anesthesiologist unfairly given peds anesthesia certificate

[angry doc]

I am looking to resolve a dilemma. I am a fellowship trained peds anesthesiologist. I graduated recently from residency and then went to do a fellowship. At that hospital I am at now is an anesthesiologist who finished residency same time as me and went to work while i went to do a fellowship.

This person applied I feel falsely for peds board certification via grandfather criteria. Although the ABA looked at the logs, I have a feeling only pediatric anesthesiology logs were shown..
the adult logs were not shown or minimally shown to deceive the ABA. The hospital i am talking about is not a children's hospital but an adult hospital..it is level 1 adult and not even a level 2 peds trauma center. Most peds cases are bread butter asa 1 and 2. The Nicu cases are erratic..few and far between...
all the nicu babies come intubated already by neonatologists and ivs and arterial lines placed by neonatologists In advance. ..


Here is the real problem...the ABA requires that a person do primarily pediatric anesthesiology in the past 2 years at time of application and persons have exposure to neonates and do high risk procedures. ...I was the peds fellowship trained person there and I did not even do primarily peds there....I did a mixture of peds and adult....like 70 to 30.. I did most of the Nicu cases.....although the babies, because of hospital practice, came already intubated with lines, etc.

so what I don't understand is how does this other person who is doing majority adult cases and not peds cases..as required by ABA grandfathering criteria, even after logs examination, get to sit for the exam and is now peds anes certified.

I really want to get in touch with the ABA. I don't think they understand the real story because I seriously doubt if a person really does not meet the criteria.....they should not be given opportunity to sit for exam or be boarded. I want the ABA to revoke the certification....this is so unfair to all the people who did a fellowship to achieve board certification and all the people who truly meet the grandfather criteria. ...I plan on going some other place to work soon.....but I want to get in touch with the board then.....any advice how I can resolve this issue?

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[Noyac]

Get accustomed to this sort of thing. It is everywhere. PM&R doing pain. Nurses calling themselves doctors. It goes on and on. I recommend you do your best to be well trained and experienced, then let the chips fall where they may.

 

[deleted171991]

This is what happens when a subspecialty tries to stand out through BS certification (board exam), instead of just training (fellowship). There will be a number of people trying to game the system, showing that pediatric anesthesia does not belong just to pediatric (fellowship-trained) anesthesiologists. Otherwise the fraudsters would sooner or later fail while practicing peds. Oh, and it's not called neonatal (and infant) anesthesia (as maybe it should).

I am sorry for you, but not too much. There are a good number of anesthesia subspecialties that either should not exist, or be called Advanced *** Anesthesia. You guys are just reaping what you sowed with the subspecialty fellowship/certification mania. I am just disgusted with where the entire specialty is going.

And, as Noyac suggested, this is just the beginning. Just wait till you get "board-certified" "pediatric" DNP CRNA noctors. One doesn't need a peds anesthesia fellowship to take care of healthy kids during routine surgeries.

 

[urge]

Let it be. The board is well aware of this stuff but in reality doesn't matter. When you got boarded back then it included peds. So just think he was peds boarded initially and now he has the separate test.

Nobody is taking your training away from you. These people will not compete for real peds jobs.

 

[Planktonmd]

You should call the police and the FBI immediately

 

[pgg]

We had this thread a few months ago -

http://forums.studentdoctor.net/thr...-not-meeting-grandfathering-criteria.1056715/

 

[IlDestriero]

It's too late now.
They examined his logs/credentials, approved his application, and he passed the exam.
Can he do what you can do? No, probably not. Are you even doing anything requiring fellowship training? Doesn't really sound like it from your description. I wouldn't worry about it.
He won't take your job if you want to practice complex peds somewhere.
I would have a problem with him becoming the division chief over me though. That would be BS.

 

[GA8314]

This is what happens when a subspecialty tries to stand out through BS certification (board exam), instead of just training (fellowship). There will be a number of people trying to game the system, showing that pediatric anesthesia does not belong just to pediatric (fellowship-trained) anesthesiologists. Otherwise the fraudsters would sooner or later fail while practicing peds. Oh, and it's not called neonatal (and infant) anesthesia (as maybe it should).

I am sorry for you, but not too much. There are a good number of anesthesia subspecialties that either should not exist, or be called Advanced *** Anesthesia. You guys are just reaping what you sowed with the subspecialty fellowship/certification mania. I am just disgusted with where the entire specialty is going.

