How do I become a neonatologist?

[LHCF]

Has anyone been torn between neonatology and obgyn? How did you make the decision?
For old bear professor and doc hollywood:
1. What is a typical day like for you?
2. How would you describe the lifestyle/malpractice issues for
neonatologists?
3. Is neonatology a competitve fellowship? (Meaning someone who wants to become a neonatologist may not match?)

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[oldbearprofessor]

Has anyone been torn between neonatology and obgyn? How did you make the decision?
For old bear professor and doc hollywood:
1. What is a typical day like for you?
2. How would you describe the lifestyle/malpractice issues for
neonatologists?
3. Is neonatology a competitve fellowship? (Meaning someone who wants to become a neonatologist may not match?)

Nope, I wasn't torn. I hated OB - liked the babies, didn't like the rest of it.

Well, this weekend I'm off so I'm spending my days reading the new 2006 neonatal resuscitation guidebook in preparation for teaching this years entering residents and fellows in a few weeks. I'm also writing grants ! But, that's not what you meant...

When on the clinical service, days for attendings are busy whether in academic or private practice. Usually we start seeing babies/doing sign-out by 8 AM with teaching and patient care rounds going on from about 9 AM until close to noon. After lunch/noon conferences, we deal with new admissions, talk to families and the like until sign-out about 5 PM. In many children's hospitals and large maternity hospitals, a fellow and/or an attending stays in house all night. Generally, it isn't the daytime person.

I covered malpractice in a recent post that you might look up. Basically, it is increasingly becoming common to sue both neonatologists and the OB at the same time, whereas in the past, it was just the OB being sued more commonly. Still, malpractice is not as big an issue, by far, in neonatology compared to OB. In academics or some private groups, it is covered by the hospital/med school and is virtually invisible to the doctor.

A couple of SDN folks have recently interviewed in neo so they could comment about competitiveness, but no, in general it is not very competitive. Of course, a few of the largest programs are relatively more competitive, but it is not particularly competitive to get a slot at a good location. In general in pedi specialties, personal qualities, letters of rec and the like are more important than step 1 scores and the school you went to.

Regards

OBP

 

[LHCF]

Nope, I wasn't torn. I hated OB - liked the babies, didn't like the rest of it.

Well, this weekend I'm off so I'm spending my days reading the new 2006 neonatal resuscitation guidebook in preparation for teaching this years entering residents and fellows in a few weeks. I'm also writing grants and preparing for my son's high school graduation! But, that's not what you meant...

When on the clinical service, days for attendings are busy whether in academic or private practice. Usually we start seeing babies/doing sign-out by 8 AM with teaching and patient care rounds going on from about 9 AM until close to noon. After lunch/noon conferences, we deal with new admissions, talk to families and the like until sign-out about 5 PM. In many children's hospitals and large maternity hospitals, a fellow and/or an attending stays in house all night. Generally, it isn't the daytime person.

I covered malpractice in a recent post that you might look up. Basically, it is increasingly becoming common to sue both neonatologists and the OB at the same time, whereas in the past, it was just the OB being sued more commonly. Still, malpractice is not as big an issue, by far, in neonatology compared to OB. In academics or some private groups, it is covered by the hospital/med school and is virtually invisible to the doctor.

A couple of SDN folks have recently interviewed in neo so they could comment about competitiveness, but no, in general it is not very competitive. Of course, a few of the largest programs are relatively more competitive, but it is not particularly competitive to get a slot at a good location. In general in pedi specialties, personal qualities, letters of rec and the like are more important than step 1 scores and the school you went to.

Regards

OBP

Thanks for the reply! That was very helpful. I like the babies too. And I think it would be so rewarding to try to give those little babies (preemies) a chance. I just wish I could go directly into a neonatology fellowship and bypass the general peds residency-but I know its required.

 

[Doc-Hollywood]

LHCF
Member
< 10 Posts


Join Date: May 2006

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Has anyone been torn between neonatology and obgyn? How did you make the decision?
For old bear professor and doc hollywood:
1. What is a typical day like for you?
2. How would you describe the lifestyle/malpractice issues for
neonatologists?
3. Is neonatology a competitve fellowship? (Meaning someone who wants to become a neonatologist may not match?)

To answer your questions specifically

1.I'm writing this at work at 5 in the morning.
There's your first clue as to a typical day

