Road to peds cardiac?

[Blueberry8]

What path do most people take to do mainly peds hearts? I know certain programs offer ~2 yr fellowship (1 yr peds, 1 yr mainly peds cardiac). Is this the way to go? Could one do an adult cardiac fellowship then a one yr peds fellowship, and go that route or vice versa? Can you do only a 1 yr peds fellowship and do complex peds hearts? Does it even matter what route you take or the order? Thanks!

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[deleted50478]

What path do most people take to do mainly peds hearts? I know certain programs offer ~2 yr fellowship (1 yr peds, 1 yr mainly peds cardiac). Is this the way to go? Could one do an adult cardiac fellowship then a one yr peds fellowship, and go that route or vice versa? Can you do only a 1 yr peds fellowship and do complex peds hearts? Does it even matter what route you take or the order? Thanks!

You can do either path but most peds cardiac docs do mostly peds days with some peds cardiac days and work in a childrens' hospital, so to me, peds to peds cardiac makes the most sense.

 

[imfrankie]

What path do most people take to do mainly peds hearts? I know certain programs offer ~2 yr fellowship (1 yr peds, 1 yr mainly peds cardiac). Is this the way to go? Could one do an adult cardiac fellowship then a one yr peds fellowship, and go that route or vice versa? Can you do only a 1 yr peds fellowship and do complex peds hearts? Does it even matter what route you take or the order? Thanks!

First off I think it's terrific you're interested in this. In my opinion it's the pinnacle of anesthesiology practice. People take various routes. In the past there weren't pediatric cardiac anesthesia fellowships; so most of the senior people in the field are either pediatric anesthesia trained, cardiac anesthesia trained, and/or pediatric ICU and anesthesia trained, who then continued to gain experience by doing cases.
I did a mid-career peds anesthesia fellowship at a large volume congenital heart center and was asked to stay on as pedi-cardiac faculty, basically continuing on the job training. Like a lot of things, people talk about the importance of extra fellowships until they want a body. It wasn't for me, but I say this to illustrate that this is one very common route. As I looked for pediatric jobs, many groups were looking for people to do hearts--and would train you up on the job. IF I were going to do complex pedi hearts, I'd choose to do a year-long fellowship in pedi-cardiac after pediatric anesthesia, if I could at all afford it--six months additional as a minimum. Most people don't go this route, but I've talked to a lot of people and it takes a good long while to get experienced enough so you are not regularly scared doing these cases. For my peace of mind and my patient's health, I'd want a well-supervised training period--more than I got in basic peds anesthesia fellowship, which was a whole lot of pump cases. We ran two rooms a day multiple cases. Finally, I'll say again I'm delighted to hear you are interested in this. What an amazing field--and I sit here rather envious.

 

[imfrankie]

You can do either path but most peds cardiac docs do mostly peds days with some peds cardiac days and work in a childrens' hospital, so to me, peds to peds cardiac makes the most sense.

Where I trained the pediatric cardiac folks rarely did any non-cardiac cases.

 

[Blueberry8]

You can do either path but most peds cardiac docs do mostly peds days with some peds cardiac days and work in a childrens' hospital, so to me, peds to peds cardiac makes the most sense.

That's what I was thinking as well. Would you be more marketable if you have a cardiac fellowship and then a peds fellowship, or not really if you ultimately want to do peds and also peds hearts? I'm just wondering if you bring something different/worthwhile to the table in terms of skills if you are trained in adult cardiac as well, or if it doesn't really enhance your marketability or relevant skills if you just want to focus on peds cardiac. I love peds and I love the heart, so just wanted to know different options and paths I could take!

 

[norwood]

Where I trained the pediatric cardiac folks rarely did any non-cardiac cases.

Ditto, a peds cardiac anesthesiologist is so specialized that at my program, he normally didn't do any bread and butter stuff. It wasn't necessarily always hearts, but it was pretty high-end intrathoracic stuff.

 

[imfrankie]

That's what I was thinking as well. Would you be more marketable if you have a cardiac fellowship and then a peds fellowship, or not really if you ultimately want to do peds and also peds hearts? I'm just wondering if you bring something different/worthwhile to the table in terms of skills if you are trained in adult cardiac as well, or if it doesn't really enhance your marketability or relevant skills if you just want to focus on peds cardiac. I love peds and I love the heart, so just wanted to know different options and paths I could take!