And, as Noyac suggested, this is just the beginning. Just wait till you get "board-certified" "pediatric" DNP CRNA noctors. One doesn't need a peds anesthesia fellowship to take care of healthy kids during routine surgeries.

I agree that this is getting a bit ridiculous. The fellowship mania has it's downsides. Additional training and credentials is fine, but let's not translate that into the community where bread and butter peds and cardiac soon "require" a fellowship.

We do a good amount of pediatric dental and B&B cardiac, and we all do it all...... And we do it pretty well.

 

[Baller MD]

Med student question here: is it possible to get a gig primarily doing cardiac cases without doing a cardiac fellowship?

 

[urge]

Med student question here: is it possible to get a gig primarily doing cardiac cases without doing a cardiac fellowship?

Possible, but becoming less possible every day.

 

[kazuma]

Med student question here: is it possible to get a gig primarily doing cardiac cases without doing a cardiac fellowship?

Yes, at least one person in my class is going to do private practice hearts and another person was given the option to do hearts with a different group. Recent graduates from my program have also done private practice hearts without a fellowship, but it's probably becoming less common due to the surplus of cardiac trained graduates.

 

[Wiscoblue]

When the differential is minimized between cardiac and non cardiac anesthesia salaries the older cardiac guys will stop doing hearts. The younger guys, even without a fellowship are then given the option to do hearts.

 

[G0S2]

No cardiac fellowship here. Advanced TEE testamur and I do cardiac regularly.

Do cardiac fellows have an edge over me? Yes, in academia.

 

[epidural man]

.....any advice how I can resolve this issue?

Yes.

Stop being angry. You did a fellowship to be damn good, not to have one-up on other people (at least I hope).

As others have said, you now have the skill. It doesn't matter what other people do or say.

Although, next time a sick NICU 2400gm perferated bowel comes through, have them assign it to your "peds" trained partner. You may feel satisfied when he asks you to help, or do the case.

 

[criticalelement]

Get accustomed to this sort of thing. It is everywhere. PM&R doing pain. Nurses calling themselves doctors. It goes on and on. I recommend you do your best to be well trained and experienced, then let the chips fall where they may.

I agree with this. There are a TON of things that will and should make you see red. You can write letters to the ABA ASA AMA the president etc etc etc... This will take up all of your time. Or you can just move on with your life. YOur choice. Just know that the way the ABA are implementing the boards now will make the whole system irrevelant and cheap. ANd they can't even see that because they are too busy counting all the money that they just got into.

 

[urge]

No cardiac fellowship here. Advanced TEE testamur and I do cardiac regularly.

Do cardiac fellows have an edge over me? Yes, in academia.

Why is that when we talk about fellowships, peds fellows are deemed superior to non fellowship trained peers, but cardiac fellows don't get the same treatment?

 

[deleted171991]

Because PP groups are run by non fellowship-trained people who do cardiac cases, not peds?

 

[G0S2]

There are plenty in PP groups that are not peds trained but do and enjoy those cases. Mostly healthy kiddos.

With regard to cardiac, most cases in my pp gig are fairly straight forward CABGS and valves. Not massive aorta reconstructions (thoracoabdominal aneurysms etc) that are referred to academic centers.

My take on this whole thing is that if as an anesthesiologist you enjoy and are competent with any case whether peds or cardiac and have demonstrated so then more power to you. I absolutely get why some would opt to pass an exam and be grandfathered into a sub specialty. I also understand the benefit of doing a fellowship.

If the day comes when the hospital decides that only fellowship trained docs can do CT I will gladly accept it and move on.

 

[Baller MD]

No cardiac fellowship here. Advanced TEE testamur and I do cardiac regularly.

Do cardiac fellows have an edge over me? Yes, in academia.

Isn't it true that TEE certification is no longer given out unless you do a fellowship?

 

[Baller MD]

I agree with this. There are a TON of things that will and should make you see red. You can write letters to the ABA ASA AMA the president etc etc etc... This will take up all of your time. Or you can just move on with your life. YOur choice. Just know that the way the ABA are implementing the boards now will make the whole system irrevelant and cheap. ANd they can't even see that because they are too busy counting all the money that they just got into.

Can you clarify what you mean by this?

 

[kazuma]

Isn't it true that TEE certification is no longer given out unless you do a fellowship?

