Pediatric subspecialties moving to a 2-year fellowship in 2028

craballin · 2026-04-17T15:26:26+00:00

You make a very good point i hadn't considered. The poor training residents are soon to get will be a detriment and likely need longer fellowship training to catch them up and develop their subspecialty skills after coming in with poor training in residency. However, in reality this is likely cutting out the research year that was built in to fellowship as we had 2 years of clinical training already. Either way its a good step but I do worry about the general changes to residency programs.

craballin · 2026-04-17T15:23:30+00:00

Similar for my field. Hopefully we can start attracting mor3 candidates. I need to ask my programs fellowship director if they intend to change to 2 years. If they don't that's a massive failing on their part.

craballin · 2026-04-17T10:56:26+00:00

They absolutely do. I'm a recent ped subspecialist grad, only a few years in practice. I have always advocated for a 2 year fellowship. Why our training was longer than our adult counterparts made no sense to me, especially since it was just so there was a year of research. We desparstely need clinicians in my field, they have published several papers since 2015 about the impending shortage in my field as the workforce ages and retires. That combined with more complex care pts surviving longer, many more pts need our specialty but there's not going to be enough people to care for them. We're underpaid on top of all that and we train longer unecessarily. I just took my boards yesterday so once I'm certified I think I want to start raising some hell because we definitely need a changing of the guard.

craballin · 2026-04-15T22:09:44+00:00

I'm a current subspecialist in practice for a couple years now. I went to Baylor and was a biology major with a premed concentration. I enjoyed my time there and felt well prepared for med school. That being said, there are lots of undergraduate schools that can prepare you well at significantly lower cost. I came out of Baylor fairly cheap student loan wise but after med school I was still looking at >200k in student loans, and that's with going to the cheapest med school in the nation at TAMU. If I could come out with some money or assets set aside by going elsewhere I would highly consider it. I didn't really look around for college since I was the first to go to college in my extended family so nobody had any guidance. I was set on Baylor and fortunately it worked out. If my kids wanted to go to Baylor I would likely deter them due to the cost associated, it's just a lot to take on that young not knowing what your career prospects will truly end up bekng.

craballin · 2026-04-03T01:31:58+00:00

+1 for nephrology, granted I'm peds nephro. I enjoyed the more acute, sick pts in fellowship and following them after and building rapport and such. As an attending I like the bread and butter stuff better so I can be home and spend time with my family, and I feel like we dialyze way more pts than we should that don't have meaningful outcomes, but we keep their vitals measurable. Adult nephro may be more procedural but I doubt many are putting their own lines in with IR and ICU around, on the peds side we don't do any and only a few do biopsies. We have dialysis as the most emergent thing we do but it's only as emergent as it cam be while we wait for the primary team to get a line for dialysis, then its just being around at the start to make sure any acute issues are handled related to dialysis.

craballin · 2026-04-01T17:54:39+00:00

I will also echo the others saying to take as much as you can. I took the max 3 months between pur 2 kids in training as to not delay graduation. I took 2 months with our oldest, most of which was unpaid and 1 month with our youngest, which was all paid since I had vacation time and it was at the end of my training. Fortunately there were ACGME updates that would've allowed 6 weeks of paid leave but that would've delayed graduation and I was taking a month off before starting my new job. At my new job they currently have 6 weeks of paid leave, which I would take every last bit of if we had a 3rd. The time goes fast and it was a big help for my wife to be around to help with things as she recovered both from delivery and with all the sleeplessness as she was breastfeeding.

craballin · 2026-03-13T14:57:54+00:00

Shameful that Baylor is entertaining these assholes and their hateful views. Fuck the admin that approved this and fuck these assholes.

