neonatology vs. pediatric anesthesiology

[rina33]

I am attracted to both fields and need to decide asap (I'm a fourth year) whether I'm applying in peds or anesthesiology. Any advice you would give to someone in my position? If anyone else decided between peds critical care fields and pediatric anesthesiology, I'd love to hear how you made your decision, and to gain some insight in general about elucidating the differences. I've asked the anesthesiologists on sdn as well.
Thanks in advance.

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[oldbearprofessor]

I am attracted to both fields and need to decide asap (I'm a fourth year) whether I'm applying in peds or anesthesiology. Any advice you would give to someone in my position? If anyone else decided between peds critical care fields and pediatric anesthesiology, I'd love to hear how you made your decision, and to gain some insight in general about elucidating the differences. I've asked the anesthesiologists on sdn as well.
Thanks in advance.

My guess is that the anesthesiologists will have a different view than we do.

It's true as the first response you got there indicated that you initially have to decide pedi vs anesthesia. You have to be willing to care for adults during your training if you go anesthesia. But you don't have to decide primary vs non-primary care for your ultimate career at this point. Neither pedi anesthesia nor neonatology (or PICU) are primary care specialties.

As ultimate career choices, both areas have in common, among other things, airway management, critically ill patients, and night/weekend duty throughout one's career. What is different is the age range of patients (although if you end up with PICU you would cover the whole pedi range) and whether you are providing long-term management. A neonatologist will do daily rounds, manage feedings, meet with families, etc. It is subspecialty and critical care, with a large daily dose of overall patient management responsibilities.

In general, pedi anesthesia is more OR-oriented with some family contact but less so than neo or PICU. You won't spend as much time worrying about feeding intolerance and making rounds in pedi anesthesia.

Another important difference is the role of research in your career plans. All neonatologists or PICU fellows must do some research during their training. It does not have to be basic science and many neonatologists will not do any research during their career. But, it is an important part of your training. Although research is certainly possible and encouraged in pedi anesthesia, it is not as central to the training program at most places from what I understand.

Good luck with your decision. Both are great career choices!

 

[kickazzz2000]

I faced the same choice my fourth year of medical school and found very late in the year that I could tolerate adults no longer. I am thankful for that epiphany every day.

 

[J-Rad]

I'm sure I'm posting long-past the death of this thread, but I'll add my 2. One thing to think about is that anesthesiologists can do fellowships in pediatric anesthesia alone or combined with pediatric critical care (CHOP, Hopkins are two). The nice thing about the combined fellowship is that you can (depending on the hospital you are at) practice within both fields. Some might also consider it a great advantage to get to the goal of practicing critical care pediatrics without having to go through general pediatrics residency. To some (esp. those who are very subspecialty oriented) learning developmental milestones, doing routine well-baby exams...is tedium at best. There is no way to train in neonatology without doing a peds residency first. Another thing to think about, as a corollary to the above, is what might appeal to you about the neonatology field vs. the peds CCM field (an option from anesthesia, as stated). Some like neonatology for its access to critical patients and procedures, but somewhat more narrow list of diagnoses and pathophysiologies encountered (you know, the old joke that there are only 10 diagnoses in neonatology) and more narrow age-range of patients. Others would consider this a negative and find that the variety of pathology that can be encountered in the PICU the different age ranges (I've helped to care for 2 day old to 17 year olds in our PICU) to be appealing (though you'll see plenty of "bread-and-butter" critical patients [asthma, respiratory failure, sepsis...]). PICU patients can often be chronic boarders, but the plethora of NICU feeder/growers whose eyes need to be checked, whose head ultrasounds need to be redone are painful to some and beloved by others. I am the type that does fine with the acute resussitation of the neonate, but hates the chronic care thereafter (Oh God, RN Ratfarm, please don't show me another residual at 0200...No...No...ARRRGGH!!!). But there are many who have a passion for both (thus, probably the reason it is the only pediatric subspecialty that is not undermanned). I came to residency knowing I wanted to be a pediatric cardiologist but I really enjoy the PICU despite how challenging a field it can be. So evaluate your personality and goals and think about what options are there. Don't just evaluate the positives of either field, but also the negatives that may be avoidable by training in the other (obviously, if you can't stand adults, not going into gas maybe the best...).

 

[rina33]

Thanks for the info... and for everyone's replies. As for the last one, do you know any other places that have combined fellowships? I'm pretty limited to the west coast in terms of geography, and I've heard that working in a picu as a peds anesthesiologist out here doesn't happen much.
Thanks for your thoughts....

Also, what does everyone think in terms of lifestyle difference between the two fields (residency and after)? Do you think they are pretty different, and that I could find a job in anesthesiology with minimal night/wknd call (whereas this is not the case in neo?) Thanks for the insight!

