Pediatrics and Procedures

[kaps22]

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I loved being in the OR but I love taking care of children (I don't want to do a gen surg residency for 5 yrs before being able to to see any kids) ...so my question is: How can you incorporate procedures into a Pediatric career? I know that Pedi GI does scopes. Are there other ways to do more procedures as a Pediatrician (subspecialist) . Thanks!

Med Student

 

[iatrosB]

I loved being in the OR but I love taking care of children (I don't want to do a gen surg residency for 5 yrs before being able to to see any kids) ...so my question is: How can you incorporate procedures into a Pediatric career? I know that Pedi GI does scopes. Are there other ways to do more procedures as a Pediatrician (subspecialist) . Thanks!

Med Student

Peds EM, peds critical care, and peds hospitalists would all have procedures.

 

[dsherida]

Peds interventional cardiology spend the majority of the day in the cath lab doing procedures that can be pretty intense. They are doing a lot of cool things, from angioplasty to closing holes, to putting in stents, to creating holes...and the list goes on and on!

 

[14022]

I would say peds em and hospitalists have relatively few procedures, especially in an academic medical centers where the residents will do the majority of procedures.

i otherwise agree with the other posts with a few additions.

peds cards- not only interventional cards do procedures- there is ep and even general peds cardiologists do diagnostic cath
peds pulm- scopes
peds gi- scopes, ercp, liver biopsies
peds heme/onc- bm biopsies, lumbar punctures
peds critical care- intubations, arterial/venous lines, chest tubes, lp's, pericardiocentesis, etc
nicu- intubations, uac/uvc, periperal venous lines, chest tubes, lp's

also, peds urology and peds ent are great specialties for people who love both pediatrics and surgery. both specialties have a lot of clinic in addition to time in the or. ent not only operates, but they also do a lot of scopes as well.

 

[kristing]

ICU either NICU or PICU. That's where you'll get the most and the broadest.

 

[doctawife]

I would say peds em and hospitalists have relatively few procedures, especially in an academic medical centers where the residents will do the majority of procedures.

I work full time in a pedi ER, and I do a fair number of procedures. My sub-boarded colleagues (folks who got subspecialty training in pedi EM) do even more. Every shift I splint, drain someone's abscess, sedate someone and do spinal taps. Most months I've done at least one intubation, one nailbed repair and at least one laceration repair as well. The subboards add chest tubes, lines, and fracture reductions to the mix.

 

[kaps22]

great, thanks so much for your help!

 

[14022]

I work full time in a pedi ER, and I do a fair number of procedures. My sub-boarded colleagues (folks who got subspecialty training in pedi EM) do even more. Every shift I splint, drain someone's abscess, sedate someone and do spinal taps. Most months I've done at least one intubation, one nailbed repair and at least one laceration repair as well. The subboards add chest tubes, lines, and fracture reductions to the mix.

Just out of curiousity, do you work in a community setting or academic medical center? If you work in a community setting, I am sure you do a ton. At our hospital (large academic medical center), the ER attendings do relatively few procedures. The residents do all of the LP's, splints, suturing, abscesses, etc. For traumas, the peds trauma surgery team does most of those procedures. Even intubations and such, most of those kids are intubated in the field by paramedics prior to arriving to the ER. So my comment was directed towards academic centers, where from my experience the attendings defer most of the procedures to the residents and fellows, which seems to hold true in the PICU and NICU as well.

 

[oldbearprofessor]

If I could comment about the idea of having trainees do procedures....

I work at a large Children's Hospital and also do some time at a smaller NICU setting. We have, at the various places, residents, fellows, NNPs, bedside nurses and RTs who all do various "procedures" on babies. Nonetheless, in my several decades as an attending, I have either done or assisted on every type of procedure done in neonatology every year I've been there (with the possible exception of chest tubes, which is a bit hit/miss fortunately). Usually I do (or directly guide by visualizing the cords, etc) several intubations and lines each month.

The reason is that we are a training site.....not every trainee gets every 600 g baby intubated right away. Not everyone can find the UAC or knows some of the "tricks" I know about placing them, etc, etc. Sure, if I was in private practice I MIGHT do more procedures, but even this is variable. From a pure billing/time basis, most private NICUs have non-neonatologists doing many or most of their procedures.

