PICU Job Market

[sparklystu]

Hi,

I'm a current fourth year applying to peds residency and have a strong interest in pursuing a Peds Critical Care Fellowship. I'm just curious what others have found regarding the potential for job opportunities and the current state of the market in this field. Of course, I know I have a long way to go before I even apply to fellowship and it's quite possible that I will change my mind throughout residency, but I hear things about other peds specialties and am just curious where that information comes from. Is it more anecdotal, or is there a place to see what current job opportunities are like?

Ultimately, if I enjoy it I believe it's worth pursuing, but on the other hand another 3 years of training for difficulty finding a job is a little worrisome. Curious to hear if any of you have experiences with this!

Thanks!

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[SurfingDoctor]

I will tell you generally speaking, no one is going to be able to provide you with a clear idea of what the PICU job market will look 6+ years down the road. Certainly, what was true for the PICU job market 6+ years ago is not the same as it was to day. The PICU market is probably more constrained than other markets because it is hospital based and resource heavy, thus it requires a lot of up front investment from a hospital system to support such a unit (it's not like you can set up a PICU clinic wherever). This is usually offset by the bigger revenues it generates, but still it is a large up front cost. Additionally, because it is hospital based, it is subject to more market forces on hospital-only revenue. And much of children's hospital based revenue relies on government aide and Medicare/Mediaid. So, given the current issues in healthcare, it is unclear what it means for hospitals, though generally speaking, many hospitals are nervous about the future of hospital-based healthcare (http://www.aha.org/presscenter/pressrel/2016/160612-pr-aca.shtml).

Again, because of these and the potential for many other factors (hospital specialization, regional centers of excellence, private versus public resources) it very hard to predict anything. Currently, the job market goes in fluxes (we are hiring for the first time in 4 years where I work and we are hiring a lot, but once we are done I suspect it will be another 4 years plus before we upstaff again). Most academic centers are looking more for cardiac intensivist and less for just PICU training unless you have a unique academic asset, and there seem to be a number of private practice jobs and locum jobs from my understanding. How that will look down the road, I don't know. I don't think the market is saturated yet, but it will eventually get there because just like all hospital-based specialities, the number of applicants into the pool will eventually outpace the building of hospitals.

If you want to see current jobs available in PICU, here is a list:
http://pedsccm.org/view-jobs-doctors.php

There are plenty of PICU people on here and so maybe they can offer a different perspective.

 

[Stitch]

Agree with above. There's no telling what's going to happen that far out. In general intensivists can get jobs, but it depends on what kind of job you want. Research oriented vs clinician, specific interests and training (cardiac, ECMO, neuro, etc). I suspect there will generally be jobs as PICU is pretty versatile and any children's hospital needs one to do anything big, ,but it all comes down to you and what you want.

 

[gomizzou]

Just to echo what those above have said, there will always be jobs but if the market is tight you may not end up in your top location or practice type right away. Right now there is a huge demand for people with dual Cardiology/PCCM training, a CT-ICU year tacked on to the end of fellowship, or experience and interest in helping primarily in a CT-ICU.
If you look at the job postings for the past few years you can see that there are all kinds of jobs out there, and there are often jobs that never make those listings but are spread via word of mouth.

 

[Phantomrih]

Just to echo what those above have said, there will always be jobs but if the market is tight you may not end up in your top location or practice type right away. Right now there is a huge demand for people with dual Cardiology/PCCM training, a CT-ICU year tacked on to the end of fellowship, or experience and interest in helping primarily in a CT-ICU.
If you look at the job postings for the past few years you can see that there are all kinds of jobs out there, and there are often jobs that never make those listings but are spread via word of mouth.

Sorry to resurrect this. But would this also apply to someone with added interventional pulmonology training? I want to know how feasible this is and if it results in any gains whether in demand or pay.

 

[SurfingDoctor]

Sorry to resurrect this. But would this also apply to someone with added interventional pulmonology training? I want to know how feasible this is and if it results in any gains whether in demand or pay.

What is interventional pulmonology? Are you asking if someone who is dual boarded in pediatric pulmonary and critical care? One could do it, but I don’t think it would generate much more pay or demand. The number of pediatric critically ill patients who need bedside bronchoscopies (therapeutic or diagnostic) is pretty small.

 

[Phantomrih]

What is interventional pulmonology? Are you asking if someone who is dual boarded in pediatric pulmonary and critical care? One could do it, but I don’t think it would generate much more pay or demand. The number of pediatric critically ill patients who need bedside bronchoscopies (therapeutic or diagnostic) is pretty small.

Okay thanks! Interventional pulmonology is something I've been hearing more about, but in relation to adults so since you said most peds don't need that many procedures anyway, this probably wouldn't apply. Thanks!

 

[MEN2C]

Also remember that while adult Pulm and adult cc fellowships are often combined (you could do one or the other, but most times it's a combined fellowship), in pediatrics they are separate and if you want to do both, you'll have to tack on at least two years of training after your primary fellowship to meet ABP requirements (e.g in adults you can get both Pulm and CC certified in 3 years but in Peds you'd have to spend 3 years in CC and then 2 years in pulm or vice versa to meet the requirements). Given the nature of pediatric critical illness and what's in demand, a lot of people who do combined fellowships with CC in pediatrics tend to do it with cardiology as people mentioned. Either a full 2-3 year second fellowship (peds fellowships are mostly 3 years but if you've done a fellowship before, they can waive the research requirement, shortening the time - if ABP and your program agrees) leading to board certification or a 1 year fellowship in CVICU that's not accredited to make themselves marketable and to obtain skills.

I strongly thought about doing PICU (ended up going to NICU), and the fellows in my experience do tend to enjoy their jobs. But some of them do have a harder time finding the job they want in the location they want.

 

[FlowLimited]

Okay thanks! Interventional pulmonology is something I've been hearing more about, but in relation to adults so since you said most peds don't need that many procedures anyway, this probably wouldn't apply. Thanks!

These interventional procedures are nearly non-existent in pediatrics. Many bronchoscopies are performed on children using the smallest scopes that have instrument channels that are too small for forceps or other tools. Additionally, the majority of the lung diseases for which interventional procedures are indicated are much less common in pediatrics (lung cancer, interstitial lung disease, etc.).

 

[thetubes]

These interventional procedures are nearly non-existent in pediatrics. Many bronchoscopies are performed on children using the smallest scopes that have instrument channels that are too small for forceps or other tools. Additionally, the majority of the lung diseases for which interventional procedures are indicated are much less common in pediatrics (lung cancer, interstitial lung disease, etc.).

The smallest forceps I believe you can put down is 1.5mm and thus the smallest scope you could use is the 4.0 hybrid (with a 2mm channel) but the bigger point is that transbronchial lung biopsy is very low yield and almost always not worth the risks associated.