 

[J-Rad]

On a quick search Pittsburgh is another program (Pitt is considered one of if not the premier peds CCM program(s). Carcillo is a big name). I doubt you'd find a pediatric anesthesiologist (only) running a PICU, but if they were double boarded in peds CCM/anesthesia, then there would be no reason for difficulty finding a position. My guess would be that there just aren't that many people with such double boarding out there. As I alluded to the hospital you practice in may affect your practice (ex. In Maine I met a peds anesthesiologist who was double boarded. When he was at his previous hospital somewhere on the West Coast he worked in the PICU a few days a week and in the OR a few days; he said he liked that mix. At the Maine hospital the PICU was owned/operated by the hospital but the anesthesiology group was part of a private medical practice so he could not do both. He came to the hospital as an anesthesiologist only).
According to the online bio of the above guy, he trained at Seattle Children's (UWash) program. On this page: http://www.seattlechildrens.org/health_care_professionals/education/gme_anesthesiology.asp it alludes to some of their peds anesthesiologists attending in the PICU making me think dual training at this program would be possible. It makes me wonder if other facilties that have both peds anes. and peds CCM fellowships might let you design a double board program.
I can't speak to the lifestyle of either neos or anesthesiologists (I only work with military neos and am not a gasser). I'll bet OBP has posted some stuff about the field somewhere and some lifestyle answers may be found on the anesth. forum.

 

[KidDoc29]

I'm sure I'm posting long-past the death of this thread, but I'll add my 2. One thing to think about is that anesthesiologists can do fellowships in pediatric anesthesia alone or combined with pediatric critical care (CHOP, Hopkins are two). The nice thing about the combined fellowship is that you can (depending on the hospital you are at) practice within both fields. Some might also consider it a great advantage to get to the goal of practicing critical care pediatrics without having to go through general pediatrics residency. To some (esp. those who are very subspecialty oriented) learning developmental milestones, doing routine well-baby exams...is tedium at best. There is no way to train in neonatology without doing a peds residency first. Another thing to think about, as a corollary to the above, is what might appeal to you about the neonatology field vs. the peds CCM field (an option from anesthesia, as stated). Some like neonatology for its access to critical patients and procedures, but somewhat more narrow list of diagnoses and pathophysiologies encountered (you know, the old joke that there are only 10 diagnoses in neonatology) and more narrow age-range of patients. Others would consider this a negative and find that the variety of pathology that can be encountered in the PICU the different age ranges (I've helped to care for 2 day old to 17 year olds in our PICU) to be appealing (though you'll see plenty of "bread-and-butter" critical patients [asthma, respiratory failure, sepsis...]). PICU patients can often be chronic boarders, but the plethora of NICU feeder/growers whose eyes need to be checked, whose head ultrasounds need to be redone are painful to some and beloved by others. I am the type that does fine with the acute resussitation of the neonate, but hates the chronic care thereafter (Oh God, RN Ratfarm, please don't show me another residual at 0200...No...No...ARRRGGH!!!). But there are many who have a passion for both (thus, probably the reason it is the only pediatric subspecialty that is not undermanned). I came to residency knowing I wanted to be a pediatric cardiologist but I really enjoy the PICU despite how challenging a field it can be. So evaluate your personality and goals and think about what options are there. Don't just evaluate the positives of either field, but also the negatives that may be avoidable by training in the other (obviously, if you can't stand adults, not going into gas maybe the best...).

Mostly true, but you cannot do peds CCM unless you have done a Peds reisdency first. I finished a Pediatric residency and am now doing a 5 year program in Anesthesia, Peds Anesthesia, and Peds CCM. Hopkins and CHOP are the only two places that really offer this, and in order to do Peds CCM training and sit for those boards, you must be a BC pediatrician. Anesthesia alone is NOT a route to this combined training.

 

[J-Rad]

http://www.hopkinsmedicine.org/anesthesiology/Education/fellowship/PICU.cfm#combined_ped

I stand corrected and apologize for unintentionally misleading. But evaluating what you like and don't like about each field still holds true. In anesthesia's case a Peds Anesthesiologist could deal with interesting pathology, and often critical patients (in the OR, and occasionally in the PICU) without some things that are tedious in Peds residency (I'm not bashing peds, I'm a resident in it). Conversely, maybe peds to some Peds Critical Care position is entirely appealing...

 

[rina33]

Thanks everyone. I think I'm just going to have to double-apply and get a better sense of things from the interviews.

 

[augmel]

another consideration is that you can do a peds internship and then go right into anesthesiology. If you really can't decide do peds, and then if you change your mind you can switch straight over to anesthesia without losing a year.