peds surg

[nonbilious]

anyone out there in a peds surg fellowship or headed towards one?

I'm looking for some insight into the field (bread and butter, lifestyle, career opps, etc) and my school has not much to offer.

also, did you want to go peds prior to entry into gsurg residency? I guess I wonder if my interest in peds surg as a med student is enough to get me into gsurg residency b/c I imagine things can change is 5-7yrs.

thanks

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[nonesuchgirl]

IANAPS, but ped surg = what's left of "real" "general surgery". These days most of the adult gen guys are specialists who happen to be able to do most everything.

I want peds surg b/c I want general surgery, but I've got a ways to go yet.

Hopkins has 6 peds surgeons and 2 fellows (one attending is mostly admin, though, i think, and another is mostly burn/craniofacial.) It's one fellow a year, 2 year programme.

There's a lot of trauma, transplants, defect repairs, kids who probably shouldn't be alive, oncology.

 

[Winged Scapula]

We don't have any current members who are peds surgeons or peds fellows, nor do I know of any (save nonesuchgirl) who are interested.

As she notes, it really is the last bastion of the true general surgeon - everything from hearts, abdomen, chest, etc. The bread and butter will depend on where you are, but you can generally expect a lot of neurologically devastated kids for whom you are pegging and traching and or doing Nissens on (good Lord, the old Nissen G tube train was rampant in my residency. Lots of sick kids.) There will be ports for the Heme-Onc kids, and then your general stuff: hernias, appys, pyloric stenosis, foreign bodies - either swallowed or inhaled (that was BIG time...number 1 reason for staying late was some kid with a dime in his main stem), pectuses, trauma, etc.
Transplant may or may not be done by Peds surgeons, but often is. Then there is all your neonatal stuff: we had a large component of Hirschsprungs (large Amish population), choledochal cysts, biliary atresia, LOTS of duodenal atresia and not infrequent gastroschisis/omphaloceles. ECMO, CDH, circs (if you do not politically object), cloacal dystrophy, etc.Really a good variety.

There are not a lot of peds surgery fellowships around; it is considered one of the most competitive to get in (probably as a function of the around 20 spots per year). Lifestyle can suck if you have to take trauma or ED call - then its can be as bad as any other general or trauma surgeon (I trained at a Level 1 trauma center with the only Children's Hospital for hours...Ped Surgery was the busiest service for add on cases after hours - many times those ECMO kids got transferred in very late at night). But if you can find a practice that's mostly elective stuff, you'll have a much better chance at being home once in awhile. For rather obvious reasons, jobs tend to be at academic medical centers, but there are community pediatric surgeons...but you'll get most of the "neater" stuff at a university hospital.

Most people considering peds surgery enjoy their general surgery residency because the stuff you're doing is not far off from the fellowship training. You don't have to make up your mind now because there will be 4 years to apply for peds surgery fellowships (or something else should you change your mind). Because of the competition, lab time may be necessary simply as a hoop to be jumped through, so you can extend that 4 years to 6 for decision making. And you'll want to be at a residency with a Children's Hospital so you can do lots of peds cases.

Hope this has helped; I'm sure others will have some input as well.

 

[tussy]

I was interested in peds surg until i actually did a rotation in it. Lots of screwed up kids with bad stuff; neuro defects, cancer etc. It's very depressing because most of them still have bad outcomes despite your best efforts. The staff at childrens hospitals (from nurses to doctors to everything in between) are the most passive aggressive difficult to work with people you'll ever meet. Then, there are the parents!!!!! Not a pleasant work environment at all.

 

[smq123]

I was interested in peds surg until i actually did a rotation in it. Lots of screwed up kids with bad stuff; neuro defects, cancer etc. It's very depressing because most of them still have bad outcomes despite your best efforts. The staff at childrens hospitals (from nurses to doctors to everything in between) are the most passive aggressive difficult to work with people you'll ever meet. Then, there are the parents!!!!! Not a pleasant work environment at all.

There's a lot of trauma, transplants, defect repairs, kids who probably shouldn't be alive, oncology.

I totally agree with tussy. I thought peds surg might be cool (the wide variety of cases! You get to do it all!) until I did my MS-3 peds rotation.

Kids with such terrible hydrocephalus that they don't look remotely human. Kids on vents, kids with trachs. Kids in comas. Kids with permanent brain damage due to intractable seizure disorders. Kids with colostomies. Kids on TPN. For a lot of the students on my rotation, our mantra became "We're never having children. Ever."

