In which surgical fields can you operate exclusively on kids?

[aalamruad]

Hi y'all, quick question: I know that some surgical specialties/subspecialties don't have pediatric patient populations large enough to allow a peds-only practice (e.g. trauma surgery, vascular surgery), so I'm wondering which ones allow you to work exclusively in peds.

Updated lists:

Yes (I think)
Ophtho
Neurosurgery
General
Ortho
CT/congenital
Urology
ENT
Plastics (rarely)
Transplant (rarely, except for heart transplants)
OMFS (very rarely)

No (I think)
Trauma
Vascular
SurgOnc
Surgical critical care

Gracias!

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[mestielest]

Pediatric Urology?

 

[aalamruad]

Pediatric Urology?

Just added it to the "Yes" category, is that right?

 

[Hangry]

ENT you can definitely have an all pediatric practice.

"Surg onc" at a pediatric level is primarily done by general pediatric surgeons as I understand it. Or at least I would be surprised if you could do peds surg onc without also supplementing your practice with more general peds surgery procedures.

Fetal surgery is also a thing but you are operating on both babies and mothers.

 

[Levo]

I know there are ENTs who do peds only. It also seems to me like it would be very possible to be a pediatric plastic surgeon after a craniofacial fellowship, although they may end up being like pediatrics cardiologists who care for both kids and adults with congenital anomalies. At the children's hospital in my home town, the pediatrics general surgeons take trauma call, so they are in effect pediatric trauma surgeons despite not having done a dedicated trauma fellowship. As far as transplant, I know of one surgeon who has completed both a peds fellowship and a transplant fellowship and does transplants in kids only plus peds gen surg cases when there are no transplants.

 

[aalamruad]

ENT you can definitely have an all pediatric practice.

"Surg onc" at a pediatric level is primarily done by general pediatric surgeons as I understand it. Or at least I would be surprised if you could do peds surg onc without also supplementing your practice with more general peds surgery procedures.

Fetal surgery is also a thing but you are operating on both babies and mothers.

I know there are ENTs who do peds only. It also seems to me like it would be very possible to be a pediatric plastic surgeon after a craniofacial fellowship, although they may end up being like pediatrics cardiologists who care for both kids and adults with congenital anomalies. At the children's hospital in my home town, the pediatrics general surgeons take trauma call, so they are in effect pediatric trauma surgeons despite not having done a dedicated trauma fellowship.

Got it, just updated the lists, thanks!

 

[mestielest]

Just added it to the "Yes" category, is that right?

Yep!

 

[HereWeGo17]

I interviewed with someone who specializes in pediatric transplants only


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[aalamruad]

I interviewed with someone who specializes in pediatric transplants only


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Thanks!

Any idea if that person did a fellowship in peds transplant surgery, or did they just do a transplant fellowship and decide to only work with kids? And what organ(s) if you don't mind me asking?

 

[HereWeGo17]

Thanks!

Any idea if that person did a fellowship in peds transplant surgery, or did they just do a transplant fellowship and decide to only work with kids? And what organ(s) if you don't mind me asking?

I think they did 1 year transplant fellowship followed by 1 year peds fellowship


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[Astra]

Lol the title of this thread is creepy without context

 

[Dr. Death]

ENT you can definitely have an all pediatric practice.

"Surg onc" at a pediatric level is primarily done by general pediatric surgeons as I understand it. Or at least I would be surprised if you could do peds surg onc without also supplementing your practice with more general peds surgery procedures.

Fetal surgery is also a thing but you are operating on both babies and mothers.

Is fetal surgery via peds surgery or via OB/Gyn?

 

[SurfingDoctor]

If you are a surgeon who specializes in disease or malformation X that only happens in children...

Transplant and Plastic Surgeons are almost never pediatric specific... unless you are talking about the heart.

Also no such thing as Pediatric Surgical Critical Care... not as a subspecialty

General Pediatric Surgeons cover traumas.

 

[aalamruad]

If you are a surgeon who specializes in disease or malformation X that only happens in children...

Any examples?

Transplant and Plastic Surgeons are almost never pediatric specific... unless you are talking about the heart.

General Pediatric Surgeons cover traumas.

Got it, thanks!

