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

[dhb]

I was just hoping to take care a lot of kids in the 3-18 age demographic.

You don't need a Ped's fellowship for that

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[numbmd]

Ahhh the wisdom of quack333. This guy probably started his training around 1960 and he just finished. Sounds like he's happy. Also sounds like he's best trained MF on the planet as well. It doesn't sound like he's overly concerned with salary although it probably doesn't SUCK! I don't hear about opportunuty cost with training for half a century.

Don't agonize about your pay as a specialist. To paraphrase JPP, As long as you get to push the white stuff or crack the yellow dial, you AINT gonna have to worry about the future price of gas as you Plunk down some coin on a surburban.

Any concern about green is so dependent on the actual hospital you end up at. Our peds guys make less than most of the rest of the group (400-450K). Cardiac guys make almost twice that. But that is the peculiarities of our group. people get paid by units and cardiac is more unit intensive than peds.

Do what you want. Happiness comes from within. The rest is bull**** mental masturbation.

 

[pushthesux]

Do what you want. Happiness comes from within. The rest is bull**** mental masturbation.

Well said...wish I could get that through my thick skull.

 

[BLADEMDA]

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. 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.

You are telling it like it is.

 

[maceo]

Is pediatric anesthesiology or cardiac anesthesiology more stressful? Thanks.

they both are very un interesting and hi potential for getting me sued and keeping me around the hospital for longer than i wanna be.. but peds is a million times more stressful.. think about it. killing a 2 year old or killing a 70 year old with a bad valve. which one would you rather be involved with? the answer is neither... but you will feel worse with the two year old.. by far.

 

[Powerfade]

While you definitely don't do peds for the money (unless you find a group where the rest of the members hate it so much that they're willing to subsidize the peds person) here's a few other things to consider. On the upside, the great majority of peds surgical cases are not for kids with some congenital problem. (those kids go to a children's hospital) Given that concession, other than the immediate surgical problem, they will have relatively pristine protoplasm. No 100 pack year smoking histories, ETOH, crack, etc... You manage their airways, start IV's, and you're golden. Most pediatric surgeons are pretty easy to deal with. Most CT surgeons aren't. The downside, you're taking care of 3 patients, the kid and the 2 parents. Kids cry. PO versed helps (timing is everything) But in PACU a crying kid is a breathing kid.

Get good at timing the preop versed so you take a docile kid back to the OR, be confident in your airway skills, and be able to throw in an IV with your eyes closed, and everyone will think you're a magician.

 

[Arch Guillotti]

Most pediatric surgeons are pretty easy to deal with. Most CT surgeons aren't.

You are lucky, the ones I dealt with in residency were mostly prima donnas and often difficult to deal with. Agree w/the CT surgeons though.

 

[Masseter Spasm]

I work in an academic institution and am fellowship trained in pediatric anesthesia. I spend the majority of my time providing pediatric anesthesia, but also do adult cases as well. In short, I do everything except transplant and cardiac. I take general and pediatric call for the department.
I enjoy having subspecialty training in pediatric anesthesia but did not want to do it 100% when I finished fellowship. I like taking care of the healthy kids but am comfortable with the ASA 4's and neonates.
Having the opportunity to work with a number of different surgical subspecialists, I will say that most pediatric surgeons are outstanding. Pediatric surgical fellowships tend to be selective and require excellent technical skills. Often they attract humanistic personalities. Obviously, exceptions exist and institutions vary.
When I am providing anesthesia for a 4 hour adult Lap Chole or 6 hour ORIF tibia fracture with an abrasive surgeon, I feel fortunate that much of my time is spent around the efficient/pleasant pediatric surgeons in my institution.

 

[Powerfade]

Alluded to it my previous post, I know a practice where they pay the peds guys double units. Definitely not the norm. Consider that there are more practices where a common pooled unit is used so that cherry picking the good payors is prevented. Bottom line is make your decision to do either fellowship on the intrinsic value to you. You enjoy hearts or peds, you'd like to have the additional training/knowledge, etc... Then find a practice with a common unit and you'll do fine financially because in that scenario all you care about is banking maximum units and that your group has a reasonable unit value.