The kids who shouldn't be alive, and the kids who come in after a trauma are the hardest, I think. My personal favorite was the kid who came in with an SCI because his mother, who, despite being an experienced ED nurse, still thought it would be "okay" to let her pre-school aged child ride on an ATV by himself and without a helmet. Poor kid might not walk again.

 

[SocialistMD]

We don't have any current members who are peds surgeons or peds fellows, nor do I know of any (save nonesuchgirl) who are interested.

Adding myself to that list. I don't have much to add, just updating or offering a different perspective when I see fit.

There are not a lot of peds surgery fellowships around; it is considered one of the most competitive to get in (probably as a function of the around 20 spots per year).

This has increased to around 38 spots. I think there were six added for this year, and there are more on the horizon.

Most people considering peds surgery enjoy their general surgery residency because the stuff you're doing is not far off from the fellowship training. You don't have to make up your mind now because there will be 4 years to apply for peds surgery fellowships (or something else should you change your mind). Because of the competition, lab time may be necessary simply as a hoop to be jumped through, so you can extend that 4 years to 6 for decision making. And you'll want to be at a residency with a Children's Hospital so you can do lots of peds cases.

I think it is important to go to a program with a Children's Hospital, but I think it should be done at a place that has either (a) no fellow or (b) a very large number of pediatric surgeons. When I first arrived at my program, there were three surgeons and two fellows, and the fellows made the schedule. This led to very little operating for the residents on the service. That has since changed, but the lesson remains burned in my mind.

To answer the OP's questions, I didn't want to do pediatric surgery when I started residency or even during my intern year. It wasn't until my second year rotation (we didn't do peds when I was an intern) at our children's hospital that I realized it is what I wanted to do. For me, it was about the broad scope of practice (as those above have said, it is the last bastion for general surgery) and job satisfaction. You will see while operating on adults that most of the morbidity and mortality encountered has nothing to do with anything you did technically and everything to do with their pre-operative condition. Not usually the case with kids. Nearly all of them go home, and they are generally better than they were before they saw you. My experience seems to counter that of tussy, but I think it is more a matter of expectations. The kids with other problems are low functioning coming in and you are simply trying to deal with their one issue and keep them at their baseline, something that is usually possible. Adults come in apparently highly functional until you take out the head of their pancreas or their sigmoid/rectum or stomach, left upper lobe, right hemiliver, etc... Then they die after a two month stay in the ICU because they had a post-op MI, aspirated around their NG tube because apparently NPO doesn't include milkshakes from Dairy Queen, developed pneumonia because they refused to get out of bed or use their incentive spirometer, had a massive PE from a DVT that they may or may not have had pre-op, etc... Kids truly are "otherwise healthy" and usually leave your care that way. If they aren't, you know know it upfront and you understand that you aren't going to make them so simply by redoing their G-tube or placing their 8th Broviac, so you do it and move on (with the patient not on your service).

As stated before (both by myself and others), pediatric surgery is the only true general surgery left. As a result, you shouldn't look at it as having to do a general surgery residency to be able to be a pediatric surgeon because being a pediatric surgeon is being a general surgeon. I don't understand wanting to do pediatric surgery without enjoying general surgery itself (that, perhaps, is just me). The only "unique" procedures to pediatrics are corrections of congenital defects, and those will never make up your bread and butter cases. Everything else is general surgery.

What is it that makes you want to be a pediatric surgeon, and what is it you think they do that makes general surgery something that, to you, is only a means to an end?

 

[Winged Scapula]

i Was Interested In Peds Surg Until I Actually Did A Rotation In It. Lots Of Screwed Up Kids With Bad Stuff; Neuro Defects, Cancer Etc. It's Very Depressing Because Most Of Them Still Have Bad Outcomes Despite Your Best Efforts. the Staff At Childrens Hospitals (from Nurses To Doctors To Everything In Between) are The Most Passive Aggressive Difficult To Work With People You'll Ever Meet. Then, There Are The Parents!!!!! Not A Pleasant Work Environment At All.

Qft.

 

[BlondeDocteur]

I've been very, very interested in pediatric surgery for the last two years, and have spent a good amount of time exploring the field.

There are 32 accredited fellowships, with a few others in the works (i.e. Louisville) that should win accreditation soon. However, some of these are one fellow q2 yrs type places, so there are on average 25 spots in the country per annum. This of course makes things extremely competitive-- it is, bar none, the most difficult fellowship to secure (harder than plastics or surg onc).