Learn to take care of neonates with a pediatric anesthesia fellowship, and follow with a pediatric cardiac anesthesia fellowship. Then you will be among the best if you want to do congenital cardiac.

 

[Blueberry8]

First off I think it's terrific you're interested in this. In my opinion it's the pinnacle of anesthesiology practice. People take various routes. In the past there weren't pediatric cardiac anesthesia fellowships; so most of the senior people in the field are either pediatric anesthesia trained, cardiac anesthesia trained, and/or pediatric ICU and anesthesia trained, who then continued to gain experience by doing cases.
I did a mid-career peds anesthesia fellowship at a large volume congenital heart center and was asked to stay on as pedi-cardiac faculty, basically continuing on the job training. Like a lot of things, people talk about the importance of extra fellowships until they want a body. It wasn't for me, but I say this to illustrate that this is one very common route. As I looked for pediatric jobs, many groups were looking for people to do hearts--and would train you up on the job. IF I were going to do complex pedi hearts, I'd choose to do a year-long fellowship in pedi-cardiac after pediatric anesthesia, if I could at all afford it--six months additional as a minimum. Most people don't go this route, but I've talked to a lot of people and it takes a good long while to get experienced enough so you are not regularly scared doing these cases. For my peace of mind and my patient's health, I'd want a well-supervised training period--more than I got in basic peds anesthesia fellowship, which was a whole lot of pump cases. We ran two rooms a day multiple cases. Finally, I'll say again I'm delighted to hear you are interested in this. What an amazing field--and I sit here rather envious.

Thank you for your reply! This was extremely helpful. I spent some time in the heart room at our childrens hospital and have never had such an adrenaline rush before! Let alone kids are adorable. So doing peds cardiac sounds extremely challenging but fun! With most of these programs that offer 2 yr peds cardiac fellowship (boston, chop, not sure what other ones) do you apply as a ca-2 I assume, or do you apply just to a peds fellowship, complete that and then reapply for the peds cardiac portion? I'm sure I can look it up on a different website but just wondering if you had any idea!

 

[imfrankie]

Thank you for your reply! This was extremely helpful. I spent some time in the heart room at our childrens hospital and have never had such an adrenaline rush before! Let alone kids are adorable. So doing peds cardiac sounds extremely challenging but fun! With most of these programs that offer 2 yr peds cardiac fellowship (boston, chop, not sure what other ones) do you apply as a ca-2 I assume, or do you apply just to a peds fellowship, complete that and then reapply for the peds cardiac portion? I'm sure I can look it up on a different website but just wondering if you had any idea!

Not sure, but don't discount doing your peds fellowship one place then pedi-cardiac at another. Different flavors, different ways of doing things. I've really benefited by seeing just how many ways things can be done. My advice--find nice people.

 

[courtnes]

I haven't seen combined peds/peds cardiac fellowship, it seems like you can go either the pediatric route or the adult cardiac route prior to peds cardiac fellowship - per Boston Children's at least. Most of the fellows I worked with (not at Boston Children's) did pediatric anesthesia fellowship prior to peds cardiac.

I agree with you that it's the most incredible field, I hope that as I continue my training I keep down this path - but I'm trying to keep an open mind.

 

[itwasalladream]

It's possible to go the adult cardiac --> peds CT route, but I think it makes you somewhat less marketable for peds CT. The job opportunities for someone who takes that track are there, but less clear cut. This is mainly because you haven't done a year of general peds fellowship. Many children's hospitals large enough to be doing peds ct would prefer all their anesthesia staff are "peds trained," and you would likely be viewed as something in the middle, having not completed a formal ACGME peds fellowship (nowadays with special board certification). Your role when not in the heart room, or on non-ct call could be a bit of a dilemma, for instance. Going the peds-->peds CT route is more common and probably keeps more doors open.

 

[deleted50478]

I'm sure you could get a job doing general peds + cardiac after doing adult and peds cardiac fellowships, but you might be better prepared for a mixed job if you went the peds fellowship route. The other thing to consider is that you might stop after one fellowship. In that case would you prefer adult hearts or general peds?

 

[michigangirl]

Unless you always want the option of doing adult hearts, peds fellowship followed by peds cardiac is the way to go-- the most marketable/straightforward training path to focus on pedi hearts. Also gives you flexibility to do bread and butter peds if you ever need to/want to/are required to in the job you take.

 

[OB1🤙]

Adult fellowship is necessary to get NBE certified. For some (many?) that will be important nowadays.

