Pros and Cons: Pediatric Anesthesiology vs. Cardio-Thoracic Anesthesiology

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AK_MD2BE

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I know, I know. Some of you will see that I am only a medical student and think, "He's not even in residency yet, why is he worrying about a fellowship?" Well, pretty simple really. I know that I want to do a fellowship, and I don't want to move my family for only 1 year after residency is over. Therefore, I would like to do my residency at a place where I could stay for an additional year to do my fellowship. So, what are the pro's and con's of pediatric anesthesiology vs. cardio-thoracic ("hearts" as I've heard it called) anesthesiology. Thanks for your knowledge and insight. :)

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I know, I know. Some of you will see that I am only a medical student and think, "He's not even in residency yet, why is he worrying about a fellowship?"


You can read minds???


Well, pretty simple really. I know that I want to do a fellowship, :)

You know that you want to do it now but that could change. Fellowship programs come and go. There are tons of mitigating factors that go into a fellowship location and they shouldn't be made in medical school.

With all that said, I would choose hearts over peds for reimbursement reasons.
 
I, personally, would never do Pediatric anesthesia. Why? Because I really like kids.

-copro
 
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I, personally, would never do Pediatric anesthesia. Why? Because I really like kids.

-copro

Could you elaborate? I'm not in my clinical years yet, but was thinking either Peds or Peds Anesthesia.
 
With all that said, I would choose hearts over peds for reimbursement reasons.

How does the reimbursement after a peds fellowship compare to general anesthesia? I know that for a lot of peds subspecialties, you make the same or less than you would as a general pediatrician.
 
I know, I know. Some of you will see that I am only a medical student and think, "He's not even in residency yet, why is he worrying about a fellowship?" Well, pretty simple really. I know that I want to do a fellowship, and I don't want to move my family for only 1 year after residency is over. Therefore, I would like to do my residency at a place where I could stay for an additional year to do my fellowship. So, what are the pro's and con's of pediatric anesthesiology vs. cardio-thoracic ("hearts" as I've heard it called) anesthesiology. Thanks for your knowledge and insight. :)

You wont know if you want to do a fellowship until you put of with 4 years of crap during residency. This is somewhat like the premeds who say they know they want to do pediatric cardiothoracic surgery as a freshman.

PS: and you dont often need a fellowship to do hearts.
 
Could you elaborate? I'm not in my clinical years yet, but was thinking either Peds or Peds Anesthesia.

My own personal experience is that everyone involved in the care of children is stressed-out, anxious, screechy, tense, and generally no fun to be around. It also makes you have a tainted view about the general health of children. I'm talking about the pediatric anesthesiologists, the pediatric surgeons, and the pediatricians. They are generally not "wonderful" and "caring" doctors, as the public believes. And, it is still an area of medicine that is aching for better evidence-based practice. Hard to get a good IRB to approve studies on kids. Plus, you work on and save these trainwrecks for maybe a few weeks, and then they die anyway. It's very depressing.

No, pediatric anesthesia will ruin your attitude and potential for happiness. I'll do generally healthy kids in my practice someday, but anyone under the age of 2 gets a pediatric anesthesiologist. A kid less than 2 going to the OR usually has got some serious **** wrong with it, and I just don't want to be a part of that.

-copro
 
A kid less than 2 going to the OR usually has got some serious **** wrong with it, and I just don't want to be a part of that.

-copro

Interesting. I'm curious to what extent this is institution dependent. My experience (admittedly CA1 only) is that the children's hospital where I train does a very high volume of ASA 1-2 kids. Some are o/w normal kids with hernias, redo circs, etc; we get a lot of kids with big problems for small surgeries (downs kids for tubes, etc.) I found it a delightful place to work - patients and staff, both. There are the occasional highly depressing cases - the kids you can't save or, even worse, the kids whom parent's can't let go. But overall it's a pretty cheery place, certainly in comparison to the adult OR's.
 
