Peds vs Peds Surgery

[DarkBluMage]

I’ve been torn and going between these two specialities for the past few months and wanted to get some insight or advice.
I really enjoy being in the OR. During my surgery clerkship I rotated with gen Surg for a month. I enjoyed being scrubbed in and appreciated every opportunity they gave me to participate in the surgery. Time flew by in the OR and I didn’t find myself counting the minutes like I did with other clerkships. My issue is the length of training time (residency + fellowship), and the harsh aspect of training for over 80hrs every week for that entire time. I’m not afraid of working hard but at some point I do want to start a family and be an active parent and the feedback I get from residents is that the active parent part isn’t realistic during residency. I’m also concerned about my mental health in having to put those things off, not really having a life, and basically living in the hospital for the next 9 years after graduating medical school. Im turning 31 this year and I can feel my biological clock ticking already and the thought of risking not having a family by waiting until after residency/fellowship terrifies me. Unfortunately I’ll be 40 by the time I actually become a Peds surgeon if I choose that route. As for Peds i also enjoyed the clerkship. I know I want to work with kids and not mainly adults, but I’m not sure if I’d feel completely fulfilled without doing any kind of procedures since I really enjoy working with my hands and the satisfaction of making a difference immediately. I’m also not sure what types of procedures could be possible as a pediatrician. I hate being in clinic and would prefer to be a pediatric hospitalist, which apparently requires a fellowship now. I feel like I’m in a position of being stuck between choosing the chance to have a family vs a surgical career. I’ll be finishing up my clerkships in 5 months and will have to decide by then. Pro cons list below for tldr

Peds pros:
- work with kids immediately
- less rigorous residency training
- shorter training time (residency +fellowship)
- able to start a family sooner

Cons:
- less procedural work
- lack of work satisfaction (no surgery)
- lower salary


Ped surg pros:
- work satisfaction (enjoy OR and working with hands)
- salary

Cons:
- length of training (residency + fellowship)
- rigor of training
- risk of not having a family
- possibly not matching Peds surg fellowship

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[DOVinciRobot]

The pediatric surgery fellowship after general is the most competitive fellowship in medicine.

If you want to work with kids and do surgery I’d recommend doing a surgical sub specialty (ortho or ENT) and then a peds fellowship. Would shave 3 years off your training and those fellowships are not very competitive.

It really comes down to if you want to work with kids primarily or be a surgeon, because that’s the real difference. If you ONLY want to do surgery on kids then I would recommend just doing peds and forgetting the surgery part, because you’ll be miserable doing basically 5-7 years of adult training just to get the opportunity to apply to a pediatric fellowship of some sort

 

[DarkBluMage]

The pediatric surgery fellowship after general is the most competitive fellowship in medicine.

If you want to work with kids and do surgery I’d recommend doing a surgical sub specialty (ortho or ENT) and then a peds fellowship. Would shave 3 years off your training and those fellowships are not very competitive.

It really comes down to if you want to work with kids primarily or be a surgeon, because that’s the real difference. If you ONLY want to do surgery on kids then I would recommend just doing peds and forgetting the surgery part, because you’ll be miserable doing basically 5-7 years of adult training just to get the opportunity to apply to a pediatric fellowship of some sort

Thanks for the suggestion! I’ll look into those because I don’t want to get stuck primarily treating adults. I feel more frustrated when dealing with adults and I really love working with kids. Aren’t ENT and ortho more competitive than gen surg?

 

[LunaOri]

You could also do a somewhat procedural specialty like peds anesthesia, peds GI, peds cardiology.

 

[DarkBluMage]

You could also do a somewhat procedural specialty like peds anesthesia, peds GI, peds cardiology.

Do you know how to go about finding more info about subspecialties and their procedures? I have a hard time finding info on what procedures they do.

 

[Smurfette]

Thanks for the suggestion! I’ll look into those because I don’t want to get stuck primarily treating adults. I feel more frustrated when dealing with adults and I really love working with kids. Aren’t ENT and ortho more competitive than gen surg?

ENT and ortho are more competitive than GS. BUT peds surgery is WAYYYY more competitive than any of those. As in, if there is no alternative GS subspecialty you would be willing to do, do not pursue it. Last year, there were 44 positions open. And many of those who matched have done extra fellowships or lab time to increase their chances (in other words, will be more than 9 years of PGY training before they are in practice). One of my former co-residents was a cringe worthy PGY-13 his last year of peds surgery fellowship.