He said he's a Testamur. You have to do a fellowship to become boarded. Anyone who is interested in TEE and studies/passes the advanced exam can attain testamur status.

 

[nimbus]

He said he's a Testamur. You have to do a fellowship to become boarded. Anyone who is interested in TEE and studies/passes the advanced exam can attain testamur status.

That's what they should have done for the peds boards too. Given testamur status but no certification to those who take and pass the test without a fellowship.

 

[urge]

That's what they should have done for the peds boards too. Given testamur status but no certification to those who take and pass the test without a fellowship.

Testamur status is meaningless. It is a gimmick of the NBE. The only reason to become testamur is to get certified eventually. Otherwise there is no point.

We are taking about people who were certified in the full spectrum of anesthesia. And you are suddenly going to tell them they are no longer certified in peds because you created your own exam? Plus, you are not even going to give them a break at it? WTF!

 

[G0S2]

The hospitals I work for want that testamur certificate to do hearts. I chose to sit for the advanced TEE exam to say " I do lots of cardiac and I sat for the same board exam fellows do."

I'll never be certified but for the time being that NBE certificate allows me to do the cases I enjoy. I'm good at echo and the surgeons I work for know it.

Agree it's a way for NBE to rake it in but that goes for my MOCA as well.

 

[nimbus]

My hospital and at least one other in my area also requires testamur status to do hearts. So it's not meaningless.

 

[DrLight]

From the ABA: "grandfathering" criteria will be applicable only through the certification examination in pediatric anesthesiology in 2015, after which authorized fellowship training in pediatric anesthesiology will be required....

Only one more year for non-fellowship trained people to be grandfathered in....

 

[sevoflurane]

Phoenix hospitals are requirering you to be testamur status in order to do hearts.

 

[deleted126335]

It wouldn't surprise me that in 10 or so years, peds certification will be required to do anything more than bread and butter peds. If I were younger and able to sit for the exam for grandfather status, I would absolutely would.

 

[Baller MD]

All this talk about certification for doing specific cases are great and all but the REAL QUESTION IS THIS: will CRNAs be allowed to do peds and heart cases in the future?!

 

[sevoflurane]

They already do those cases.

 

[Baller MD]

They already do those cases.

Then what is the point of limiting the number of anesthesiologists that can do them if CRNAs are doing it left and right?

 

[Planktonmd]

Then what is the point of limiting the number of anesthesiologists that can do them if CRNAs are doing it left and right?

It's because no one is better than us anesthesiologists at screwing ourselves!

 

[urge]

My hospital and at least one other in my area also requires testamur status to do hearts. So it's not meaningless.

Another artificial hurdle brought to you by the NBE. If testamur status didn't exist you hospital would not be asking for it.

Then what is the point of limiting the number of anesthesiologists that can do them if CRNAs are doing it left and right?

The NBE creates this Testamur status to suck in more money, and as you can see hospitals start requiring it just because it is available. The day there are enough certified people around, hospitals will say Testamur is no longer good and require certification.

Now, a CRNA can do the same job without any of this.

 

[nimbus]

Another artificial hurdle brought to you by the NBE. If testamur status didn't exist you hospital would not be asking for it.

The NBE creates this Testamur status to suck in more money, and as you can see hospitals start requiring it just because it is available. The day there are enough certified people around, hospitals will say Testamur is no longer good and require certification.

Now, a CRNA can do the same job without any of this.

Yes.....I agree. Nevertheless preparing for the exam has made me a better echocardiographer and I don't know that I would have done it if the hurdle wasn't there. It was a pain in the ass.

I think the same could be said of the peds exam.

Also, the decision was made by our med staff credentialing committee with input from our cardiac anesthesiologists and surgeons.

 

[deleted171991]

Yes.....I agree. Nevertheless preparing for the exam has made me a better echocardiographer and I don't know that I would have done it if the hurdle wasn't there. It was a pain in the ass.

I think the same could be said of the peds exam.

The same could be said of any good exam.

But why not let any anesthesiologist take it, if it's so pertinent that it can't be passed just by showing up?

 

[sevoflurane]

The same could be said of any good exam.

But why not let any anesthesiologist take it, if it's so pertinent that it can't be passed just by showing up?

