Procedure heavy specialties in peds

[sscooterguy]

Hi,
I have a growing interest in peds. I originally thought surgery was my calling because I love to work with my hands and do procedures. However, I'm in the middle of my peds rotation right now, and I really love it, more than I thought. I know about peds surg and peds ortho, but what are the non surgical specialties that are procedure heavy? How many procedures do Peds EM, GI, Cardio, Critical care really doing? What kind of procedures, etc? Thanks for any input.

sscooterguy

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[Bernardo_11]

If you want to enter specialty with a lot of procedure consider going to either Critical Care Peds (ie PICU doc) or neonatology (ie NICU doc). Both of them deal with intubations, putting in various peripheral/central lines, running codes (which is kinda like a procedure), insertion of chest tubes, pericardiocentesis (sometimes), and some other form of concious sedation.

Peds GI does a lot of endo/colonoscopy and that can be rather lucrative.

Peds Cardio is not as procedure oriented as Adult cardio... most of these kids don't have blocked coronaries which warrent catheterization. You'll be spending most of your time reading echos and diagnosing congenital lesions that will eventually be corrected by a peds cardiothoracic surgeon. Mind you, there's nothing wrong with doing that and the knowledge you'll gain will be amazing, but this is not what you'd want to go into if you like hands on type procedures.

Peds ER- can pretty much do everything PICU docs can do.

Peds Heme-Onc- main procedures are bown marrw taps and delivering intrathecal chemo.

Peds Rheum- joint aspirations.

Peds neuro- LP's mainly, also reading EEG's

Peds pulmonology- mainly doing bronchoscopy

Dev/Behavioral peds- are you kidding me? We think for a living. 😉

That's just kind of smidgen of what the various specialties do. If you like a lot of hands on work, go for one of the intensive care specialties.

Hope this helps.

Nardo
DeeBee Peds fellow

 

[notstudying]

If you want to enter specialty with a lot of procedure consider going to either Critical Care Peds (ie PICU doc) or neonatology (ie NICU doc). Both of them deal with intubations, putting in various peripheral/central lines, running codes (which is kinda like a procedure), insertion of chest tubes, pericardiocentesis (sometimes), and some other form of concious sedation.

Peds GI does a lot of endo/colonoscopy and that can be rather lucrative.

Peds Cardio is not as procedure oriented as Adult cardio... most of these kids don't have blocked coronaries which warrent catheterization. You'll be spending most of your time reading echos and diagnosing congenital lesions that will eventually be corrected by a peds cardiothoracic surgeon. Mind you, there's nothing wrong with doing that and the knowledge you'll gain will be amazing, but this is not what you'd want to go into if you like hands on type procedures.

Peds ER- can pretty much do everything PICU docs can do.

Peds Heme-Onc- main procedures are bown marrw taps and delivering intrathecal chemo.

Peds Rheum- joint aspirations.

Peds neuro- LP's mainly, also reading EEG's

Peds pulmonology- mainly doing bronchoscopy

Dev/Behavioral peds- are you kidding me? We think for a living. 😉

That's just kind of smidgen of what the various specialties do. If you like a lot of hands on work, go for one of the intensive care specialties.

Hope this helps.

Nardo
DeeBee Peds fellow

I agree with the above- I'll just add the following...
Some peds cardiologists do caths-we have one who does quite a bit of cardiac caths to look at anatomy prior to CT surg going in, and to do balloon septostomies and VSD repairs and so on.

Also peds hospitalists, while a new specialty and not as procedure oriented as PICU do more than primary care docs (sedations especially, but also LPs, thoracenteses, PICC lines, and central lines).

 

[Atlas]

Nardo,

I'm not disagreeing with you, but I didn't think Peds GI was THAT lucrative. The only jobs I found (online) were few and they started $170k-ish. I mean, for peds sub, that may be a lot. Do you know of others who are doing Peds GI and doing well financially? Thanks.

Atlas

 

[Bernardo_11]

I agree with the above- I'll just add the following...
Some peds cardiologists do caths-we have one who does quite a bit of cardiac caths to look at anatomy prior to CT surg going in, and to do balloon septostomies and VSD repairs and so on.

Also peds hospitalists, while a new specialty and not as procedure oriented as PICU do more than primary care docs (sedations especially, but also LPs, thoracenteses, PICC lines, and central lines).

I guess i depends on the other specialties available. The peds cards in my area rarely do caths anymore for the purposes of diagnosing anatomical lesions, they rely on echos mainly for that purpose. And for some weird reason, they'll use an adult interventional cardiologist to do the septostomies you speak of.

Also, with the hospitalists, that can depend on your location as well. The hospital I trained had a good peds anesthesiologist who would put in those PICC and central lines for us. The extent of what a hospitalist does procedurewise has been limited only to LP's. We called surgeons to put in the chest tubes on the floor.

 

[Bernardo_11]

Nardo,

I'm not disagreeing with you, but I didn't think Peds GI was THAT lucrative. The only jobs I found (online) were few and they started $170k-ish. I mean, for peds sub, that may be a lot. Do you know of others who are doing Peds GI and doing well financially? Thanks.

