Pediatric Fellowship- poor match results?

[skankhunt42]

Hey,

I heard that something like 45% of Peds programs went unfilled. I saw the 2017 stats (for the 2018 start) said something like 20% of spots went unfilled. Seems like this cycle was even worse.

What gives? Is Peds that bad a gig?

---

Members don't see this ad.

 

[dchz]

you seem like someone with good deduction skills.

But some go purposely unfilled for fun.

 

[ambiturner]

A lot of peds spots are at small programs with questionable case numbers. However, a lot of big programs didn't fare well either.

Peds is coming off a time of big expansion where there was a lot of demand as our services expanded into MRI, IR, dental, etc. and community groups started recruiting for fellowship trained people for even their healthy kids. During this era big children's hospitals were hiring 3-5 people a year. Now most of them have hit steady state, making it very difficult to get a job at a free standing children's hospital, and community hospitals are swamped with peds people so most PP jobs involve no more than 1-2 days of peds a week, mostly healthy. The value of a fellowship in such a practice is dubious.

Residents respond to market forces and if you can do a regional year, working 4 hours a day with no call and lots of moonlighting money, and get just as good a job as with a peds fellowship working 60 hrs/wk with overnight call and ICU time, which would you pick?

All that doesn't change the fact that peds is the best field though and working with kids is (for me) far more rewarding than the majority of adult practice.

 

[Guillemot]

Residency prepares one for B&B peds. Fellowship prepares one for sick kids. Maybe people are figuring that out.

 

[deleted50478]

My guess is the match system is to blame. Programs all interview and accept the same people then go unfilled while plenty of people want those spots.

They should never have started a fellowship match.

 

[HalO'Thane]

I have felt for several years now that there are way too many fellowship spots in way too many programs. I think the driving force behind all of this is the desire for cheap yet skilled labor. Fellows provide this opportunity for children’s hospitals. This, in my opinion, has been a very shortsighted strategy with no real consideration for long-term implications for the job market for future fellows. I also think it doesn’t help when programs talk about making a pediatric anesthesia fellowship two years. At the end of the day it doesn’t make much sense to pursue a pediatric Fellowship unless you really love working with kids because there is a good chance you can find a higher paying job as a generalist without having to spend another year in training. This is coming from a pediatric anesthesiologist who happens to love his job.

 

[dchz]

Residency prepares one for B&B peds. Fellowship prepares one for sick kids. Maybe people are figuring that out.

this is a good point. I also got some experience and got to do norwood, fontan, and glenns during my ca-1 to ca-3 year. so you can sometimes get that during residency too. obv i don't feel like i'm qualified to do those cases. but it did tell me i don't want to do those cases and be paid less or equal to a generalist... that's probably why peds are not matching as well... a lot of economic answers behind this...

 

[narcotics999]

I just can't handle the mental torture of seeing sick kids (really sick kids). So pass.

 

[dchz]

I just can't handle the mental torture of seeing sick kids (really sick kids). So pass.

A lot of peds is really pretty rewarding. The secret bout sick kids: now matter how sick they are, they have more regenerative reserve than adults. The sick kids are less of a mental torture and more of a "they get better" specially given we're always working with the curative (read: surgical) specialties.

 

[skankhunt42]

you seem like someone with good deduction skills.

But some go purposely unfilled for fun.

How about that...a cynic on SDN. Thanks for the comment....but you subsequent posts were more insightful....

 

[skankhunt42]

I have heard similar things with our Pediatric faculty...that the current sentiment is there are not enough full time Pedi jobs out there. I would imagine this is the biggest factor.

Its funny how the pendulum swings. In 5 years there is going to be a big need because of the downturn in applicants now.... Unless the sky does actually fall like they say so often will be the case on SDN.

 

[nimbus]

One of our practice sites is a stand alone pediatric hospital. However we have several recent hires with peds fellowships who work at one of our other sites practicing 100% adult anesthesia. Same is true for multiple ACCM fellows who do 100% general cases in the OR+-OB.

 

[nimbus]

My guess is the match system is to blame. Programs all interview and accept the same people then go unfilled while plenty of people want those spots.

They should never have started a fellowship match.

Can’t those people get the open spots after the match?

 

[Psai]

One of our practice sites is a stand alone pediatric hospital. However we have several recent hires with peds fellowships who work at one of our other sites practicing 100% adult anesthesia. Same is true for multiple ACCM fellows who do 100% general cases in the OR+-OB.