Any anesthesiologist CAN take it. To pass the advanced boards takes a considerable amount of dedication and self motivation. This means a lot of sacrifice if it does not change your paycheck.
My wife elected to not put in the effort even though she has been doing hearts for the last 5+ years.
Personally, I enjoy the self study and the pursuit of anesthesia knowledge after residency.
I will soon be working along side of peds anesthesiologists. I'm looking forward to doing more complex peds. For me, it's just fun to mix things up and really motivate for lifetime learning.

I've never been happy doing just one thing as any one thing becomes redundant after a while. The exception would be critical care. That aspect of anesthesia is definately not for me.

 

[Happy doc]

Hi

 

[nap$ter]

I had a similar situation in my institution. we used to have a ped fellowship trained attending and the rest of us practice peds without fellowship. But the ped fellowship doc is the weakest one he can't place A line in a kid never did any central line or IO in a kid etc Beside his poor skills he cannt get along with resident, CRNA finally he is been kicked out the department. In the same time the person who had the grandfather peds board is well recognized at all levels!! and all the peds suergeon requesting him.
The conclusion fellowship will not help you to become a good doc!! You might have a fellowship but you did it in a place where you just pracice T&A that is a useless fellowship. So be carful if u want to write him up to ABA he might sue u especially if he is well recognized at all level and he might have a lot of cases to support him. so my advice stop your antisocial behavior and live the life try not to ruin your future!!! The battle is not to fight your colleague and he is not A CRNA he is a anesthesiologist and he has the right to practice anything as long as he is good at it. And the chief of his department approved his credentials !!!!

oh boy. the stupidity of this post saddens me.

here's an analogous paragraph:

"we have a cardiac, icu, and peds trained board certified MD at my group who sucks clinically, and has an ego that prevents him from getting along with staff and patients. at the same time we have a DNP CRNA who wears a white coat and introduces himself as "Dr Anesthesia". We and the hospital allow it because he strokes our surgeons and strokes our patients! They love him and request him all the time! He is really good at saying yes all the time! stop your antisocial protesting and don't report him because he might take you to court!"

this topic was covered ad nauseum in the post linked above.

it is not individual anecdotes, clinical competency, or value of a fellowship that is at question here. the question is: "is it ever ok to lie about clinical experience to gain a fellowship certification?"

the answer is a black and white "NO".

you don't have to have facts to report a suspicion. i have reported these threads to the ABA in the past - it is up to them to investigate and gather facts. probably nothing will happen, but my conscience is clear.

To the OP - you should do the same. report the guy. (BTW, even if the neonates are intubated/lined up the case still qualifies under the ABA definitions. But if his numbers/ratios are an exaggeration his cert should be revoked).

 

[Guy Caballero]

oh boy. the stupidity of this post saddens me.

Thanks for warning us about your subsequent post. I read it despite your warning. I will just say, "you don't know what you don't know."

 

[Vaporizer]

My advice you should wait till you secure a different place then contact the ABA. The problem if you start doing this now before leaving this place you might face a lot of troubles.
You will not only causing trouble for him but also for the director who sign his cases off .So you might not able to get any recommendation from this place at all.That is mean you might not be able to find a job in a good place.In the same time if you stayed in your place after raising this problem they might find a way to kick you out. The other way if you still in this place and your are the ped fellowship person request his case log and evaluate it and find out you might be mistaken.

 

[jw3600]

I had a similar situation in my institution. we used to have a ped fellowship trained attending and the rest of us practice peds without fellowship. But the ped fellowship doc is the weakest one he can't place A line in a kid never did any central line or IO in a kid etc Beside his poor skills he cannt get along with resident, CRNA finally he is been kicked out the department. In the same time the person who had the grandfather peds board is well recognized at all levels!! and all the peds suergeon requesting him.
The conclusion fellowship will not help you to become a good doc!! You might have a fellowship but you did it in a place where you just pracice T&A that is a useless fellowship. So be carful if u want to write him up to ABA he might sue u especially if he is well recognized at all level and he might have a lot of cases to support him. so my advice stop your antisocial behavior and live the life try not to ruin your future!!! The battle is not to fight your colleague and he is not A CRNA he is a anesthesiologist and he has the right to practice anything as long as he is good at it. And the chief of his department approved his credentials !!!!

My advice you should wait till you secure a different place then contact the ABA. The problem if you start doing this now before leaving this place you might face a lot of troubles!
You will not only causing trouble for him but also for the director who sign his cases off !!So you might not able to get any recommendation from this place at all!! That is mean you might not be able to find a job in a good place.In the same time if you stayed in your place after raising this problem they might find a way to kick you out. The other way if you still in this place and your are the ped fellowship person request his case log and evaluate it and find out you might be mistaken!!