Bread and butter pediatric surgery is, as others have noted, true general surgery. You operate literally all over the body, unless it's brain, bones or heart (most places have congenital cardiac surgeons do the tricky baby heart stuff). However, there are two enormous downsides to the field as I see it:

1) Lifestyle. Attending pediatric surgeons routinely work 80+ hours a week, and the number of emergency cases is huge. They are extremely driven, dedicated, compassionate people who don't mind being called in 2-3 nights a week, minimum, to operate.

The fellowship is extremely rough. In most places you are q2 for two years of training. Q2 for two solid years. I thought that CHONY was the exception to the rule, but I was assured by all attendings I've spoken to that this is the norm. On the nights they're not on call, the fellows are often in-house till 8 or 9 PM. On the nights they're on-- well, we don't even have a call room for them since they're working so much.

2) Futility of care. I know-- what?! Kids get better, right? Well, there's a difference between an 8 year old with an appy and an 26wk preemie with an enormous host of congenital anomalies who, night after night, requires some intervention or another. I think most people who trained in/rotate through highly specialized children's hospitals encounter this and feel extremely frustrated. In New York, due to the enormous population, high %age of immigrants from all over the globe, and the large Hasidic Jewish population (who practice first cousin marriage and have done so for generations, leading to a host of isolated congenital anomalies) we have a very high number of extremely sick children whose parents have a "do everything" approach. Someone else wrote in the "good, bad and ugly" post that the major downside to peds surg is operating on children who "frankly shouldn't be alive." As ugly a sentiment as that may be, I certainly felt it.

I made the decision not to pursue that training path, despite the intellectual fascination it holds for me. There was no way I could envision a happy family life that, 7 years from now, would have me working 120+ hours a week. I think I've found another way to surgically manage congenital anomalies that will hopefully be equally satisfying. To all those pursuing it, best of luck-- but honestly, I did my research for two years and spoke to attendings and fellows at various institutions, and they assured me what I posted above was accurate.

 

[SocialistMD]

There are 32 accredited fellowships

Not to nitpick (well, not completely; your post does basically crap on my future profession so I do feel somewhat justified), but there were 40 programs that participated in the NRMP match last year, 5 of which are in Canada. Stanford, Florida, Indiana, OHSU, Northwestern and Vanderbilt all added fellowships.

The fellowship is extremely rough. In most places you are q2 for two years of training. Q2 for two solid years. I thought that CHONY was the exception to the rule, but I was assured by all attendings I've spoken to that this is the norm. On the nights they're not on call, the fellows are often in-house till 8 or 9 PM. On the nights they're on-- well, we don't even have a call room for them since they're working so much.

True, but at most institutions that is home call (ACGME rules and all). Our chief residents are on home call their entire chief year, and on many services (colorectal, vascular, HPB, VA) that means they are called in several nights a week, so I don't really see the difference.

Again, some see a lot of pediatric surgery as futile care (although, those "futile" patients are generally not on my service and I don't have to manage anything but their acute surgical issue, so it isn't that bad), but I see most of it as less futile than much of the adult surgical population (see: vascular and oncology), and most of my patients are innocent (read: haven't destroyed their bodies over their lifetime to end up with lung, colon or pancreas cancer or PVD, CAD, or AAA requiring repair or weren't out on the streets looking for trouble when they were shot/stabbed/beaten, didn't have a blood EtOH level of 0.43 when they plowed their car into a wall, etc...), which makes it much easier to try and help them because I genuinely care that they make it through. Maybe I've become cynical after countless nights on call in the ICU, but Jesus, enough is enough.

 

[nonesuchgirl]

and most of my patients are innocent (read: haven't destroyed their bodies over their lifetime to end up with lung, colon or pancreas cancer.

Not that you need to do anything to develop any of those.

I wonder how many people who are in a line of work that deals with ****ed up kids believe in a higher power, and why.

 

[Winged Scapula]

Adding myself to that list. I don't have much to add, just updating or offering a different perspective when I see fit.

Who knew? Cool...good to have someone interested who can offer good info.

This has increased to around 38 spots. I think there were six added for this year, and there are more on the horizon.

Also very cool...we've needed more for awhile (I knew 20 was sort of low, but had no idea that it had increased so much).

 

[nonbilious]

I really appreciate everyone's feedback, its much more insight than I have been able to dig up.