There are no typical days. It depends on the typs of practive you join
You have I would say more options in neonatology than just about any other career , in terms of lifestyle, practice type and hours and even income
I have friends that are in academic neonatology with a primary research focus and they do 3/4 of their time ( or more ) in their lab, and only set foot into the NICU a few months a year. I have others that are on a primary clinical track and do very little resarch but have a very big teaching job.
I can really comment more about the private practice worls since that's what I do.
There are solo practitioners ( pretty rare ) .....and small private groups, and large private groups.
A couple of my friends work for Pediatrix, which I think of as the Wal Mart of Neonatology. They cover lots of hospitals besides their own. I am not bashing pediatrix. I actually interviewed in a few of their programs, but I decided not to join "the Firm". The whole corporate mentality wasn't for me
I work in a hospital based group of 5 docs. We provide 24 hour in-house coverage for a pretty busy 30-40 bed unit. When I am working I am very busy. When I am off I am OFF. No beeper. No office. Off. I like to travel so that works out great. I can go pretty much anywhere I want since I am not on the schedule and this doesn't count as vacation. I get pretty good chunks of time off and then do one week where I am in the hospital about 90 hours. I do that on average one in 5 weeks. the rest of the weeks are closer to 40-50 hours, providing night and weekend call. We make our own schedules so all of us pretty much work when we want and are off on the times we want off. ( for the most part ) Holidays and weekends still need to be covered so you always end up missing something
One thing is for sure, if you choose this field you will work your share of nights. Some places offer call from home, but rest assured : you will be spending a fair amount of time in a hospital at night. That's actually the part I like. I like to be up at 3 AM taking care of really sick patients. Guess if I didn't I'd be working in an office writing Ritalin scripts and doing sports physicals and getting gum out of ears.
All 5 fellows from my class went into private practice.
4 of the 5 in the class behind me went academic.
People choose for various reasons. I guess my class was materialistic since at the time the salaries were about double to do private. I just waw one of my friends at SPR and I am happy to report that things are greatly improving on the salary front on academic part ( at least where he works ) Great news!
A "typical day" would be as follows:
Some type of sign-out rounds in the morning usually about 8 AM with the previous evening physician. ( residents of course probably getting there to preround at 6 or 7AM... )Then actual rounds on your census of babies ( fellows making rounds with the residents before the attendings show up to make sure nothing is screwed up to make the fellow look bad ) Attending rounds with the entire team usually begin at about 1000 and continue until finished ( stopping sometimes for lunch or a noon conference ) usually wrapping up by 2 PM, when the scut is carried out feverishly. Sign out rounds usually occur for the night call doc at about 5 or 6 PM.
And the whole process repeats.

Torn between neonatology and OBGYN

? Not in a millions years
I Loved neonatology.
I Hated OBGYN. The two ( though working close together ) are MILES apart. If you had said torn between neonatology and peds critical care, or anesthesiology I think those are more similar. I almost did anesthesiology as a career. In a crash c-section I am still always watching the anesthesiologist instead of the OB

2. Lifestyle?
Well I think lifestyle is pretty good. The salaries are also variable , based on location and type of practice. You can work every other night on call ( or be on call every night I guess if you are in a small town area and provide coverage for deliveries or emergeicnes ( YUCK ). Obviously if you are doing bench research with a very light clinical duty, you are not on call a whole lot.
I can only comment on my salary and I am very happy with it. Four years out in practice now ( after 4 yrs college, 4 yrs med school and 6 yrs residency and fellowship )and I think I am earning almost the minimum salary for a major league baseball player. I'm pretty stoked about that. Malpractice is one area of concern I suppose. I work in a high risk field. You will be sued sooner or later. My partners have all been sued for various things, and it seems like never for any actual malpractice, only bad outcomes which do happen with the sickest patients. I've testified in a few depositions already for OB's that were getting sued, in which I took care of the baby afterwards. (The external fetal monitor doesn't do much as far as I can tell other than increase your c-section rate and make money for the lawsuit industry. Trial lawyers, defense lawyers. They all get paid in the end.
I honestly don't worry about getting sued, but the more I get into the field the more I find myself doing things defensively....to cover my ass. I don't like it but I think we all do it. I still consider myself to be somebody that tries to practice medicine without thinking of things like that, but It's pretty hard these days. All physicials practice defensive medicine from time to time either intentionally or on a subconscious level. We use words like " being extra cautions" when what we are really saying is "I am ordering this test to rule out you suing me should something bad happen later"

3. Last I checked it still wasn't too competative. I think like most careers there is ebb and flow in the job market. There are still plenty of jobs at teh present time and I don't see that changing in the next decade. Maybe there will be even more available as pediatric residency training gets more and more watered down in the care of the newborn. When I was a resident in 96-99 people told me I was nuts for doing the fellowship and said I'd never find a job because I guess the market wasn't so hot at the time. I didn't care, it's what I loved. Now as more and more hospitals are delivering more and more complex cases away from referral centers and as more and more spraql occurs with nice 800 bed hospitals in the burbs with 30 somethings having their IVF and their 24 week twins, there seem to be a plethora of jobs. Also last time I checked you can virtually get a job in just about any academic department. So many medical schools, so few fellowship graduates.
Getting a fellowship isn't probably too difficult. Try to get a fellowship at a really good program with a very busy unit. Try to go to at least an ECMO center so at least you can manage an ECMO patient and you won't be limited by where you can go and work.
Even though we don't do ECMO, I was glad I trained and am comfortable with managing those patients, in case I ever decide t oleave my current practice and work in a place where the do ECMO
**Match?? Is there a match now?
When I applied you just applied and thei either offered you a spot then and there ( or within a week or so )

I would suggest doing some electives in the NICU. Seeing is believing. Maybe you will get hooked. It's really addictive.

