NICU/PICU vs. Adult ICU

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jsmith123

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Hey everyone,
I'm looking for some advice on choosing a career path. From the beginning of my medical training, I've known that I want to practice some sort of critical care medicine. At first, I thought it was NICU. Then I gradually became hooked on trauma and drifted towards Anes/CCM. Then I found out about the possibility of Emergency Medicine/CCM. This has really excited me because it offers me the option to go into straight EM work later on if I get tired of the ICU. Also, it offers the ability to "mix things up" to decrease burnout. I'm trying to think long-term and see if having a family later in life might make me want the "better" work hours of EM. But, I still REALLY like the NICU and the PICU. The catch is, I don't have ANY desire to practice general Peds. So, if I go the NICU or PICU routes, 1st, how readily available are jobs? Is it going to be hard to find employment in certain areas? (ie can I move to just about any decent sized city and get work?) 2nd, is there the oppotunity to have "better" work hours in these professions if I want to spend more time with my kids one day? (I'm not married yet, so all that is theoretical right now!)

Thanks!

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jsmith123 said:
So, if I go the NICU or PICU routes, 1st, how readily available are jobs? Is it going to be hard to find employment in certain areas? (ie can I move to just about any decent sized city and get work?) 2nd, is there the oppotunity to have "better" work hours in these professions if I want to spend more time with my kids one day? (I'm not married yet, so all that is theoretical right now!)

Thanks!

the only question i know anything about to answer is your last one. at a PICU i rotated at, the three attendings were 3 on, 6 off. definitely time for family, and not too busy in the summer. but the winter months the 3 on can be grueling. but then they get 6 off to defrag :)

good questions though, i'm interested to see any responses.
 
Just to add something here, this may be better suited for another forum but....

I think that what I like the most about the NICU and PICU (although I do love developemental physiology and there's something about a sick baby that intersts me...) is the whole atmosphere.

What I mean is, the NICU/PICU doc stays in the unit and doesn't wander around the hospital/clinic and really gets to know/bond with the rest of the staff. That's one of the things I like most about the ED as well. The doc doesn't feel so much like a formal "outsider" coming in, seeing patients, issuing orders and leaving to do other things. It's more of a "family" atmosphere. At least that's been my experience. It's also been my expereince that this isn't as true of adult ICUs. The units I've been in, the docs breeze in and out, they see patients on the floor and in multiple ICUs (yes, "intensivists" are seeing floor and step-down patients...) and there doesn't seem to be that relationship between physician and staff. The docs don't really seem to be part of the team, but rather like they are on the floor. (Does that make sense?)

The other thing I like is that in the PICU, the PICU team sees all the patients and runs the show. In the adult ICUs, individual services seem to have a greater input. I like the idea of managing all aspacts of a patient's care and I like the idea that all the patients in MY unit are MY patients.

Does anyone know (and like I said, this may be the wrong forum) if these aspects of PICU/NICU life are present in adult settings as well? Maybe I'm just in the wrong hospital?
 
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Greetings: I think Dr. F.L. Kid who interviewed and found a neo job much more recently than I did will have the best answers for you. However, I did want to say that I would encourage you to focus at this point on whether you want to take care of critically ill children or adults. These are extremely different career paths (and residencies!) and it is important to do what you feel will be the most rewarding for you. To the best of my knowledge, job opportunities remain readily available throughout the country in neonatology and there are certainly options to do shift-work, part-time work, etc for some time if you wish. In general, most neos work in periods of either 2 weks or 1 month on the clinical service with the number of months on service ranging hugely depending on the type of position. For example, some academic faculty who hold NIH grants may only do 2 months of clinical service/yr whereas other clinical faculty or private practicioners may be on service virtually every month.

It is certainly true that neonatologists get to know the staff (nurses, respiratory therapists, etc) very well and that neonatology is very much a team effort in which the staff physician is just one cog, albeit the one who directs the team. Best of luck in your decision process and feel free to PM me if you have other questions.

Regards

"oldbear professor"
 
I'm trying to think long-term and see if having a family later in life might make me want the "better" work hours of EM.

Actually, out in the real world I am told that most intesivists are doing shift work type deals that probably rival the hours of EM (i.e. scheduled shifts/time on and off).
 
To answer old bear professor, I like treating kids and adults. I think I gravitate more towards the PICU because of the atmosphere and the variety. All the sick kids go to the same place, so you may have a trauma patient, a transplant patient, a DKA pt., a congenital heart disease pt. etc., whereas adult ICUs (in my limited experience) are more compartmentalized.

So, I guess I'm drawn to PICU less because of kids and more because of the rest of the things that go along with it. I like variety. It's one of the things I like about EM. I'm that guy who likes aspects of EVERY rotation!

