invitro

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I am deliberating between medicine(cards) and anesthesiology, particularly pediatric anes. It's a tough choice.......

A couple of questions for anyone involved in peds/thinking about the fellowship.

-1- Do CRNAs routinely do peds cases? Or are they primarily the domain of MDAs?

-2- Is there a lot of continuity of care? That is one aspect of medicine that I really enjoy.

-3- From a financial point of view, it appears that it is a sound judgement...looking at gaswork, there are quite a few opps for peds-trained MDAs....what does the market look like for people applying now? I don't care where I practice....I would prefer small town, midwest over the city. Salaries? On gas work the texas jobs had salaries ~300-400k. Does that sound about right?

thanks.
 

UTSouthwestern

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1. Pedi anesthesia is done primarily with MDA's, although there are some facilities that allow CRNA's to do some pedi cases. The major pediatric centers are heading to almost 100% pedi fellowship trained MDA's as the only providers to be allowed to do pedi anesthesia.

2. That depends on you. The vast majority of pedi anesthesia guys here at Children's Medical Center keep a list of their patients and maintain a record to stay familiar witht the patients and their families. Many families request that the same pedi anesthesiologist do subsequent anesthetics especially when the anesthesiologist shows an effort to connect with the kids. I have seen families bring several of our attendings cakes and gifts for making their kids so relaxed and comfortable. Side note: You guys going into pedi anesthesia should really know your pain management well as that will be the distinguishing skill that keeps the kids coming back to you.

3. That advertisement on Gaswork is for our pedi group at CMC - Anesthesia for Children (AFC). They are starting all new people at the partnership level with a salary of $400K plus benefits. Not a cakewalk program as the hospital was just named the 14th pediatric level I trauma center in the U.S. Salaries for the other major pedi groups are in that range ($350-550), in this region and I suspect elsewhere. Also understand that nationwide, there are only 1,500 - 2,000 fellowship trained pediatric anesthesiologists and so getting that training certainly makes you almost unique (Average of 40 pedi anesthesiologists per state, obviously more in larger/more populous states, less in smaller states).

Understand that pedi anesthesiology isn't all a bed of roses as many general anesthesiology groups try to pull the bread and butter ENT and GI cases to surgicenters away from major pediatric care facilities, while leaving the more complicated and less insured cases to be taken care of at the children's centers. That has and will continue to cut into the profit margin of the pediatric anesthesiologists. Also understand that you should be prepared to handle some incredibly sick and complex pathologies. Adults crash in minutes, kids in seconds (many times less than 10 seconds), and if you cannot commit to learning pedi physiology/pathology and weight based anesthesia, you should avoid pedi anesthesia for your patients' sakes.