NICU questions

[bigfootisreal]

I am a 3rd year MD student and I’ve recently found a great deal of joy rotating through the NICU. I’ve read some of the other posts on sdn but was curious if anyone could give me a small breakdown of the field itself. I am interested in what a traditional NICU docs lifestyle looks like (private practice included), as well as salary, competitiveness, and location options. Is it possible to practice outside of a major metro city? I’m also curious about the future of the specialty and the job market (maybe not taking Covid into acccount).
Thank you!

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[oldbearprofessor]

Hi and glad for your interest. Neo has been for the last many years (my sub-I was 38+ years ago) and continues to be a great field for me and my colleagues. I don't know many (there are always exceptions) folks who've regretted it as a career. Here are some of my observations, there are other neos on here who hopefully will chime in.

Lifestyle is variable but either private or academics you've committed yourself to a career that includes night call, usually in house. Frequency is highly variable from every 4th to a couple times a month but it is unlikely to go away until you are a VERY oldbear (older than me, and that's OLD). Now then, having said that, I don't think the lifestyle is all that terrible overall. Lots of folks have jobs in which they work some pattern of weeks or months on and off clinical service, academics are often 20-50% clinical, etc. It's not the cush lifestyle but it's not crushing, IMHO.

Salary I prefer not to discuss, other sites and sources cover that. There is a PP vs academic gap, but there are also lots of "semi-academic" positions where you might be at a NICU affiliated with the university. The PP vs academic gap is not as large as it once was from my vantage point and it can be balanced by lifestyle considerations.

Location? There are babies everywhere! Depends on what you want in terms of acuity, night call, salary, etc. Then are lots of NICUs in moderate sized towns (e.g 150,000-1 million population) and some on the outskirts of big cities close enough to have your chickens run free in the yard.

Job market? Good but not a "I can go anywhere" world. PP has more opportunities more broadly than academic. If you insist on being within the "big" academic market cities (near Fenway park for example....), you'll have more competition for jobs than in smaller communities. This is true for almost everything though. COVID has not been a huge factor in neonatology jobs as babies keep coming and for the most part most COVID+ moms do not deliver NICU babies.

My strong suggestion for med students is to try to arrange a sub-I in the NICU. It'll tell you if that's for you in a flash.

 

[bigfootisreal]

This was super helpful, thank you so much! Would you say as a whole that it is a relatively competitive field to get into?

 

[blue.jay]

Hi and glad for your interest. Neo has been for the last many years (my sub-I was 38+ years ago) and continues to be a great field for me and my colleagues. I don't know many (there are always exceptions) folks who've regretted it as a career. Here are some of my observations, there are other neos on here who hopefully will chime in.

Lifestyle is variable but either private or academics you've committed yourself to a career that includes night call, usually in house. Frequency is highly variable from every 4th to a couple times a month but it is unlikely to go away until you are a VERY oldbear (older than me, and that's OLD). Now then, having said that, I don't think the lifestyle is all that terrible overall. Lots of folks have jobs in which they work some pattern of weeks or months on and off clinical service, academics are often 20-50% clinical, etc. It's not the cush lifestyle but it's not crushing, IMHO.

Salary I prefer not to discuss, other sites and sources cover that. There is a PP vs academic gap, but there are also lots of "semi-academic" positions where you might be at a NICU affiliated with the university. The PP vs academic gap is not as large as it once was from my vantage point and it can be balanced by lifestyle considerations.

Location? There are babies everywhere! Depends on what you want in terms of acuity, night call, salary, etc. Then are lots of NICUs in moderate sized towns (e.g 150,000-1 million population) and some on the outskirts of big cities close enough to have your chickens run free in the yard.

Job market? Good but not a "I can go anywhere" world. PP has more opportunities more broadly than academic. If you insist on being within the "big" academic market cities (near Fenway park for example....), you'll have more competition for jobs than in smaller communities. This is true for almost everything though. COVID has not been a huge factor in neonatology jobs as babies keep coming and for the most part most COVID+ moms do not deliver NICU babies.