 

[pinkowl250]

I'm a PGY-1 peds resident. There are plenty of us who love procedures and want to incorporate them into our daily work. There are ultimately lots of opportunities to do procedures in peds subspecialties such as GI, NICU, PICU, cardiology, pulmonology, even hospitalist medicine. But ultimately (as stated by a user above), I think you do need to decide if you want to be a surgeon or a pediatrician primarily, as this would affect which residency you choose. Just wanted to reassure you that there are plenty of opportunities to do procedures in peds. But ultimately we are not surgeons and we are broadly trained in all aspects of caring for children. Feel free to reach out, I love pediatrics and just wanted to offer that perspective.

 

[babybrains]

Agreed that you need to decide if you like surgery or pediatrics more. I'm in a peds subspecialty (peds neuro), and the two years of pediatrics residency were awful as someone who wasn't interested in gen peds and wanted to just get to my specialty. I love working with children, but pediatrics (especially inpatient pediatrics) is so much more than just that. If you're a surgeon at heart, I can't imagine gen peds being fulfilling, but if you enjoy rounding with the gen peds teams, that's a different story.

I have a few friends who went anesthesia -> peds anesthesia, and they seem pretty happy with their choice; that may be a more procedurally-heavy route than gen peds -> ICU/cards/ED.

 

[DarkBluMage]

Agreed that you need to decide if you like surgery or pediatrics more. I'm in a peds subspecialty (peds neuro), and the two years of pediatrics residency were awful as someone who wasn't interested in gen peds and wanted to just get to my specialty. I love working with children, but pediatrics (especially inpatient pediatrics) is so much more than just that. If you're a surgeon at heart, I can't imagine gen peds being fulfilling, but if you enjoy rounding with the gen peds teams, that's a different story.

I have a few friends who went anesthesia -> peds anesthesia, and they seem pretty happy with their choice; that may be a more procedurally-heavy route than gen peds -> ICU/cards/ED.

how did you go about finding out more about the subspecialties? I didn't have any exposure to them in my Peds clerkship. I was inpatient Peds mostly and spent the rest of my time in the nursery and Peds clinic. I didn’t mind rounding on gen Peds but we didn’t do anything hands on during my time there which did bother me.

 

[DarkBluMage]

I'm a PGY-1 peds resident. There are plenty of us who love procedures and want to incorporate them into our daily work. There are ultimately lots of opportunities to do procedures in peds subspecialties such as GI, NICU, PICU, cardiology, pulmonology, even hospitalist medicine. But ultimately (as stated by a user above), I think you do need to decide if you want to be a surgeon or a pediatrician primarily, as this would affect which residency you choose. Just wanted to reassure you that there are plenty of opportunities to do procedures in peds. But ultimately we are not surgeons and we are broadly trained in all aspects of caring for children. Feel free to reach out, I love pediatrics and just wanted to offer that perspective.

I messaged you

 

[babybrains]

how did you go about finding out more about the subspecialties? I didn't have any exposure to them in my Peds clerkship. I was inpatient Peds mostly and spent the rest of my time in the nursery and Peds clinic. I didn’t mind rounding on gen Peds but we didn’t do anything hands on during my time there which did bother me.

Peds neuro is its own residency, and I was interested in that in part due to my interest in neuro in general, so I sought out rotations/sub-Is in the field. I know people who did NICU/PICU rotations in med school; you could probably look into if your school offers any exposure to pediatric subspecialties in rotations, and pick one or two that you think you'd be most interested in.

 

[DOVinciRobot]

Thanks for the suggestion! I’ll look into those because I don’t want to get stuck primarily treating adults. I feel more frustrated when dealing with adults and I really love working with kids. Aren’t ENT and ortho more competitive than gen surg?

Yes, but the road block is the residency. The fellowship isn’t very competitive. The pediatric surgery fellowship is literally the most competitive specialty in medicine. The fellows that make it make the neurosurgery applicants to Hopkins look like scrubs. It’s honestly brutal. Unless someone also loves GS and would be completely happy being a general surgeon then they shouldn’t ever go into GS simply because they want to do peds surgery.

 

[voxveritatisetlucis]

Yea even the Peds surgeons at the no name community hospital that my school rotates in went to Harvard and Upenn for med school then top surgery residencies

 

[DarkBluMage]

Yes, but the road block is the residency. The fellowship isn’t very competitive. The pediatric surgery fellowship is literally the most competitive specialty in medicine. The fellows that make it make the neurosurgery applicants to Hopkins look like scrubs. It’s honestly brutal. Unless someone also loves GS and would be completely happy being a general surgeon then they shouldn’t ever go into GS simply because they want to do peds surgery.

Preciate the insight, I really don’t think I’d be happy if I ended up just doing gen surg due to not getting into ped surg 😭
I really want to work with kids no matter what I decide to do.

 

[operaman]

Lots of great advice here. Peds surg really is nuts in terms of how competitive it is. If you’ve got the chops to match into it, then you should have no trouble with ent or Ortho residency and your odds of coming out with a peds focused practice would be much higher.