Plus, I don't really think that we have any TRUE adult ICU docs here. We do have a Pulmonary service that admits IM/FP pts to the unit and Trauma Surg handles the surgical pts. But many other services can admit as well. Our "intensivist service" is run by Anes. and is pretty much limited to putting in lines and other procedures. They don't actually manage pts.
 
Can't comment on the job market for adult critical care, since I am pretty far detached from it ( except during Tropical storm allison, when the adult hospital next door lost all power in the floods and I hand bagged a big giant post CABG adult who was intubated ( thankfully, only for about 10 minutes )

PICU--the job market is not as good as neonatology, and most positions are in adacemic centers. Many hospitals have an NICU, or need delivery room coverage. Not too many hospitals have a PICU and merely ship the sick kids out. Still I have friends doing pedi critical care and they really enjoy it. I think the salary is OK, but any time the words"academic" precedes your job title, expect to get short changed come payday. ( but there is more to life than just money..........don't tell my wife I said that )

I recently interviewed ( 2001-2002 ) for neonatology jobs, having finished my fellowship in 2002.
The job market is getting MUCH better as older docs retire, and as residency trianing coninues to water-down the training that peds residents get in newborn medicine and as fertility meds and poor people help the premies keep rolling in !
When I was a second year peds resident and I told one of my NICU attendings that I wanted to do what he dod, he tried to talk me out of it saying that I was nuts and would never find a job.

by the time I was a first year fellow I was getting paged from recruiters at least once a week. This only accelerated as I continued through fellowship. How these people found me, I have no idea.

I had a nice time interviewing, and interviewed at about 90% private practice.
I didn't want to do research, and didn't want to climb the academic ladder.
However I loved teaching students so I found the ideal practice for me, in a group of 5 docs and 10 NNP's covering a large busy unit with lots of high risk OB, peds surgery etc. We also have students from the local medical school rotating with us, so I get to teach, I get to practice clinical medicine, and since there are no residents and fellows I still get to do all of the procedures, which is one of the reasons I chose this career.
We do one week on service where we spend about 90 hours "in-house" ( with a NNP to do lots of the grunt work )
Then I have lots and lots of time off, just covering the odd nights or 24 hr call on Saturday.

There are lots of different types of jobs....group practice ( small , medium and large ), even solo ( if you are crazy enough to take call every night )

you can cover very busy units with lots of sick kids, or just cover level 1 and 2 nurseries ( less critically ill ).
you can go into academic neonatology and do 10 months bench research, or primarily teaching and clinical work, or a mix of all of the above.
there are LOTS AND LOTS of jobs in acaemic neonatology. you can just about live anywhere you want, and you can certainly make a name for yourself with hard work. Looking back, I do miss some of the really sicker term kids ( on ECMO and Nitric, adn the D hernias ) but the trade off is that our unit is pretty happy, without half my census being the unfixable kids that inhabit all tertiary care units

the job market for private practice is no as robust ( think of how many NICU's does one city really need, and if it's in a nice city, why would we leave....therefore come cities or regions may not have any jobs at all ! )

But as I said, the job market is improving every time I look, and I don't expect that to change.

Finally let me give a pulg for the career.
Neonatology is a wonderful career. The patients are incredibly resilient. The families are generally nice ( at least as nice as people are in any other area of medicine )
You can play with lots of high tech toys. You get to be a part of a field that is really in it's infancy ( pardon the pun ) so yowe are still really learning how to do it, and things are constantly evolving.

My friends doing general peds are in their office 5 1/2 days a week looking down throats and writing Ritalin and discussing poop. God Bless them. I couldn't do it.

I'd rather be up at 330 AM putting in a chest tube, and then have the next 4 days off to go to Vegas
 
I ended up choosing straight EM over a career in PICU, but still really like PCC and have a good friend who is part of a 3 doc rotation (72 on, 6 days off). The ability to take control of a sick child's physiology and keep it alive is pretty cool.
The free time is pretty much as above, with his winter months involving tougher days of call and the rest of the year pretty relaxed. I think the key in PICU is to latch onto the right job/group. I think if you were in a smaller group with a big PICU to cover in an academic setting, it could suck.
However, the docs that I know make, no kidding, 350K or more yearly. I think this is probably an outlier figure, and definitely the highest peds income figure Ive ever heard, but I dont know that it would be too difficult to arrange a situation similar to theirs if you dont want to go into academics. Of course, 'interesting' is a lot more important than 'lucrative', I would hope. They are the only PICU in our half of the state, work in a private hospital but have an affiliated university program, and offer some pediatric floor coverage in addition to their PICU (20 or so beds) duty. I dont think any of them like general peds and mostly work on the floor as kind of a trade off for getting to run the well paid and interesting PICU. My understanding is that the PICU job market is very good, but finding a niche outside of academia is much more difficult. Still, it obviously can be done.

