Nurse Practitioners in NICU

[Osmosis_JonesDO]

Hello,

I am a 3rd year student and I have been really struggling with finding a field that I am passionate about. However, recently I had the experience to shadow a physician in the NICU and I loved it. Being the specialist for these newborns who wouldn't make it without your care and intervention is something I can really see myself doing with my life. I enjoy the acuity of critical care and the NICU seems like a really special place.

However, the neonatologist seemed pessimistic about the future of the field and mentioned how there are more and more midlevels entering the field and hospitals would rather hire them than the doctor. He also mentioned that by the time I would be practicing the job market would be tight due to this and pay would not be what it is today. Now pay is not something incredibly important to me, but I do not want to go into a field where I would be fighting with midlevels for a job. I am hoping this was just the views of one pessimistic doctor and was hoping someone else with more experience could give me their take on the future of this field. Thanks!

---

Members don't see this ad.

 

[SurfingDoctor]

Hello,

I am a 3rd year student and I have been really struggling with finding a field that I am passionate about. However, recently I had the experience to shadow a physician in the NICU and I loved it. Being the specialist for these newborns who wouldn't make it without your care and intervention is something I can really see myself doing with my life. I enjoy the acuity of critical care and the NICU seems like a really special place.

However, the neonatologist seemed pessimistic about the future of the field and mentioned how there are more and more midlevels entering the field and hospitals would rather hire them than the doctor. He also mentioned that by the time I would be practicing the job market would be tight due to this and pay would not be what it is today. Now pay is not something incredibly important to me, but I do not want to go into a field where I would be fighting with midlevels for a job. I am hoping this was just the views of one pessimistic doctor and was hoping someone else with more experience could give me their take on the future of this field. Thanks!

Did you ask him to provide of an example of job he wanted to do but was given to a APN instead? I bet you'd hear crickets.

As for the job market, that's multifaceted and more a reflection of where hospitals are (and where they aren't). There's plenty of need for a neonatologist in the sticks, BUT the payor population is more Medicare and Medicaid and thus, it's harder to operate hospitals, for which neonatology is a hospital-based specialty. But, neonatology is also a specialty that community hospitals are willing to support, because birth can be a financial gold mine for a hospital. All that being said, you have 7+ years till you'd graduate and its hard to predict what job market would look like so do what you are most interested in and the let the chips fall where they may.

 

[Osmosis_JonesDO]

Thats fair, no he did not provide specific examples of this. I understand its pretty ridiculous to be worried about the job market and APN's when I have so many years of training left, it was just discouraging to hear this about the first field that has really grabbed my interest. I guess do you see a situation where NICU's are only staffed by nurse practitioners without the need for a neonatologist, or will there always need to have a neonatologist on staff?

I'm naturally a worrier at heart, but I will try to take your advice and just follow my interest and not let this dissuade me.

 

[SurfingDoctor]

Thats fair, no he did not provide specific examples of this. I understand its pretty ridiculous to be worried about the job market and APN's when I have so many years of training left, it was just discouraging to hear this about the first field that has really grabbed my interest. I guess do you see a situation where NICU's are only staffed by nurse practitioners without the need for a neonatologist, or will there always need to have a neonatologist on staff?

I'm naturally a worrier at heart, but I will try to take your advice and just follow my interest and not let this dissuade me.

We've had APNs in our PICU for years. They never practice independently and maybe this would be surprising to hear, but maybe all except one or two out of 20 or 30 would probably want to practice independently. Most like taking care of patients and having some autonomy, but most don't want to have all the responsibility of dealing with managing 12+ patients with critical illnesses simultaneous. And least that is my summation.

 

[DO2015CA]

NNPs would rather do the lines and procedures. They don’t actually want to do the medicine. They can do feeder growers on their own. But they won’t be able to replace neos. There is a lot of protocols in nicu but at the same time all the absolutely weird stuff that happens where you have to lean on a broad knowledge base.

Work at a level 3-4 nicu if you have concerns of encroachment. NNP may be able to manage level 2 stuff but that if you want to be a neo then it most likely wouldn’t be enough complexity for your liking anyways .

 

[mvenus929]

I admit that I am not in the NICU. However, I did work for a NICU group out of residency for a year.

NNPs are great as permanent residents of the NICU. They can do procedures and the day-to-day stuffs. But they don't have the broad sense of things that can happen, things that do happen, and how to fix them.

We had NPs staffing level 1 and level 2 nurseries in our division, which were also staffed by general pediatricians (like me). As our state was not an independent practice state, we have to sign off on all the NP's notes. Level 3 and 4 NICUs require much more thought and nuance, but the NPs serve as an extra pair of eyes and hands to help out when things go south.

 

[FrkyBgStok]

NNPs are great as permanent residents of the NICU.

This!

This is what I have personally seen the NNPs do. When I did my NICU rotation, I would get progressively sicker patients each year but there was always that few days of getting back into the groove of things that the NNPs controlled stuff. But after that, them and the residents pretty much did the same thing each day throughout the day so, to me, it seemed like a career of being a resident. Similar to a lot of the specialty surgical PAs. And it is hard for residents to take over for specialists so not happening.

 

[oldbearprofessor]

Advanced practice nurses, with differing titles and roles, have been part of neonatology for as long as I have, and that's close to 40 years. Few NICUs of almost any size could function without them (of course, there are exceptions, but not many these days).They do not take away jobs from neonatologists who are caring for Level 3 or 4 babies or most Level 2's. It is true that small Level 1-2 NICUs who wish to staff deliveries 24/7 will use them for that staffing and rounding whereas if they weren't around, that staffing would be done perhaps by neonatologists (or by non-neo pediatricians), but that's not really causing neonatologists to not be employed. The job market for neonatology remains good and is likely to remain so, although like other fields there may be some downward financial pressure from reimbursers.