Do a fellowship they said. Keep ahead of the crnas they said. Lol. Cardiac and pain are the only ones worth doing.

 

[nimbus]

Do a fellowship they said. Keep ahead of the crnas they said. Lol. Cardiac and pain are the only ones worth doing.

Not exactly. The only hope of getting a job at our peds hospital is by doing a peds fellowship. However, there are more peds fellows than peds hospital jobs. The peds fellowship pays off some but not for others.

 

[manygas]

Hey,

I heard that something like 45% of Peds programs went unfilled. I saw the 2017 stats (for the 2018 start) said something like 20% of spots went unfilled. Seems like this cycle was even worse.

What gives? Is Peds that bad a gig?

I'm curious to know where did you got/heard that info...You can see which programs were unfilled by going to the fellowships section on the SPA website and clicking "available fellowship positions".

Take note that not all programs will post their unfilled spots, so it underestimates the number of unfilled spots. From the list I don't see any of the "big" programs.

 

[AdmiralChz]

Interesting, didn’t know this. Interest will be an order of magnitude less if/when they make it a 2 year fellowship, which is currently being floated.

 

[shepardsun]

Interest will be an order of magnitude less if/when they make it a 2 year fellowship, which is currently being floated.

Along these same lines, the center I did my peds residency at was only hiring peds anesthesiologists who could do peds hearts- and the year I left, they interpreted that to mean people who did a SUPER fellowship on top of the original one.

 

[deleted171991]

Hey,

I heard that something like 45% of Peds programs went unfilled. I saw the 2017 stats (for the 2018 start) said something like 20% of spots went unfilled. Seems like this cycle was even worse.

What gives? Is Peds that bad a gig?

As predicted just a couple of years ago. It's a matter of supply vs demand, the market simply doesn't need (read: PAY for) overqualified pediatric anesthesiologists for healthy kids, and there are only so many dedicated children's hospitals in the country.

That's exactly what will happen to cardiac anesthesia, too, when the number of percutaneous procedures increases. One won't need a cardiac anesthesiologist for a TAVR etc. We're just not there yet.

 

[deleted592694]

This is generally true; some shops don't have an absolute requirement, but the major centers tend to only hire those with a second year of cardiac under their belt. I'm currently a fellow, and have also been told by some departments (if they're even hiring) that they are going in the direction of preferring their pediatric anesthesiologists to have either a cardiac or pain second year when hiring new faculty.

Again, this is for academic departments; I have not found difficulty finding private practices willing to hire Peds grads granted one is willing to also take care of adults.

Along these same lines, the center I did my peds residency at was only hiring peds anesthesiologists who could do peds hearts- and the year I left, they interpreted that to mean people who did a SUPER fellowship on top of the original one.

 

[deleted126335]

As predicted just a couple of years ago. It's a matter of supply vs demand, the market simply doesn't need (read: PAY for) overqualified pediatric anesthesiologists for healthy kids, and there are only so many dedicated children's hospitals in the country.

That's exactly what will happen to cardiac anesthesia, too, when the number of percutaneous procedures increases. One won't need a cardiac anesthesiologist for a TAVR etc. We're just not there yet.

The Willie Sutton Rule is based on a statement by notorious American bank robber Willie Sutton, who when asked by a reporter about why he stole from banks, answered: “Because that's where the money is.”

It seems that "where the money is" has become a moving target.

 

[Modanq]

When you go to all these specialized hospitals all the complex cases are staffed by sub specialized CRNAs who only work 1 or 2 rooms. We need to expand our role. Perhaps Anesthesiology residents should be able to apply for pediatric or adult IM fellowships and jump ship to cardiology or peds critical care.

 

[AdmiralChz]

Hey,

I heard that something like 45% of Peds programs went unfilled. I saw the 2017 stats (for the 2018 start) said something like 20% of spots went unfilled. Seems like this cycle was even worse.

What gives? Is Peds that bad a gig?

I think we might be overstating this, your numbers are a little off:

https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2018/02/Results-and-Data-SMS-2018.pdf

Wayyy down on page 61 - 184 out of 213 positions filled. That’s an 86% fill rate, substantially below that of pain and cardiac (95+%, pain is the page above), but overall probably in line with where it needs to be (as others have said, not really a huge need to increase the number of training positions). 37 out of 55 programs filled (67%), so it’s probably 1 or
2 at each place.