Interesting. I'm curious to what extent this is institution dependent. My experience (admittedly CA1 only) is that the children's hospital where I train does a very high volume of ASA 1-2 kids. Some are o/w normal kids with hernias, redo circs, etc; we get a lot of kids with big problems for small surgeries (downs kids for tubes, etc.) I found it a delightful place to work - patients and staff, both. There are the occasional highly depressing cases - the kids you can't save or, even worse, the kids whom parent's can't let go. But overall it's a pretty cheery place, certainly in comparison to the adult OR's.

My experience as a medical student at our Children's Hospital is similar to that described above as well.....overall it's more efficient, people are happier, and there is less b!tchiness. The sad depressing cases are relatively infrequent. The reason some residents don't enjoy working there is that they don't like kids or don't like how intense the cases can be, not that it's a depressing experience, from what I have heard/seen.
 
My experience as a medical student at our Children's Hospital is similar to that described above as well.....overall it's more efficient, people are happier, and there is less b!tchiness. The sad depressing cases are relatively infrequent. The reason some residents don't enjoy working there is that they don't like kids or don't like how intense the cases can be, not that it's a depressing experience, from what I have heard/seen.

Thanks for both of your insights. How are the hours in peds anesth as compared to general? Do you take more call?
 
I'm glad that this is your experience. I can tell you that there is only one of the pediatric anesthesiologists (out of 8) that I enjoy working with. I don't like any of the surgeons. I hate the NICU attendings. And, the PICU has maybe one or two clinicians who have more than three brain cells.

Again, I love kids. I just can't stand of taking care of them.

-copro
 
OK, one person on this thread is obviously not a fan of pediatric anesthesiology. What about Cardio? It would seem to me that doing a fellowship might make someone "more marketable", is that true? Might you be able to command a higher salary and/or increased job security as a result? Thanks for the insight. :)
 
With all that said, I would choose hearts over peds for reimbursement reasons.


Actually, Noc, hearts are probably the least profitable cases you can do nowadays.

Since most hearts are 65 and over, means you get reimbursed via medicare which is abismal to begin with. And as you know hearts are three hours long with a good surgeon, and God-only knows-how-long with a bad one.

A medicare CABG pays about 800 bucks...thats gonna change for the better (a little) since anesthesia actually got medicare increases this year, I believe.

SO, speaking from a pure Benjamin point of view, pure profitibility is best when you do alotta short cases on people with private insurance, like tonsils/adenoids on little gorillas whose parents work for a living and have insurance.

Used to work with an ENT guy....super, super nice dude.... who could do between 15-20 cases at the surgery center....tonsils, adenoids, PETs, FESSs..all healthy kids/young adults....and be done by 2pm. :love: Trinity, I'm sure you know the ENT dude I'm referring to...

The Childrens Hospital I did 6 months at during my residency was my favorite rotation. Thats why I did 6 months.
 
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So what is the best fellowship to do with regards to reimbursement besides pain?
 
There probably isn't a fellowship, outside of pain, where you can be pretty sure that the extra year of training (where you're not making good money and others are) will be significantly offset with a higher income later. Peds, Cardiac, OB, Regional, and whatever else all have the same issues. You might get lucky (I did), but I don't think you can make a financial argument to do a fellowship, so you really need to like what you are doing, or want to do another year for another reason, to do it. On the other hand you can make yourself more marketable with a fellowship, which won't make much difference if you don't plan to live in a major city, but can make all the difference if you are trying to work in a competitive area. Of course then you will probably be making less money anyway...
 
Interesting perspective Copro. Pediatric anesthesia will ruin your attitude and potential for happiness? The same can be said for the heroin addict that you do a valve replacement on, gets septic in the ICU, and the best outcome you can hope for is that he is able to smoke crack through his trach.

A kid less than 2 going to the OR usually has got some serious **** wrong with it? Disagree. PE tubes, tonsils, hernias, circs, MRIs.