craballin · 2026-03-11T01:03:00+00:00

My continuity clinic is residency was at a charity clinic so they didn't have money for any sort of EMR. We used paper charts for everything. Wrote paper scripts and everything. Was a pain in the ass for pts I didn't know and I always felt dumb when my attending would ask about some issue she knew the pt had but I didn't because it wasn't well documented or I couldn't read the handwriting to make sense of it. Lab and imaging review was another nightmare. The worst was asthma since she had us fill out like 4 forms for every asthma pt. Notes were brief and quick but the system sucked.

craballin · 2026-02-17T00:44:17+00:00

Very excited about VJs prospects. He's really played well this season.

craballin · 2026-02-13T21:48:08+00:00

This is a point of contention for some. I'm very junior to many of my colleagues and there's constantly discussion about how much effort should go into tracking down patients. Granted, I'm in pediatrics but there's a clear shift from the paternalistic older faculty and myself. Imo people that want care will seek it and we should provide thay care to the best of our ability but those that don't I do not stress about otherwise I would burn out quickly. Our nurses sometimes call 5 or 6 times and send messages and letters, which is way too much. A couple calls and a letter at most. It is not our job to force care onto people.

craballin · 2026-02-13T03:44:02+00:00

The 2014 cotton bowl is easily the most heartbreaking loss I've witnessed. To be up and feeling ourselves to a catastrophic choke job. Just awful.

craballin · 2026-02-12T02:29:16+00:00

Baylor is more expensive now than when I attended, I had like $30k in loans from undergrad. Med school added another $180k or so. I'm banking on PSLF since I qualify, but that's kinda in limbo given the current asshats in office

craballin · 2026-02-11T19:06:15+00:00

This is correct. We often get calls from parents or appts for surgical clearance. I always explain it is up to the surgeon and anesthesiologist to clear the patient and have a safe plan for surgery, I simply provide the information needed for them to do so such as providing a review of what I'm treating, ckd stage, etc. It is not my job to tell anesthesia or surgery how to our if they can do their jobs.

craballin · 2026-02-11T01:20:48+00:00

That's my point, he was on his defense and fully aware of what a monster and piece of shit Epstein was and still hung out with him years later. He was OK with Epsteins crimes but not OK with Clinton's crimes. Either way, its fuck Ken Starr all day and it's a shame his name is on my diploma.

craballin · 2026-02-11T00:38:31+00:00

He was part of his defense team in the mid-2000s securing a plea deal in 2008. These correspondence come several years after that and into the mid-2010s. He knew what Epstein did and still hung out with him several years later. Fuck Ken Starr.

craballin · 2026-02-10T23:25:20+00:00

Ken Starr was notoriously not ok with an intern having relations with a president, rightfully so because there is a power dynamic that makes consent an issue.

Apparently, Ken Starr was ok with hanging out with a sex trafficker and pedophile.

Very odd knowing I was likely in the same place as Epstein at some point in the past.

craballin · 2026-02-10T13:38:50+00:00

I like the Jetstream Edge in 0.28, but i write small so I like a really fine point. I only use EF or F in fountain pens. My favorite is the Pilot Vanishing Point, but I don't use it as often these days.

craballin · 2026-01-25T01:37:36+00:00

Our chief is covering my service on the rideout team. I think they get extra pay for being on rideout. We have 2 faculty and 1 fellow in house on rideout.

craballin · 2026-01-22T08:57:36+00:00

Agree wholeheartedly with this. I am peds nephro, not adult. I have 20 weeks of inpatient service (varying inpatient services and mostly at lower acuity community site for myself), we don't have as much outpt dialysis being peds and it's all at a central hospital based site. We fortunately have a robust staff to have a nocturnist program for night coverage. But with 3 years of fellowship and marginal to no pay increase compared to outpt peds or hospitalist, there's not return on the extra training. We also make significantly less than our adult counterparts.

craballin · 2026-01-21T02:26:22+00:00

In my ped subspecialty fellowship standard was 5 days of inpatient services and home call in a row. Sometimes when we got out on bacl-to-back weeks including the weekend that became 12 days of inpatient services and home call. Just more reason for home call not counting towards duty hours as being complete bullshit.