I guess for me this is part of trying to make the decision to do a gs residency or something with a separate track (nsurg for example). I am very interested in peds surg, as well as surg onc and see myself heading towards those two if I do gs. On the other hand ns just has so many cool toys.

thanks again everyone, i am going to try and get some outside ps experience. From what everyone is saying, my peds rotation didn't quite give me the exposure everyone is talking about.

 

[maxheadroom]

I still have nightmares of NICU rounds. I'd go see one of those 25 weekers and as soon as I approached the Isolette, they'd desat and brady just to make me look bad.

My takehome lesson from Pedi Surg was that when things go well, it's great. When things don't go well, it's the most depressing service on earth. At least with the vasculopaths and lungers I could rationalize away their problems by reminding myself that they'd done it to themselves. All of those short-gut kids after NEC and the kids with Graft vs Host after BMT were enough to make me want to go home and cry. Ugh.

 

[Blade28]

I never thought I'd like Peds Surg until I did two months of it as an intern. And despite the ridiculously brutal call schedule (due to illnesses and others taking vacation, I ended up Q2-Q3 for most of the 2 months), I loved it. Loved dealing with the parents (apparently I'm good at it!), loved the variety of cases, loved the NICU/PICU...guess that all made the difficult situations (terminal cancer, bad trauma, child abuse cases, etc.) worth it.

I'd consider Peds Surg if my first love weren't CT Surg. Then again, there's always Peds CT as well...

 

[DoctaJay]

In order to do peds surg don't you have to match into an academic surgery residency (7 year program) and then apply for a fellowship? Its not likely to get into a fellowship going into a normal general surgery residency without research right?

 

[SocialistMD]

Not that you need to do anything to develop any of those.

Seriously, though, how many of your lung or pancreas cancer patients aren't smokers and how many of your colon cancer patients didn't eat like absolute crap for their entire lives? Most of them rode their bodies pretty hard to get where they are.

I wonder how many people who are in a line of work that deals with ****ed up kids believe in a higher power, and why.

I don't know, as I only contribute to the denominator in that equation.

In order to do peds surg don't you have to match into an academic surgery residency (7 year program) and then apply for a fellowship? Its not likely to get into a fellowship going into a normal general surgery residency without research right?

Not necessarily, although it does put you in a pretty big hole if you don't. Of the five fellows we've had since I've been here, all had some sort of research experience (one had a PhD, two did peds research at their home institution and two did peds research at another institution, as they were not from programs with strong pediatric surgery research). In talking with the fellows here and with the few chiefs who have gone into pediatrics from my program, it seems the most important thing is to have research/publications in peds surg, as that has been something each of them has had. If that is something you can get without doing time in lab, it may be enough (one of our chiefs last year fit this mold), but for most, doing time in a lab, particularly one with a pediatric surgeon (or at the very least, picking up a clinical project with one) is the best way to put yourself on the map. Pediatric surgery is an even smaller world than general surgery, and the harsh reality is that a lot of it still comes down to who you know in addition to what you know.

 

[nonesuchgirl]

Seriously, though, how many of your lung or pancreas cancer patients aren't smokers and how many of your colon cancer patients didn't eat like absolute crap for their entire lives? Most of them rode their bodies pretty hard to get where they are.

Well, I don't do lung or colon, but most of the pan ca people aren't smokers...

 

[SocialistMD]

Well, I don't do lung or colon, but most of the pan ca people aren't smokers...

I just reviewed our database, and a majority of our patients were. It's also a known risk factor, particularly if you have a certain DNA polymorphism. Other self-abuse risk factors for pancreas cancer include alcoholism and type 2 diabetes (which I consider a self-abuse disease because of the patient population that gets it). I'm in an HPB lab, and while it is sad when someone develops pancreas cancer, I rarely see it happen in someone who has been anything close to a saint for his/her adult life.

 

[smq123]

Again, some see a lot of pediatric surgery as futile care ... but I see most of it as less futile than much of the adult surgical population (see: vascular and oncology)

I'd agree with this. Little kids can be amazingly resilient...as a lot of peds oncologists will tell you. A lot of their medical conditions are either treatable or manageable.

most of my patients are innocent (read: haven't destroyed their bodies over their lifetime to end up with lung, colon or pancreas cancer or PVD, CAD, or AAA requiring repair or weren't out on the streets looking for trouble when they were shot/stabbed/beaten, didn't have a blood EtOH level of 0.43 when they plowed their car into a wall, etc...), which makes it much easier to try and help them because I genuinely care that they make it through.

I would agree that most kids are innocent, and didn't do anything to "deserve" what they're suffering through.