Also I such thing as Pediatric Surgical Critical Care... not as a subspecialty

Sorry, but what did you mean to write here?

 

[SurfingDoctor]

Any examples?

Craniosynostosis syndromes comes to mind

Sorry, but what did you mean to write here?

The "I" should have been a "no"

 

[FrkyBgStok]

it depends on where you are i suppose. if you are a neurosurgeon in a major children's hospital, then sure, but the neurosurgeon i worked with in med school only did peds once or twice per week and the rest were adults and he said that peds neurosurgery was like that. so all of yours could possibly be practiced exclusively on kids, but only a couple could probably be practiced exclusively on kids.

 

[Hangry]

Is fetal surgery via peds surgery or via OB/Gyn?

I'm no expert, but from what I've heard either is possible, although I suspect the peds surg track is more common.

 

[aalamruad]

it depends on where you are i suppose. if you are a neurosurgeon in a major children's hospital, then sure, but the neurosurgeon i worked with in med school only did peds once or twice per week and the rest were adults and he said that peds neurosurgery was like that. so all of yours could possibly be practiced exclusively on kids, but only a couple could probably be practiced exclusively on kids.

Bummer. I wonder what percent of peds neurosurgeons have peds-only practices. @neusu might you have a rough estimate?

 

[aalamruad]

I'm no expert, but from what I've heard either is possible, although I suspect the peds surg track is more common.

Aren't there only like 50 peds surgery spots per year? Seems like there would be way more Ob/Gyn residents interested in fetal surgery than peds surg fellows simply because there are way more Ob/Gyn residents out there

 

[Hangry]

Aren't there only like 50 peds surgery spots per year? Seems like there would be way more Ob/Gyn residents interested in fetal surgery than peds surg fellows simply because there are way more Ob/Gyn residents out there

How many fetal surgeons do you think there are in the country?

There's not a ton of people interested in it from any specialty, it is an incredibly small and niche field. I hesitate to speculate more on the field as I am just as ignorant about it as anyone else, but my suspicions that peds surgery is a more common path rest on two assumptions.

1. Peds surgery fellows are PGY-9s when they graduate, and have likely spent the last 9 years of theirs lives in highly specialized academic centers climbing the academic ladder. No field is more niche and hyperspecialized than fetal surgery, so it's a more gradual transition for them than an obgyn resident that is a PGY4 and has spent a good portion of that residency delivering babies and not operating and may have even been at a nonacademic hospital. Peds surgery fellows are more likely to be in an environment where they may have rubbed elbows with fetal surgeons. Who would you be more likely to want to train as a fetal surgeon if you were on the fellowship committee?

2. Historically, I think most fetal surgeons are peds trained and are more likely to take on of "their own", plus the reasons outlined above. A quick glance at faculty lists at fetal surgery centers in the U.S. seems to support this.

 

[aalamruad]

How many fetal surgeons do you think there are in the country?

There's not a ton of people interested in it from any specialty, it is an incredibly small and niche field. I hesitate to speculate more on the field as I am just as ignorant about it as anyone else, but my suspicions that peds surgery is a more common path rest on two assumptions.

1. Peds surgery fellows are PGY-9s when they graduate, and have likely spent the last 9 years of theirs lives in highly specialized academic centers climbing the academic ladder. No field is more niche and hyperspecialized than fetal surgery, so it's a more gradual transition for them than an obgyn resident that is a PGY4 and has spent a good portion of that residency delivering babies and not operating and may have even been at a nonacademic hospital. Peds surgery fellows are more likely to be in an environment where they may have rubbed elbows with fetal surgeons. Who would you be more likely to want to train as a fetal surgeon if you were on the fellowship committee?

2. Historically, I think most fetal surgeons are peds trained and are more likely to take on of "their own", plus the reasons outlined above. A quick glance at faculty lists at fetal surgery centers in the U.S. seems to support this.

Ah, good points, extent of training and exposure is definitely more important than size of potential applicant pool.

 

[OrthoTraumaMD]

Ortho is tricky. Yes you can work with only kids, but most orthopods, in addition to their subspecialty practice take trauma call and general call which is basically whatever comes in. Unless you work exclusively at a children's hospital.