 

[deleted171991]

Adult fellowship is necessary to get NBE certified. For some (many?) that will be important nowadays.

Only if they want to do adult hearts, right?

 

[IlDestriero]

The problem with going from adult hearts to pedi hearts is that even at places where the Peds cardiac staff do only peds cardiac kids, they also do their anesthetics for their non cardiac surgery. We wouldn't hire someone without a peds anesthesia fellowship as they don't have experience with the various non cardiac cases they would be doing on the kids with congenital cardiac disease.

 

[psychbender]

During residency, of my attendings at an outside, private, hospital was Peds fellowship trained (not specifically Peds Cardiac), but did extra cardiac during his fellowship, and did extra adult hearts during his residency. When he was hired, he expressed interest in doing both adult and peds cardiac, and they started with additional on-the-job training in both sets of cardiac ORs. As a result, he was able to split time between the general Peds rooms, the Peds cardiac OR, and the adult cardiac ORs. This was not a Childrens' hospital, just a regular, private hospital with a decent-sized CT program, that was well-known and regarded in the region. Considering there are plenty of people doing adult hearts out in the real world without CT fellowship, this would seem like a viable option to do all three.

 

[urge]

We wouldn't hire someone without a peds anesthesia fellowship as they don't have experience with the various non cardiac cases they would be doing on the kids with congenital cardiac disease.

That is crazy.

Sounds more like a turf war to me.

Peds people can be so childish.

 

[OB1🤙]

I've known people who have done an accredited adult cardiac fellowship to get NBE certified, with elective time spent doing peds hearts, then a second "peds cardiac" non-accredited year splitting time between peds cardiac and "general" (but quaternary) peds.

 

[IlDestriero]

You're right, it's silly. I'm sure a cardiac fellowship prepares you for TEF repairs, pediatric regional, neonatal difficult airways, and all the other things unique to peds practice that we see all the time in the OR yet would be very uncommon for congenital heart kids.
In fact generalists should probably be able to just sit for the peds boards.
I did pedi hearts, can I do adult hearts? After all they're just like kids hearts, but without all the jacked up anatomy.
I don't think any large children's hospital would hire an attending without a pediatric fellowship unless they grandfathered in with significant experience.

 

[btbam]

I haven't seen combined peds/peds cardiac fellowship, it seems like you can go either the pediatric route or the adult cardiac route prior to peds cardiac fellowship - per Boston Children's at least. Most of the fellows I worked with (not at Boston Children's) did pediatric anesthesia fellowship prior to peds cardiac.

I agree with you that it's the most incredible field, I hope that as I continue my training I keep down this path - but I'm trying to keep an open mind.

Our hospital has a combined peds/peds cardiac program, but I would guess only 1 fellow every 2-3 years does it. Typically they do 9 months of the general peds side including PICU and pain and then 9 months of cardiac. A few of our peds cardiac attendings did adult cardiac followed by peds cardiac so YMMV.

 

[btbam]

You're right, it's silly. I'm sure a cardiac fellowship prepares you for TEF repairs, pediatric regional, neonatal difficult airways, and all the other things unique to peds practice that we see all the time in the OR yet would be very uncommon for congenital heart kids.
In fact generalists should probably be able to just sit for the peds boards.
I did pedi hearts, can I do adult hearts? After all they're just like kids hearts, but without all the jacked up anatomy.
I don't think any large children's hospital would hire an attending without a pediatric fellowship unless they grandfathered in with significant experience.

Just to back up what you said, our peds cardiac attendings have zero problem asking the general side people for help on difficult airways or on the occasion they are in a general OR with something like a TEF/CDH etc... They are all truly badass cardiac specialists, but are aware enough to realize they don't get to see a lot of stuff outside their bubble.

 

[chmd]

You're right, it's silly. I'm sure a cardiac fellowship prepares you for TEF repairs, pediatric regional, neonatal difficult airways, and all the other things unique to peds practice that we see all the time in the OR yet would be very uncommon for congenital heart kids.
In fact generalists should probably be able to just sit for the peds boards.
I did pedi hearts, can I do adult hearts? After all they're just like kids hearts, but without all the jacked up anatomy.
I don't think any large children's hospital would hire an attending without a pediatric fellowship unless they grandfathered in with significant experience.

Of course you can do adult hearts -- just like bc/be anesthesiologists can do peds.

 

[ambiturner]

Of course you can do adult hearts -- just like bc/be anesthesiologists can do peds.

in either case: prop, sux, tube