Combined peds/anesthesia programs?

[sje97]

Hi all,

Current MS3 at a DO school. Highly interested in applying for the combined peds/anesthesia residencies. I’m hoping to do PICU and peds anesthesia. I’m wondering if anyone has any insight on how competitive these programs are? Any advice on what to do at this point to make myself a better applicant? Happy to post my scores/other info if it would be helpful!

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[GassYous]

Peds ICU has been given away to the midlevels so don't waste your time. The programs that I'm aware of that do a peds intern year and then peds anesthesia track are Boston Children's and Penn. Any combined residency is a waste of time because you waste time training in something that you won't really use. There are practices that do pediatrics without peds fellowship.

You'll probably change your mind when you're in residency so just aim for the programs that will train you the best.

 

[Zekchar]

Do you want to do pediatrics or anesthesia the rest of your working life? Pick one and do it.

I've never heard of this combo training but likely except for the 3 ivory towers who offer this, no place will take you for this mess of a track. Either your anesthesia colleagues will get annoyed at you for messing up their calls while decreasing their flexibility to swap late assignments or the peds people will be annoyed at having to work around your post call days etc. You have X years to earn good money. It may be even less if medicare for all or a public option comes into play (which I still support). I'd avoid the [(X peak earning years - unnecessary and unprofitable training years) = total lifetime earning ] equation as best as I could. Good luck, but I'd choose one and commit.

 

[Nivens]

I trained with many people in that combined program, and my wife was a peds anesthesia fellow. We know of one one person who has gone on to do peds ICU and pedi anesthesia after. All the rest have done pedi anesthesia only, which my wife does without a pediatrics residency. We have several friends who have switched out of the combined program to just anesthesia. Be careful what mid-20s you signs mid-30s you up for.

 

[Justice4all]

We have a few that have PICU training in their background. None of them still works in PICU and only do pediatric anesthesia.

 

[WheezyBaby]

Just to offer some different perspective, there are definitely people practicing PICU from a peds anesthesia background. They tend to be concentrated on the east coast, eg hopkins, but exist elsewhere. Some do exclusively PICU, some split their time. Whether this is a good idea for a training pathway to do PICU or not I'm not going to debate, but they exist

 

[kidthor]

I know a handful of people who did the whole combined peds, anesthesia, PICU, peds anesthesia route. It used to be a bit more abbreviated, but not anymore. The people who do the combo are amazing clinicians - and absolutely wonderful people. They land in extreme ivory tower jobs at places that don't pay well. And it's a serious amount of training to endure.

No joke, many daytime / no-call CRNAs make much more per hour than most of my ultra-peds-trained colleagues. In fact I know a decent number of nurse managers who make more than they do. Which is absurd, but it's also reality.

Buyer beware.

 

[sje97]

Thanks for the feedback everyone! I do know that from reading previous posts and from this one, the consensus seems to be that picking one or the other is perhaps more beneficial in the long run.

 

[sje97]

I trained with many people in that combined program, and my wife was a peds anesthesia fellow. We know of one one person who has gone on to do peds ICU and pedi anesthesia after. All the rest have done pedi anesthesia only, which my wife does without a pediatrics residency. We have several friends who have switched out of the combined program to just anesthesia. Be careful what mid-20s you signs mid-30s you up for.

Thank you for the reply! Do you mind my asking what your cohorts average stats/applications were like? It’s okay if you aren’t comfortable sharing. Just trying to get a general idea of whether or not I would even be considered a competitive applicant.

 

[Nivens]

Thank you for the reply! Do you mind my asking what your cohorts average stats/applications were like? It’s okay if you aren’t comfortable sharing. Just trying to get a general idea of whether or not I would even be considered a competitive applicant.

I honestly have no idea what their applications were like, but I imagine they were quite strong.

 

[26B]

I know a handful of people who did the whole combined peds, anesthesia, PICU, peds anesthesia route. It used to be a bit more abbreviated, but not anymore. The people who do the combo are amazing clinicians - and absolutely wonderful people. They land in extreme ivory tower jobs at places that don't pay well. And it's a serious amount of training to endure.

It's a long road for sure. A few of my colleagues are currently in this pathway. Peds (3 years), PICU (3 years), anesthesia (3 years), followed by peds anesthesia fellowship (1 year). PGY-10 by the time you're done, or PGY-11 if you add a year of peds cardiac anes to that. A person who chooses this pathway will have had several more years of training than most neurosurgeons by the time they become an attending, but will be making a small fraction of what a neurosurgeon makes. Obviously one should not choose a career path for the money, but the financial implications of this pathway should not be ignored.