My strong suggestion for med students is to try to arrange a sub-I in the NICU. It'll tell you if that's for you in a flash.

@oldbearprofessor from your 30+ experience what would you say is the impact of NNPs? I know they cannot replace neonatologist but are they displacing job opportunities for new grads? My wife just started 3rd yr of her pediatric residency, she is considering neo but is concerned about the lifestyle and night calls (we are expecting a baby soon).
I am not sure how easy it is to get jobs for her and myself (IM hospitalist considering fellowship) in the same city.

 

[oldbearprofessor]

This was super helpful, thank you so much! Would you say as a whole that it is a relatively competitive field to get into?

Generally it is not competitive to get a fellowship spot. Getting a spot at the largest/highest ranked programs is moderately competitive.

 

[oldbearprofessor]

@oldbearprofessor from your 30+ experience what would you say is the impact of NNPs? I know they cannot replace neonatologist but are they displacing job opportunities for new grads? My wife just started 3rd yr of her pediatric residency, she is considering neo but is concerned about the lifestyle and night calls (we are expecting a baby soon).
I am not sure how easy it is to get jobs for her and myself (IM hospitalist considering fellowship) in the same city.

NNPs are an integral part of the team in almost every NICU in the US. They cover small nurseries, including at night without a neonatologist in house (usually as home backup), work as team members in all size NICUs in almost every conceivable role. They used to handle transports but increasingly that is often done by dedicated hospital transport teams. They are not displacing neos IMHO and overwhelmingly neos have a very good relationship with the NNPs who work with us (and PAs, although they are less common by far in NICUs). We appreciate them a lot and always have. I'm not going to try to comment on the challenges of being a mom and a neonatologist, but will say that the majority of women I know in neonatology are moms and make it work. Not necessarily easy, but there are plenty of women she can talk to about how they've made it work so I won't try to do that. Of course, a dad who is a real partner at home etc helps a lot!

 

[blue.jay]

NNPs are an integral part of the team in almost every NICU in the US. They cover small nurseries, including at night without a neonatologist in house (usually as home backup), work as team members in all size NICUs in almost every conceivable role. They used to handle transports but increasingly that is often done by dedicated hospital transport teams. They are not displacing neos IMHO and overwhelmingly neos have a very good relationship with the NNPs who work with us (and PAs, although they are less common by far in NICUs). We appreciate them a lot and always have. I'm not going to try to comment on the challenges of being a mom and a neonatologist, but will say that the majority of women I know in neonatology are moms and make it work. Not necessarily easy, but there are plenty of women she can talk to about how they've made it work so I won't try to do that. Of course, a dad who is a real partner at home etc helps a lot!

Thanks for your opinion @oldbearprofessor
My job is flexible, I will offloading household chores and baby duty if she is interested.

 

[connormcdavid]

@oldbearprofessor or others, could you comment on the typical schedule that most groups follow and if there is a difference based on academic/private/employed?

for example, is it typical to do service weeks with group coverage/a nocturnist overnight, 7 on 7 off, or 12 or 24 hour shifts etc.? If there is variability in the practice set up, is it easy to find jobs with these different setups?

also, based on my limited experience there is a lot of day to day variation. Do you agree with this/ does it ever start to feel very routine?

thank you!

 

[oldbearprofessor]

@oldbearprofessor or others, could you comment on the typical schedule that most groups follow and if there is a difference based on academic/private/employed?

for example, is it typical to do service weeks with group coverage/a nocturnist overnight, 7 on 7 off, or 12 or 24 hour shifts etc.? If there is variability in the practice set up, is it easy to find jobs with these different setups?

also, based on my limited experience there is a lot of day to day variation. Do you agree with this/ does it ever start to feel very routine?

thank you!

