Advice on Pediatric Surgery

[Avefenix]

Would like to know what your thoughts are...

I'm currently a R3 and doing my Pediatric surgery rotation. Never was interested in peds surgery until this rotation. I have already told my PD that I'm interested and now I'm trying to figure out what options I have to increase my chances of getting accepted. I haven't decided whether I should take 1 or 2 years off.

I'm in a big Level 1 trauma community program (15 General Surgery attendings) in the West. We have a children's hospital with 10 pediatric surgery attendings but no fellowship. I'm the first class in my program and have done well on my ABSITE scores. Currently have a few publications to my name but no basic science research. I don't know how being in a community program affects my chances, especially a new one.

Ideally I would like to stay in my current city and do research with the pediatric surgery group but they are not in academia (ie. private practice). Some people have mentioned that I would have to move to another city with a peds surgery fellowship for research. I would rather not have to move since I have a family and the added moving expense.


1 of 10 recent new peds surgery attendings matched into fellowhip without any research experience but had a lot of publications. I don't know how common that is. Would it be a better idea to finish my residency then do research and try to apply ?

Thanks for any input you guys might have.

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[glade]

Without getting into specifics, I'm familiar with an institution that actually has a relatively good track record of getting people into Peds (meaning, one every few years, which is pretty impressive). And honestly a lot of that has to do with connections, for one, which go a long way in a small subspecialty. That's unfair, because it hearkens back to the "legacy admissions" that we all hated back in college and medical school. But what are you gonna do? Just play the game. So go to your Peds Surgery attendings and start figuring out who has any type of connections and see if they'll help you out. If they have connections, honestly that's like 60% of the battle right there and the rest of it is you following the formula of research and interviewing well.

There's more, but start there.

 

[Winged Scapula]

I agree with glade.

I come from an institution which puts someone into Peds Surg every few years. Now, all of them have had 2 years in the lab but I'm not sure that's the deciding factor. Most would probably tell you that a year in the lab isn't much help because if the point of being in the lab is to get publications, a year isn't going to be long enough.

I think it is, as it is in all small surgical specialties, connections which will help you. It sounds as if you have a ****load of Peds surgeons hovering around you. They probably all went to different programs and can provide some form of help to you.

I'm not sure how finishing residency and doing research then would help you over doing it between R3 and R4. It IS possible to do research in PP; you do not have to be in academia and if you have a Children's Hospital in town, I'd bet there are people doing research there. Start asking around what's out there. If all else fails, come up with something YOU'D like to study and see if you can get some institutional support.

 

[ESU_MD]

Your best bet is to see if you can get one of those 10 surgeons to take a liking to you and call one of his/her buddies and get you in. Thats alot easier than doing research, especially if you are doing the research just to "get in to peds"

Its weird that these programs put such an emphasis on research, I guess its just a rite of passage. Isnt peds surgery one of the last pure technical-heavy fields though, (similar to CV surgery)? meaning, the pediatricians are always involved pre/post op and assume the bulk of the patient management.

God bless anyone who can go into this field, not only is it sad to take care of sick kids all the time, this field is a magnet for cliques and malignant personalities. In one instance, as a junior resident I saw a NICU nurse try to tell a staff surgeon not to take a baby out of the crib to examine him!!

 

[Winged Scapula]

Its weird that these programs put such an emphasis on research, I guess its just a rite of passage. Isnt peds surgery one of the last pure technical-heavy fields though, (similar to CV surgery)? meaning, the pediatricians are always involved pre/post op and assume the bulk of the patient management.

I think it depends on where you train. Our pediatric surgeons did all the patient management for patients with surgical diseases except when it came to things like complex renal, neurological etc. issues. The only exception was in the PICU where the patients were managed by peds intensivists and peds surgeons.

And yeah, those NICU nurses... 🙄

 

[glade]

Any nurses who deal with any kids are ridiculous. It's like they think they're "protecting" the kids from everyone else. Which would be great, except they're actually just protecting them from being taken care of. Someone should tell them to go home and have kids of their own if they want to be moms.

 

[ESU_MD]

anecdotally, there seems to be alot more hot female nurses/ancillary personnel and hell even doctors in children's hospital.