 

[nimbus]

I think we might be overstating this, your numbers are a little off:

https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2018/02/Results-and-Data-SMS-2018.pdf

Wayyy down on page 61 - 184 out of 213 positions filled. That’s an 86% fill rate, substantially below that of pain and cardiac (95+%, pain is the page above), but overall probably in line with where it needs to be (as others have said, not really a huge need to increase the number of training positions). 37 out of 55 programs filled (67%), so it’s probably 1 or
2 at each place.

Page 30(24) shows 86% fill rate overall but only 66% of positions were filled by US MD grads.

 

[deleted50478]

Page 30(24) shows 86% fill rate overall but only 66% of positions were filled by US MD grads.

Earlier I thought the problem was the match itself - adequate applicants but failure to distribute applicants to available programs, but it seems that isn’t the problem. Almost all applicants matching suggests cost > benefit.

What they should do is have 2 fellowship tracks for peds: 1) cardiac 2) non-cardiac (neonates + other big cases in small kids).

Fellows should not do any bread and butter peds! If a program can’t give you good cases most days they should either have fewer fellows or no fellows. If you are doing bread and butter cases more than a negligible amount you are just getting ripped off since you were fully trained to do those cases without supervision (and with full pay) after residency. Worse than the lost salary is the wasted opportunity to train as a peds anesthesia specialist. If you are giving up a year and $300k, the least the program should do is fill that year with fellow-level cases.

If fellowships had more fellow-level training and less resident level training/cases, then we’d see cost < benefit again.

 

[skankhunt42]

think we might be overstating this, your numbers are a little off:

https://mk0nrmpcikgb8jxyd19h.kinstacdn.com/wp-content/uploads/2018/02/Results-and-Data-SMS-2018.pdf

Wayyy down on page 61 - 184 out of 213 positions filled. That’s an 86% fill rate, substantially below that of pain and cardiac (95+%, pain is the page above), but overall probably in line with where it needs to be (as others have said, not really a huge need to increase the number of training positions). 37 out of 55 programs filled (67%), so it’s probably 1 or
2 at each place.

Thanks for sharing this...but I think this was for the 2018 appointment year. I was refering to the most recent October 2018 match (2019 appointment)

 

[Libertas]

Earlier I thought the problem was the match itself - adequate applicants but failure to distribute applicants to available programs, but it seems that isn’t the problem. Almost all applicants matching suggests cost > benefit.

What they should do is have 2 fellowship tracks for peds: 1) cardiac 2) non-cardiac (neonates + other big cases in small kids).

Fellows should not do any bread and butter peds! If a program can’t give you good cases most days they should either have fewer fellows or no fellows. If you are doing bread and butter cases more than a negligible amount you are just getting ripped off since you were fully trained to do those cases without supervision (and with full pay) after residency. Worse than the lost salary is the wasted opportunity to train as a peds anesthesia specialist. If you are giving up a year and $300k, the least the program should do is fill that year with fellow-level cases.

If fellowships had more fellow-level training and less resident level training/cases, then we’d see cost < benefit again.

Definitely disagree with that. I am a pediatric anesthesiologist at a freestanding children’s hospital. I have worked with a decent number of fellows in my first couple years out and the majority are not anywhere close to “pediatric competent” starting out. Many (most?) residencies are not providing solid pediatric training— 2 months is an exposure, not a competency. I did 5 months of as a resident, at a major children’s hospital, which is an exception and not the norm.

Being a pediatric fellow sometimes means doing a Norwood or a TEF, but it also means having a day where you do 20 healthy ent cases by lunch. I firmly believe all of that is required to make a proper pediatric anesthesiologist.

 

[Psai]

Definitely disagree with that. I am a pediatric anesthesiologist at a freestanding children’s hospital. I have worked with a decent number of fellows in my first couple years out and the majority are not anywhere close to “pediatric competent” starting out. Many (most?) residencies are not providing solid pediatric training— 2 months is an exposure, not a competency. I did 5 months of as a resident, at a major children’s hospital, which is an exception and not the norm.

Being a pediatric fellow sometimes means doing a Norwood or a TEF, but it also means having a day where you do 20 healthy ent cases by lunch. I firmly believe all of that is required to make a proper pediatric anesthesiologist.