 

[Bougie]

You don't need a Ped's fellowship for that

This is changing. Word from the interview trail: unless you're practicing in Verysmalltown USA, the trend is that hospitals (not just peds hospitals) want to be able to stamp BOARD CERTIFIED PEDIATRIC SPECIALISTS on their website and brochures. A hospital with BOARD CERTIFIED PEDIATRIC SPECIALISTS is a huge selling point for attracting young professionals (who dump money into the coffers) into a community. City officials pressure hospitals which in turn pressure their physician providers groups. A hospital with BOARD CERTIFIED PEDIATRIC SPECIALISTS usually make more cash (mostly because of donations....everybody wants to donate to a peds unit/hospital) than an adult hospital.

Several groups are looking to fill that role to stay competitive (yeah Mr Hospital Administrator, we have a peds guy) and will hire a BOARD CERTIFIED PEDIATRIC SPECIALIST straight out of fellowship over some old goat who has been doing kids for decades without a fellowship. That being said, the group may still have the old goat do the kids and they may dump the Qsign gomers and mullethead bikers on the BOARD CERTIFIED PEDIATRIC SPECIALIST, but at least they still have the contract with the hospital.

Something to consider.

And no, peds guys do not always get paid less. They usually get paid 20-30K more and are at a better bargaining position because of the first two paragraphs.

Also agree with peds surgeons being more pleasant. Ahole surgeons are that way because of lack of confidence and/or lack of skill. Peds surgery is highly competitive and so you get the cream of the crop; i.e confident, skilled surgeons without personality disorders.

 

[AK_MD2BE]

Bump...amidst all of the doom and gloom on this board I thought I would bring up something else to talk about .

 

[CanGas]

Man, as a CA1 it is way too early to be thinking about this. Sure you have a leaning so pursue that, do some anesthesia, some ICU, some ER, ect but until you have rotated in your clinical years you have no idea what else you might find to be interesting.

Worry about location later. Many people feel going somewhere else to do your fellowship is better as you end up with less of a "inbred" experience. You really want to see how things are done elsewhere.

CanGas

P.S. I'm going to second the depressing Peds experience. Surgeons are good but taking care of all the train wrecks was depressing beyond belief. After that experience if my wife and I have a 24weeker I am saying wrap them in a blanket and hand them over so we can say goodbye. There is no way in hell I am putting my kid though those experiences.

 

[drRumi]

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.

urge, it's been a while since this post. im curious, do you still feel this is true?

 

[5twilight5]

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.

Thank you for your insight and obviously you know more since you are a cardiac anesthesiologist but with all the baby boomers getting older and the evidence piling up that stents and IR procedures are a temporary fix and not helping much in the long scheme of things, I have been told by many people that cardiac surgeries will be on the rise soon. I am interested in doing a cardiac fellowship, mostly because I LOVE cardio. Just wanted to hear any opinions on if this rumor is true. THANKS!

2 weeks remaining...GOOD LUCK guys!

 

[5twilight5]

oopsies i just realized that this thread is hella old!

 

[md2010sgu]

At my institution last year, the peds anesthesia staff actually made $1000/yr less than the generalists.... put that in your pipe & toke it.

I was going to say something similar to this. A lot of my attendings I rotated with that came from private practice before going academic (and CA3's looking for jobs) said that in terms of salary/billing peds and cards fellowship trained anesthesiologists get paid the SAME as ones who do NOT do fellowship (both in an academic setting and private practice...in general...I'm sure there are exceptions... just like some babies are born with two penises). I heard this from MULTIPLE faculty members at different academic institutions where I did my anesthesia rotations. They all told me one common theme every single time the conversation of fellowships came up...
Only do fellowships if you really are interested or want to get further training for your interest. The money you lose by doing a 1-2 yr fellowship while you can be earning $350,000/yr you will never ever make back . Also in their experience, having a fellowship only confers a SLIGHT advantage when hiring. Take this with a grain of salt... but this is coming from former senior partners of huge anesthesiologist groups.

 

[md2010sgu]

oopsies i just realized that this thread is hella old!

It's a great thread though... more so for the MS4's like me waiting for March 18th!!!!!!!!!!