Give ent a strong look. Peds fellowships aren’t that competitive because there isn’t really any pay increase and many of us found peds kind of annoying at times.

Lots of great cases especially if you get into complex airway work. Lots of interesting peds ear cases too. Biggest drawback in peds ent imo is the sheer volume of bread and butter tubes and tonsils that need doing. Even at the major academic centers, the famous attendings are still shucking tonsils half the time.

Though I suppose ped surg was a lot of appys too, but tubes and tonsils are the most common surgical procedures done in the country not counting circumcision. Even so, can be a really cool practice.

Residency would definitely offer lifestyle perks. 5 years usually and often with some research time and easier blocks where many residents will start families if they’re so inclined.

 

[Latteandaprayer]

ENT and ortho are more competitive than GS. BUT peds surgery is WAYYYY more competitive than any of those. As in, if there is no alternative GS subspecialty you would be willing to do, do not pursue it. Last year, there were 44 positions open. And many of those who matched have done extra fellowships or lab time to increase their chances (in other words, will be more than 9 years of PGY training before they are in practice). One of my former co-residents was a cringe worthy PGY-13 his last year of peds surgery fellowship.

The peds fellow on my rotation did Peds residency, then GS, then 2 years of peds surgery research, and then started peds surg fellowship. And she still says she barely made it… it’s intense

 

[Big Time Hoosier]

Pediatric dentist here. As an “outsider,” I’m a bit curious. What makes peds surgery the most competitive specialty in medicine? Is it because it’s so limited by training slots?

Big Hoss

 

[DoctwoB]

Similar to Peds ENT or ortho, Peds Uro is a good option.

Like ENT and Ortho, Uro is tough to match into for residency, but easy to get a good Peds fellowship. It's a great field, does a lot of plastic/reconstructive type surgery, good mix of open and robotics. It's probably a bit less OR heavy than Peds ortho, typical schedule may be 2 clinic days, admin day, surgery center day, and OR day. Pay is good and similar to general urology at most centers.

 

[DOVinciRobot]

Pediatric dentist here. As an “outsider,” I’m a bit curious. What makes peds surgery the most competitive specialty in medicine? Is it because it’s so limited by training slots?

Big Hoss

Very few spots that are isolated at major academic centers. You have to have a large pediatric hospital just to get enough of the case volume and variety. It is one of the last few fields that is true “general” surgery. Very broad based practice on kids.

2 years of high quality research with people in the field is functionally mandatory, and most people who match do a lot more than that.

A few years ago there was something published showing that 25% of peds surgery fellows came from the same 4 residency programs. All elite academic centers. So that’s who you’re competing with, and the match rate is still like 40% even with those elite credentials

 

[2010houston]

Peds anesthesia might be a great fit if you didn’t mind being on the other side of the drapes. I do this and absolutely love it. And unlike peds fellowship in GS, you will have no trouble getting into peds fellowship in anesthesiology.

 

[DarkBluMage]

Peds anesthesia might be a great fit if you didn’t mind being on the other side of the drapes. I do this and absolutely love it. And unlike peds fellowship in GS, you will have no trouble getting into peds fellowship in anesthesiology.

I feel like I’d be jealous being stuck behind the drapes

 

[DarkBluMage]

Similar to Peds ENT or ortho, Peds Uro is a good option.

Like ENT and Ortho, Uro is tough to match into for residency, but easy to get a good Peds fellowship. It's a great field, does a lot of plastic/reconstructive type surgery, good mix of open and robotics. It's probably a bit less OR heavy than Peds ortho, typical schedule may be 2 clinic days, admin day, surgery center day, and OR day. Pay is good and similar to general urology at most centers.

I’ll definitely look into those options! Thank you!

 

[DarkBluMage]

Lots of great advice here. Peds surg really is nuts in terms of how competitive it is. If you’ve got the chops to match into it, then you should have no trouble with ent or Ortho residency and your odds of coming out with a peds focused practice would be much higher.

Give ent a strong look. Peds fellowships aren’t that competitive because there isn’t really any pay increase and many of us found peds kind of annoying at times.

Lots of great cases especially if you get into complex airway work. Lots of interesting peds ear cases too. Biggest drawback in peds ent imo is the sheer volume of bread and butter tubes and tonsils that need doing. Even at the major academic centers, the famous attendings are still shucking tonsils half the time.

Though I suppose ped surg was a lot of appys too, but tubes and tonsils are the most common surgical procedures done in the country not counting circumcision. Even so, can be a really cool practice.

Residency would definitely offer lifestyle perks. 5 years usually and often with some research time and easier blocks where many residents will start families if they’re so inclined.