How can you do 20 with all the charting required

 

[Twiggidy]

Not exactly. The only hope of getting a job at our peds hospital is by doing a peds fellowship. However, there are more peds fellows than peds hospital jobs. The peds fellowship pays off some but not for others.

Booyah.

Market saturation. We graduate tons of fellows (I bet the same can be said for cardiac) but it doesn't match the number of people who retire, therefore you take what you can get. Then the rumors fly around (especially on places like SDN) about "Why do a fellowship when you can get the same job and make the same or more money a year faster?"

 

[Twiggidy]

Interesting, didn’t know this. Interest will be an order of magnitude less if/when they make it a 2 year fellowship, which is currently being floated.

I honestly thought it would topple when they created a board exam. I won't be shocked if cardiac heads in that direction as well and then you'll need to take TWO exams

 

[Twiggidy]

The Willie Sutton Rule is based on a statement by notorious American bank robber Willie Sutton, who when asked by a reporter about why he stole from banks, answered: “Because that's where the money is.”

It seems that "where the money is" has become a moving target.

In academics the money is all the same. In private practice the money is in hearts and OB. The lifestyle combined with money is probably in pain, per se.

 

[Twiggidy]

How can you do 20 with all the charting required

That's why you do the fellowship. You learn.

 

[BigRedBeta]

We need to expand our role. Perhaps Anesthesiology residents should be able to apply for pediatric or adult IM fellowships and jump ship to cardiology or peds critical care.

PICU job market has been fairly tight the past 5 years or so, and all those PP anesthesia jobs that will take a fellowship trained anesthesiologist? Yeah, those don't really exist in the PICU world. PICU's of any reasonable size (even just >10 beds) and acuity that are PP are very rare...Dallas, Atlanta, Denver, some places in California, Portland, and that's pretty much the extent. Everything else is academic or small without subspecialty support which means any complex stuff gets shipped to bigger centers.

And when 85%+ (or more) of your job force is in academics, that depresses market value. Again, it comes down to following the money, but very few PICU people are making what anesthesiologists, even with a pediatric paycut, are making.

 

[Libertas]

You can press epic macro buttons with one hand and mask with the other... Ear tubes , meatotomies, etc....mask cases without an airway or IV don’t need much charting

 

[WholeLottaGame7]

Definitely disagree with that. I am a pediatric anesthesiologist at a freestanding children’s hospital. I have worked with a decent number of fellows in my first couple years out and the majority are not anywhere close to “pediatric competent” starting out. Many (most?) residencies are not providing solid pediatric training— 2 months is an exposure, not a competency. I did 5 months of as a resident, at a major children’s hospital, which is an exception and not the norm.

Being a pediatric fellow sometimes means doing a Norwood or a TEF, but it also means having a day where you do 20 healthy ent cases by lunch. I firmly believe all of that is required to make a proper pediatric anesthesiologist.

Agree with this. Also, doing 100% high-acuity cases for an entire year will burn you out pretty quickly. It's not like adult cardiac where you have a couple TEE months, a couple months supervising in the CTICU, etc. You need those "healthy" peds days every once in awhile for your sanity.

 

[Libertas]

Agree, the real problem is all the tiny programs out there with one or two fellows eeking out cheap labor to make their department run easier. If your division isn’t busy enough to support more than a handful of fellows, it’s not big enough for a pediatric fellowship.

In my opinion, if the choice is to go to local hometown peds fellowship, you’re probably better off taking a job out of residency. If you want to practice “real” peds, go to a brand name program, not a hospital that does maybe one tef or cdh a year.

It’s shocking how many peds fellowship grads I have met that never did a cdh or tef in fellowship.....

 

[deleted50478]

Definitely disagree with that. I am a pediatric anesthesiologist at a freestanding children’s hospital. I have worked with a decent number of fellows in my first couple years out and the majority are not anywhere close to “pediatric competent” starting out. Many (most?) residencies are not providing solid pediatric training— 2 months is an exposure, not a competency. I did 5 months of as a resident, at a major children’s hospital, which is an exception and not the norm.

Being a pediatric fellow sometimes means doing a Norwood or a TEF, but it also means having a day where you do 20 healthy ent cases by lunch. I firmly believe all of that is required to make a proper pediatric anesthesiologist.

Plenty of people do ent without a fellowship so it’s a tough sell to suggest that people doing a proper fellowship with minimal bread and butter peds couldn’t get trained-up on healthy ENT cases on-the-job, after fellowship, for attending pay.

