Peds Superspecialization (Cards/Pain/Regional/Transplant)

[Nivens]

Hi everyone-

So the ongoing saga that is my specialty decision has stretched all the way to the end of my third year, and I stand in a position I never thought I'd find myself- considering becoming a surgeon. Midway through this past year (if anyone recalls) I was agonizing about whether to do pedi ICU or pedi anesthesia, but now that my surgery rotation is in the books I realize it's the OR for me, either as a pediatric surgeon or pediatric anesthesiologist. Don't worry, I'm not going to ask y'all to help me decide (though feel free to chime in, of course)- But I am curious if anyone has any information or experience about the actual practice realities of pedi anesthesia "super specialties", boarded and otherwise. The reason I ask is two-fold: first, while I am willing to work with adults for residency to eventually get to the career I want, I really would like to work exclusively with children long-term, probably in a large academic center/children's hospital and I understand many pediatric anesthesiologists find themselves covering both pedi and adult ORs (at least at my institution). Second, I find these areas of pediatric medicine very interesting (keeping with my ICU inclinations), and want to know if these represent actual options or are far better in theory than execution.

I have done my homework as best I could- I have a rough idea of the training available (very rough idea), but I wanted to hear everyone's input.

Much love,
McTwisp

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[WholeLottaGame7]

Hi everyone-

So the ongoing saga that is my specialty decision has stretched all the way to the end of my third year, and I stand in a position I never thought I'd find myself- considering becoming a surgeon. Midway through this past year (if anyone recalls) I was agonizing about whether to do pedi ICU or pedi anesthesia, but now that my surgery rotation is in the books I realize it's the OR for me, either as a pediatric surgeon or pediatric anesthesiologist. Don't worry, I'm not going to ask y'all to help me decide (though feel free to chime in, of course)- But I am curious if anyone has any information or experience about the actual practice realities of pedi anesthesia "super specialties", boarded and otherwise. The reason I ask is two-fold: first, while I am willing to work with adults for residency to eventually get to the career I want, I really would like to work exclusively with children long-term, probably in a large academic center/children's hospital and I understand many pediatric anesthesiologists find themselves covering both pedi and adult ORs (at least at my institution). Second, I find these areas of pediatric medicine very interesting (keeping with my ICU inclinations), and want to know if these represent actual options or are far better in theory than execution.

I have done my homework as best I could- I have a rough idea of the training available (very rough idea), but I wanted to hear everyone's input.

Much love,
McTwisp

At my program, the peds people are pretty much exclusively peds. There are also designated peds hearts people. The peds heart people will still do general peds, but the general peds people will not do peds hearts, if that makes sense. Peds ICU is either peds residency + peds ICU fellowship, or peds residency + anes residency + peds ICU fellowship, I don't think many (if any) peds ICU people have only done anesthesia. We don't have specialized peds regional or peds transplant.

 

[imfrankie]

If I had what it takes to be a surgeon, I'd do pedi-ortho.

 

[twoliter]

Hi everyone-

So the ongoing saga that is my specialty decision has stretched all the way to the end of my third year, and I stand in a position I never thought I'd find myself- considering becoming a surgeon. Midway through this past year (if anyone recalls) I was agonizing about whether to do pedi ICU or pedi anesthesia, but now that my surgery rotation is in the books I realize it's the OR for me, either as a pediatric surgeon or pediatric anesthesiologist. Don't worry, I'm not going to ask y'all to help me decide (though feel free to chime in, of course)- But I am curious if anyone has any information or experience about the actual practice realities of pedi anesthesia "super specialties", boarded and otherwise. The reason I ask is two-fold: first, while I am willing to work with adults for residency to eventually get to the career I want, I really would like to work exclusively with children long-term, probably in a large academic center/children's hospital and I understand many pediatric anesthesiologists find themselves covering both pedi and adult ORs (at least at my institution). Second, I find these areas of pediatric medicine very interesting (keeping with my ICU inclinations), and want to know if these represent actual options or are far better in theory than execution.

I have done my homework as best I could- I have a rough idea of the training available (very rough idea), but I wanted to hear everyone's input.

Much love,
McTwisp

The ABA website (see below) lists all the programs that offer a combined pediatric and anesthesia residency. That's something to consider.

http://www.theaba.org/Home/AnnouncementLetter

Children’s Hospital Boston and the Brigham and Women’s Hospital

University of California, Irvine and Miller Children’s Hospital Long Beach

Johns Hopkins University School of Medicine and Johns Hopkins Children’s Hospital

Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford

The University of North Carolina Hospitals

The University of Pittsburgh Medical Center

Medical College of Wisconsin

 

[BobBarker]

Yes, there are plenty of exclusively pedi academic anesthesia jobs. Pedes surgery is one of the most difficult surgical fellowships to get. Only excellent candidates and many have taken 1 or 2 years off for pedi research. This is in addition to a 5 year residency and a two year fellowship. It will be much more of a realistic option to get to actually work exclusively with children if you go the anesthesia route.

 

[IlDestriero]

I'm a pediatric anesthesiologist at an academic children's hospital. Feel free to PM me with questions.

 

[michigangirl]

I've posted extensively on the pediatric-anesthesia combined residency-- I think you've made it clear it's the OR all the way for you, so this track is a bit of overkill unless you can't see your life without the pedi-ICU. Regarding becoming a surgeon-- pediatric surgery is a rough, long road, but if you can handle the general surgery residency and everything that goes with it, and scalpels are your passion, I say go for it.

Now for the anesthesia-- and you need to make sure you love being on the other side of the drapes...

Like IlDestriero, I do peds anesthesia at a large academic children's center. Most pedi anesthesiologists at large children's hospitals only take care of kids. So I wouldn't worry too much about the partial adult practice thing. There is a future for folks who are committed to taking care of the most complex kids in the OR-- NICU/PICU patients abound at these large centers and these hospitals are referrals for subspecialty pediatric surgery (peds urology/ent/neurosurg).

In terms of pedi anesthesia subspecialty, peds cardiac and peds pain are really the only well established (and IMHO the only necessary) areas. There is a push to formalize pedi cardiac subspecialty training, right now though most do an extra 6 months-1 year of only pedi cardiac anesthesia training in addition to the 1 year of general peds anesthesia.

Some do both pedi cardiac and pedi gen. anesthesia-- I feel strongly that to do pedi cardiac well, you need to do it for a large majority of your time. At our center the peds cardiac anesthesiologists only come to the general ORs to do cases if cardiac case got cancelled or there aren't any cases that day.

Happy to chat more by PM as well.
Good luck.

 

[sevoflurane]

At my old shop, you did the pedi fellowship and then were mentored in the pedi heart room with full subspecialty pay (no mini fellowship ). They also did general peds.
Busy pedi heart program. Some of my old residency colleagues do pedi hearts w/o any extra mini-fellowships. These individuals were more than likely handpicked or expressed interest early in their pedi fellowship year . They also do crani's, trauma, pain, and other complex peds.

 

[Nivens]

Thanks for the advice/thoughts everyone. I took my surgery shelf yesterday so haven't had time to shoot out any PMs but will def take you both up on that offer soon!