But what I hated were the parents who inflicted this on their kids. (And you'd have to admit that there are a fair number of those.)

- The parents who decided not to seek treatment for their kid's bloody bowel movements, because, hey! That'll go away on its own, right?

- The parents who shovel their kids with so much salt and fat that their kids end up with a BMI of 40 by the time they hit the fifth grade. (Another favorite patient was the 9 yo kid who came in with a ureter stone. When I ran into the nephrology attending, she said very succinctly, "If I ate fries, chips, and Pepsi every day like this kid, I'd have kidney stones too." Of course his parents were whining and complaining constantly because he was for the FAR and those "lazy" urologists couldn't be bothered to get to him, and he was hungry and "needed" his Big Mac, and didn't want to be NPO, so could they please get their lazy butts down to see him, blah, blah, blah....)

In any case - SocialistMD, good luck pursuing peds surg. It's not for me, but it sounds like it's something that you're really passionate about. And God knows that we need dedicated, motivated, and skilled pediatric surgeons.

Well, I don't do lung or colon, but most of the pan ca people aren't smokers...

Definitely not true.

MANY patients with pancreatic CA were fairly heavy smokers. It's definitely a risk factor, and has proven to be so many times.

Obviously, not all patients with pancreatic CA were smokers. But I would say that on a busy HPB service, probably at least 75% of your people with adenoCA will be long-time smokers.

(Not all people who need a Whipple or a distal panc have pancreatic CA. If you need a Whipple for cyst removal or something, then yes - being a smoker doesn't necessarily affect that.)

 

[SocialistMD]

But what I hated were the parents who inflicted this on their kids. (And you'd have to admit that there are a fair number of those.)

Agreed. However, it is much easier (for me) to treat the kid and ignore the parent than it is to treat the patient who did it to him/herself. People can be as demanding as they want, but I can always walk away and stop listening to it. Plus, like Blade, I'm pretty good at sweet-talking the parents. I am empathetic, but not sympathetic (and no, tired, I'm not just -pathetic), which is probably why I enjoy pediatric surgery more than adult surgery.

 

[tussy]

Seriously, though, how many of your lung or pancreas cancer patients aren't smokers and how many of your colon cancer patients didn't eat like absolute crap for their entire lives? Most of them rode their bodies pretty hard to get where they are.

Not true for colon. Diet is only a minor risk factor for colon cancer and some argue it's not a risk factor at all. Genetics is the biggest risk factor.

But, it's a slippery slope to start blaming patients for their disease.

I think it's great for anyone to choose peds surg. It's not for me despite thinking it might. I love kids and i hated that these sick little kids were so miserable and i didn't feel like i made much of a difference in their lives. That they would cry when they saw me. I still operate on kids - appys, choles, trauma etc ( i work where there is no children's hospital). I like this kind of peds surg - the easy stuff, the kids you can actually make better and make a difference. I also like that i can turf the disaster kids to the childrens hospital where people like you are there to take care of them!!!

 

[SocialistMD]

But, it's a slippery slope to start blaming patients for their disease.

I don't blame them for their disease, per se. I just get incredibly frustrated with the fact that, despite the surgeon's best effort and a technically sound operation, adults still may never make it out of the hospital because of the preoperative comorbidities they bring with them. Even if you don't think colon cancer is related to diet (the ADA still says high fiber diets are associated with a decreased risk of colon ca), the post-op MIs, pneumonias, wound infections, etc... aren't helped by the 30 pk/yr smoking history, the non-compliance with your orders to get out of bed and walk/use the incentive spirometer and the rampantly out-of-control diabetes despite the insulin drip. At the end of the day, it often feels like we have wasted a lot of time and resources on many adults who linger, half-dead, in the ICU for months before the family finally lets go. I've never had that feeling at our children's hospital.

Again, maybe it is because we shield ourselves from the chronic kids who make you wonder why they are still alive, but they aren't on my service; I'm just a consultant. I don't feel responsible for the patient's overall outcome because I know upfront that I can't change it. I'm just there to make sure their Mickey-button works and doesn't kill them.

 

[BlondeDocteur]

I didn't mean to crap on the field, Socialist. I find the field to be the most fascinating and compelling one in medicine.

A couple of further points:

A. The 32 number is tossed around by most peds surgeons. As I said, I thought several of the 37 programs listed on FREIDA still had provisional accreditation. You're right, they are expanding, which is sorely needed.