Hey what great timing. My 27 weeker with the perf is done getting his ex-lap. Time to see him and get a waffle and a big cup of coffee

post specific questions, though I only browse this forum rarely. I usually check in a few days aftere I post something so I'll try to answer

also try www.neonatology.net and specifically here for more information. I think that's a pretty good synopsis

 

[TexasRose]

Thanks for the detailed posts, DocHollywood and OBP. We practically need to make a sticky out of this topic, given how often these questions come up!


TR
Budding neonatologist

 

[oldbearprofessor]

Thanks for the detailed posts, DocHollywood and OBP. We practically need to make a sticky out of this topic, given how often these questions come up!


TR
Budding neonatologist

Heh, heh, I was certain of neo before graduating from med school and a lot of our PL-1's know for pretty certain they want to do neo early on.

I wanted to comment a bit about night call. Doc Hollywood and I work a lot at nights and it isn't always a matter of sleeping in a hospital bed (or at home taking calls). A few hours of sleep on-call is common, a whole night of sleep is rare (assuming one can sleep in a hospital on-call room and bed and no sleep at all happens a good bit too.

I know that for many people, a career of more than 20 years of working regularly at night and some holidays seems like a horrible future, but it really isn't. As has been pointed out, if you like and believe in what you do, and recognize that there is no choice but to work at night in the baby business, it just isn't that big a deal. The overall life style, as Doc H pointed out, isn't bad at all. No one wants to be awoken at 3 AM and go to see a patient if they don't have to, but as an attending, you are in charge and responsible. This comes with a lot of challenge and somewhat less scut than being awoken at 3 AM as an intern or resident. Lost sleep is still lost sleep, but the level of responsibility of what you are doing (usually at least - some 3 AM stuff isn't important) balances this out and makes night call as an attending a tolerable experience and often relatively "enjoyable". I personally don't mind at all spending a night at the bedside of a very sick baby, but a night of taking phone calls about runny noses, etc would drive me nuts. Of course, others feel differently!

It's about making choices and a sense of accomplishment and interest in what you are doing. So, although much of what I see on SDN advises med students and residents to find the career with the most $$/hr and the least night-call, be certain of the trade-offs that will make YOU happiest with your life, before passing up a career in a pedi specialty for a better "lifestyle". Nothing wrong at all with other specialties with less hours or minimal nights, but I never considered them, would have hated most of them, and don't think the nights are a big deal at all.

And the rewards from a research career add to that....

Regards

OBP

 

[Qwest]

Doc-Hollywood --> I sent you a PM

Thanks OBP + Doc-Hollywood for taking the time to answer questions about neonatology.

Is it weird for me to like neonatology but hate having to go through 3 yrs of pediatric residency? I absolutely love working with babies, but not dealing with runny noses, otitis media, general peds stuff... Did you guys have the same feelings?

 

[oldbearprofessor]

Doc-Hollywood --> I sent you a PM

Thanks OBP + Doc-Hollywood for taking the time to answer questions about neonatology.

Is it weird for me to like neonatology but hate having to go through 3 yrs of pediatric residency? I absolutely love working with babies, but not dealing with runny noses, otitis media, general peds stuff... Did you guys have the same feelings?

Actually, I liked a lot of it. It's important to learn that stuff, especially as we deal with older babies with BPD. Now, I hated adolescent medicine with a passion....but for a short period of time general pedi was tolerable. But I knew it was just for a while until fellowship. Also, residency at most pedi hospitals is largely inpatient so there is a lot more stuff you're doing other than general pedi. If you want to avoid too much of that look for the larger academic programs with lots of tertiary care patients for residency and you won't be overly bored with general pedi.

Regards

OBP

 

[nibrocli]

neonatology seems wonderful. . . but how do you get back onto a normal sleep schedule after a night shift?!?

 

[oldbearprofessor]

neonatology seems wonderful. . . but how do you get back onto a normal sleep schedule after a night shift?!?

I've generaly felt that I don't have a normal sleep rhythm. Six years of every 3rd night or 4th night on call (no 80 hour, days off, etc, back then) during my residency and fellowship ruined that Ithink forever.

I try post-call to stay up until mid-afternoon and go home for a short nap so I can have the evening with the kids. Othertimes, I try to stay up and then go to bed early. All depends on whether I got any sleep while on-call. It does get harder to do as you get older, but doable....

Regards

OBP

 

[LHCF]

Is neonatology anything like emergency medicine where physicians are needed 24/7, so they are assigned to work in shifts? This would make sense to me if you are doing a lot of nights and weekends just like emergency medicine physicians do. Is it common to work 3-4 12 hour shifts in a week?

 

[oldbearprofessor]

Is neonatology anything like emergency medicine where physicians are needed 24/7, so they are assigned to work in shifts? This would make sense to me if you are doing a lot of nights and weekends just like emergency medicine physicians do. Is it common to work 3-4 12 hour shifts in a week?