 

[BurghStudent]

There are neurosurgeons who do fetal surgery (check out the MOMS trial, next level).

 

[aalamruad]

Ortho is tricky. Yes you can work with only kids, but most orthopods, in addition to their subspecialty practice take trauma call and general call which is basically whatever comes in. Unless you work exclusively at a children's hospital.

Okay great, I'm mostly interested in academic medicine and I'd like to work at a children's hospital, so I'm glad to hear there are at least some opportunities out there to do peds-only in ortho 🙂

 

[IlDestriero]

It's both actually. Fetal surgery is a team endeavor with a whole multidisciplinary approach. At the core you'll have an MFM-trained OB taking care of the mom side and a peds surgeon taking care of the baby.

As you mention it's a niche thing and even in big centers only a small number of cases per year.

This is correct.
Though there a handful of children's hospitals that do the majority of the fetal cases, and everywhere else. We do them all the time.
Minimally invasive fetal is usually MFM only, open fetal is MFM with the peds surgery specialists. (General, Neuro, Cardiothoracic, occasionally ENT).
It's definitely super niche and it's a multidisciplinary team sport. I'm on the fetal anesthesia team.


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Il Destriero

 

[IlDestriero]

Okay great, I'm mostly interested in academic medicine and I'd like to work at a children's hospital, so I'm glad to hear there are at least some opportunities out there to do peds-only in ortho 🙂

Most of the Ortho guys at my place are peds only. In fact, the only ones that I think are doing both are hand and one spine guy and I'm not sure about the spine guy anymore as his practice grew quite a bit over the last couple years. They don't cover adult trauma as it's a freestanding children's hospital.
Get a job at a real Children's Hospital and kiss the gross adults goodbye forever.


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Il Destriero

 

[BeddingfieldMD]

This has more to do with where you work once an attending surgeon than the general field--assuming that you choose a surgical field that at least has a significant amount of pediatric disease and surgical treatments. With some exceptions, if you want to be a surgeon who operates 100% exclusively on children (< 18 years of age), you need to work at a bona fide pediatric hospital (usually something with "Children's" in the name). In most cases, these hospitals are wholly separate from their adult-oriented brethren and don't even admit patients who are 18 or older. There are very few community hospitals out there with enough pediatric business to keep a surgeon 100% occupied, even in kid-heavy fields like ENT. More commonly, pediatric surgeons will rotate through several community hospitals or cover these places by arrangements with nearby academic-based children's hospitals.

The list you guys have going looks pretty good. From residency, I did know of one OMFS guy who specialized on children and worked at the Children's Hospital--so it apparently is possible. There are also some pediatric surgeons who specialize in "trauma," but at most children's hospitals, trauma isn't nearly as big and doesn't receive nearly the focus as it does at an adult trauma center. Most pediatric cardiac surgeons specialize exclusively on children (including cardiac and pulmonary transplants), but as has been pointed out, I think options to be a liver transplant surgeon and do only kids are more limited--because of the lesser demand for such surgeries. There are definitely pediatric-only ophthalmologists, urologists, orthopedists, general surgeons, neurosurgeons, ENTs, and plastic surgeons. Agreed that I don't recall seeing any vascular surgeons who do only pediatrics. And I think most of the surg-onc work for kids is done by general surgeons who do fellowships in pediatric surgery. Also have never heard of a "pediatric" OBGYN who does gynecologic congenital work and other such things--but they may exist somewhere in the more specialized children's hospitals.

In any event...the takeaway is that if working 100% with kids is your career goal, realize that you will most likely have to live in a city with a dedicated children's hospital--and that you may have to move somewhere you weren't really considering for your first job because these jobs only open up periodically due to their limited nature.

 

[tiedyeddog]

it depends on where you are i suppose. if you are a neurosurgeon in a major children's hospital, then sure, but the neurosurgeon i worked with in med school only did peds once or twice per week and the rest were adults and he said that peds neurosurgery was like that. so all of yours could possibly be practiced exclusively on kids, but only a couple could probably be practiced exclusively on kids.

Really depends on where you practice. If you're at a stand-alone pediatric hospital you're more then likely doing pediatrics only. More common for people in private practice to do an adults and pediatrics mix.