B. There are less than 800 fellowship-trained pediatric surgeons in the US right now (a number quoted to me at Columbia, at Memorial Sloan-Kettering, the Harvard system and Michigan)-- so it is indeed a small, but fiercely devoted, community. Most pediatric surgeons stay in academics, since research is required to land a spot, and since most wish to stay affiliated with academic children's hospitals to hoover up the intriguing cases.

C. Nonbilious/Nonesuch: in case you are female, a word of advice: this is an extremely hard-working field, and they are unfortunately suspicious of women wishing to enter it. I felt, when contacting attendings/fellows, they thought I was drawn to it because of a desire to work with cute little babies or some other gendered nonsense. It took several rounds before I could convince them my interest was genuine. Just a heads-up in case you encounter the same disbelief.

 

[nonesuchgirl]

C. Nonbilious/Nonesuch: in case you are female, a word of advice: this is an extremely hard-working field, and they are unfortunately suspicious of women wishing to enter it. I felt, when contacting attendings/fellows, they thought I was drawn to it because of a desire to work with cute little babies or some other gendered nonsense. It took several rounds before I could convince them my interest was genuine. Just a heads-up in case you encounter the same disbelief.

*is a girl*

Babies are ugly. Strange babies even moreso.

i'm too lazy to quote more but maybe we get most of that other 25? idk.

 

[SocialistMD]

in case you are female, a word of advice: this is an extremely hard-working field, and they are unfortunately suspicious of women wishing to enter it. I felt, when contacting attendings/fellows, they thought I was drawn to it because of a desire to work with cute little babies or some other gendered nonsense. It took several rounds before I could convince them my interest was genuine. Just a heads-up in case you encounter the same disbelief.

I think this goes away once you are a resident. 40% of the fellows we have had since I've been here have been women, and 50% of the residents going into pediatric surgery we have graduated since I've been here have been women. Granted, this is a very small n (5 and 2, respectively), but I think that once you have "proven" your dedication (by going through a general surgery residency and still demonstrating you want to do it), gender isn't that big of a deal.

 

[BlondeDocteur]

I know, Socialist-- it is odd! Given that general surgery residency is roughly 28% female nationally (per FREIDA), pediatric surgery is 31%-- slightly disproportionately female. My ns are are small as well, but 50% of the CHONY fellows since I've been a student have been female, and 4/7 of the residents who've gone into it have been women.

Still, as a med student, it's what I encountered.

 

[SocialistMD]

The thing I don't understand is, why would they care? Free labor is free labor and if, in doing a project, you realize pediatric surgery isn't for you, I've saved you the pain of a surgical internship/residency by the early exposure I've offered.

 

[MediCane2006]

I'm on my peds rotation right now. I'd never even considered peds as a possible specialty, but I gotta say, it's a pretty cool field, and there have been some aspects of the rotation that have made me wonder if I might have a future in it...

1. Patients - I mean, peds wins hands-down over the other fields in this category. So, so many cute kids. Even the little NICU babies are cute. I have had so much fun hanging out with my post-op appy kids making friendship bracelets, holding the Nissen babies in the NICU, etc etc. Whereas with the adult patients, I'm more often trying to exit the room gracefully while the high-maintenance private plastics patient whines about not having enough pain medication, or the gross/disgusting/slimeball trauma patient tries to cop a feel.

2. Surgeries - it's amazing how with pediatric anatomy, even a simple hernia can turn into an elegant case. The tissue planes are beautiful, the tissue handling has to be incredibly delicate, and all the cases are done through incisions that are too tiny to be believed. Pediatric surgeons are very technique-conscious - the operative field is so small, every move has to be precise and carefully planned. My technique has gotten SO much better in the two months I've been on this rotation

3. Personalities - pediatric surgeons - at least the ones I work with - have this little whimsical personality thing going on that's just hilarious. Maybe it comes from dealing with the pediatrics residents on a daily basis, but they all wear cartoon ties, funny scrub caps, hand out stickers on rounds, etc etc. It's just such a different climate from the adult surgery world (I can't imagine our chairman handing out stickers on post-op Whipple rounds, or our surg onc guys coming to clinic in Bob The Builder ties)...and it's nice, in a sort of Patch Adams-way, when you get a pat on the back from the attending for making the patients in clinic laugh.