 

[IlDestriero]

I was going to say something similar to this. A lot of my attendings I rotated with that came from private practice before going academic (and CA3's looking for jobs) said that in terms of salary/billing peds and cards fellowship trained anesthesiologists get paid the SAME as ones who do NOT do fellowship (both in an academic setting and private practice...in general...I'm sure there are exceptions... just like some babies are born with two penises). I heard this from MULTIPLE faculty members at different academic institutions where I did my anesthesia rotations. They all told me one common theme every single time the conversation of fellowships came up...
Only do fellowships if you really are interested or want to get further training for your interest. The money you lose by doing a 1-2 yr fellowship while you can be earning $350,000/yr you will never ever make back . Also in their experience, having a fellowship only confers a SLIGHT advantage when hiring. Take this with a grain of salt... but this is coming from former senior partners of huge anesthesiologist groups.

Have to disagree with our med student friend here. That may be true in some places, for some jobs, but it is definitely not true in others (most?). Fellowship trained people can be offered higher signing bonuses, decreased time to partner, somewhat higher salary, less work for same salary, etc. It is supply and demand, needs of the group, and how various practices are set up. Some PP places pay to get the fellowship people there, some may not, or not much. At an eat what you kill place, salary depends on payer mix and some luck. I can tell you that 24 peds ENT cases and out by 4 pays a lot of $$.
As for "SLIGHT advantage when hiring", that is ridiculous. If a group needs a peds, pain, or cards anesthesiologist, than the hiring advantage is INFINITE as no fellowship = no job. If you are looking for a job that doesn't need fellowship trained people, and you plan to do general cases, than the fellowship may only offer a slight advantage. Also, the value of the fellowship cannot be overlooked if the CRNAs evolve into unsupervised practitioners under a reformed health care system, time will tell about that.

 

[md2010sgu]

Have to disagree with our med student friend here. That may be true in some places, for some jobs, but it is definitely not true in others (most?). Fellowship trained people can be offered higher signing bonuses, decreased time to partner, somewhat higher salary, less work for same salary, etc. It is supply and demand, needs of the group, and how various practices are set up. Some PP places pay to get the fellowship people there, some may not, or not much. At an eat what you kill place, salary depends on payer mix and some luck. I can tell you that 24 peds ENT cases and out by 4 pays a lot of $$.
As for "SLIGHT advantage when hiring", that is ridiculous. If a group needs a peds, pain, or cards anesthesiologist, than the hiring advantage is INFINITE as no fellowship = no job. If you are looking for a job that doesn't need fellowship trained people, and you plan to do general cases, than the fellowship may only offer a slight advantage. Also, the value of the fellowship cannot be overlooked if the CRNAs evolve into unsupervised practitioners under a reformed health care system, time will tell about that.

Hey man... appreciate the input. I'm just regurgitating a common theme I kept hearing from 5 different attendings (2 from univ california, and 3 from NY). That being said I'm glad you gave your experience, the future anesthesiologists need to hear as much as possible.

BTW, does this mean you can hire me in 4 years ;P for tons of mula, few cases, and an early out ? Doubly serious if you are in California

 

[urge]

...said that in terms of salary/billing peds and cards fellowship trained anesthesiologists get paid the SAME as ones who do NOT do fellowship (both in an academic setting and private practice...in general...

That's true.

 

[IN2B8R]

That's true.

Urge: I too am a cardiac guy. I would not say that cardiac anesthesia is dead or is dying.... Yeah, cardiologists are driving the numbers down, but there will always be a need for CT surgeons and cardiac trained anesthesiologists. As for the money issues and the headaches we have to deal with that the generalists do not deal with, well, that's 'nother story...

 

[AngryBird69]

498K median salary for Peds gas (2010 MGMA)!? Why does peds gas buck the trend of "peds pays less"?

 

[sevoflurane]

Urge: ... As for the money issues and the headaches we have to deal with that the generalists do not deal with, well, that's 'nother story...

I do both. Both can be very demanding at any point. However, my toughest cases are usually (but not always) in the CT room. Things can turn south quickly... anything in the chest needs to be particularly respected. < 2mo. olds with laryngospasm gives me the same feeling.