I was able to hear an ent doc give a talk for us on the field. I’ll definitely reach out to her to get more insight! Thank you!

 

[WheezyBaby]

The order i would approach your decision-making is as follows

1) do you have to be a surgeon?

2) are you primarily or are you exclusively interested in working with children?

Your toughest decision is going to be if the answer to 1 is yes and the answer to 2 is exclusively. If that's the case, I think the tolerability of an adult surgical residency would be too awful to endure for the number of years it would take before you'd be meaningfully taking care of kids. If you only have any interest in caring for kids, I would give the surgeon vs proceduralist question a lot of thought. That being said, the only fields in peds I really consider meaningfully procedural in a way someone interested in surgery would consider meaningful are interventional cards, interventional pulm, and gastroenterology. NICU, PICU, PEM, and peds anesthesia honestly aren't that procedural. The job markets for interventional cards / pulm are quite tight to my knowledge, and it's usually just a subset of peds GI that is doing a meaningful volume of scopes. Alternatively you'd be looking at suffering through 5+ years of adult surgical training before moving to peds. As challenging as that training is for people who actually want to do those fields, I can't imagine doing it and hating the work.

If the answer to 1 is yes and the answer to 2 is primarily, I think a variety of surgical residencies followed by peds fellowship is a reasonable pathway, but I agree with others about cautioning you proceeding down the gen surg to ped surg pathway just due to the risk of you not matching fellowship. That said, it depends ped surg offers a job thats potentially unlike what you'd get in other pediatric surgical subspecialties with regard to the variety and scope of surgeries under your routine scope of practice, the involvement in the day to day care of critically ill children in the NICU and PICU, etc.

If the answer to 1 is "eh, maybe, I just like doing stuff with my hands sometimes", regardless of what the answer to 2 is, I'd def consider the medical peds subspecialties.

 

[DarkBluMage]

The order i would approach your decision-making is as follows

1) do you have to be a surgeon?

2) are you primarily or are you exclusively interested in working with children?

Your toughest decision is going to be if the answer to 1 is yes and the answer to 2 is exclusively. If that's the case, I think the tolerability of an adult surgical residency would be too awful to endure for the number of years it would take before you'd be meaningfully taking care of kids. If you only have any interest in caring for kids, I would give the surgeon vs proceduralist question a lot of thought. That being said, the only fields in peds I really consider meaningfully procedural in a way someone interested in surgery would consider meaningful are interventional cards, interventional pulm, and gastroenterology. NICU, PICU, PEM, and peds anesthesia honestly aren't that procedural. The job markets for interventional cards / pulm are quite tight to my knowledge, and it's usually just a subset of peds GI that is doing a meaningful volume of scopes. Alternatively you'd be looking at suffering through 5+ years of adult surgical training before moving to peds. As challenging as that training is for people who actually want to do those fields, I can't imagine doing it and hating the work.

If the answer to 1 is yes and the answer to 2 is primarily, I think a variety of surgical residencies followed by peds fellowship is a reasonable pathway, but I agree with others about cautioning you proceeding down the gen surg to ped surg pathway just due to the risk of you not matching fellowship. That said, it depends ped surg offers a job thats potentially unlike what you'd get in other pediatric surgical subspecialties with regard to the variety and scope of surgeries under your routine scope of practice, the involvement in the day to day care of critically ill children in the NICU and PICU, etc.

If the answer to 1 is "eh, maybe, I just like doing stuff with my hands sometimes", regardless of what the answer to 2 is, I'd def consider the medical peds subspecialties.

This was perfect! Thank you! I think I could live without surgery as long as I could work regularly with my hands. I’ll give the Peds subspecialties a hard look. Peds GI may be what I lean towards

 

[WheezyBaby]

This was perfect! Thank you! I think I could live without surgery as long as I could work regularly with my hands. I’ll give the Peds subspecialties a hard look. Peds GI may be what I lean towards

I don't know what peds center you have available to you to get exposure, but I'd consider bread and butter GI to be diagnostic upper and lower endoscopy with tissue biopsy and occasional interventions like hemospray for ulcers. Large centers may have more advanced interventions like ERCP, push pull enteroscopy etc, but that's definitely a smaller subset of GI proceduralists. Down the peds -> peds GI pathway there is definitely also a lot of nonprocedural time (majority of peds residency and a significant portion of GI fellowship)

 

[pazzer2]

You also have to consider the lifestyle of a pediatric surgeon. Because there are so few, they are on call a lot. And they get called into the hospital for many different issues that require urgent surgical intervention. The most common are related to venous access (esp NICU). But also plenty of appendectomies, GI surgery, etc. Its tough to maintain work-life balance, so keep that in mind.