Pediatric Surgery + General Surgery career

[Micro115]

Was wondering, do any of you know pediatric surgeons who still operate on adults b/c they still enjoy adult pathology? Perhaps this would occur in smaller towns where the volume of patients is also smaller. I'm also asking this question since I wonder if being both a pediatric and general surgeon is "too much" in terms of retaining the knowledge and skills to do such a wide variety of operations.

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[Winged Scapula]

Real fellowship trained pediatric surgeons tend to be found in academic or larger city practices and limit their practice to children. I have, on occasion, seen a "legal adult" operated on by a pediatric surgeon but only in the case of a long-term patient whose anatomy was well-known by the pediatric surgeon who had cared for them for years. It was always a topic of, "Should we refer them to an adult general surgeon?" when it came up.

I suspect that most pediatric surgeons don't want to operate on adults, and prefer a larger city practice so that they can do someone else than hernias and appys; it would be hard to sustain a pure pediatric surgery practice in a small town. However, if you were really so inclined to work your arse off to get into a pediatric fellowship and then return to a small town to practice, I'm fairly confident you could get privileges to operate on both adults and kids. You'd probably want to send out the more complicated pediatric cases, not because you couldn't fix them, but because you might not necessarily have the resources for pre- and post-op care (ie, a dedicated NICU, rads who do a lot of peds, etc.).

 

[njbmd]

Was wondering, do any of you know pediatric surgeons who still operate on adults b/c they still enjoy adult pathology? Perhaps this would occur in smaller towns where the volume of patients is also smaller. I'm also asking this question since I wonder if being both a pediatric and general surgeon is "too much" in terms of retaining the knowledge and skills to do such a wide variety of operations.

The pediatric surgeons at our children's hospital do operate on adults from the standpoint of burns. Our burn unit, which is located at the children's hospital takes both adults and children. It is run by the pediatric surgery service and thus, the pediatric surgeons do burn surgery on the adults that are in that unit. I cover the burn unit for them from time to time on weekends and get to do some pediatric cases myself. It's a great hospital.

 

[nonbilious]

The pediatric surgeons at our children's hospital do operate on adults from the standpoint of burns. Our burn unit, which is located at the children's hospital takes both adults and children. It is run by the pediatric surgery service and thus, the pediatric surgeons do burn surgery on the adults that are in that unit. I cover the burn unit for them from time to time on weekends and get to do some pediatric cases myself. It's a great hospital.

not sure if it is known (or you want it to be) but what hospital?

 

[SocialistMD]

Was wondering, do any of you know pediatric surgeons who still operate on adults b/c they still enjoy adult pathology?

The only one that I know was the chairman at my medical school, but all he did was hernias on adults (he held a patent on some sort of mesh plug or something), nothing more involved than that. Part of the beauty of operating on kids is that they aren't adults, and I personally wouldn't want to spend the time specializing to then go back and operate on adults.

Perhaps this would occur in smaller towns where the volume of patients is also smaller.

I have seen several adult general surgeons perform appys on pediatric patients. If you want to build a rural practice, I wouldn't waste my time doing a fellowship in pediatric surgery, as most non-pediatric hospitals (particularly rural hospitals) do not have the facilities or ancillary staff for the true "pediatric" cases (TEF, imperforate anus) to be done there, and as Winged Scapula said, you generally would send them to a referral center for care.

I'm also asking this question since I wonder if being both a pediatric and general surgeon is "too much" in terms of retaining the knowledge and skills to do such a wide variety of operations.

I don't think so, but it depends on how you define the scope of a general surgeon and how realistic your expectations of general surgery are. In this day and age, it is rare to see someone do an aorto-bifem one day, an APR the next and a Nissen fudoplication the next. Most community general surgeons will do lumps and bumps, hernias, breast, thyroid/parathyroid and uncomplicated colon/small bowel work. Anything involving vascular, HPB, complex colo-anal work or the esophagus are generally sent to specialists in those fields. Thus, the saying that pediatric surgeons are the only true general surgeons left, as they operate anywhere from the neck to the toes (minus the bones). To circle back around, if you were to have what most people consider a general surgery practice, I think you could retain that knowledge and still be a pediatric surgeon. Again, though, I have to ask why you would want to do that.

 

[PeepshowJohnny]

I'm not sure if the OP understands how rare and subspecialized Pediatric surgeons. It's not like "Well, I'm going to be a surgeon...but a pediatrics one...not an adult one".

A Pediatric surgeon completes a two year fellowship after his general surgery training. I could find only 37 Pediatric training fellowships in this country. Of the ones that had info, most seemed to only take 1 fellow a year. Those that are trained do not typically go to work in small communities, they are employed at tertiary care facilities. Their patient load is usually very high (due to the shortage of surgeons) and any extra time they have would be spent on academic medicine pursuits (research, teaching, and grant writing etc.) not working on adults.