This pediatrics subspecialty has the best work-life balance

Studies show that 1 in 4 kids or teens has a behavioral, developmental, emotional, or learning problem.^[] However, a shortage of specialists means long wait lists and a chronic demand that’s left unmet.

MDLinx spoke with Emily Wassmer, MD, IBCLC, a fellow at Children’s Hospital of Philadelphia, for an insider's perspective on the critical need for more developmental and behavioral pediatric (DBP) specialists. 

The specialist shortage

Dr. Wassmer says the dearth of DBP specialists primarily stems from a lack of exposure during training. While pediatrics is a required rotation, its subspecialties aren’t. “If you do your core rotations at an institution without DBP, you won’t experience the subspecialty clinically,” she explains. “You may hear about it in passing while seeing primary care patients, but that will also be attending-dependent.”

Typical career path

DBPs start with a 3-year residency in pediatrics, followed by 3 years of fellowship training.

Dr. Wassmer described the path to DBP: “You get into any pediatric fellowship through the ERAS fellowship match, similar to the process you go through for residency. For pediatric subspecialties, applications are due in the summer, interviews are in the fall, and Match is in late November or early December. This process is done in the academic year before you plan on starting fellowship (summer/fall 2024 cycle if you want to start fellowship in summer 2025).”

She also shared that since this pediatric subspecialty match was recently combined with the subspeciality match for Internal Medicine, partners trying to couples-match may want to consider this option.

Earning potential for DBPs

“A disheartening but common reason why people don’t go into pediatric subspecialties is the salary,” says Dr. Wassmer. “Doing subspecialty training in pediatrics almost always guarantees you’ll lose lifetime earnings by doing extra training. Unlike adult specialists, pediatric specialists do not see a big jump in salary (or jump at all) after completing subspecialty training.” Her opinion aligns with salary data for pediatric subspecialists.^[]

Dr. Wassmer said that most DBPs make just under $200,000 as attendings. “I’ve heard of starting salaries as low as $150,000 to $160,000, but have also seen places that will start over $200,000. Pediatric subspecialties, in general, often end up with salaries in the $180,000 to $240,000 range, which is the same as or lower than that for general pediatricians,” she explained.

A rewarding career

Dr. Wassmer understands that mental health fields can be challenging, and many clinicians experience burnout, particularly when treating young patients. Nonetheless, she finds the field rewarding. “We love having long-term continuity with our patients. We also love diving deep into issues and trying to get to the bottom of them,” she shared.

“You can be more of a ‘general DBP’ who diagnoses and manages things like autism, ADHD, and developmental delays,” she explains. “Or, you can pick a more specific niche within the field, such as focusing on genetic disorders like Down syndrome or Fragile X. I personally have a clinical interest in hearing loss, so I’m interested in working in a pediatric hearing loss clinic doing autism evaluations, as autism often presents very differently in kids with hearing loss.”

Such a varied field means Dr. Wassmer enjoys its multidisciplinary nature that allows her to collaborate with speech therapists, occupational therapists, audiologists, and genetic counselors.

A day in the life of a DBP

Dr. Wassmer said her schedule changes weekly in fellowship. She sees her own patients one half-day per week, but in her 2nd and 3rd years, it’ll increase to a full day. She spends another half-day per week participating in a LEND fellowship, a 1-year government-funded multidisciplinary program for trainees working with children with neurodevelopmental disabilities.

“The other 3 days vary depending on my rotation, which could be neurology, genetics, rehab, resident teaching, community experiences, child psychiatry, or DBP,” she explains. She said fellows occasionally have consults with patients in the hospital (about two or three times a month), but the consults aren’t urgent. She also covers her own patient messages throughout the day.

“In my program, the fellows cover patient calls on weeknights, and the attendings cover patient calls on weekends. After-hours patient calls are infrequent, hardly ever more than one per night,” she says.