Anesthesia vs Neonatology?! Help...

[djsbaseball2014]

Hey everyone, I am a current 3rd year medical student on rotations. I am still early on in my clerkships but I am having some conflicting feelings. I came into medical school with a strong interest in Anesthesia and am currently on my anesthesia rotation at a VA medical center. My experience has been less than thrilling and is strongly making me reconsider. Additionally, I spent some time in the NICU during my peds rotation and fell in love with it. Neonatology is even more interesting to me because of a strong emotional connection I have due to being born premature and spending time in the NICU as a baby.

I just wanted to get some peoples opinions on these fields and possibly some advice/predictions where you think these specialties are headed. I will post a little pros/cons list below.

Anesthesia
Pros:

• GREAT lifestyle + compensation for the amount of work you do which is attractive for later in my career
• Flexibility when it comes to OR settings/types of anesthesia/care you can provide
• The medicine/procedures are interesting and fun
• the personalities attracted to anesthesia fit my personality well
• immediate results to your actions
• Interesting fellowships which are becoming more popular

Cons:

• CRNA's do a large majority of the work with the anesthesiologist mainly there for intubation/extubation
• Patient interactions are transient
• Seems like you get criticism from CRNAs and Surgeons with nobody truly appreciating your work
• Patient's don't really remember you
• very few practices that are MD only that allow you to do your own cases

Neonatology
Pros:

• STRONG emotional connection to patient population
• You get to form a connection with patient's and their families
• Actually feel like a physician who has patient's that you can diagnose/treat
• You are an intensivist, do procedures and get alot of interesting medicine
• Flexibility in your career based of what level of NICU you work in

Cons:

• 3 years peds residency + 3 years fellowship which is an additional 1-2 more years than anesthesia would require
• Salary/earning potential is significantly less
• Burnout is a real thing
• NP's highly involved in the NICU though not to the same extent as CRNA's are in the OR

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[Cornfed101]

Also I’m not sure where you get the “great” lifestyle of an anesthesiologist from. It is not a lifestyle friendly field. Surgeons operate at all times of the day and night so someone has put the pt into a coma and be the internist of the OR for them…

Agree with everything except this. Anesthesiologists are typically in a good size group so the call is spread out. I was mentored by an anesthesiologist that worked 6am-2pm 5 days a week with call once every 5-6 weeks on the weekend.

 

[Davidfromcali]

Think alot of it depends on personality. As an anesthesiologist, you’ll need to be content with not being the patients “doctor”. And I get the whole pre op and post op care but let’s be real, the surgeon is really the patients doctor in the vast majority of patients minds as well as the other specialists that the patients sees In clinic . It’s just the way it is. As a neo, you’ll get the opportunity to be at the center of a families and their infants care. Obviously there’s overlap with other peds specialists and surgeons but a neo is at the center of it all when the infants in the NICU.

 

[Chelsea FC]

Head on over to the anesthesia forum my dude. Seems pretty close to 100% would disagree it’s a lifestyle field.

No one will admit their job is a lifestyle field because work once you start doing it day to day its hard. Even the Derm people will say that.

 

[xDNA]

Neonatology
Pros:

• STRONG emotional connection to patient population
• You get to form a connection with patient's and their families
• Actually feel like a physician who has patient's that you can diagnose/treat
• You are an intensivist, do procedures and get alot of interesting medicine
• Flexibility in your career based of what level of NICU you work in

Cons:

• 3 years peds residency + 3 years fellowship which is an additional 1-2 more years than anesthesia would require
• Salary/earning potential is significantly less
• Burnout is a real thing
• NP's highly involved in the NICU though not to the same extent as CRNA's are in the OR

I'm a RN in a level 4 NICU, we're a teaching hospital.

I agree with almost all your "Pros" for Neonatology from what I've seen, with the exception that "...[you], do procedures..." In my hospital, there arent many procedures to be done, just a handful, and they are generally all done by our NNPs (PICC placements, Umbilical Lines, Intubations...etc). I can honestly say in my 4yrs here I've never seen a Neo do a line. I've seen them do intubations on babies with difficult anatomies and/or critical airways but thats about it. OTOH, our NNPs generally take a backseat on the medicine side of things. Us nurses usually use NPs as our first person to contact so we arent overwhelming the docs (I work at a 100+ bed NICU so theres ALOT of us nurses). But big medical decisions are all physician driven, as it should be. Every now and then there are "NNP team babies" where essentially the NPs are in complete control of that patient, BUT the baby has to meet a certain criteria, and usually those babies are not complex in the slightest.

My point about Neos not really doing any procedures also makes me disagree with your "Burnout" arguement. We have some pretty old docs, atleast 6 I know is in there 60s, and thats not including our oldest Neo who I'm pretty sure is in her 70s, She's been a Neo for 47years!!

I forgot what I was looking at Medscape? I think it was called, but Neos in my area supposedly make $375-450k. I'm not sure how much you were looking to make or how much more you need, but that seems good to me LOLOLOLOL.

I would say the downside to Neo at my job is it doesn't seem like a lifestyle specialty to me. I dont know all the details on their scheduling but we do always have 1 Neo in house everynight to watch our entire NICU with 2 NNPs. I'm not sure how often they have to do this and stuff, but that is something they do here. They always look tired LOL. but after rounds usually between 10pm-12am, they just sleep unless its something the NNPs cant handle or if the NNPs are overwhelmed. They also cover the NICU of other hospitals within our system. So sometimes they are on main campus with us, or sometimes they have to go 45min away to another hospital. but usually when they go to the other hospitals, they are much less acute Level 2's and are generally done by like 2-4pm in comparison to being done at 6-7pm here at main campus.

 

[xDNA]

In regards to not doing procedures that is something, much like anesthesia, that, unfortunately, lazy older attendings have given away. I plan to do as many procedures as I choose and if a nnp doesn’t like it then they can go to medical school and put their license on the line: full stop

I also plan on not working with nnps (physician only group) but if I do then will,
from day one, let them know I will be doing any procedure I so choose.

Regardless, your input is definitely valued! But, just because the neos at your shop have sold the procedure part of the field at your location doesn’t mean that is the way it is everywhere

Yeah I hear you! I wish I could offer more insight, but yeah I only have experience in this NICU within our hospital system.

I will say that, I think Neonatology is freaking awesome dude! My experiences here were transformative and a major reason I decided to try and get into medical school. By far the best patient population too, BAR NONE!

 

[xDNA]

Also, you should post more. Always good to have a nursing perspective and you seem rather level-headed. Thanks for your input! Mind if I ask which general location you are in? I try to keep my pulse on regional trends of the field. Thanks!

Try? Still trying or moved on?

I'm in the Mid-Atlantic

I'm in the application cycle now! Hoping for a successful cycle!