Finally, for those who like to do procedures, being at an academic center in a field (NICU/PICU/EM/cardio/GI and others) often represents a balance between keeping our hands busy and doing the other things we like doing. Like many, when I started, doing procedures was one of the real appeals of critical care medicine. Now, multiple decades later, it's still fun to do occasionally, but neither I nor most of my fellow faculty would consider it the major draw to the field. We still do it and like it, but the challenge of critical care medicine is the real appeal.

 

[14022]

Nonetheless, in my several decades as an attending, I have either done or assisted on every type of procedure done in neonatology every year I've been there (with the possible exception of chest tubes, which is a bit hit/miss fortunately). Usually I do (or directly guide by visualizing the cords, etc) several intubations and lines each month.

Thanks for your input as usual. That is completely different from my experience. I have done four months in NICU in medical school and residency (granted not a significant amount of time but adequate to get a sense of NICU academia) and I have never seen an attending do a procedure. They have stood there and watched as fellows did them and provided verbal advice, but I haven't even seen an attending put on sterile gloves. Most likely my hospital is an anomaly.

But I am still curious as to specifically how many procedures you do a year. You said that you "have either done or assisted on every type of procedure done in neonatology every year I've been there." Does that mean you do or assist with one intubation a year, one UAC per year, one chest tube per year, etc? Because if so, I still think that is NOT a significant number of procedures and wouldn't be gratifying for someone choosing NICU as a career based solely on their affinity for procedures. And you still can't convince me that being a private practice neonatologist "MIGHT" do more procedures. If you are the only doctor in the unit without residents, NNP's, fellows, etc, how is it possible that you wouldn't do significantly more procedures? The babies outside of academic medical centers still need lines, ET tubes, LP's, etc., right?

 

[oldbearprofessor]

But I am still curious as to specifically how many procedures you do a year. You said that you "have either done or assisted on every type of procedure done in neonatology every year I've been there." Does that mean you do or assist with one intubation a year, one UAC per year, one chest tube per year, etc? Because if so, I still think that is NOT a significant number of procedures and wouldn't be gratifying for someone choosing NICU as a career based solely on their affinity for procedures. And you still can't convince me that being a private practice neonatologist "MIGHT" do more procedures. If you are the only doctor in the unit without residents, NNP's, fellows, etc, how is it possible that you wouldn't do significantly more procedures? The babies outside of academic medical centers still need lines, ET tubes, LP's, etc., right?

There are academic neonatologists who don't do any procedures and there are plenty who do a ton of them. I am primarily research faculty so I don't do as much time on service as most of the others in my group. I do work the same number of in-house nights though as all of the others. I don't keep count of procedures (I don't have to report them to the RRC ), but would estimate that I either do or have my hands guiding 10-20 intubations, peripheral art lines and UAC/UVC's/year. Some of my colleagues do a lot more. I take my turn bagging way more babies than that as well. Again, I could do more or fewer procedures. A lot depends on how much I want to be the one teaching the residents, etc. Post-call, our residents and fellows go home based on ACGME work-hour rules. A lot of times that leaves us "in charge" as faculty, at least in the primary teaching modes. I really don't know what is most common, but many academic centers have gone to 24-hour in-house attendings, so they had better be prepared to "put on gloves" and go to work!

In terms of private neonatology practice, it is extremely variable. Some private groups are located at children's hospitals with pediatric residencies and lots of NNPs. Other private groups operate out of relatively small institutions with few procedures. If call is taken from home, many of the procedures will be done by nurses and NNPs or RTs. So, in general, I agree that private practice neo has more procedures than academic, but I don't agree that it has to be a huge difference or that it always is.

 

[quack333]

I went through the same thinking process as you-- love kids and love procedures. I started out in gen peds, then did PICU fellowship (after ruling out peds EM, peds cards, and NICU), finally realized I could do more procedures and hands on care of kids in anesthesia-- now I practice pediatric cardiac anesthesia and it's the best job ever!

Any peds fellowship= 3 yrs residency and 3 yrs fellowship.
Anesthesia residency= 1 yr internship, 3 yrs residency, 1 yr fellowship.

I think you'll be pleasantly surprised.

 

[edmadison]

I went through the same thinking process as you-- love kids and love procedures. I started out in gen peds, then did PICU fellowship (after ruling out peds EM, peds cards, and NICU), finally realized I could do more procedures and hands on care of kids in anesthesia-- now I practice pediatric cardiac anesthesia and it's the best job ever!

Holy cow! Did you really do six years of residency/fellowship to do CC and then 4 more years for GAS?

I'm just counting down my time until I can start my CC fellowship (2 years, 3 months)

Ed