Same ****ty grammar. Same double exclamation points. What's your angle here compadre?

 

[boggy]

The OP already states that the ABA reviewed the persons case logs so it makes sense that the anesthesiologist or the director contacted the ABA to ask for their guidance was told to submit logs and did so. Since they accepted the logs after review and then the person passed the test. The criteria used for grandfather entry are less clear than OP indicates. For example one research attending does one day of pediatrics each week and four day of research---100% of their clincial practice is pediatrics. Now another attending works one room with residents each day doing pediatrics and another room doing simple adults with a crna. 100% of that persons day is also working with pediatrics. Now suppose someone covers three rooms of pediatrics one day and does adults alone for the next two days. Well on average they are doing a room of pediatrics each of the 3 work days. The ABA did not specify exact case numbers and left it up to the department directors to identify those individuals with pediatric skills to take the exam but did not state how many cases were required. Certainly the person in question must know pediatric anesthesia as she passed the exam This will repeat whenever other subspecialty board certificates are added and hopefully they will indicate exact case numbers over a period of time.

 

[nap$ter]

T Certainly the person in question must know pediatric anesthesia as she passed the exam T time.

absolutely untrue. see some of the threads about the exam.

 

[Guy Caballero]

The original poster has made the common error of believing that the ABA wishes to have fewer pedi certified anesthesiologists. As I described in the other thread:

Do you think the ABA wants more or less pedi certified anesthesiologists? If they have less, it will be seen as not necessary. They need a critical mass of pedi certified anesthesiologists so that it becomes the de facto requirement in order to take care of kids. Same for cardiac. Certification in that is coming, which will make the Echo exam obsolete in 10 years. Why would the ABA watch the income stream go to another certifying board? OB will likely follow.
Pretty soon, you will not be able to practice without a couple of subspecialty certifications. Each one will have their 10 year limit and MOCA recertification. This will be the next generations cost of doing business. It is big business.

It's a classic example of Sutton's Law.
When in doubt, follow the money trail.

 

[Guy Caballero]

It seems that many here are not familiar with the ways newly adopted board exam work in the ABMS system. When a new board certification is adopted, people may grandfather into that specialty for a period of five years. It does not translate to doing a fellowship. They are not equivalent. Any place who is doing hiring has the ability to look at the CV and see that they did not do a fellowship. However, if they meet requirements to sit for the exam (these requirements are traditionally not very stringent), then they are allowed into the process. This is the way it is for every new ABMS board. A handful will get in that maybe should not have, but after that small window closes, there is only one entry point and no one else gets in. The stance of the ABMS is that they have to have that period of time to let those people in so that they are not excessively exclusionary to the process. Whether you believe it or not, there are a lot of people who never had a pedi fellowship who do a great job taking care of complex pedi cases. They have to let them in and a few others will sneak in with them. Believe it or not, there are non fellowship trained anesthesiologists practicing pain, cardiac, OB, pediatric anesthesia etc. Many of them could teach their fellowship trained colleagues a thing or two. One of the smartest cardiac guys I have ever met is not fellowship trained in cardiac. His TEE exam could put a cardiologist's exam to shame.
Take comfort in knowing that the window of opportunity for pedi anesthesiology is almost closed and it will not be an issue for you again. Next time, the cardiac or OB people will be complaining. For the record, my certification stated that I was a diplomate of anesthesiology (all of it, not just some of it). I choose not to pursue pedi subspecialty certification, however, my written and oral boards covered pedi, OB, and cardiac. You do not get to decide if I get to do pediatric cases. At some point, we have to trust that I will defer a complex neonate to someone who is better qualified than myself. Likewise, fellowship training or subspecialty certification do not guarantee that you are a capable pediatric anesthesiologist. All it means is that you spent an extra year and knew enough to pass a test on a certain day.
Congratulations on passing the exam. Just know that you are not the judge and jury on who gets to sit for the exam. The ABA does that and they have their process in place and are more than capable of taking care of the process.

