peds vs gas

[heavyw8]

---

Members do not see this ad.

i'm a 3rd year debating between anesthesiology + ped fellowship vs pediatrics +/- fellowship

i like kids a lot and i enjoyed my peds rotation. however, i don't think i'll be able to rotate through anesthesiology until the beginning of 4th year. my plan is try to set up some shadowing over spring break.

peds is enticing because i have a lot of options for fellowship after residency. i like anesthesia because of the phys/pharm + immediate gratification like everyone else. one of the biggest things holding me back is the pay. 150-200k as a pediatrician (i dont think the subspecialties are much better) vs 400-500k as a pediatric anesthesiologist almost seems like a no brainer.

i have a pretty good idea of the pediatrics lifestyle, but what about the pediatric anesthesiologist's lifestyle?

any thoughts on income? seems like peds will either stay the same or go up whereas anesthesia (from what i've read on this forum) is headed down?

what about practice location? am i restricted to a childrens hospital as a pediatric anesthesiologist? is there geographic flexibility?

other than that, anyone have any advice?

 

[Silent Cool]

i'm a 3rd year debating between anesthesiology + ped fellowship vs pediatrics +/- fellowship

i like kids a lot and i enjoyed my peds rotation. however, i don't think i'll be able to rotate through anesthesiology until the beginning of 4th year. my plan is try to set up some shadowing over spring break.

peds is enticing because i have a lot of options for fellowship after residency. i like anesthesia because of the phys/pharm + immediate gratification like everyone else. one of the biggest things holding me back is the pay. 150-200k as a pediatrician (i dont think the subspecialties are much better) vs 400-500k as a pediatric anesthesiologist almost seems like a no brainer.

i have a pretty good idea of the pediatrics lifestyle, but what about the pediatric anesthesiologist's lifestyle?

any thoughts on income? seems like peds will either stay the same or go up whereas anesthesia (from what i've read on this forum) is headed down?

what about practice location? am i restricted to a childrens hospital as a pediatric anesthesiologist? is there geographic flexibility?

other than that, anyone have any advice?

Gas + Peds fellowship: $$$$$$$$$$$$$$$

Peds + Peds fellowship: $$$

done.

 

[IlDestriero]

If you want to do 100% peds anesthesia, most of the positions will be in Children's Hospitals, but there are peds PP groups or subgroups around.

 

[heavyw8]

bump

 

[IlDestriero]

The peds anesthesiologist lifestyle is like the anesthesiologists lifestyle. You get in 30-60 min before the first case to set up and meet the family (~7a) and work until the last case is done (~3-6p). Hop in the Benz and race home to your trophy wife. Rinse and repeat.
Late shifts and call are very variable depending on the practice. Could be Q4 or Q30. Most practices have between 6 and 12 weeks of vacation.
There is no clinic, minimal follow up, etc. When you're on, you're on, and when you're off, you're off. It's pretty nice. The pay doesn't hurt either.
What do you want to know.

 

[Socrates25]

i'm a 3rd year debating between anesthesiology + ped fellowship vs pediatrics +/- fellowship

i like kids a lot and i enjoyed my peds rotation. however, i don't think i'll be able to rotate through anesthesiology until the beginning of 4th year. my plan is try to set up some shadowing over spring break.

peds is enticing because i have a lot of options for fellowship after residency. i like anesthesia because of the phys/pharm + immediate gratification like everyone else. one of the biggest things holding me back is the pay. 150-200k as a pediatrician (i dont think the subspecialties are much better) vs 400-500k as a pediatric anesthesiologist almost seems like a no brainer.

i have a pretty good idea of the pediatrics lifestyle, but what about the pediatric anesthesiologist's lifestyle?

any thoughts on income? seems like peds will either stay the same or go up whereas anesthesia (from what i've read on this forum) is headed down?

what about practice location? am i restricted to a childrens hospital as a pediatric anesthesiologist? is there geographic flexibility?

other than that, anyone have any advice?

I'm a pediatrician and it seems to me like this is a no-brainer from you. You havent given us a single reason as to why you would like peds.

I cant say for sure, by my impression was that peds anesthesiologists get paid quite a bit less than other fellowship trained gas docs, simply because peds is going to be a lot of chronic problem kids who are on medicaid.

For someone looking to maximize income, I would do neither peds nor peds anesthesia.

 

[secants]

The new SDN interviewee on the front page is a Peds-Anesthesiologist in case you wanted to read what she has to say.