To the private practice guys out there: if you have a peds fellowship in PP do you get stuck doing all the kids or are you open to do an adult here or there? Peds has become an interesting option for me since in PP I could do the kid cases and still keep the adult skills fresh.
 
Interesting perspective Copro. Pediatric anesthesia will ruin your attitude and potential for happiness? The same can be said for the heroin addict that you do a valve replacement on, gets septic in the ICU, and the best outcome you can hope for is that he is able to smoke crack through his trach.

A kid less than 2 going to the OR usually has got some serious **** wrong with it? Disagree. PE tubes, tonsils, hernias, circs, MRIs.

To the private practice guys out there: if you have a peds fellowship in PP do you get stuck doing all the kids or are you open to do an adult here or there? Peds has become an interesting option for me since in PP I could do the kid cases and still keep the adult skills fresh.

Here's the perspective I have from talking and watching the private anesthesia group at my internship hospital

1) Fellowships are encouraged - The director of the group was pretty adament about saying that they look more closely at people with fellowships than non fellowship applicants. Their reason is that they bring something different to the table. Any anesthesiologist can do most of the pretty simple cases reasonably quickly but when the weirder type of cases come in they like to have someone with that skill

2) All the kids that come up go to peds trained anesthesiologists. They prolly only do ~10-15 pediatric cases/week so its not a heavy volume but they still like to have peds trained anesthesiologists on staff.

The hosptial I'm at right now doesn't do any cardiac so none of them have done a cardiac fellowship.

According to the group director, fellowships are encouraged to have even if you might not use it. It certainly helps get your foot in the door and makes you stand out as an applicant.
 
Dude we do lots of healthy 2 year olds, in addition to the sick ones.

Examples?

Until then, I'll stand by my statement: a kid under the age of 2 who goes to the OR usually has some serious **** wrong with it.

-copro
 
healthy kids under 2 y/o that have CSOM have PETs & adenoids done.

In my opinion (just mine), a kid under two who goes for these usually does have some serious **** wrong with it (sleep apnea, etc.) and may present as a difficult airway. These kids should get a pedi anesthesiologist, not a generalist.

-copro
 
I am also interested in completing a fellowship in peds (for now)

I asked around my community program to the old private practice docs. The response:

Everywhere in the real world, everyone does hearts and does them well. However, no one ever wants to do sick kids. So, if you are willing (and trained) to do sick kids, that will make you more hirable (is this a word?). You will be more sought after because of your willingness to provide a service to the hospital.

Also, hospitals want to provide service to pediatrics (and OB) by experts because this is an entrance way into the hospital. The patients become customers for life.

IMHO.

Cubs

PS. I had lasik today and I am now 20/15 in the right and 20/20 in the left. I love LASIK.
 
Examples?

Until then, I'll stand by my statement: a kid under the age of 2 who goes to the OR usually has some serious **** wrong with it.

-copro

urology
-circs
-chordee correction
-hypospadias repair
-orchiopexy
-urethral meatotomy

plastics
-cranial spring
-cleft palate
-nevus excision
-dermoid cyst
-pulse dye laser
-suture removals

general
-hernias

ent
-tubes/tonsils

etc.
 
urology
-circs
-chordee correction
-hypospadias repair
-orchiopexy
-urethral meatotomy

plastics
-cranial spring
-cleft palate
-nevus excision
-dermoid cyst
-pulse dye laser
-suture removals

general
-hernias

ent
-tubes/tonsils

etc.

In the majority of cases you present, either this kid is going to have the procedure done MUCH earlier than age 2 or they can wait. Most generalists I know are not going to routinely feel comfortable giving anesthesia to a tiny kid. And, most of the urology stuff can be done under local, especially if they are really tiny. I've never given anesthesia for a phimosis or circ on a kid. Done by the primary service.

-copro
 
In the majority of cases you present, either this kid is going to have the procedure done MUCH earlier than age 2 or they can wait. Most generalists I know are not going to routinely feel comfortable giving anesthesia to a tiny kid. And, most of the urology stuff can be done under local, especially if they are really tiny. I've never given anesthesia for a phimosis or circ on a kid. Done by the primary service.