 

[GassYous]

It's a long road for sure. A few of my colleagues are currently in this pathway. Peds (3 years), PICU (3 years), anesthesia (3 years), followed by peds anesthesia fellowship (1 year). PGY-10 by the time you're done, or PGY-11 if you add a year of peds cardiac anes to that. A person who chooses this pathway will have had several more years of training than most neurosurgeons by the time they become an attending, but will be making a small fraction of what a neurosurgeon makes. Obviously one should not choose a career path for the money, but the financial implications of this pathway should not be ignored.

Meanwhile brand new NPs with zero practical experience are doing central lines and taking care of critically ill premies in the NICU.

 

[kidthor]

Meanwhile brand new NPs with zero practical experience are doing central lines and taking care of critically ill premies in the NICU.

And intubating them...

 

[WholeLottaGame7]

Hi all,

Current MS3 at a DO school. Highly interested in applying for the combined peds/anesthesia residencies. I’m hoping to do PICU and peds anesthesia. I’m wondering if anyone has any insight on how competitive these programs are? Any advice on what to do at this point to make myself a better applicant? Happy to post my scores/other info if it would be helpful!

My institution has (or had) a combined program, but not sure if it's even still matching applicants. Multiple people dropped out of the combined track to focus on anesthesia. I think you end up being good at both but great at neither, even the ones who stuck it out I would say were a little behind their peers because their anesthesia training kept getting interrupted.

I think PICU and peds anesthesia are two pretty separate fields. I think you should decide which you'd rather do so you can at least narrow it down to 6 years (peds/PICU) or 5 years (anesthesia/peds fellowship). If you love critically ill children and want to develop long, meaningful, and oftentimes painful relationships, do PICU. If you like critically ill children but are happy to go home at night and dissociate at least a little, do peds anesthesia.

 

[Mehd School]

PICU has been given away to the midlevels? Hmph that’s news to me and I’m probably considerably more in touch with the PICU world than you are

He's right. My spouse is a neonatologist and trained in an enormous big name institution for residency and fellowship. There were NICU's and PICU's in their big health system that even as a senior fellow, my spouse wasn't allowed inside of. Midlevels run those ICUs.

 

[GassYous]

lol at the peds resident coming here to tell me how it is. Your field is promoting multi-year hospitalist fellowships just to take care of basic floor patients, don't tell me what you think about the picu world.

 

[sje97]

My institution has (or had) a combined program, but not sure if it's even still matching applicants. Multiple people dropped out of the combined track to focus on anesthesia. I think you end up being good at both but great at neither, even the ones who stuck it out I would say were a little behind their peers because their anesthesia training kept getting interrupted.

I think PICU and peds anesthesia are two pretty separate fields. I think you should decide which you'd rather do so you can at least narrow it down to 6 years (peds/PICU) or 5 years (anesthesia/peds fellowship). If you love critically ill children and want to develop long, meaningful, and oftentimes painful relationships, do PICU. If you like critically ill children but are happy to go home at night and dissociate at least a little, do peds anesthesia.

It seems to be a recurring theme that people drop for the anesthesia track specifically. Is this because of better financial opportunities in anesthesia? Stress of being in both programs? Other? Just curious to know.

 

[WheezyBaby]

It seems to be a recurring theme that people drop for the anesthesia track specifically. Is this because of better financial opportunities in anesthesia? Stress of being in both programs? Other? Just curious to know.

It's a long training pathway you can opt out of and earn considerably more money for considerably less hours of work. It's not surprising many would go in that direction

 

[shepardsun]

A little late to the party here but I did a peds residency followed by an anesthesia residency and am now doing academic generalist anesthesia. Pretty much everything everyone said here rings true, so I won't try to repeat too much. I will say that peds is just really awful from the standpoint of requiring a ton of extraneous and lengthy training. Don't even get me started on the hospitalist fellowship nonsense. I'm not sure why accredited peds fellowships are three years except to say that specialized cheap labor is awesome for hospitals.

I told myself I wanted to be the PICU/peds anesthesia rockstar towards the tail end of med school and got interested in that path after I had already applied to peds, so was too late to do the combined programs. I did genuinely enjoy my peds residency on the whole, but I will say that if you go into a combined program with the goal of being an acute care badass, you will absolutely detest and despise the outpatient component of your training which will be next to useless in the long run of what you want to do.

The longitudinal relationships and chance to watch pathophysiology and trauma evolve over time is what attracts me to PICU, and at the current salary I make as a generalist the financial opportunity cost for that training, with interest over 30 years or whatever my career will be, easily hits seven figures.