Now, that all having been said, there are some very big negatives to peds surgery (most of which have been touched on by others in this thread)

1. The patients - good God. There are some kids out there whose stories are so depressing, you don't even want to go into the room on rounds because you don't know what to say. The little baby who was born to a mom who had been trying to get pregnant for 15 years, who has some awful, incredibly rare syndrome causing disseminated uber-aggressive sarcomas (she just sits in the room with him 24 hours a day, because she wants to make the most of what little time she has with him). The 17-year-old who went to the doctor with a "flu" and ended up having disseminated multiple myeloma and probably won't live past his senior year of high school. The 12-year-old who has had three separate craniotomies for recurrent meningiomas and is now back with his fourth. The gorgeous little three-month old baby with a spiral femur fracture and multiple old healed rib fractures (parents ADAMANTLY denied any abuse of course). And every day there's another new horror story. I don't understand how people who work in this field can avoid depression, after awhile. I know there were days I definitely came home and cried.

2. Surgeries - well, you have your hernias, your appy's, and your Nissen G-tubes. And lines. Lots and lots of lines. Point being, unless you're in a major academic center with a big referral basis, you're not going to be doing the complex reconstructions for cloacal exstrophy, or resection of CCAM malformations. So while it's true you are a "general surgeon" in pediatrics, it seems like many of them still end up doing a large number of a limited variety of cases.

3. Personalities - I couldn't agree more with Tussy, peds really seems to attract the crazy/passive aggressive/ emotionally unstable/just generally painful personality types when it comes to nursing and medical staff. I'm the nicest person ever (I usually get the "too nice to be a surgery resident" tag), and I've gotten into at least four-five major arguments each week when some peds resident/attending/nurse flips out for no apparent reason. The parents are, for the most part, fairly reasonable, but you get some nut-jobs there too, and they're nut-jobs who are freaked out about their kid, so their nut-jobbiness gets magnified. I don't remember ever being so emotionally exhausted as I am at the end of each day on this rotation. I don't know how these attendings do it.

Boo, that post is way too long but I'm post call and can't condense it any further. Just wanted to put my two cents in....

 

[Scrubbed In]

Can any current or hopeful Pediatric Surgery fellows touch on the volume of publications you had prior to matching? Obviously quality takes precedent over quantity, but as a junior level resident right now quantity is all I can produce! Thanks!

 

[SocialistMD]

Can any current or hopeful Pediatric Surgery fellows touch on the volume of publications you had prior to matching? Obviously quality takes precedent over quantity, but as a junior level resident right now quantity is all I can produce! Thanks!

I can't give you exact numbers of publications, as they vary. One of my former chiefs had several publications, but only one in pediatric surgery. He said that was all that was discussed at his interviews. The most recent graduate of our program had about 9 publications (all clinical). In performing a pubmed search of our fellows, the number varies from around two to more than ten.

My best advice is to seek out a pediatric surgeon at your institution and find out what sort of retrospective review you can do. As has been mentioned before, most pediatric surgeons have an academic interest and have plenty of ideas, but many at smaller hospitals are too busy clinically to act on any of it.

 

[smq123]

i'm too lazy to quote more but maybe we get most of that other 25? idk.

That's very doubtful. Especially because a website hosted by the place where you work specifically mentions it:

"Cigarette smoke contains a large number of carcinogens (cancer causing chemicals). Therefore, it is not surprising that cigarette smoking is one of the biggest risk factors for developing pancreatic cancer. For example, smoking during college has been associated with a 2-3 fold increased risk of pancreatic cancer."

[http://pathology.jhu.edu/pancreas/BasicRisk.php]

I know that you've said in past threads that you work in the surgery department's administrative office, but if you ever get a chance to shadow with the HPB team, ask the patients with biopsy proven adeno if they were ever smokers, and for how long. (Not just all the patients - the ones who have adeno. Smoking, as far as I remember, doesn't have an effect on all pancreatic pathology, just adenoCA.) I'd be willing to bet that many of them were heavy smokers at some point. Not all - obviously - but many.

 

[SocialistMD]

"Cigarette smoke contains a large number of carcinogens (cancer causing chemicals). Therefore, it is not surprising that cigarette smoking is one of the biggest risk factors for developing pancreatic cancer. For example, smoking during college has been associated with a 2-3 fold increased risk of pancreatic cancer."

One of the persons integral in making the connection was Lillemoe when he was at JHU.

 

[nonesuchgirl]

I know that you've said in past threads that you work in the surgery department's administrative office,

Pointless nitpick, I know but it's actually a medical office. The admin people are scary.

We = my dudes moreso than all the dudes entirely. Sorry. "They" get the non-smokers, lol, and everyone else gets the chainsmokers. IDK.