If you mean is the care entirely based on shifts, like in the ER, the answer is "not usually." Although nights may be covered with separate doctors from days, usually days are assigned for residents, fellows and attendings based on a 1 week to one month rotation in any given NICU. The reason is to enhance continuity of care. Unlike the ER where patients may stay a few hours usually, in an NICU, stays are weeks to months. The more consistency of care, the better, at least in terms of daytime decision-making regarding ventilation, feeding, etc. Families really hate the switch-over of neonatologists (and fellows, residents), they would certainly not like it to occur daily. Now, there are some smaller NICU's that may work shorter sequences or even shifts, but most NICU's do not work as true shifts for daytime coverage.

Regards

OBP

 

[nibrocli]

usually days are assigned for residents, fellows and attendings based on a 1 week to one month rotation in any given NICU.

OPB,
can you elaborate? maybe explain to us what a sample month might look like for you. ie, how many day shifts, night shifts, etc in a given month?

thanks so much!

 

[LHCF]

OPB,
can you elaborate? maybe explain to us what a sample month might look like for you. ie, how many day shifts, night shifts, etc in a given month?

thanks so much!

Yes, this is what I was getting at. I'm trying to see how this works when babies need care 24/7 but the same attending can not be there for all those hours.

 

[oldbearprofessor]

Yes, this is what I was getting at. I'm trying to see how this works when babies need care 24/7 but the same attending can not be there for all those hours.

Let me try to clarify. Remember that I do academic medicine and things are different between academics and between academics and private practice. However, in our instititution, an attending will be assigned to the NICU for each month. Depending on the size of the NICU, there may be more than one attending and there may be a different attending for the sickest babies (Level 3) vs the growing premies, not as sick babies (Level 2). It would be typical for one attending to be responsible for about 10-20 babies for the month, depending on the level of sickness. Usually the attending will have attached to them a team of primary care-givers. This may include one or two residents in pediatrics, one or two nurse practioners and a neonatal fellow. In the morning, the residents/nurse practioners, with the assistance of the fellows will see each baby and perform a physical exam, and review the lab. After that, the whole team will see all of the babies and this would include teaching (pimping) rounds...

All of this lasts until midday or early afternoon. Then, the rest of the day is spent dealing with problems. This same team will round every day Monday-Friday for the whole month. Weekends are handled differently depending on where you are. Often, the person who rounds on the weekdays will be responsible for some of the weekends but not all. Other neonatologists who are not on duty for the month will cover the "other" weekends. It would be typical to work, over the course of the year, perhaps one weekend/month in many systems.

Nighttime call usually begins around 5 pm. The daytime team briefly discusses the babies with the on-call doctors and then goes home. The resident and fellow will usually be on call every 4th-5th night with other residents covering other nights. This is variable. The attending may take call from home on some schedule, or may take in-house call (larger NICU's). Usually this is divided equally by all of the attendings available throughout the year. So, it can range from every 5th night to every 2 weeks depending on the system. I prefer in-house call as frequent calls at home at night are more difficult than just being there. In a busy level 3 center with ECMO, inhaled nitric oxide and the like, an in-house attending is becoming standard.

The real distinctions come in terms of how many months one is "on-service" like this. It can range from 2 to 12 months/year in both private and academic. Usually it is less in academics as we are doing research, it is more in private practice. Sometimes the daytime person doesn't take any nights, sometimes they do, depending on the system. On the whole though, it would be typical to take some type of nightcall as an attending somewhere between 1/5-1/10 of all nights and to do 10-15 weekends/year. I note that weekends may mean just rounds in the morning and turning the team over to the on-call person by midday or early afternoon.

Hope this helps.

Regards

OBP

 

[nibrocli]

OPB,
as usual, great post. thanks a ton.

LHCF,
for some info from the private practice side of things, i dug up the following thread. scroll down to post #10:
http://forums.studentdoctor.net/showthread.php?t=70520

 

[Mossmoon]

Now then, in general, I think the hardest time-period in becoming and practicing as a neonatologist while having a family is fellowship, especially the first year, which is mostly clinical. This is as tough as internship in most places with more stress and responsibility. So, you'll need a solid support system in place for that year for you and the family. The later years of fellowship are more research-oriented and not as bad, although still lots of night call in most places.

I deferred entry to med school until next year (in the UK but planning on moving straight to the USA as I am from there originally). I am married and a nurse, so I know what juggling hospital and family life can be like to a certain extent.

You mentioned the most difficult time is during fellowship. Planning strictly based on work intensity, would you say that the easiest time is during medical school? I have been considering having my first baby soon because a) I want to and b) I wonder if I would have more time for them while I am studying than post-med school. My idea is to have my mother come visit whenever exams are coming up. If I wait until I am an attending I will be in the papers for having IVF at 60.

Actually it isn't that bad- I will be 31 when I graduate. Oh, and if you haven't guessed, I also plan on being a neonatologist.