-copro

Uh, OK dude I will just leave it alone by saying again that we put to sleep tons of healthy kids who are less than 2 years old. Many 1 and two year olds.
 
Could somebody please talk about the major differences in stress level? What about financially (do fellowship trained guys make more)? Thanks.
 
:)So, the way I see it, 95% of practicing anesthesiologists (guessing 5% go into pain management) fall into one of three categories:
1. General anesthesiologists
2. Pediatric anesthesiologists
3. Cardiac anesthesiologists
So, if you chose to NOT do a fellowship...could you please explain why? If you did decide to do a pediatric or cardiac fellowship, could you please explain why you chose to do so? Thanks for the insight.
 
:)So, the way I see it, 95% of practicing anesthesiologists (guessing 5% go into pain management) fall into one of three categories:
1. General anesthesiologists
2. Pediatric anesthesiologists
3. Cardiac anesthesiologists
So, if you chose to NOT do a fellowship...could you please explain why? If you did decide to do a pediatric or cardiac fellowship, could you please explain why you chose to do so? Thanks for the insight.

I'm eleven years out in private practice.

I chose not to do a fellowship because I was 200K in debt and wanted to get out and start generating C notes as fast as possible.

Plus I'd had enough of the resident life.
 
I'm a cardiac anesthesiologist. I'm sad to say that cardiac is a dying field. I feel 10 times more comfortable than general anesthesiologists in the OR, but have to put up with 10 times more sht than them. My salary is about the same. In terms of effort/benefit ratio cardiac is at a loss. If you feel like you need to do a fellowship I would recommend Pain, Peds, ICU, Cardiac, and Regional, in that order.
 
:)So, the way I see it, 95% of practicing anesthesiologists (guessing 5% go into pain management) fall into one of three categories:
1. General anesthesiologists
2. Pediatric anesthesiologists
3. Cardiac anesthesiologists
So, if you chose to NOT do a fellowship...could you please explain why? If you did decide to do a pediatric or cardiac fellowship, could you please explain why you chose to do so? Thanks for the insight.

Graduating resident, no fellowship. Why not? Finances for one thing. Getting a paycheck versus one more training year is huge for some people, myself included. There are many people in positions of either low student loan debt, personal situation not ready to 'settle down' or either dissatisfaction or not enough stimulation in general anesthesia that the pros of one year more than outweigh the cons. Seems most people I know that did pain kind of burned out on OR anesthesia and wanted an out. One year and you got it. I know a few pedi fellows who were literally born to do pediatrics. You know these people too...some people just love it and some people do anesthesia just to do pedi.

Location of work is another thing. Get out of the big cities and there are plenty of jobs that don't do sick kids and don't do cardiac but still need generalists. If you want to do academics and climb that ladder then a fellowship is probably a good way to start. But in todays climate academic jobs are easy to get anyways.
 
AK_MD2B,

I'm a practicing pediatric cardiac anesthesiologist and intensivist (pediatric residency, pediatric critical care fellowship, anesthesia residency, pediatric anesthesia fellowship). I LOVE my job. I love the people I work with and love my patients. You should choose your field not based on reimbursements, but by whether or not it makes you happy. Otherwise don't stay in medicine- it's not worth the grief. Don't base your decision on advice on an online forum. See for yourself--- spend time in the OR with a few different pediatric and cardiac (and even pedi cardiac) anesthesiologists to see what their lives are like. Unless you win the lottery, you will be spending a big percentage of your future at work-- might as well pick something that will make you happy. I can honestly say that I wake up and look forward to going to work because I know that I will make a difference in a kid's life. Would you want someone taking care of your kid who doesn't give a damn about him? (I don't think you can answer that unless you have kids yourself. ) Finally- peds and cardiac are not mutually exclusive-- you can combine the two, or like two other ambitious fellows I know-- do both. Feel free to e mail me offline for further questions.
 