There is a huge amount of variability in how clinical services are arranged at the attending level. Almost everything you can think of is done somewhere. Whether you can find the arrangement you'd like depends on your geographical preferences as well as job openings. In general, speaking broadly, academics are more likely to operate "traditional schedules" with clinical daytime service for 2-4 week stretches and a separate call schedule that includes all the faculty in-house. Private groups may have more shift type or nocturnist type opportunities but this isn't absolute.

WRT being routine? Well, I suppose that can be said of about anything. Having said that, I've NEVER heard a neontatologist complain that the job felt routine. Each of our babies is different in many ways. Sure, we have a relatively small number of primary diseases that are common (and a ton that are rare), but the presentation and care never feels routine for the sick babies.

 

[RTC19]

If you don't mind me chiming in, are DOs at a disadvantage for matching NICU and other more competitive Peds fellowships?

Do fellows get to see their own kids most days if they have them? Do most fellowships have a 24-hour call system or a night float system?

Thank you, @oldbearprofessor and @bigfootisreal, for the informative thread! We should sticky this!

 

[oldiebutgoodie1211]

Hi and glad for your interest. Neo has been for the last many years (my sub-I was 38+ years ago) and continues to be a great field for me and my colleagues. I don't know many (there are always exceptions) folks who've regretted it as a career. Here are some of my observations, there are other neos on here who hopefully will chime in.

Lifestyle is variable but either private or academics you've committed yourself to a career that includes night call, usually in house. Frequency is highly variable from every 4th to a couple times a month but it is unlikely to go away until you are a VERY oldbear (older than me, and that's OLD). Now then, having said that, I don't think the lifestyle is all that terrible overall. Lots of folks have jobs in which they work some pattern of weeks or months on and off clinical service, academics are often 20-50% clinical, etc. It's not the cush lifestyle but it's not crushing, IMHO.

Salary I prefer not to discuss, other sites and sources cover that. There is a PP vs academic gap, but there are also lots of "semi-academic" positions where you might be at a NICU affiliated with the university. The PP vs academic gap is not as large as it once was from my vantage point and it can be balanced by lifestyle considerations.

Location? There are babies everywhere! Depends on what you want in terms of acuity, night call, salary, etc. Then are lots of NICUs in moderate sized towns (e.g 150,000-1 million population) and some on the outskirts of big cities close enough to have your chickens run free in the yard.

Job market? Good but not a "I can go anywhere" world. PP has more opportunities more broadly than academic. If you insist on being within the "big" academic market cities (near Fenway park for example....), you'll have more competition for jobs than in smaller communities. This is true for almost everything though. COVID has not been a huge factor in neonatology jobs as babies keep coming and for the most part most COVID+ moms do not deliver NICU babies.

My strong suggestion for med students is to try to arrange a sub-I in the NICU. It'll tell you if that's for you in a flash.

why don’t you discuss salary by giving an average and ballpark figures?

 

[NurWollen]

If you don't mind me chiming in, are DOs at a disadvantage for matching NICU and other more competitive Peds fellowships?

What is fellowship like for people who have kids at home? Do people get to see their kids most days? Is it mostly a 24-hour call system or a night float system?

Thank you, @oldbearprofessor and @bigfootisreal, for the informative thread! We should sticky this!

I'm a DO and new NICU fellow. I'm sure I lost out on interviews for being a DO but I still got more interviews than I could go on and matched very high on my rank list. I got interviews at places that didn't interview me for residency. I'd say NICU is slightly less competitive than peds residency is.

 

[RTC19]

I'm a DO and new NICU fellow. I'm sure I lost out on interviews for being a DO but I still got more interviews than I could go on and matched very high on my rank list. I didn't have great board scores either. I got interviews at places that didn't interview me for residency. I'd say NICU is slightly less competitive than peds residency is.

Thank you!

 

[oldbearprofessor]

If you don't mind me chiming in, are DOs at a disadvantage for matching NICU and other more competitive Peds fellowships?

Do fellows get to see their own kids most days if they have them? Do most fellowships have a 24-hour call system or a night float system?