 

[oldbearprofessor]

You mentioned the most difficult time is during fellowship. Planning strictly based on work intensity, would you say that the easiest time is during medical school? I have been considering having my first baby soon because a) I want to and b) I wonder if I would have more time for them while I am studying than post-med school. My idea is to have my mother come visit whenever exams are coming up. If I wait until I am an attending I will be in the papers for having IVF at 60.

Well, this is the second time recently I've been asked here to comment on being a mother and a neonatologist...hmmm, perhaps it's time for a gender-check

In addition to referring you to mommd.com and some others here, I would say that there are two standard answers to that question. The first is that the last yr is best for kids -last yr of med school, last yr of residency and last yr of fellowship. In this way of thinking, the first yr of each is the hardest. An alternative theory is that there isn't any "best" time - so have the kids whenever you want and whenever you're fortunate to have them.

I can't tell you which is best for you. I can only say that having healthy children is the most important thing of all whether you're a mother or father, so make your decisions based on that. You can always take time off and come back to school or career.


Regards

OBP

 

[Mossmoon]

I asked you because I have noticed you tend to replies with thought out answers unlike some and because you might not know exactly what it means to be pregnant, but you HAVE gone through all the neonatology years. You make a good point about the first years that I hadn't thought of. On the subject of health, I am torn between all of the people that say 35+ is fine and my endocrinologist that complains that women should have babies at 20.

Thank you for the link and have a nice time at the graduation!

 

[DrMom]

stickied per recommendation of oldbearprofessor

 

[kickazzz2000]

I was in your shoes, but went the reverse direction. I loved anesthesiology and would have certainly done peds anesthesiology ( or CV and worked the congenital heart cases )
I think there is a lot of similarities between the two careers.
What changed my mind was that I felt I wanted a bit more patient contact,

PS: you can spend plenty of time at home and still do neonatology.
I am in a pretty awesome private group and we work 1 really bad week ( well over 90 hrs ) out of 6, and the remaining 5 weeks we are only doing about 2 night calls a week with large chunks of time off.
for example, I am just completing my long week. Next week I only work Tuesday night 5 PM to 8 AM. the rest of the time I am off.
The beeper gets turned off when I leave the hospital, much like yours will

PS: nobody is morally superior based on their career choice.
It's how you conduct yourself, not what specialty you choose

My story was even more drastic. I was an anesthesiology applicant (hoping to do Peds Anesthesia) who did a month of neonatology towards the end of my MS4 year. Absolutely loved it. Scrambled into a peds prelim, dumped anesthesia, and a year from now, will begin my fellowship. Never looked back.

 

[jackjinju]

My story was even more drastic. I was an anesthesiology applicant (hoping to do Peds Anesthesia) who did a month of neonatology towards the end of my MS4 year. Absolutely loved it. Scrambled into a peds prelim, dumped anesthesia, and a year from now, will begin my fellowship. Never looked back.

wow....i was almost gonna do peds anesthesia until turned on to NICU....started fellowship this month....where are u gonna be next year? PM me if u like.

andrew

 

[oldbearprofessor]

I used "thankless" because, relative to other specialties, neonatologists put in so much - physically and emotionally - in comparison to what they get in return. How many of their patients can thank them?

Well, one of my former patients, who weighed less than 600 g when born, and is now a college student, posted a very nice note on my Facebook wall thanking me.

 

[jocg27]

Well, one of my former patients, who weighed less than 600 g when born, and is now a college student, posted a very nice note on my Facebook wall thanking me.

wow...that's very cool

 

[LHCF]

Well, one of my former patients, who weighed less than 600 g when born, and is now a college student, posted a very nice note on my Facebook wall thanking me.

How rewarding!

 

[Doc-Hollywood]

oops, I noticed I already replied in this thread back in May ( and once earlier thna that. wow this is an old thread. )

funny in rereading the post I made back in May I was up with a patient that night and was replying while he was in surgery after suffering an intestinal perf/NEC

I just discharged him yesterday.

time flies

 

[bella189]

I'm also looking into the profession of neonatology. i've read this thread and I think all the information posted here is really helpful.

I am only 14. I am just starting high school this year and have been researching the field of neonatology for some time. I have one question, how do I go about volunteering at a hospital? Do I just ask if they are looking for volunteers? Do I go in person? Do I call? Do I write? I think that this would be an amazing learning experience for me. Any thoughts or advice?

 

[Kaelin]

Hello everyone my name is Kaelin and I was looking for some information on becoming a neonatologist. I am 15 and a sophmore. I have allways wanted to be a neonatologist. I was looking for any advice on what colleges or medical schools I should attend to better my experience so that I will be prepared to become a neonatologist. Is there a certain major I should choose in college so that I would have a better chance of being excepted into a good medical school?

 

[Courtny]

I wonder if these posters are real high school students?? In any event, how and why would any teenager want to become a neonatologist? It is not anything like babysitting your little nieces and nephews, kids. neonatology is a grueling, thankless profession in which you deal with very very sick babies; many don't get better and those that do often won't end up completely "normal." Hat's off to those who can do this work...

