hours for Picu or Nicu after fellowship

[nightowl]

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Hey everyone,

I'm looking for a specialty where I can do procedures and am leaning towards pediatrics. I also am considering ob/gyn because I like the OR, but I'm leaning towards peds bc I want to eventually have more control over my hours with part-time as an option. I'm wondering if the hours as a picu or nicu doc are just as bad as ob/gyn. I've heard shift work could be an option. but as a rule, rather than an exception, what are the hours like? I don't mind a few long days, but would like to be able to limit my hours to part-time and take less call when kids are young.... my husband is doing gen surg, so I know I'm going to be bearing most of the home responsibility. Would love more info/insight. Thanks!

also, I know peds ER is another option with definite shift work, I'm just wondering if these specialties are anywhere near as flexible 🙂

 

[CrazyPeds527]

As someone very interested in a PICU career, I have thought long and hard about some of the things you mentioned. My wife is an Ob/Gyn resident, so I have a unique perspective.

It's a nice idea to want to work part-time when you are young, but that can be a tough time to find part-time work. For example, looking at PICU or NICU; you finish residency and decide you cannot bear the thought of doing general pediatrics. You pursue PICU or NICU fellowship, and your PGY-4 years is basically intern year all over. Whether it's a program with day/night or q4 call, you will be likely working 70-80 hours/week again. At the end of fellowship, you go job hunting and find that it is difficult to find a position where part-time is available because you are coming on as a junior attending and are the low person on the totum pole. Again. You find a position working part-time, but it involves a lot of nights, because these fields involve night call (and many PICUs and NICUs are making their attendings in-house overnight, even if they have fellows). Maybe that's ideal, maybe not. Those part time jobs are out there, from what I have seen, but they can be tough to find.

The upside; NICU/PICU jobs can involve less than 26 weeks of service a year, and when you are not on the service, your time is much more regular. The variability in jobs is large...academic center vs private small hospital; day/night shifts as an attending vs some centers where call is rotated as q2 or q3. The patients are interesting and complex (although the emotional toll that sick/dying children can take on you cannot be overlooked).

For OB/Gyn, the life as an attending is even more highly variable. Even with the advent of the new laborist model, those jobs havent taken off yet as the hospitalist model has in medicine & pediatrics, partly because some women have desired a physician who sees them throughout their pregnancy be 'their doctor' and deliver their child. The other thing that needs to be considered is which field of Ob/Gyn you are interested in. There is a big difference in becoming an REI or Uro/Gyn physician where hours tend to be more predictable, vs Gyn/Onc, MFM or even General OB where the hours can be less predictable.

Bottom line: it may be challenging to choose peds or OB based on the variables you have mentioned. But things to remember: you can't control what you love. If you truly love the OR & operating, you cannot get that through pediatric training. My wife loves OB/Gyn and although she hates the hours some days, she could never see herself doing another specialty. But she also will tell any medical student she advises that if they love something else as well, they should really consider doing the other speciality because the demands of OB/Gyn training and life after training are quite high.

However, you want to make sure that the procedures you love doing are enough in the ICU. I have heard PICU docs joke that some of them are 'closet surgeons', but in reality there is a big difference between sticking a chest tube in a kid and opening a kid's abdomen or chest, or delivering babies and doing emergent c-sections and ectopic pregnancy cases.

If you have more questions, feel free to PM me; there are also a lot of people on this board interested in PICU or NICU (see previous threads) who I'm sure have 2 cents on the subject.

Good luck!
~Crazy

 

[bjackrian]

Very helpful and interesting post--thanks!

 

[oldbearprofessor]

You pursue PICU or NICU fellowship, and your PGY-4 years is basically intern year all over. Whether it's a program with day/night or q4 call, you will be likely working 70-80 hours/week again.

The upside; NICU/PICU jobs can involve less than 26 weeks of service a year, and when you are not on the service, your time is much more regular. The variability in jobs is large...academic center vs private small hospital; day/night shifts as an attending vs some centers where call is rotated as q2 or q3.

Good post as always by "Crazy" but let me elaborate on these parts a little bit. I'm primarily talking NICU, but PICU isn't that much different. First, I agree that much of the first year is similar to internship in terms of night call. But it's better in that you are doing what you "want" to do every month. No covering the adolescent floor at night 👍 or the ER . There is a zero % chance of having to do a work-up for abdominal pain in a teenage girl when doing your PL-4 year as a neo fellow.🙂

After the first year of fellowship, it gets better as far as hours since you are largely doing research with either cross-covering nights or a few clinical months each year.

As an attending, the possibilities are complex. One thing to consider that hasn't been mentioned is the difference between in-house and at-home call. To be sure, it is almost impossible to imagine a new attending who isn't covering somewhere at nights. Only folks waaaaay older than even me have that as a perogative.😱 But you can choose where you take call. There are jobs available in smaller "community" hospitals with home call where you don't get called in too much. Be cautious about home call in bigger places. You'll get called more than you'd like and it can be better to be in-house.

Regardless, although part-time is hard to arrange (but not impossible), there are options that may suit you. For those with small kids, however, you need to have a backup plan. Even taking home call on a quiet service can see the stat page to the hospital so someone has to be home with the kids if that happens and taking the toddlers to the zoo may not happen that day, etc.

Talk to folks who've lived this life and see what you think. Many have done it and done it well in the NICU and PICU world. But it isn't easy.