 

[Aether]

I'm a pediatrician and it seems to me like this is a no-brainer from you. You havent given us a single reason as to why you would like peds.

I cant say for sure, by my impression was that peds anesthesiologists get paid quite a bit less than other fellowship trained gas docs, simply because peds is going to be a lot of chronic problem kids who are on medicaid.

For someone looking to maximize income, I would do neither peds nor peds anesthesia.

peds anesthesiologists do make generally more than reg anesthesiologist. I dont about 500k. I dont even know about 400k. Maybe if the job is hard to fill 400k. I think the pediatricians lifestyle is immensely better than worrying about laryngospasm in a child/infant every case. And another thing, you kill a kid under anesthesia, it may be your last case EVER. career ending. Moreover, they may file criminal charges against you. I hate to sound morbid but keep that in the back of your mind.

 

[IlDestriero]

And another thing, you kill a kid under anesthesia, it may be your last case EVER. career ending. Moreover, they may file criminal charges against you.

What is this nonsense?
Malpractice is malpractice, lawsuits can happen to anyone, even if you do everything right. Anesthesia can be stressful, it can be "exciting" at times. Kids are no different in that respect. They can sue you until they're 18 though.
Criminal charges? What are you smoking? Maybe if you deliberately euthanize a patient. Unable to resuscitate the MVA trauma or the Hail Mary cancer resection? That's the job.

 

[Noegrus]

Forget about that. When and where can I find a trophy wife? I hear peds residents are adorable. Correct?

 

[IlDestriero]

Picu nurses. That's where it's at.
Ask anyone. 😉

 

[Aether]

What is this nonsense?
Malpractice is malpractice, lawsuits can happen to anyone, even if you do everything right. Anesthesia can be stressful, it can be "exciting" at times. Kids are no different in that respect. They can sue you until they're 18 though.
Criminal charges? What are you smoking? Maybe if you deliberately euthanize a patient. Unable to resuscitate the MVA trauma or the Hail Mary cancer resection? That's the job.

Not nonsense. Bump off a healthy 6 yo after a tonsil and see how far you get. Extubate a tad early, kid goes to laryngospasm(cuz he comes from a smokers household) for some reason you cant break it fast enough kid arrests etc etc etc etc etc. Not nonsense, very realistic scenario. These are issues we deal with on the daily especially if you are a peds anesthesiologist. Different scenario killing a 73 yo after cabg. And i can guarantee if that happens to you you wont be working there for long at the minimum not to mention a very large law suit that certainly exceeds your limits. Which means better give the benz away..

 

[Noegrus]

The risks are there, yes, but healthy kids undergoing T&A don't arrest and die too often. The mortality is 1 in 15000 and even that is mostly not due to anesthetic reasons. The frequency of intraop cardiac arrest in kids with or without comorbidities is 1 in 10000 cases.
My dad and his several dozen peds anesthesia colleagues have practiced for 30 years without the sky falling down. They started back when you only had a pulse and bp apparatus to work with. Its gonna be OK. Some sick kids will die despite our desperate attempts to save them. Elective procedures on healthy kids will still be done with little risk. It is what it is.

 

[michigangirl]

Not nonsense. Bump off a healthy 6 yo after a tonsil and see how far you get. Extubate a tad early, kid goes to laryngospasm(cuz he comes from a smokers household) for some reason you cant break it fast enough kid arrests etc etc etc etc etc. Not nonsense, very realistic scenario. These are issues we deal with on the daily especially if you are a peds anesthesiologist. Different scenario killing a 73 yo after cabg. And i can guarantee if that happens to you you wont be working there for long at the minimum not to mention a very large law suit that certainly exceeds your limits. Which means better give the benz away..

Pediatricians have their share of malpractice risk, and its more complicated because its not under their immediate control. General pediatrician sends a kid home after a sick visit for a "cold", kid ends up in ER six hours later in septic shock on ECMO. Kid falls down a few steps and gets sent home from ED without a head CT-- kid ends up herniating from an epidural hematoma.

We could review scenarios like these for days. Agree wholly with IlDestriero.

 

[Aether]

Pediatricians have their share of malpractice risk, and its more complicated because its not under their immediate control. General pediatrician sends a kid home after a sick visit for a "cold", kid ends up in ER six hours later in septic shock on ECMO. Kid falls down a few steps and gets sent home from ED without a head CT-- kid ends up herniating from an epidural hematoma.

