Information on different pediatric surgical specialties

[account]

I am a current second year medical student interested in surgery, and also the pediatric patient population. I have heard it is extremely competitive to match into a pediatric surgical fellowship from general surgery, but is the same true for pediatric orthopedics/ENT/urology etc? (Assuming you match into their respective residencies, I understand these are also competitive.) Are there certain pediatric surgical fields which are only available in an academic setting? Can they all sustain a practice where you just see pediatric patients? What are the most common procedures for each pediatric field that would not otherwise be performed for an adult population?

Also, if this is better suited for another forum, please let me know and I will post there. Thanks.

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[JJMrK]

A pediatric orthopaedic fellowship after orthopaedic residency is not competitive with the exception probably of the top fellowships. It is less competitive than other fellowships. It tends to be more clinic and less operating than many other orthopaedic sub specialtys. Some people enjoy seeing kids, achieving good outcomes with no operative techniques, treating healthy patient’s etc. Many people who go into a surgical field, however, are interested in doing the least amount of clinic, not the most. The surgeries involves operating all over the body including spine, deformity correction, fractures, foot reconstruction etc and that is also sometimes a draw for folks. It is sort of like being a general orthopaedic surgeon (which doesn’t really exist otherwise in most places), just in kids.

 

[DoctwoB]

Ditto for most of the other surgical subspecialties. Getting a pediatric urology fellowship is easy and there are often unfilled positions at decent programs (though like in any field, some of the top spots will be competetive). I've heard the same for ENT and Neurosurgery.

As a Peds Urologist you can definitely have a practice of 100% kids at an academic center or children's hospital. Or you could choose to join a general urology group and be their peds person while still practicing some adult urology. There aren't as many 100% peds private jobs, though they do exist (particularly in the very large private urology groups).

As a pediatric urologist the main surgeries you do are hypospadias repairs, inguinal hernias and orchiopexies (so many of these), circumcisions/revisions, ureteral reimplants for vesicoureteral reflux, pyeloplasties for UPJ obstructions, bladder augmentations/bladder neck slings for spina bifida, as well as dealing the the less common congenital stuff that arises like bladder exstrophy/epispadias, disorders of sexual differentiation, posterior urethral valves, etc.

Many general urologists will do some of that bread and butter stuff (hernias/orchipexies) but most will refer other pediatric stuff to the dedicated peds guys.

 

[account]

Thank you both, appreciate the responses!

 

[HighPriest]

You can do about 85% of what a pediatric ENT does as a general ENT. Peds ENT fellowships are really designed for complex ENT cases, which are a big deal but which represent a small portion of all ENT peds surgery. So, airway reconstruction, pediatric head and neck neoplasms, and a good portion of cochlear implants (certainly not all) are usually fellowship trains guys. But we all do peds surgery right out of residency. Or, at least, we all could if we wanted. Most do.

In a large ENT group, you could be their peds guy, but because most of them will be very comfortable doing peds, they’re not going to send basic cases to you just because it’s a kid. You can be 100% peds at a pediatric hospital with fellowship.

I’m not sure how competitive ENT peds fellowships are anymore. Maybe someone else can comment.

 

[Pir8DeacDoc]

You can do about 85% of windows hat a pediatric ENT does as a general ENT. Peds ENT fellowships are really designed for complex ENT cases, which are a big deal but which represent a small portion of all ENT peds surgery. So, airway reconstruction, pediatric head and neck neoplasms, and a good portion of cochlear implants (certainly not all) are usually fellowship trains guys. But we all do peds surgery right out of residency. Or, at least, we all could if we wanted. Most do.

In a large ENT group, you could be their peds guy, but because most of them will be very comfortable doing peds, they’re not going to send basic cases to you just because it’s a kid. You can be 100% peds at a pediatric hospital with fellowship.

I’m not sure how competitive ENT peds fellowships are anymore. Maybe someone else can comment.

I'd agree with this. I'll add that some pedi Otos do cleft lip and palate surgery. Depends on their training and practice set up where they work. One of ours had a lot of cleft experience in fellowship. But the craniofacial plastics guys did all those cases. The other had a lot of airway experience. Neither loved ears. So our otologists did the cochlears. As of about a decade ago when I finished residency pedi oto wasn't a competitive fellowship. The hard ones were facial plastics and otology.

 

[dienekes88]

Congenital heart surgery is a fellowship at the end of an already long path (either after General surgery/cardiothoracic fellowship or after integrated cardiothoracic surgery residency), and folks get thinned out along the way. In the past, the challenge of matching a fellowship has varied greatly from year to year, but the real challenge is getting a job after. Even if you are fellowship trained, the extraordinary variety, the technical challenges, the complex 3 dimensional geometry, the nuanced decision making, and the public reporting of outcomes means that you need to be in a strong mentored position for a few years after fellowship to get to the point where you feel comfortable doing these operations, and this is not always easy to find.

Operations include: atrial septal defects, ventricular septal defects, tetralogy of fallot repair, PDA ligation, coarct repair, canal repair, Norwood procedure, bidirectional Glenn, Fontan, aortic/mitral/tricuspid/pulmonary valve repair or replacement, arterial switch operation, truncus repair, Rastelli, total veins repair, vascular rings, Ross procedure, sub aortic membrane resection, heart transplantation, ventricular assist device implantation, ECMO, and the list goes on and on...