I am a high school student and I want to become a neonatologist because im interested in it and my twin cousins spent a month and a hlf in the NICU so I spent alot of time there. It was interesting and I know it's alot of hrad work but its a rewarding career.
Courtny

 

[anos09]

Hello, my name is Ann and I am a sophmore in high school. I am very interested in neonatology, and I was wondering if someone could answer a few questions I have.
First of all, what is the biggest difference between becoming a neonatologist and becoming a neonatal nurse?
How many years of schooling must you aqquire before becoming a neonatal nurse?
Is it a career that is currently in-demand?
And lastly, for those of you who are neonatologists or neonatal nurses, what is a day in your shoes like?
Thank you so much for you help, it is greatly appreciated,
Ann

 

[Complications]

I'm sorry... does anybody know how to delete a post? I have been trying to delete this forever and I just can't figure it out....

Ann

I think you can just hit edit and delete the text ... but did you get your question answered?

RN - 2 or 4 year program
neonatology - 4 years undergrad + 4 years medical school + 3 years peds residency + 3 years fellowship.

Hope that helps ...

 

[mshheaddoc]

If you are looking for information about the NNP (Neonatal Nurse Practioner) I suggest visiting allnurses.com as there is alot of information on NNP's there.

 

[anos09]

Okay, thanks everyone. You were very helpful
Ann

 

[Mossmoon]

In terms of complete practicality only, because personal enjoyment, fulfillment, etc is to subjective, is going into neonatology worth the three extra years? I mean this based on money and benefits only. What is the typical salary along the way (in residency and fellowship)? I am getting a little bit of a late start AND relocating from another country (UK to USA) so I want to know practicalities as well as anything else. Thanks for any help.

 

[oldbearprofessor]

In terms of complete practicality only, because personal enjoyment, fulfillment, etc is to subjective, is going into neonatology worth the three extra years? I mean this based on money and benefits only. What is the typical salary along the way (in residency and fellowship)? I am getting a little bit of a late start AND relocating from another country (UK to USA) so I want to know practicalities as well as anything else. Thanks for any help.

I usually avoid $$ questions in terms of careers, because I don't think that's the deciding issue for people interested in pedi or neo, however, since no one is awake yet in my house (3 teens and New Years day at 9 AM or so...), I'll answer a bit of what I think you're asking. Feel free to let me know if I'm missing the actual question.

Assuming one does a 3 year residency either way, and pediatric salaries of about $50,000/yr by the time you are doing residency.

http://www.med.yale.edu/pediat/education/residencyprog.html#salaryben

as an example I Googled...exact amounts can usually be found easily on the net.

Then as a fellow, one would make a bit more (PL-4 to PL-6 salary), assume then a mean of $55,000/yr.

As a private practicing pediatrician, one can probably start anywhere from $80-140,000/yr (RuralMedicine can correct me here....) depending on hours, location, etc.

http://pediatrics.about.com/cs/pediatriccareers/a/pedi_interview_2.htm suggests slightly higher numbers and a mean of $130,000

So, one probably loses about $80,000-$200,000 during training, not taking into account taxes, costs of living, etc.

Can one make this up as an attending? Well, in academic neonatology it will take you a while as salaries are not that much higher (on occasion lower) than in private pedi, but, despite the myths, eventually most but definitely not all academic neonatologists will make an amount that allows this difference to be made up, even accounting for increases in general pedi salary. Again, who knows what will happen in 10 years though? Although you might not be interested now in research, that may change and the opportunities are considerable for both clinical and basic-science oriented research so you might decide that academics isn't so bad! NIH loan repayment may also help make up the difference for some.

In private neonatology, one would probably be able to make that up in 2-5 years, with all the usual caveats about work hours, location, etc and not knowing what the market will be like in 10 years.

So, the answer is yes, you can financially do better by neo, but the make-up time is probably at least 5 years out of residency, maybe more like 6-10 years. Only you can decide if its worth it for your family and for the vastly greater personal satisfaction one gets out of neo IF that is what you really like doing.

Regards and Happy New Year.

OBP

 

[BPD]

Hi OBP

As you said, monetary compensation should not be a consideration when choosing between peds and neonatology. I also know that $$$ questions are not your favorite. But now that I am about to be a neonatology fellow and looking at an academic neonatology career, I would really like to know what the natural progression of a typical academic neonatologist's salary is...starting, 3 years into practice and 10 years into practice. You think you can make an exception and oblige???

I did find this link but the figures seem to be very inflated
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Happy New Year

Thanks

BPD

 

[Mossmoon]

I agree that money shouldn't be the deciding factor about becoming a physician in the first place, but in the real world, where houses, education and everything else are so expensive, once that decision is made, you have to be realistic about whether you can afford to do x+y years of education. That is why I asked for *only* practical reasons. I realise there is more to it... But once you hit a certain age, and have family to consider, you have to approach everything from as many angles as possible. Thanks for the reply.

About the merging with the sticky: I agree, except that it is very difficult for someone new to the forum or that doesn't come very often to find the question they are looking for when it is on a thread of 100+ posts!