This is a beast... and we've seen it recently. Good thing to read up on for anyone doing cardiac on a regular basis cuz it's kind of a zebra that turns into a lion:





http://circ.ahajournals.org/content/121/4/584.full

 

[sevoflurane]

 

[sevoflurane]

498K median salary for Peds gas (2010 MGMA)!? Why does peds gas buck the trend of "peds pays less"?

Protoplasm reserve, skill involved (try putting in an IJ in a 1 month old or a micropremie with difficult IV access), syndromes, family-doctor interactions, little mistakes can do a lot of harm, etc, etc. I still think the peds cardiac guys are the bomb! They have impressed me the most... without question.

A day of lap choles and appy's is kush compared to a day of 12 T&A's (or many more in the ACT model).

 

[michigangirl]

498K median salary for Peds gas (2010 MGMA)!? Why does peds gas buck the trend of "peds pays less"?

jigga whaaaat?

that median just seems waay too high, especially with all the academic peds jobs out there to dilute it out. Are these people pure peds?

 

[AngryBird69]

Yeah seems crazy high right? Here is the actual data

jigga whaaaat?

that median just seems waay too high, especially with all the academic peds jobs out there to dilute it out. Are these people pure peds?

Sevo, wow. Well that explains it lol. Thanks.

 

[sevoflurane]

Academic washout can be brutal (not always and call can be light if you are peds only).

My wife and I have a very good friend that had to stay in the area due to family.

She's getting RIPPED OFF!

 

[sevoflurane]

BTW... if you are peds fellowship trained and are looking for a job, PLEASE make sure your contract says "peds" and not "peds and general"...

At least do a percentage if you want to continue doing adults... 80/20 sounds about right to start.

Michgirl, ILD and the others know way more about this than I do.

 

[Ignatius J]

Great info in this thread. Thanks, everyone.

 

[RussianJoo]

I do both. Both can be very demanding at any point. However, my toughest cases are usually (but not always) in the CT room. Things can turn south quickly... anything in the chest needs to be particularly respected. < 2mo. olds with laryngospasm gives me the same feeling.

This is a beast... and we've seen it recently. Good thing to read up on for anyone doing cardiac on a regular basis cuz it's kind of a zebra that turns into a lion:





http://circ.ahajournals.org/content/121/4/584.full

We had a case of left ventricular rupture after MVR for stenosis a few months ago. The guy bleed out in minutes and nothing could have been done.


this paper is not from my institution. Something else to think about.



[PubMed - indexed for MEDLINE]

J Heart Valve Dis. 2008 Jan;17(1):42-7.
Left ventricular rupture after mitral valve replacement: risk factor analysis and outcome of resuscitation.
Hosono M, Shibata T, Sasaki Y, Hirai H, Bito Y, Takahashi Y, Suehiro S.
Source

Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan. [email protected] [email protected]
Abstract
BACKGROUND AND AIM OF THE STUDY:

Left ventricular (LV) rupture is a rare but lethal complication after mitral valve replacement (MVR). Hence, the occurrence of LV rupture after MVR and the outcome of resuscitation was assessed.
METHODS:

Between January 1991 and June 2005, a total of 258 patients underwent MVR at the authors' institution. Thirteen preoperative factors and 13 surgical factors were analyzed to assess the incidence of LV rupture after MVR.
RESULTS:

Among the patients, there were six cases of LV rupture (2.3%). Age >69 years (p = 0.0174), hemodialysis (p = 0.0119), echocardiographic end-diastolic left ventricular diameter (Dd) <50 mm (p = 0.0104), resection of the basal chorda of the posterior leaflet (p = 0.0086), mitral annular reconstruction (p = 0.009), and additional left atrial plication (p = 0.0269) were each considered as significant risk factors for LV rupture following MVR. All ruptures were type III. There were two hospital deaths (mortality 33%). At more than one year after surgery, all surviving patients were in reasonable health.
CONCLUSION:

Older age, hemodialysis, and Dd <50 mm are significant risk factors for LV rupture after MVR. Preservation of the basal chordae of the posterior leaflet was important to prevent LV rupture, while endocardial patch repair with elective intraaortic balloon pumping was suggested as an effective treatment for type III rupture.