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AK_MD2B,

I'm a practicing pediatric cardiac anesthesiologist and intensivist (pediatric residency, pediatric critical care fellowship, anesthesia residency, pediatric anesthesia fellowship). I LOVE my job. I love the people I work with and love my patients. You should choose your field not based on reimbursements, but by whether or not it makes you happy. Otherwise don't stay in medicine- it's not worth the grief. Don't base your decision on advice on an online forum. See for yourself--- spend time in the OR with a few different pediatric and cardiac (and even pedi cardiac) anesthesiologists to see what their lives are like. Unless you win the lottery, you will be spending a big percentage of your future at work-- might as well pick something that will make you happy. I can honestly say that I wake up and look forward to going to work because I know that I will make a difference in a kid's life. Would you want someone taking care of your kid who doesn't give a damn about him? (I don't think you can answer that unless you have kids yourself. ) Finally- peds and cardiac are not mutually exclusive-- you can combine the two, or like two other ambitious fellows I know-- do both. Feel free to e mail me offline for further questions.

:wow:
 
I want to do mostly peds but am really sick thinking about one more year... Is it possible to have a subspecialty peds track while CA-3 and then do mostly peds? Do groups consider subspecialty training?
 
I realize that there is a tremendous amount of variability between different private practice groups, but on the whole...if you do a pediatric fellowship are you expected to do all peds cases, 50% peds, 25% peds...how does it break down in general? I think that it would be fun and challenging, but stressful at the same time...so it might be nice to have a few "bread and butter" cases mixed in with some tough peds cases. Thanks. :)
 
I realize that there is a tremendous amount of variability between different private practice groups, but on the whole...if you do a pediatric fellowship are you expected to do all peds cases, 50% peds, 25% peds...how does it break down in general? I think that it would be fun and challenging, but stressful at the same time...so it might be nice to have a few "bread and butter" cases mixed in with some tough peds cases. Thanks. :)

Could somebody please help me on this question? Thanks. :)
 
Depends on the practice that you choose.

We have 2 peds fellowship trained docs. We try to assign them to peds rooms more than randomly. That said, They probably spend less than 1/4 of their total cases doing peds.

There is significant variability on this issue. Some practices have separate peds call. Some practices are peds only mostly healthy bread and butter peds. Some practices are all the sick neonates and big cases that you could possibly want every day.

I am a resident. I do Peds cases regularly. The faculty assigned to my room is invariably a Peds trained gasser. They take care of all the sick-as-crap infants too (and, when I say "infants", I mean the syndrome, preemies that have everything wrong with them... not my bag, baby). They take pretty much exclusively Peds call as well.

If you want to do this for a living, more power to you.

-copro
 
You can do everything without the fellowship. That's right - pain, peds, CV, anything. I currently do a ton of healthy peds, pain and OB, in addition to the regular B&B. Guess what pays the best? the regular GA bread and butter cases.

Not doing CV currently - but would feel comfortable in the heart room had I to be ther - just don't enjoy that stuff all that much. Plus, like jet said - high number of medicare case in hearts.

now, if you want a career in academics, by all means do the fellowship.
 
My own personal experience is that everyone involved in the care of children is stressed-out, anxious, screechy, tense, and generally no fun to be around. It also makes you have a tainted view about the general health of children. I'm talking about the pediatric anesthesiologists, the pediatric surgeons, and the pediatricians. They are generally not "wonderful" and "caring" doctors, as the public believes. And, it is still an area of medicine that is aching for better evidence-based practice. Hard to get a good IRB to approve studies on kids. Plus, you work on and save these trainwrecks for maybe a few weeks, and then they die anyway. It's very depressing.

No, pediatric anesthesia will ruin your attitude and potential for happiness. I'll do generally healthy kids in my practice someday, but anyone under the age of 2 gets a pediatric anesthesiologist. A kid less than 2 going to the OR usually has got some serious **** wrong with it, and I just don't want to be a part of that.