 

[glade]

Dude, Pediatrics is the gold-mine. But that's to be expected, since it's basically the perfect specialty for the majority of women in medical school. It deals with kids, it has a very manageable schedule, and the subject matter isn't that tough. Probably up to 25% of Peds residents are totally drillable. I give it the glade Seal of Approval. 👍

 

[Avefenix]

Thanks for the advice. From what I've heard the community of Pediatric surgeons is very small and everyone knows everyone. It's who you know that makes a difference. I'll make an appointment to sit down and talk with the more senior attending. Even if one of them decides to vouch for me, would that be sufficient or research by required ?

 

[SocialistMD]

... Even if one of them decides to vouch for me, would that be sufficient or research by required ?

Ask your faculty what they think of your application and how competitive you'll be without research or how much better it will make you look with more of it. They'll be able to evaluate you more completely, and they'll be able to call their friends at other programs and ask if you'd be competitive for their match list. If they think you'll be fine without the research, then it is a waste of time to do it unless you have some burning research question that you think can be answered in two years...

 

[pntgrd]

I was wondering why pediatric surgery is so competitive. I don't think their incomes or lifestyle are that great. Is it just that the number of slots is low compared to adult surgical specialties?

 

[Winged Scapula]

I was wondering why pediatric surgery is so competitive. I don't think their incomes or lifestyle are that great. Is it just that the number of slots is low compared to adult surgical specialties?

Yes. There are relatively few training spots available.

Its also commonly seen as the last real bastion of general surgery so many of us find that attractive.

 

[glade]

I was wondering why pediatric surgery is so competitive. I don't think their incomes or lifestyle are that great. Is it just that the number of slots is low compared to adult surgical specialties?

It's an artificially created competition. In case you didn't notice, most kids don't get sick. Therefore, if you're going to be a Pediatric Surgeon, you need to cover large population areas. Like, if you only covered one city of 50,000, you'd probably operate once a month and go broke in your second week. It's a slight exaggeration, but not really. Therefore, there aren't a lot of training spots. Therefore, it's hard to get into. That's Pediatric Surgery in a summary. A lot of people get all jazzed about it because they're like "if it's hard to get into and I get into it, that means I'm the best surgeon EVAR!!!!" No, not really.

 

[treehorsio]

I will answer the OP with a dissenting opinion, although according to glade, since I was a female medical student and didn't go into peds, beware: I may be ******ed. Apparently surgery is so much more intellectually strenuous than pediatrics that it's amazing I matched. Must have been my cleavage.

Anyway, I will be realistic and say that you are already starting from a weaker point not being academic-affiliated nor having a fellowship. As you know pediatrics is extremely competitive. All of our residents who have matched in pediatrics have taken 2 years of research and we've had an 100% match rate over the past 10 years. I am not aware of anyone who has NOT done this at any other institution and matched (I'm sure it happens, just not frequently). However, a common option is to take a year to do a PICU fellowship at your institution of interest in lieu of research. A few folks from other places have done this (sadly, they haven't matched at our place but a former chief resident of mine from med school did this and matched there).

Regardless, I would strongly consider 2 years of research somewhere else in an academic institution with an affiliated fellowship: they are going to know the PDs, PP folks won't. One year is not enough. I know it's a pain to move but if you really want to do peds, load the boat. I think doing 2 years AFTER residency is a viable option; one of our chiefs did this and matched at MD Anderson for surg onc.

In terms of fellowship institutions on the West Coast, Stanford has a great program, lots of research, OHSU's is in its infancy (and has some...interesting...personalities). I can't remember about UW, and, as you probably know, UCLA is probably the best on the coast. Good luck.

 

[glade]

When I was referring to "drillable females," I was talking about Pediatrics, not Pediatric Surgery. I haven't met a hot Pediatric Surgeon ever, mostly because I only know a few of them and they're all guys.

 

[pntgrd]

I will answer the OP with a dissenting opinion, although according to glade, since I was a female medical student and didn't go into peds, beware: I may be ******ed. Apparently surgery is so much more intellectually strenuous than pediatrics that it's amazing I matched. Must have been my cleavage.


In terms of fellowship institutions on the West Coast, Stanford has a great program, lots of research, OHSU's is in its infancy (and has some...interesting...personalities). I can't remember about UW, and, as you probably know, UCLA is probably the best on the coast. Good luck.

UCLA does not have a pediatric surgery fellowship.

 

[BlondeDocteur]

And UW's is awesome.