pediatric emergency medicine fellowship

Each year hundreds of residents apply to Pediatric Emergency Medicine (PEM) fellowships. There are multiple reasons that an EM resident might want to undertake a PEM fellowship, but over the last 15 years, fewer Emergency Medicine (EM) residents are applying for PEM fellowships than Pediatric residents, unpublished data suggesting that Pediatric candidates now outnumber EM candidates 20 to 1.

Recently, a group of PEM Fellowship Program Directors formed the “EM-to-PEM task force” of like-minded individuals desiring to promote PEM fellowships to EM residents. A PEM fellowship is an excellent career move for a resident who has a passion for the emergency care and advocacy of children. In this post, we will discuss and review benefits of EM residents undergoing a PEM fellowship.

Advantages to fellowship training in general

  1. More than defining the niche that physician will undertake, a fellowship accelerates acquisition of specialized skills that will be needed for career success in both academic and community settings. Research skills, teaching techniques, and time to explore areas of interest are among the benefits.
  2. Fellowship provides the opportunity to receive mentorship from leaders in the field. It is a time to make contacts that will inspire and help with promotion during a career. Whether it is ultrasound, EMS, or pediatrics, a fellowship helps to define a future specialization and can make a physician more marketable in both academic and community settings. Development of additional skills can also enhance and prolong job satisfaction for physicians, especially through outreach, advocacy and involvement in national committee work.

Why specifically a PEM fellowship?

Many EM trained physicians take fantastic care of children. Given this fact, why would someone devote more training to PEM? Here’s why.

  1. Acuity and frequency are 2 very important variables to factor when considering additional training. EM residents may initially begin their residency training feeling that managing the pediatric patient is not as difficult as the adult. This is due to the perception that for most children, the acuity is often low. Since it is actually the low frequency of high acuity illnesses presenting in the pediatric ED, it is often not until closer to graduation that the EM resident truly comprehends how difficult it is to provide excellent care for all pediatric patients seen in the ED. By the end of EM residency, all EM residents will be competent to care for kids, but not many will be comfortable.
  2. Comfort comes with repetition. Repetition and practice of common life-threatening presentations (congestive heart failure, sepsis, blunt trauma) happens frequently in the adult emergency department (ED) but not in the pediatric ED. Furthermore, many severe pediatric illnesses are sometimes difficult to distinguish from more benign entities. For example, after seeing 15 children in a shift with the same virus, what are the signs or clues that enable emergency physicians to pick out the child with early myocarditis? Not only does repetition assist with comfort for managing the overtly ill, it also aids in developing the vigilance that is needed for finding the covert. Emergency physicians will eventually gain this comfort level with experience. The pediatric fellowship accelerates this comfort level by front-loading the physician’s career with an enormous number of pediatric cases. The sheer volume of sick children managed during a PEM fellowship will be the strongest foundation for the PEM-trained physician’s comfort.
  3. Pediatric emergency physicians are in huge demand. There is increased pressure from the public, government, and even trauma accreditation bodies to ensure that PEM fellowship-trained physicians are available at EDs and trauma centers. Most residency training programs are also seeking attending physicians with PEM specialized knowledge to bolster their core faculty. While Pediatric/PEM physicians can only work pediatric shifts, the EM/PEM physician has an advantage in being more flexible and adaptable. They may be employed more easily in EM training programs, because they can easily fit into the needs of these organizations. Departmental chairs may have the need for a percentage of effort in both the pediatric and adult ED. EM/PEM physicians, for instance, can work 50/50 adult and pediatrics shifts.
  4. Credibility in positions of advocacy. A physician trained in EM-PEM is an excellent advocate for all physicians taking care of pediatric emergencies in both the community and academic setting. A PEM fellowship bestows the power to augment and enhance the strategies for delivering quality care for all children and this is most advantageous in areas with limited resources.

Drawbacks of PEM fellowship

  1. Concern that EM skills will decay: to help combat this, most fellowships allow moonlighting and provide time to maintain these skills.
  2. Salary decrease: during fellowship training, there is a salary decrease compared to what one would be making as a general EM attending. Having the opportunity to moonlight helps offset these losses, but it is still hard for physicians to overcome especially when loans are considered.

We believe that the job opportunities for EM/PEM fellowship-trained physicians are excellent compared to the sometimes-limited entry-level general EM jobs. PEM fellowship training affords you a competitive advantage to join academic faculties and other desirable positions.


Undertaking a PEM fellowship has numerous advantages for the graduating EM resident. It assists in making one more marketable in both academic and community settings and for leadership positions, and it trains one to give the best care possible to one of our most at-risk populations.

This blog post contributed on behalf of the PEM Fellowship Program Director EM-to-PEM taskforce.

Image: Can Stock Photo

James O’Neill, MD

James O’Neill, MD

Director, Pediatric Emergency Medicine Fellowship
Wake Forest Baptist Health
James O’Neill, MD

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Sean Fox, MD

Sean Fox, MD

Associate Professor
Adult and Pediatric Emergency Medicine
Carolinas Medical Center
Sean Fox, MD

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Maybelle Kou, MD

Maybelle Kou, MD

Director, The Altieri Pediatric Emergency Medicine Fellowship
Inova Children's Hospital
Inova Fairfax Hospital Emergency Department;
Associate Clinical Professor of Emergency Medicine
George Washington Medical Center;
Assistant Professor of Pediatrics
Virginia Commonwealth University School of Medicine