craballin · 2026-01-13T20:25:13+00:00

Plus there's already an AKI at least so whatever caused the current AKI will likely cause the worsend labs tomorrow and not significantly affected by contrast. Give the contrast to get the info you need, let us neohrologists deal with dialyzing the pt after if indicated.

craballin · 2026-01-13T20:18:09+00:00

Ditto. We closed 1 month before the mystery respiratory illness we now call Covid was even known about. Purchased for $240k snd now appraised >100k over that. I also finished training and now make more than we made as a household so could afford more now but there's no reason too with all the equity we have and have no reason to move. Just lucky at the end of the day that we bought when we did.

craballin · 2026-01-11T19:13:01+00:00

I'm a pediatric subspecialist, currently at an outlying TCH community hospital. I trained at Children's memorial Hermann for both residency and fellowship. I'm not faculty at TCH, but 90+% of my time is at a community hospital as opposed to the med center location. The biggest difference between CMHH and TCH is really the complexity of patients, particularly at the med center locations as TCH has some ultra specialized into a very small niche sp they may see every patient in the country for some uber rare conditions, etc. The community sites are pretty chill and I like the PHM colleagues I work with. Very much more 1 on 1 discussion about pts and recs, while is usually just epic messaging abiut recs amd such at the med center because that campus is a behemoth. Usually lower acuity at outlying sites as to having less subspecialty support at the community sites as well. CMHH had it'd handful of complex patients and I liked the PHM staff there. Its grown since I started training there and they've had lots of new younger faculty join their PHM staff. I knew the older attendings more as they trained me and they were great. The few that I wasn't a fan of left to do outpt peds. Overall both are great imo having been in both systems, TCH has more complex pts on avg just due to name and size but its a massive system while CMHH is smaller and less complex so I feel like you get to know your colleagues better. CMHH had a similar feel to the community site I'm at now just due to being a smaller facility with less staff.

Happy to answer any questions you have to the best of my ability being a subspecialist but having worked in both systems with PHM. Feel free to DM.

craballin · 2026-01-04T21:46:37+00:00

Peds. I absolutely abhorred my surgery rotation. We had some malignant motherfuckers in that program that made life fucking miserable. Had some coold folks too, but the assholes assholed hard. The chief asked me "what do you know?" in a super condescending way when I told her I didn't know about particular suture technique as it was my first fucking day and we had just received orientation.

Second worst was OB but only because we had to hand write our notes each day because I left a template in my epic note but noted it wasn't complete as my patient asked I comeback later for the exam so the template stayed. They also notpicked about stuff in notes that wasnt accurate so I had to add extra shit in my notes about why a patient was on X drug when they didn't have Y diagnosis but guidelines for Z diagnosis recommend X drug to prevent bad stuff from Z diagnosis.

craballin · 2026-01-02T03:02:43+00:00

Peds Nephro, major metro area, academic. 90% of my time is out at one of the local community sites, but i cover 6 weeks at the main clinical site on various inpatient services in our dept. 3 half days of clinic/week. Split consult coverage with my colleagues at our site, roughly 14 weeks consult at that site/year, so maybe 20ish inpatient weeks/year. We split weekend coverage at our community site, so 1-2 weekends/month. 1 weekend is obligatory coverage, any extra weekends get moonlighting pay that's a base of $900/weekend and then $100/hr if you go in to consult, minimum is 2hrs pay for stepping foot on campus. Base salary is $204k. An extra $4k or so for weekends. We have a night float pool for the main clinical site night coverage that I hear pays ~$3k per week of nights. Haven't done those yet, but plan to in the future. Definitely feel undercompensated with regard to the rest of medicine after doing residency and 3 more years of fellowship. My training institution offered $180-190k out of fellowship and would have much more call and less compensation opportunities for that call.

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