Thank you, @oldbearprofessor and @bigfootisreal, for the informative thread! We should sticky this!

There may be some DO bias especially at some of the most well-known academic programs, but I'd generally say it's minimal to none at the overwhelming majority of programs. Take a look at the fellows roster at some places you're interested in and that will give you an idea.

Oh, I hope they get to see their kids and even their pets. Most if not virtually all places have fellows on a 24-hour system or at least a rotating q4-6 overnight call system for those not on service. A true night float system would be hard given that most programs only have 2-4 fellows/year.

Let me see more activity on this forum and then I can do some stickies. Generally been trying to avoid them but we can certainly have 1 or 2 as we develop.

 

[RTC19]

There may be some DO bias especially at some of the most well-known academic programs, but I'd generally say it's minimal to none at the overwhelming majority of programs. Take a look at the fellows roster at some places you're interested in and that will give you an idea.

Oh, I hope they get to see their kids and even their pets. Most if not virtually all places have fellows on a 24-hour system or at least a rotating q4-6 overnight call system for those not on service. A true night float system would be hard given that most programs only have 2-4 fellows/year.

Let me see more activity on this forum and then I can do some stickies. Generally been trying to avoid them but we can certainly have 1 or 2 as we develop.

Thank you for this very helpful reply!

 

[oldiebutgoodie1211]

There may be some DO bias especially at some of the most well-known academic programs, but I'd generally say it's minimal to none at the overwhelming majority of programs. Take a look at the fellows roster at some places you're interested in and that will give you an idea.

Oh, I hope they get to see their kids and even their pets. Most if not virtually all places have fellows on a 24-hour system or at least a rotating q4-6 overnight call system for those not on service. A true night float system would be hard given that most programs only have 2-4 fellows/year.

Let me see more activity on this forum and then I can do some stickies. Generally been trying to avoid them but we can certainly have 1 or 2 as we develop.

what kind of income do neonatologist make in ur experience?

 

[Dr. Vinnie Boombatz]

@oldbearprofessor I'm interested in neo, but I have little interest in doing research. I realize that research is a big part of fellowship, but after fellowship if I never wanted to do research again is that something I could do at a level 3 or 4 nicu. Also when you differentiate between PP and academia, does PP include neonatologists at private non-profit hospitals or just at independent groups.

 

[FrkyBgStok]

I am not in NICU but I was at a community residency where the NICU docs made great money with no research requirements. I think the nice thing about NICU is that there are so so many different practice environments that you can definitely make a career in a decent NICU without academic responsibilities. at least the traditional ones.

 

[NurWollen]

Neonatologists probably have more opportunities for private practice than any other peds subspecialists. Plenty of community hospitals with level III NICUs. Can't say that as much about peds inpatient floors, PICUs, oed cardiology services, ID, etc.

 

[oldbearprofessor]

@oldbearprofessor I'm interested in neo, but I have little interest in doing research. I realize that research is a big part of fellowship, but after fellowship if I never wanted to do research again is that something I could do at a level 3 or 4 nicu. Also when you differentiate between PP and academia, does PP include neonatologists at private non-profit hospitals or just at independent groups.

Sure, most neos don't do research in a traditional sense, although some do QI type work that can cross-over to being research. There is not a clean distinction between PP and academia in that a number of "Academic" places also run community NICUs in a more PP type of fashion. None of this has anything to do with the non-profit or for-profit status of hospitals per se.

 

[KP2AZ]

I'm a DO and new NICU fellow. I'm sure I lost out on interviews for being a DO but I still got more interviews than I could go on and matched very high on my rank list. I got interviews at places that didn't interview me for residency. I'd say NICU is slightly less competitive than peds residency is.

Similar to @NurWollen , I am a DO as well who is going into Neonatology (currently doing interviews). I would say being a DO was more of an issue applying to residency than it is for NICU fellowship. Ive gotten interviews from pretty much everywhere I wanted.