 

[oldbearprofessor]

Hi OBP

As you said, monetary compensation should not be a consideration when choosing between peds and neonatology. I also know that $$$ questions are not your favorite. But now that I am about to be a neonatology fellow and looking at an academic neonatology career, I would really like to know what the natural progression of a typical academic neonatologist's salary is...starting, 3 years into practice and 10 years into practice. You think you can make an exception and oblige???

I did find this link but the figures seem to be very inflated
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

Happy New Year

Thanks

BPD

Hi BPD and happy new year to you too. The problem is that the term "academic" means such different things at different places in neonatology. For example, there are several "university" hospitals and Children's hospitals in which the neonatologists are actively teaching residents and even fellows but the groups are definitely not paid by the medical school and would usually be considered "private." Furthermore, some of these groups do clinical research further blurring the line. Even the largest private practice group in the US actively is doing research and has numerous academic appointments among its faculty making the lines very blurry.

Having said that, there are certainly, at many (?most) of the largest 10-20 Children's Hospitals groups that are very traditionally academic. I don't immediately know what percent of neonatologists work at these, but it certainly is a minority of all neonatologists and quite likely a minority of neontalogists involved in teaching medical students and residents.

Now then, with that background...to your actual question.

Well, it still is tricky to figure out, because after a number of years, many academic faculty, such as those paying their children's college tuitions, do consulting on the side for various purposes. Also, salaries at the big-name centers on the East Coast are reportedly different than in the mid-west and West coast (I have no proof of this....). South seems to fall in-between. Of course, in academics, one can have a college tuition plan included that is either partial or fairly substantial as well as variable health and life insurance benefits. Lets not forget travel. I go lots of places, almost always funded by someone else, and often with my family using frequent flyer miles.

Okay, with all of that taken into account, I think that the typical academic neonatology salary starts at about $100-$140,000/yr and typically increases about $5000/yr. It is a bit higher than most other pedi academic specialties (we bring in the money) and of course, increases with tenure and administrative appointments. At some centers, including ours, a substantial bonus is given for in-house night-call (hard to give an average on this, but certainly in the $10-40,000 range).

Hope this helps, I welcome data points from others.

OBP

 

[drsmiles101]

That was really useful information.Any input on salaries and lifestyle after PICU fellowship.I was in a dilemma between NICU and PICU for my fellowship and finally chose PICU.
Happy New Year to you all!

 

[oldbearprofessor]

That was really useful information.Any input on salaries and lifestyle after PICU fellowship.I was in a dilemma between NICU and PICU for my fellowship and finally chose PICU.
Happy New Year to you all!

Lifestyle - I don't think as many PICU's have gone to 24-hour in-house attendings as NICU's have. But it's coming in the largest centers for sure. Personally, I greatly prefer in-house call - much less disruptive for the family and I get MORE sleep compared to 4-5 calls after midnight at home and trying to decide when to come in or not. As long as it's just 2-3 days/month, I'd rather be in-house. To date, basic science and even clinical research in PICU has lagged behind neo, but hopefully this will change as enough PICU folks are around to give folks time to develop research interests.

Salary - very similar to NICU. I think perhaps a bit lower in that there aren't as many private practice jobs out there, but I don't have much direct info on the relative salaries. Academic jobs would be very comparable to NICU.

By the way, in the earlier posts, I should have noted that the merging of academics and private practice is even more extensive in neo than I made it sound. For example, the largest Children's Hospitals have increasingly hired neonatologists to work in level 2 NICU's they operate. Such folks may have academic appointments and do some level 3 work but not do any research and not be on a tenure track. Why do they do it? Lifestyle - it's not always a barrel of fun for an "older" ("older" is defined as anyone older than me ) neonatologist to do q 5-6 in-house call and a bunch of busy level 3 months and the level 2 arrangements and management of the practice by the university or children's hospital is appealing given the chance to do "a little" level 3 and teaching.

Lots of options out there in the critical care pediatric specialties (neo, picu, cards)! This includes all shift-work jobs, part-time jobs, time-shares, etc.

OBP

 

[baya]

OBP: if I did peds, I might specialize in neonatology. Do you have any idea if I could live in a rural-ish area of the west coast and work as a baby-doc? Or do they ship most babies straight out to big urban hospitals for their care?

Depends how rural and depends on how far you're willing to commute. Moderate sized communities will often have a small level 2 nursery with a neonatologist but not very rural areas. To work in those areas you'd need to be within reasonable range of a big city. Since most intensive care in neonatology for ventilator-dependent babies is headed towards 24 hrs in-patient and shift work for attendings, there are a variety of ways to make this work without actually living in the city.
OBP

okay, so howsabout me trying to work someplace like Santa Rosa, Eureka, Santa Cruz, Santa Barbara, etc. and living a 20 minute drive out of town someplace pretty. Might that work?

Also, if you care to elaborate on "24 hrs in-patient and shift work for attendings", I'd like to hear more. Do you mean that the attending goes in for a 24 hour shift in the NICU and then goes home for a couple of days?

