Bottom line, only do peds if you are interested to do another year of subspecialty and like doing the cases not for any other reason. You are giving up roughly 500k of income to do the extra year. But let’s go through your questions.
- my favorite attendings were peds trained. I thought they were also more competent and personable than the other attendings. This may not be the case where you are training. L Pediatric Surgeons know your value and you work closely with them during these cases (ie if you say stop, they actually stop). Sure difficult personalities still exist but much fewer in peds surgery world. I enjoyed the patient interactions with parents and kids. Nurses are more collaborative as well. I genuinely had a good time doing peds cases. At the time I was making the decision the job market was not like todays and I worried about Crna encroachment so I decided it was better to be subspecialized.
- peds also has high demand but not as high as CT for the simple reason that true pediatric surgery is only done at a few hospital centers typically in major cities. Peds is not profitable for community hospitals and takes a large amount of infrastructure and staff (ie picu, peds floor, peds ER) so most medium to smaller hospitals don’t even bother. A lot of kids are on Medicaid so not big money makers for anyone. The flip side to that is with the peds anesthesia board certification implementer a lot of hospitals that do occasional peds cases require that there be 24 hour peds beeper coverage by a fellowship trained anesthesiologist. This has increased the demand somewhat but not necessarily because hospitals are doing more peds cases. I’ll add that demand will likely increase because supply will falter. For the last few years only about 50% of peds fellowship spots have filled so we are training less peds anesthesiologists. You may start to see an effect in the next decade or so.
- this depends a lot. I would say that you can likely get a stipend over generalists for peds and taking peds beeper call. Depending on the group you may still grind away doing adult call and still hold onto the beeper on occasion. If employed by a peds academic center (where real peds cases are done mostly) you’ll get paid the academic rate which tends to be less than private. I would say… you could potentially make a slight bit more but overall it’s about the same. CT definitely has a higher premium on income.
- nothing is immune from mid level encroachment including peds and CT and pain. Your training does not determine this, hospital admins and politicians determine this. You will have rural CRNAs taking care of small neonates as well if there is a neonatal emergency and they can’t transfer. City peds hospitals will always be lead by anesthesiologists but most big children’s hospitals do the care time model with residents/fellows/CRNAs. Personally I think this is moot in todays market because even if all CRNAs were independent today there still wouldn’t be enough anesthesia providers relative to growing demand for anesthesia services. A lot of people would disagree with me on that though.
- lifestyle again depends on the group/job. Most peds call is home call unless you work at a peds hospital, so if you take 100% peds call it may get you out of taking overnight call but it depends on the job. Most private groups will not let you get out of overnight adult call but give you an extra stipend for holding the peds pager and perhaps give you less call. This varies so much it’s difficult to make a generalization. If you work outside of a children’s hospital you will likely be taking care of adults ( mostly adults) and taking care of the occassional kid that gets scheduled.
- if you want to do 100% peds you likely need to stay at a pediatric teaching hospital. So you need to be ok with being in academics and all of the upsides and downsides that go along with that. If you want to go private you should be prepared to have a hybrid practice as 100% private practice peds is not common. The one political thing I’ll say is that for better or worse America is run by really really really old people, so older people’s health care is better funded than pediatric health care. Children’s hospitals thrive on donations but a peds hernia repair is paid a fraction of a hip replacement. This does have some affect on your salary as well as contribute to the lack of hospitals that take care of children outside of major cities. This can limit your options if you want to fully utilize a peds fellowship.
In summary only do the fellowship if you enjoy the work and not for any other reason.