I think some of your decision might come down to long term care issues and whether or not you would be happy treating only children. The physiology and technology in the PI are fascinating, but the long term "trolls with trachs" management got really old for me. I really liked the first couple hours of a new patient, and after that it got pretty boring unless they tried to die. Perhaps that is self centered, but you cant really choose your tastes. The variety is similar to what you might see in the ED, and certainly higher acuity, but they are often stabilized when they arrive, the pace is slower, there are more continuity issues, and there is much less immediate problem management/instant gratification.
 
Hi Dr. FLK,

Thanks for sharing all this great information about the NICU!

I'm a 4th year student currently rotating in the NICU, and I absolutely love it. This is the happiest I've been in all of medical school. I'm sure that I want to do a Peds residency, and fairly certain I want to be an academic subspecialist.... Neonatology is high on the list right now.

My money-minded spouse has been asking me what kind of salary I could expect as a Neonatologist. I have no idea. Could you give me an idea of the types of salary/vacation/perks packages you were offered while you were looking for a job? I'm interested in hearing about Academic vs. Private Practice. Thanks for your help!

--Buddy
 
I can only tell you the $$ I was offered. ( in 2002 ) I won't name the places specifically but I will tell you the cities. these are all STARTING SALARIES. The salaries in private practice seemed to accelerate faster, and at 3-5 yrs you should expect to be equal to your partners ( unless you go to work for pediatrix, in which place the SR partners will always be light years ahead of the people that joined after pediatrix bought out the practice )


academic neonatology
Houston -100K/ yr
Cleveland-85k / yr I AM NOT JOKING

private practice
Ft Worth -150-180 /yrwith bonus
Houston 200K/yr
Burbank, CA--150K first year. then full partner so up to about 250
Toledo 150 K/yr
Chicago 200K

and my current position 190 plus 15% bonus. this was starting, and this year ( after 2 yrs )I got a 60K raise, and still I get my bonus


I agree that money isn't everything. Job satisfaction is a must.
Still, of the 5 graduating fellows in my class, all of us went into private practice.
I think it's utterly rediculous for some children's hospital /medical school worth billions to pay their new faculty ( who are deeeeeply in debt from med school ) less than what a physician's assistant holding a retractor, or a CRNA earns.

luckily, there are lots of jobs that technically private, are very academic in terms of the cutting edge health care that the physicians are practicing.
....and yes I do like making a nice living. I've worked pretty freaking hard for many years, so I don't think it's a crime to finally want to reap some financial benefit for years of missed holidays, weekends and sleepless nights

*** I want to state clearly that I have a great deal of respect for my friends and mentors that are in academic positions. All of us benefit from their hard work. After all, the articles I read in the journal, come from somewhere. ( academia for the most part )
In the end, for my wife and me ( as well as the 4 people I trained with ) we crunched the numbers and with all of our debt, found it too difficult to go that route.
There was some effort on the part of the powers that be, but it was in the form of grants which I felt gave preference to people doing primarily research and really gave the shaft to people like me that wanted to practice clinical medicine and teach.
they better figure out a solution soon, since many well-qualified people are saying "no thanks" when asked to join the faculty where they trained ( or anyplace else for that matter ) and I think this will only hurt our profession in the long run
 
Thanks for your help, FLK!
 
So yeah, I'm going to bump up a very old thread. Just curious that it is "light years" since this discussion how people feel about the differences these fields. Personally I really like critical care and am doing a med-peds residency. I think I could enjoy MICU, PICU, or NICU. As the posters said above, having a variety of patients and control in the PICU is pretty neat. Would you say things are still mostly that way, especially when compared with adult critical care? Also, how have the job markets, schedules, compensation changed over the years. Thanks
 
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Things are not too different. There are still plenty of jobs for graduating fellows in academics and private community PICUs. Still the flexibility, great variety of patients. More academic PICUs have separated the cardiacs into separate PICUs, but most still offer the fellows and attendings a very comprehensive experience taking care of every organ sytem, post-op patients, medical patients. Just need to decide if you want to take care of sick adults or sick kids. Some PICUs (like ours) do all the ECMO, so we get to take care of neonates with PPHN, etc as well-- so very exciting variety of patients. Happy to answer any more questions. Good luck!
 
Thought I did but maybe I didn't complete the process...

Edit:
Oops, apparently I have access. No idea when that happened. Thank you. :D
 
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