-copro

well said. that's actually part of the reason i didnt want anything to do with pediatrics. i'd feel terrible if i ever screwed up a kid.
 
AK_MD2B,

I'm a practicing pediatric cardiac anesthesiologist and intensivist (pediatric residency, pediatric critical care fellowship, anesthesia residency, pediatric anesthesia fellowship). I LOVE my job. I love the people I work with and love my patients. You should choose your field not based on reimbursements, but by whether or not it makes you happy. Otherwise don't stay in medicine- it's not worth the grief. Don't base your decision on advice on an online forum. See for yourself--- spend time in the OR with a few different pediatric and cardiac (and even pedi cardiac) anesthesiologists to see what their lives are like. Unless you win the lottery, you will be spending a big percentage of your future at work-- might as well pick something that will make you happy. I can honestly say that I wake up and look forward to going to work because I know that I will make a difference in a kid's life. Would you want someone taking care of your kid who doesn't give a damn about him? (I don't think you can answer that unless you have kids yourself. ) Finally- peds and cardiac are not mutually exclusive-- you can combine the two, or like two other ambitious fellows I know-- do both. Feel free to e mail me offline for further questions.

were you in residency for more than a decade???
 
Would you be able to command a higher salary after doing a pediatric fellowship? I am asking b/c you are obviously giving up a lot of money by doing a fellowship...just wondering if you can recoup that money in the long run. Thanks. :cool:
 
Would you be able to command a higher salary after doing a pediatric fellowship? I am asking b/c you are obviously giving up a lot of money by doing a fellowship...just wondering if you can recoup that money in the long run. Thanks. :cool:

At my institution last year, the peds anesthesia staff actually made $1000/yr less than the generalists.... put that in your pipe & toke it.
 
Bump...if you do a pediatric fellowship, and join a private practice, will you be stuck doing all of the neonates b/c your partners "don't mind" doing the the 12-18 year olds? I am just curious b/c the main reason I want to do pediatric anesthesiology is so that I can take care of the 3 or 4 to 18 year olds. Thanks.
 
Bump...if you do a pediatric fellowship, and join a private practice, will you be stuck doing all of the neonates b/c your partners "don't mind" doing the the 12-18 year olds? I am just curious b/c the main reason I want to do pediatric anesthesiology is so that I can take care of the 3 or 4 to 18 year olds. Thanks.

Chances are good that if you join a group that does a lot of neonates you won't be the only pedi fellowed person. For general cases on 2-3 year olds, anyone does them.
 
You can do everything without the fellowship. That's right - pain, peds, CV, anything. I currently do a ton of healthy peds, pain and OB, in addition to the regular B&B. Guess what pays the best? the regular GA bread and butter cases.
Not doing CV currently - but would feel comfortable in the heart room had I to be ther - just don't enjoy that stuff all that much. Plus, like jet said - high number of medicare case in hearts.

now, if you want a career in academics, by all means do the fellowship.


Interesting to know since this is what the competition is after.
 
Chances are good that if you join a group that does a lot of neonates you won't be the only pedi fellowed person. For general cases on 2-3 year olds, anyone does them.

So...it sounds like if I was one of the only members of a "general" practice (i.e. not a practice that was exclusively pediatric anesthesiologists) that did a pediatric fellowship, I would be stuck doing all the neonates. Not the worst thing in the world...I was just hoping to take care a lot of kids in the 3-18 age demographic.
 
You can do everything without the fellowship. That's right - pain, peds, CV, anything. I currently do a ton of healthy peds, pain and OB, in addition to the regular B&B. Guess what pays the best? the regular GA bread and butter cases.

Not doing CV currently - but would feel comfortable in the heart room had I to be ther - just don't enjoy that stuff all that much. Plus, like jet said - high number of medicare case in hearts.

now, if you want a career in academics, by all means do the fellowship.

Do you mean a fellowship in Peds/Cards only? Are you also including Pain and Critical Care?
 
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