We could review scenarios like these for days. Agree wholly with IlDestriero.

I did not say the general pediatrician has no risk. I was merely pointing out the risks in anesthesia and the ramifications of bad outcomes. I personally DO NOT want to be ever involved in litigation involving a child. Especially one i was coding in the OR. Especially if i have to go tell the parents they are DEAD or brain dead. These are real risks and scenarios that ought not be glossed over when considering peds anesthesia.

 

[michigangirl]

This thread has moved far away from the OPs question.

As IlDestriero already noted, and I will add/underline:

1. Peds anesthesiologists do make more many than almost any pediatrician or pediatric subspecialty. There will be exceptions, for example a pediatric intensivist working in a rural community where there is a high demand (and hence high salary). Or the Peds GI guy who does wicked numbers of scopes with amazing reimbursements. But there's a spectrum for all of it, and the mean and the center of the bell curve for peds anesthesia is to the right of pediatricians, no question.

2. Peds anesthesiologists don't get paid "quite a bit less" than other fellowship trained anesthesiologists. Last I checked, chronic disease affects adults too-- in fact, a bit more than children. Many folks do peds anesthesia because they like taking care of healthy patients-- yes, if you are in a large children's hospital you will take care of many kids with chronic illnesses, and some pretty sick kids. But that's a draw from some.

3. The risk controversy here is one I'm not really grasping. Again agree with IlDestriero. Every field of medicine has risk. There's a difference between being sued doing a risky profession and being sued because you did something wrong. Yes, none of us want to have a conversation with a family and tell them their kid died. But it's a risk of anesthesia, particularly for big, complicated cases. If you love the job its worth the stress.

Bottom line-- if you decide to pursue anesthesia-- you have to love the OR. You must get in there and figure out whether being in the OR is right for you. If you love it, then go for it. But if you're not a fan of the OR, then go the pediatrics route. There's also the combined residency in pediatrics and anesthesia if you decide the potential outcomes of that program align with your interests.

 

[Aether]

This thread has moved far away from the OPs question.

As IlDestriero already noted, and I will add/underline:

1. Peds anesthesiologists do make more many than almost any pediatrician or pediatric subspecialty. There will be exceptions, for example a pediatric intensivist working in a rural community where there is a high demand (and hence high salary). Or the Peds GI guy who does wicked numbers of scopes with amazing reimbursements. But there's a spectrum for all of it, and the mean and the center of the bell curve for peds anesthesia is to the right of pediatricians, no question.

2. Peds anesthesiologists don't get paid "quite a bit less" than other fellowship trained anesthesiologists. Last I checked, chronic disease affects adults too-- in fact, a bit more than children. Many folks do peds anesthesia because they like taking care of healthy patients-- yes, if you are in a large children's hospital you will take care of many kids with chronic illnesses, and some pretty sick kids. But that's a draw from some.

3. The risk controversy here is one I'm not really grasping. Again agree with IlDestriero. Every field of medicine has risk. There's a difference between being sued doing a risky profession and being sued because you did something wrong. Yes, none of us want to have a conversation with a family and tell them their kid died. But it's a risk of anesthesia, particularly for big, complicated cases. If you love the job its worth the stress.

Bottom line-- if you decide to pursue anesthesia-- you have to love the OR. You must get in there and figure out whether being in the OR is right for you. If you love it, then go for it. But if you're not a fan of the OR, then go the pediatrics route. There's also the combined residency in pediatrics and anesthesia if you decide the potential outcomes of that program align with your interests.

FULL DISCLOSURE. I made 650k last year in the midwest 🙂

If you want to put kids to sleep go into anesthesia
If you want to figure out what is wrong with them medically go into pediatrics.

 

[IlDestriero]

In the interest of full disclosure, I find it difficult to believe that you're a practicing anesthesiologist based your posts here on SDN. 😉 Particularly this gem about a single bad outcome being career ending, let alone the whole criminal charges nonsense. How far below the standard of care do you honestly believe you have to practice to result in criminal charges being filed? Turn the yellow knob and go back to the call room for a nap? That's Michael Jackson/Conrad Murray territory.
Your post does illustrate one of the other benefits of anesthesia. Strong income potential.

And another thing, you kill a kid under anesthesia, it may be your last case EVER. career ending. Moreover, they may file criminal charges against you. I hate to sound morbid but keep that in the back of your mind.