 

[Osmosis_JonesDO]

Thank you very much for the replies, they have been very helpful in understanding the structure of the NICU and alleviating my anxiety. As a follow up question, how important is it to do residency at a children's hospital or academic institution to go on to a NICU fellowship? I am starting the process of applying for audition rotations and am trying to pick out my top choices

 

[DO2015CA]

Thank you very much for the replies, they have been very helpful in understanding the structure of the NICU and alleviating my anxiety. As a follow up question, how important is it to do residency at a children's hospital or academic institution to go on to a NICU fellowship? I am starting the process of applying for audition rotations and am trying to pick out my top choices

Most peds programs are at academic institutions anyways. There are very few community peds programs. Nicu is also not very competitive (I think because how different it is than the rest of peds) so you can find a spot somewhere in the country. If fact most peds subspecialties aren’t very competitive.

 

[sliceofbread136]

I would hate to be an independently practicing nicu nnp. Being a liability sponge while having no clue what I’m doing and taking care of children that could get very sick almost instantaneously.

Although I don’t understand the independent practice push in general. As I get further along and am given more and more responsibility I really wish I could return to the safe and warm days of being a medical student where I didn’t really have to make any decisions

 

[oldbearprofessor]

I'm unaware of anywhere that uses NNPs without attending (often at home for small places) backup. Usual rules are to be able to be present within 15-20 minutes when called give or take. NNPs who have attended hundreds if not thousands of deliveries are quite competent at handling most things that can happen in the delivery room or NICU while waiting on backup.

 

[sliceofbread136]

I'm unaware of anywhere that uses NNPs without attending (often at home for small places) backup. Usual rules are to be able to be present within 15-20 minutes when called give or take. NNPs who have attended hundreds if not thousands of deliveries are quite competent at handling most things that can happen in the delivery room or NICU while waiting on back up

15 minute is more than reasonable. Having someone to go to when needed makes 100% of the difference.

What I don’t get though is those who push for complete independent autonomy. Responsibility and actually having to make the call can be brutal. I don’t think people who want more autonomy realize this. Or maybe I’m just a naturally nervous person, who knows.

 

[mvenus929]

15 minute is more than reasonable. Having someone to go to when needed makes 100% of the difference.

What I don’t get though is those who push for complete independent autonomy. Responsibility and actually having to make the call can be brutal. I don’t think people who want more autonomy realize this. Or maybe I’m just a naturally nervous person, who knows.

Dunning-Kruger effect

 

[Socrates25]

If level 3/4 NICUs run without neo attendings at night and instead have NNPs covering them, then the neo attendings need to be fired and replaced with NPs

 

[wamcp]

If level 3/4 NICUs run without neo attendings at night and instead have NNPs covering them, then the neo attendings need to be fired and replaced with NPs

Nurse practitioners replace doctors for newborn care at a Charlotte-area hospital amid national push to cut costs

In March, the hospital brought in a team of neonatal nurse practitioners to replace the board-certified pediatricians and neonatologists who used to see the newborns. That means no doctors are doing checkups on the babies there.

The hospital laid off the other neonatologist
when it brought in the nurse practitioners.

The Ledger asked if the hospital has lowered its charge for newborn care, since replacing neonatologists with neonatal nurse practitioners should result in significant cost savings. Whitfield did not respond to the question.

The Ledger called the main number of Lake Norman Regional to see what they tell patients about the level of care newborns receive. We were transferred directly to the maternity center.

The woman who answered the phone said the neonatal nurse practitioners are highly qualified and work in Level IV NICUs in Charlotte. “They’re better than a doctor,” she said. “I know it sounds scary, but they are the ones who really care for these babies. They can place lines, intubate, everything a neonatologist can do. They are more experienced than a pediatrician is with sick babies.”

The doctor won't see your newborn now

At Lake Norman Regional, nurse practitioners are replacing doctors for newborn care; Physician group says that's 'dangerous'

www.northcarolinahealthnews.org

 

[SurfingDoctor]

 

[Step Up]

Nurse practitioners replace doctors for newborn care at a Charlotte-area hospital amid national push to cut costs

In March, the hospital brought in a team of neonatal nurse practitioners to replace the board-certified pediatricians and neonatologists who used to see the newborns. That means no doctors are doing checkups on the babies there.

The hospital laid off the other neonatologist
when it brought in the nurse practitioners.

The Ledger asked if the hospital has lowered its charge for newborn care, since replacing neonatologists with neonatal nurse practitioners should result in significant cost savings. Whitfield did not respond to the question.

The Ledger called the main number of Lake Norman Regional to see what they tell patients about the level of care newborns receive. We were transferred directly to the maternity center.

The woman who answered the phone said the neonatal nurse practitioners are highly qualified and work in Level IV NICUs in Charlotte. “They’re better than a doctor,” she said. “I know it sounds scary, but they are the ones who really care for these babies. They can place lines, intubate, everything a neonatologist can do. They are more experienced than a pediatrician is with sick babies.”

The doctor won't see your newborn now

At Lake Norman Regional, nurse practitioners are replacing doctors for newborn care; Physician group says that's 'dangerous'

www.northcarolinahealthnews.org

This is a level I newborn nursery. Definitely don't need a neonatologist there, and having NNPs in the nursery instead of pediatricians isn't crazy.

 

[calvinhobbes]

And yet Pediatrics is continuing to push for a 3 year hospitalist fellowship, with rumblings for a fellowship in “community and nursery” pediatrics. Meanwhile, a FM or IM grad can work as a hospitalist just fine. And you wonder why people say pediatricians self-hate their own profession…look at what’s happening.