You used to be able to go straight into peds cardiac training after residency. I don’t have the data but I suspect no one ever finished peds cardiac and followed that up with a general peds fellowship. It’s laughable to suggest you wouldn’t be able to handle bread and butter peds after spending a year doing hearts, neonates, syndromic-kid cases, etc.

 

[deleted50478]

Agree with this. Also, doing 100% high-acuity cases for an entire year will burn you out pretty quickly. It's not like adult cardiac where you have a couple TEE months, a couple months supervising in the CTICU, etc. You need those "healthy" peds days every once in awhile for your sanity.

That’s a reasonable argument but I would say if you are mixing fellow days with bread and butter days, make it a faculty/fellow position (like a regional fellowship) with fellow days mixed with attending days and intermediate pay.
Paying a fully trained general anesthesiologist < $20 an hour to do bread and butter cases is nuts when they could get a job at a general hospital and do those cases for 2-3 times that .

 

[Twiggidy]

Plenty of people do ent without a fellowship so it’s a tough sell to suggest that people doing a proper fellowship with minimal bread and butter peds couldn’t get trained-up on healthy ENT cases on-the-job, after fellowship, for attending pay.

You used to be able to go straight into peds cardiac training after residency. I don’t have the data but I suspect no one ever finished peds cardiac and followed that up with a general peds fellowship. It’s laughable to suggest you wouldn’t be able to handle bread and butter peds after spending a year doing hearts, neonates, syndromic-kid cases, etc.

I hate to do this, but I will. I agree with you. Healthy peds isn't that hard just like bread and butter cardiac isn't that hard. By the time I was CA-2 the peds attendings were double covering the healthy peds rooms. Complex peds is hard just like complex hearts are hard.

 

[Guillemot]

I hate to do this, but I will. I agree with you. Healthy peds isn't that hard just like bread and butter cardiac isn't that hard. By the time I was CA-2 the peds attendings were double covering the healthy peds rooms. Complex peds is hard just like complex hearts are hard.

Im going to have to disagree with you on this one. As a fellowship trained academic attending, I still get off on instructing even the brightest fellow on how I like the tube taped on these low acuity, healthy peds cases. If I had residents in the room or CRNAs they probably wouldnt give a ****, but the fellows really seem to care. Take that away from me, and I'd probably quit my job!

 

[pgg]

How can you do 20 with all the charting required

Charting aside, 20 consecutive 15-minute cases sounds like a miserable half day. But the eat-what-you-kill billing might make that misery worth it ...

 

[Libertas]

Agree and disagree- it depends what you mean by healthy peds. 12yo appy? 8 year old elbow? Much different than a bunch of 12month ear tubes. Non pediatric anesthesiologists are going to have more issues with even healthy babies, and the data supports that (don’t have the reference off hand, but much high respiratory especially complications by non pediatric anesthesiologists caring for pediatric patients)

 

[deleted162650]

I don’t see what the big deal is. Kids are just little adults.

 

[Modanq]

PICU job market has been fairly tight the past 5 years or so, and all those PP anesthesia jobs that will take a fellowship trained anesthesiologist? Yeah, those don't really exist in the PICU world. PICU's of any reasonable size (even just >10 beds) and acuity that are PP are very rare...Dallas, Atlanta, Denver, some places in California, Portland, and that's pretty much the extent. Everything else is academic or small without subspecialty support which means any complex stuff gets shipped to bigger centers.

And when 85%+ (or more) of your job force is in academics, that depresses market value. Again, it comes down to following the money, but very few PICU people are making what anesthesiologists, even with a pediatric paycut, are making.

Great point.

 

[Psai]

Btw op's user name is amazing

 

[Twiggidy]

I don’t see what the big deal is. Kids are just little adults.

Meds per kilogram and airway management = peds (healthy). Depending on the case the rate limiting step is IV insertion.

 

[Libertas]

Meds per kilogram and airway management = peds (healthy). Depending on the case the rate limiting step is IV insertion.

I think anxiety management is underrated, and has a big impact that can persist for weeks.

 

[Psai]

Meds per kilogram and airway management = peds (healthy). Depending on the case the rate limiting step is IV insertion.

24 in the saphenous from age 24 hours to 24 years

 

[deleted875186]

Btw op's user name is amazing

Incredible username

 

[deleted50478]

(In case anyone was wondering)