 

[oldbearprofessor]

okay, so howsabout me trying to work someplace like Santa Rosa, Eureka, Santa Cruz, Santa Barbara, etc. and living a 20 minute drive out of town someplace pretty. Might that work?

Also, if you care to elaborate on "24 hrs in-patient and shift work for attendings", I'd like to hear more. Do you mean that the attending goes in for a 24 hour shift in the NICU and then goes home for a couple of days?

There are two modes in neonatology for attendings. Traditionally, attendings worked for a month during the days and took call from home. For small units, the nighttime would be covered in house by an NNP, in bigger units by residents and/or fellows with or without NNPs.

This still exists in many areas and of course, requires that the attending be "close" for true emergencies that can't be handled by the in-house person. Usually this means being within about 15 minutes or so, but rules and guidelines vary on this.

There is an increasing trend for in-house neonatology at moderate to large units. I don't specifically know about the cities you have mentioned but this is a fairly rapidly changing landscape and I expect more units to go to in-house attending neonatology coverage. Liability issues as well as being able to competitively advertise "we have 24 hour in-house neo" for your maternity center is driving this.

To provide this, one either needs enough full-time staff/faculty to cover 24 hrs 365 days or you have to hire "shift/moonlighting" neonatologists. Any and all imaginable ways of doing this are in vogue. I know some moms with small kids who only work nighttime/weekend shifts at whatever frequency they choose and I know many folks who do this full-time on a shift basis. I know some folks who arrange to bunch their shifts so they have extended free time. I even know some folks who work in several cities for a few weeks at a time doing shift work.

Since the need for this type of coverage is increasing, I expect the options to increase. I expect increasing use of 24 hours in-house shifts, even on weekdays. This may mean no single attending for a month, but if the number of people doing this are reasonably limited, probably is reasonable, especially in smaller centers.

I personally prefer the more traditional mode of being an attending who works for a month at a time during daytime while only doing a few nights in that sequence. In our case though, this is in-house. This mode is more common in academic centers with lots of attendings but still requires in-house coverage at nights on some days from people who are not "on-service" during the day.

Also increasingly common is the use of pediatricians who are not fellowship trained to work in-house shifts in neonatology in various roles including those of a hospitalist. They may also provide coverage for deliveries and coverage that is similar to that provided by NNPs.

Hope this helps

OBP

 

[BlueJasper]

To all of the NICU docs:

thank you for your posts!!! They have really been informative! I am an MS2 right now and am thinking about neonatalogy. I was wondering if you could do a MED/PEDS residency, or do you need to be strictly PEDS? Do fellowship programs prefer just peds, or will they encourage med/peds to apply as well??
Any advice would be greatly appreciated, as always!!!!

 

[oldbearprofessor]

To all of the NICU docs:

thank you for your posts!!! They have really been informative! I am an MS2 right now and am thinking about neonatalogy. I was wondering if you could do a MED/PEDS residency, or do you need to be strictly PEDS? Do fellowship programs prefer just peds, or will they encourage med/peds to apply as well??
Any advice would be greatly appreciated, as always!!!!

I know a veritable small army of med/peds folks who've done neonatology. We just have to remind them not to order a "bag" of saline or an "amp" of bicarb in the NICU. These folks come in handy when a nurse or parent gets sick in the NICU (it has happened), otherwise they're the same as everyone else who just did peds. Fellowship programs don't care if you did peds or med/peds.

Glad to have you!

OBP

 

[BlueJasper]

Thank you for all of your advice!! I am sure I will be seeking more over the course of next year, as I get my feet wet on the floors..so stick around : )

 

[pinkya]

Um, hi, i am new to this forum, but i also want to be a neonatologist, when i grow up. And in my junior year of high school, i am taking 3 science classes, because i want to take all the science classes they are that will help me get into college with a good pre-med program. So any advice on what i shoud start to do or not do.

 

[oldbearprofessor]

Um, hi, i am new to this forum, but i also want to be a neonatologist, when i grow up. And in my junior year of high school, i am taking 3 science classes, because i want to take all the science classes they are that will help me get into college with a good pre-med program. So any advice on what i should start to do or not do.

My genuine advice is to de-emphasize science a bit. You'll get plenty of that along the way during the next decade or so of your education. Focus on things like learning Spanish, becoming comfortably with public speaking, and the usual English, history, music, etc.

You have at least 11 more years before you apply. It really is great to have a career goal in mind early on - but keep an open mind and learn as much as you can of different things outside of science.

 

[jeonsied]

Does one HAVE to do a peds Sub-I to get into a good peds program?

 

[oldbearprofessor]

Does one HAVE to do a peds Sub-I to get into a good peds program?

Might be better to post this in its own thread, but the answer is "no." What matters is having good letters. A 4th yr elective or sub-I helps acheive that goal, but a sub-I isn't needed.

 

[ktmarie]

if i want to work in pediatrics but i want set hours from like 8-5 during the week, what field do you recommend. Neonatology looks AWESOME, but i don't know if the hours will work that well. if you could recommend some fields and give me more info on neonatology that would be great! thanks