That may ultimately be worth it to me- money isn't everything, of course, but when I consider even doing a peds anesthesia and maybe even adult cardiac fellowship (I've come to think you'll never be the best anesthesiologist you can be without adult cardiac training, but that's another soap box) in two years vs the four it would take me to do the original path of PICU plus peds anesthesia, it just hits home how crazy long this training path actually is. Mad props to the Hopkins and CHOP allstars who did it (and who inspired me to do it), but you cannot comprehend now at the end of med school just how long and exhausting that is. You just can't.

 

[GassYous]

Eh I did plenty of hearts and livers in residency. Don't really miss em that much and I have enough stress in my day to day as it is.

 

[WholeLottaGame7]

Meanwhile brand new NPs with zero practical experience are doing central lines and taking care of critically ill premies in the NICU.

I mean, I guess if you consider PICCs or umbi lines as central lines, sure, and the success rate on the former is pretty hit or miss. Pretty remarkable that they even get some of them, though, all things considered. Maybe it's different at other NICUs, but midlevels aren't doing neck/groin/subclavian lines at our institution. It's either VIR, surgery, or anesthesia.

 

[MLNS]

lol at the peds resident coming here to tell me how it is. Your field is promoting multi-year hospitalist fellowships just to take care of basic floor patients, don't tell me what you think about the picu world.

Considering I work in a picu and you don’t... Also, I have relatives who also work in these fields, in different regions of this country. So, ya, id say I know a *little* bit more about how the field is than some ornery saggy balls anesthesia attending.

I don’t even understand your point about the hospitalist fellowship. O nooo my leaders are scumbags who want to profit off of cheap labor....you really got me??? Lol, what..****ing bizarre. Meanwhile, your pitiful organization is losing to nurse “anesthesiologists.” Maybe lets be less petty and try to work together to fend off midlevels. Ya? Or we could continue to be a jackass like you?

 

[sje97]

A little late to the party here but I did a peds residency followed by an anesthesia residency and am now doing academic generalist anesthesia. Pretty much everything everyone said here rings true, so I won't try to repeat too much. I will say that peds is just really awful from the standpoint of requiring a ton of extraneous and lengthy training. Don't even get me started on the hospitalist fellowship nonsense. I'm not sure why accredited peds fellowships are three years except to say that specialized cheap labor is awesome for hospitals.

I told myself I wanted to be the PICU/peds anesthesia rockstar towards the tail end of med school and got interested in that path after I had already applied to peds, so was too late to do the combined programs. I did genuinely enjoy my peds residency on the whole, but I will say that if you go into a combined program with the goal of being an acute care badass, you will absolutely detest and despise the outpatient component of your training which will be next to useless in the long run of what you want to do.

The longitudinal relationships and chance to watch pathophysiology and trauma evolve over time is what attracts me to PICU, and at the current salary I make as a generalist the financial opportunity cost for that training, with interest over 30 years or whatever my career will be, easily hits seven figures.

That may ultimately be worth it to me- money isn't everything, of course, but when I consider even doing a peds anesthesia and maybe even adult cardiac fellowship (I've come to think you'll never be the best anesthesiologist you can be without adult cardiac training, but that's another soap box) in two years vs the four it would take me to do the original path of PICU plus peds anesthesia, it just hits home how crazy long this training path actually is. Mad props to the Hopkins and CHOP allstars who did it (and who inspired me to do it), but you cannot comprehend now at the end of med school just how long and exhausting that is. You just can't.

This is very helpful and informative! Thank you! The time commitment is definitely something that takes consideration. And I have also thought about the outpatient portion of peds potentially being less interesting than other parts of the training. Did you feel like matching into anesthesia after peds was doable? This is another route I am thinking about if I don't match into the combined program, given that there are so few of them. Just not sure whether having already done a residency and doing the match puts you at an advantage or if its about the same?

 

[deleted697127]

Be careful what mid-20s you signs mid-30s you up for.

Well said.

 

[shepardsun]

Just not sure whether having already done a residency and doing the match puts you at an advantage or if its about the same?

Huge advantage, no question. You go into the applicant cycle being a proven commodity- you've already shown you can handle the long hours, the scut work, do well on in-training exams, etc. Yeah, what it takes to succeed in one specialty may be somewhat different in another, but all other things being equal a program director is going to much rather bet on you as a candidate with proven maturity in medical training than a fresh MS4 who may have good test scores but has little practical experience to show for it. I was a fairly competitive candidate going into peds, but would have been an average candidate going into anesthesia, and the second time around top programs were tripping over themselves to convince me to rank them.