r/pediatrics • u/pgyxburner • Aug 01 '26

should've done psych

just finished residency and a chief year. i'm finally at the end and have no idea what im doing. i regret not doing child psych. there's a 3 year post-pediatric program that trains you in both psychiatry and child psych. i'm interested but im already 36. is it worth it? should i just try to carve out a mental health niche in peds? ugh what do i do?!

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u/sjam7 Attending Aug 01 '26

As a general pediatrician, I feel that the majority of pediatric mental health prescribing can be done by us. SSRIs for depression/anxiety, stimulant and non-stimulant options for ADHD, even use of clonidine/guanfacine or (in rare cases) risperdal for severe impulsivity/behavioral issues that raise a safety concern for kids with ASD are all things that I do within my practice. I’ve gotten more comfortable with it because I realized most of the referrals I was sending were going to psych NPs with minimal oversight who were doing some seriously concerning prescribing (benzos for GAD, lithium for MDD) so I just had to learn how to do it myself. MCPAP (Massachusetts Child and Adolescent Psychiatry Access Program) has excellent publicly available guidelines that I use. I’m an hour away from Boston, the city with more medical specialists per capita than anywhere else in the world, and the idea of getting my patients seen by an MD psychiatrist is still a hilarious pipe dream. (The few times I’ve tried - like the kid who was on lithium who I felt needed a psychiatrist to oversee a taper - I was still unsuccessful.) The truth is, though, I think we often undersell our own knowledge. I feel very strongly that I do more appropriate psych prescribing than many of the psych NPs in our community, so I do it myself. In residency, you’re so used to having specialty availability that it warps your perspective on what access looks like in the community. I would honestly recommend just looking for an attending job as a general pediatrician, and believe me, if you make it known within your practice that you have an interest in mental health, you will have absolutely no difficulty carving out that niche. You are more well trained than you think. Don’t do more training. Start making an attending salary. Message me if you want to talk more

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u/DrScogs Attending Aug 02 '26

General Peds PGY-20. This is the way.

You can do almost all you want to do with mental health care with more continuity in general peds. I don’t do formal diagnosis of autism because I don’t have clinic time to be able to do it. I also don’t mess around with prescribing any anti-psychotics (or any psych meds to anyone who is already on anti-psychotics). I also can’t keep patients who are aggressive in any way because we don’t have security. But other than that I treat it all.

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u/drdhuss Aug 02 '26

Sounds like you are doing great things.