 

[nap$ter]

A handful will get in that maybe should not have, The ABA does that and they have their process in place and are more than capable of taking care of the process.

disagree with blue, because of red.

grandfathering is necessary. i do not take issue with dude who has been doing peds for years (sans certificate) and is awesome at it. those guys probably aren't going to try to sit for the exam anyway - they do their thing and surgeons and hospital know and love em.

what i take issue with is young dude a few years into practice who does a few kids here and there and is thinking of his marketability and lies about his experience so that he can sit for the exam and put his certificate on his CV. this flavor of dude may not know his own limits and may not defer that sick neonate to a better-suited colleague. this dude isn't going to get a spot at a children's hospital, but he might get a spot at a community hospital with a nicu and picu and get in over his head.

you are right that you can do all the peds you want, and have experience with, etc... you don't have to do a peds fellowship to do peds hearts in some places. the fellowship is meaningless compared to experience (for now). BUT IT WILL BECOME INCREASINGLY MEANINGFUL IN THE FUTURE (fortunately or unfortunately), and folks will not be able to gain experience without a fellowship for long...

And for the record, increasingly in the future the guy you defer that complex neonate to will be someone who has passed the test and done the one year fellowship.

In general passing the pediatric anesthesia exam and doing a one year fellowship do equate (there are no guarantees) to being a competent pediatric anesthesiologist, just as in general passing the usmle's and aba anesthesia exams equate to being a competent physician anesthesiologist.

there are exceptions to every rule - life is a bell curve.

 

[Guy Caballero]

disagree with blue, because of red

The ABA has long since held the belief that they would rather have a system that lets a few "in" who maybe should not have been rather than exclude some who definitely deserved to be in. That is why they the requirements are rather loosely defined.
As others have mentioned, it is very probable that the OP does not know the entire story. Does he know the entirety of the other guy's practice and his case logs? A witch hunt based on speculation and assumptions sounds like a bad idea.
I agree that certification will take on more meaning in the future, but this is the way all ABMS certifications begin. It is not perfect, but it is designed the way it is for a reason.

 

[pjl]

Maybe it is my uneducated, non fellowship trained private practice nature speaking, but I question how it matters whether some other guy has unfair peds certification. I dont see a future job looking at him and you, with all else equal and putting his peds certificate up against your fellowship. I also know a lot of really crappy fellowship trained people in a whole slew of specialties, so I dont think a fellowship necessarily equates to better, just that the average player is better. It may "cheapen" the certification, however it can not affect the perception you obtain by having done an actual fellowship at XYZ location.
I hope he gained personal satisfaction with the process of becoming certified, just as I hope you obtained personal satisfaction doing your peds fellowship. Honestly, if both were applicants for a job with me, I think our group would have a hard time balancing the benefit of a fellowship trained guy who hasnt done adult cases/adult cardiac/OB/whatever for a year after obtaining just a residency level mastery versus a guy who has been focusing on peds while continuing to build skills in all areas. In other words, for group marketing purposes the fellowship training helps, but practically speaking in a mixed practice it may hurt you clinically.
We all take different routes to get to a point where we have the privilege of taking care of the type of patients we want, in a job that lines up with our professional and personal goals. All routes have benefits and drawbacks. The only route that I would call wrong is that of lying and deceit. So the only part of the initial post that gives me pause is the alleged fraudulent behavior. However, the OPs view may be vastly different from the truth, or even if the ABA followed this other guy around every day they may still act the same, so without that guy coming on here and discussing his credentials we will have to trust the same specialty board that decided we were fit for practice.

 

[nap$ter]

Maybe it is my uneducated, non fellowship trained private practice nature speaking, but I question how it matters whether some other guy has unfair peds certification. I dont see a future job looking at him and you, with all else equal and putting his peds certificate up against your fellowship.

Honestly, if both were applicants for a job with me, I think our group would have a hard time balancing the benefit of a fellowship trained guy who hasnt done adult cases/adult cardiac/OB/whatever for a year after obtaining just a residency level mastery versus a guy who has been focusing on peds while continuing to build skills in all areas. In other words, for group marketing purposes the fellowship training helps, but practically speaking in a mixed practice it may hurt you clinically.
.

The job exists - I have it. Community hospitals with nicu's and picu's are increasingly looking for anesthesiologists with some kind pediatric credential. Groups are looking for partners to represent that niche for the hospital.

I practiced in the adult world for a couple years prior to going back for fellowship so your second paragraph doesn't apply to me. One year of peds fellowship won't hurt your chances with a generalist group if you had a mixed practice or residency immediately prior. However, if you did 100% peds for years and then try to get a mixed practice job - sure, you will be at a disadvantage.