 

[Winged Scapula]

MediCane...

sounds like you have the rare opportunity to work with some wonderful Peds Surgeons. Tussy and I were referring to the surgeons as well in speaking about the passive aggressive personalities in peds surg. Mix the stereotypical surgeon personality, with the unable to relate to adults pediatrician and thow in a soupcon of immature passive aggressivity and you have a painful attending to deal with.

Fortunately, we got lots of the cloacal exstrophies, CCAMs, atresias, etc. to deal with to make up for it...if you just didn't have to talk to them while doing the case.

The surgeries were fascinating but I could never do Peds Surg...all those *really sick* kids, especially the neurologically impaired...some nights I'd go to sleep still hearing that horrible brain injured wail. Every now and again, a triumph or something fun...like the kids from "Jon and Kate Plus 8".

 

[MediCane2006]

Yeah, I've definitely been lucky in that sense...this peds surgery group is excellent. The attendings are all good teachers, are excited to have us in the OR, and really have a special way with the kids that is great to see. One of their newer attendings is a younger woman and she's become a wonderful mentor to me over the course of the rotation.

The rotation absolutely blows in all other respects, but the nice-ness of the attendings makes all of us residents feel a little bad about complaining...

 

[smq123]

2. Surgeries - well, you have your hernias, your appy's, and your Nissen G-tubes. And lines. Lots and lots of lines. Point being, unless you're in a major academic center with a big referral basis, you're not going to be doing the complex reconstructions for cloacal exstrophy, or resection of CCAM malformations. So while it's true you are a "general surgeon" in pediatrics, it seems like many of them still end up doing a large number of a limited variety of cases.

Fortunately, we got lots of the cloacal exstrophies, CCAMs, atresias, etc. to deal with to make up for it...

Medicane - Do you think that the limited variety of cases is because of the location of the hospital (could it be any farther out in the middle-of-nowhere?), or the over-saturation of dedicated peds hospitals in the area? Would it be different at other hospitals? I used to wonder on my peds rotation - was that the typical variety of cases in your average peds hospital, or is it just an accident of location?

One of their newer attendings is a younger woman and she's become a wonderful mentor to me over the course of the rotation.

Oh, I like her! I was only able to work with her once on my MS3 rotation, but I agree that she's soooo nice. She was such a great teacher in the OR.

 

[TXSurgResident]

I haven't been on this forum for a while (the life of the lab gave way to 4th year of residency), but was stoked to see there are others out there interested in paeds surg. I am starting to turn in my ERAS stuff now and hope to be hitting the interview trail in the new year. Best of luck to all those out there who are doing the same!

PS: While stoked that others are interested, I hope there are less than 38 of you!

 

[nonbilious]

I haven't been on this forum for a while (the life of the lab gave way to 4th year of residency), but was stoked to see there are others out there interested in paeds surg. I am starting to turn in my ERAS stuff now and hope to be hitting the interview trail in the new year. Best of luck to all those out there who are doing the same!

PS: While stoked that others are interested, I hope there are less than 38 of you!

No worries... you're far ahead of me.

What are your reasons for going after peds surg?

I was reviewing this thread looking at others and I figured out that it isn't gs that scares me, its the prospect of working on adults... I just don't like them as much.

Along that line of thinking, I checked out the video interviews with surgeons (columbia link through another thread) and felt Dr. Stolan hit the nail on the head.... I'm scarred to death of being stuck with adults if I go gs.

Then again.... knowing my track record... this too could change.

 

[beaverfetus]

this might not be helpful to you at all nonbilious, but you could consider ENT/ uro where the path to peds fellowships seem less strenuous. I mean it seems like ENT's can focus on kids with not fellowship whatsoever, and I've never gotten the impression that pediatric urology is super competitive (I may be way off the mark).

Peds uro does many of the same hernia operations, and they get the cool urogenital reconstructions. I guess thats a decent option if you don't mind being a moyle for a few cases per week.

 

[nonbilious]

this might not be helpful to you at all nonbilious, but you could consider ENT/ uro where the path to peds fellowships seem less strenuous. I mean it seems like ENT's can focus on kids with not fellowship whatsoever, and I've never gotten the impression that pediatric urology is super competitive (I may be way off the mark).

Peds uro does many of the same hernia operations, and they get the cool urogenital reconstructions. I guess thats a decent option if you don't mind being a moyle for a few cases per week.

Peds uro would be a good thought.... moyle training and all. ent.. don't know that i have the boards for that (their mean is what 245?).

but i am partial to being a generalist...