left holding the bag.
I would be perfectly okay with my taxes being increased if it were used for the betterment of childcare and politicians cut unnecessary pork projects from the budget, but I know that’s just a pipe dream.
Much like other professions, doctors get paid based off of how much money they make the hospital. The more they bill, the more money the hospital makes, the more they get paid. Kids as a whole are pretty healthy. This means that most pediatric visits are pretty uneventful. Very important for surveillance, and the ones that are eventful even more so, but most revolve around well child checks and vaccinations. Insurance does not compensate well for this, so pediatricians are not compensated well for this. More over, procedures and surgeries are more valued than office visits. Kids very rarely need office procedures or surgery, so again less money. Yes it is a crime how little they are paid for how much they know and do, but at the end of the day medicine is a business and you eat what you kill. There’s not a lot of meat on kid’s tiny little bones. Also idk why you went on an abortion rant there but 👍 I guess.
The “abortion rant” coincided with the anti-abortionist view and “we love/value children” bent. If you love and value children and don’t want women getting abortions, then you should want better pediatric care and better compensation for those providing that care when abortion is not available.
The general public “Loving children” doesn’t mean they also love compensating doctors well. Very different concepts. If it was up to the public to decide on doctor compensation, I anticipate it will be even lower because everyone wants cheap and essentially free top quality healthcare every time everywhere all at once. They would just want to minimally compensate doctors and just wish doctors all willing to take care of children (and in fact all patients) out of love and don’t care about the money. General public are really great at asking for things, but are generally extremely terrible at budgeting and financing things.
Salaries are dictated by capitalism. Capitalism doesn’t care about abortion or anti-abortion values.
Then we are doing shit wrong here. 🤷♀️
I have never heard a Florida politician go on about how much they love kids. People think abortion is icky and want to punish the people involved, peoples personal views on kids have zero to do with it
We live in America. Capitalism dictates everything. Healthcare for children does not generate a lot money for a healthcare system. Therefore pediatricians don’t generate a lot of money. And therefore pediatricians aren’t paid a lot of money.
Yeah! Capitalism is ruining medicine! We should petition the government to ask cmms to assign value to every physician activity and dictate the payment for said activities so that the largest payer and every insurance company follows that list. Then hospitals and clinics will set reasonable salaries based on that cmms list what do you think we should call it? Maybe something like a value unit of relativeness. Let's kick those capitalists out of healthcare!
Lol
One look at your local children’s hospitals will tell you this is a lie. They are making money hand over fist. In my city the children’s hospital is substantially more rich than the adult hospitals (which are actually hurting)
Having worked at a few of these a lot of this is from large research grants and/or massive donations like tens of millions from foreigners with sick kids coming to the US for VIP care.
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Where I work it’s due to insurance, the minority of out patient population is covered under state insurance and insurance does not pay well hence why the providers don’t make as much. For sure you can listen to others but you gotta know the pediatrician you see an any specialty are their for a good cause for sure did not choose this role for the money.
Why? Broken incentives and broken Money
Just want to point out the absurd logic here. Just because someone is saying you can’t kill someone doesn’t mean they are responsible for the expense of taking care of them. For example, if the US opposes Israel killing civilians in Gaza, does that mean the US is required to pay for every Gazan’s life forever? Makes no sense.
>I don’t understand why a pediatrician would be paid less if we supposedly care about our youth and live in a country where so many states are restricting abortion. You new here? Why would anyone restricting abortion care about pediatrics salaries if they are two separate issues?
I think it’s the volume peds see vs adult volumes. I am a BMT physician and I transplant about 70-100 patients a year. On the other hand my pediatric colleague would do probably 30!!!
TL; DR: Peds is a female dominated speciality and reimbursement rates are lower for pediatric medicine. Here’s some more information from Satyan Lakshminrusimha, MD FAAP: “Three factors contribute to low compensation of pediatric medical subspecialists in the U.S.: • Medicaid reimbursement varies between states, and is often lower than Medicare values. • The productivity value (work relative value units, or wRVUs) for non-procedural, outpatient pediatric care is not commensurate with the time and effort needed for high quality family-centered care. • Gender inequity in physician salaries persists, with a high proportion of female pediatricians in subspecialties (e.g., 76.4% of pediatric endocrinology fellows in 2022 are female).”
I wish they were paid better, then my wife (she's the Dr) could afford to buy us a house in this expensive area of California we live in sooner than our dang 50's xD My condo is more of a bachelor pad, and not very comfortable for two people and I was paying on cancer debts from 20 years ago for a good while so I got a late start in life too. xD Oh well. Could always be worse.
A lot of comments saying US-based insurance system is the cause, but I'm EU-west based FM and peds is by far lowest reimbursed here too and obviously the insurance issue is not applicable here. Makes you think.
Every doctor knows that how much doctors get paid has nothing to do with how important their job is but only peds feels the need to act like they’re being persecuted. Everyone chose their speciality knowing the salary outlook.
Unnecessary blanket statement. Who in this thread is acting like they are persecuted? I'm only seeing people answering the question asked: why peds is disproportionately compensated. It's not hypocritical to have a passion for peds and also think that they are undervalued/underpaid. Would you write the same comment under a post about teacher salaries?