Atlas

I guess I mean lucrative in that they can bill for the procedure and be compensated accordingly. With the ICU specialties, sometimes you get a salary from the hospital, and don't get compensated for the procedures you do. SOMETIMES I said... you just have to be vigilant when making out your contract.

As for the actual pay, it depends on the region. There are only two peds GI specialists here at Honolulu and they seem to be doing pretty well. Wouldn't dare ask them how much they make though 😀

Nardo

 

[sanz]

Guys, in that same note, what about Peds Nephrology? How big are they on procedures and what is the pay like?

Thanks in advance!

 

[notstudying]

Guys, in that same note, what about Peds Nephrology? How big are they on procedures and what is the pay like?

Thanks in advance!

Here the nephrologists do kidney biopsies, but that's about it. The biggest problem with peds (regardless of procedure-heaviness) is that most subspecialty pediatricians are in academic medical centers, and so get paid much less than private practice. There are exceptions (there are many private neonatologists who do very well, especially not in the northeast), but since some peds specialties (non procedure based ones like DBP or endo or rheum) that are very poorly compensated, the ones that actually make money often subsidize those that don't. I think the GI folks are similar-they could do much better in private practice but those jobs are very limited.

As for peds cards, I think it depends quite a bit on the training of the cardiologist and their interest-to do caths you have to have extra training. We only have one peds interventionalist who does these procedures, but we do have a great CT surgeon (who really prefers a cath rather than an echo before he cuts-we had a bedside cath the other day in the Peds CTICU), and a great adult cardiac program as well, so they certainly could do it if he wasn't there.

I've been talking to our PICU folks about our hospitalist program (I'm trying to decide between PICU, general academic peds, and somewhere in the middle). Right now they do most of the sedations, PICCs, thoracenteses (like you all the surgeons usually place chest tubes), but they are overwhelmed and the hospitalists will be doing these procedures for the floor patients, freeing up the PICU attendings and fellows for actually treating the sick kids 🙂. So I think it completely depends on the institution you are in, and how they have delineated responsibilities.

 

[14022]

As for peds cards, I think it depends quite a bit on the training of the cardiologist and their interest-to do caths you have to have extra training.

Not exactly true. You need a fourth year of training to do interventional cath, eg, close septal defects, septostomies, pda closures, etc. After the regular 3 year fellowship, every peds cards doc is qualified to do diagnostic cath, meaning they can do angiograms and determine anatomy/physiology of the abmormal heart by looking at differences in pressures and oxygen saturations in different parts of the heart.

 

[JackPB]

Hi.... what are the non surgical specialties that are procedure heavy?

How about pediatric anesthesiology? Procedures include high volumes of intubations, central lines, nerve blocks. You can work with kids all day, every day. The work is fun, residency is reasonable, jobs are plentiful, and compensation is great.

 

[sscooterguy]

How about pediatric anesthesiology? Procedures include high volumes of intubations, central lines, nerve blocks. You can work with kids all day, every day. The work is fun, residency is reasonable, jobs are plentiful, and compensation is great.

Interesting comment. I have thought about anesthesiology because of the procedures. Do you or anyone else know about training for peds anesthesia? Is there a fellowship after anesthesia? Is it a board cert or just extra training? How long is it, etc? Thanks in advance.

sscooterguy

 

[Os4prez]

just a couple more things about peds cards... you dont necessarily have to be at an academic center - im sure they have peds cardiologists in the middle of mississippi at the towns community hospital. they have their own echo - they diagnose - and ship the baby out to a place where they have a CT surgeon - you know what i mean?

the thing is with even the interventional peds card - you have to be at a huge academic center - and even then you dont get that many cases a week - compared to adult cards. but at some point we have to stop comparing peds vs adults. they make more money. we have more fun. dont try to argue with me on that.

correct me if im wrong but you make decent money in peds AIR - allergy immunology with some places also doing rheumatology as part of that fellowship. you have these minor injections procedure thingies that AI people get paid for - and you could do adult AI too - and make more $$$.

if your thinkin procedures and money - the one most lucrative field just might be private neonatology. some of those guys make over 400.

anyway thats my 5 cents again. feel free to correct me if im wrong.

peace

 

[JackPB]

Do you or anyone else know about training for peds anesthesia? Is there a fellowship after anesthesia? Is it a board cert or just extra training? How long is it, etc? Thanks in advance.

Anesthesiology is one year of internship and three years of anesthesia training. After residency, one should be qualified to handle most pediatric cases safely. The pediatric anesthesiology fellowship is useful if you want to treat kids exclusively, or if you want to handle very young or very sick kids. Fellowship-trained guys are in pretty high demand currently.

Pediatric Anesthesiology fellowships are one year long and ACGME-accredited. There is currently no board exam, but there is always a push to institute one.

 

[oldbearprofessor]

the thing is with even the interventional peds card - you have to be at a huge academic center - and even then you dont get that many cases a week - compared to adult cards. but at some point we have to stop comparing peds vs adults. they make more money. we have more fun. dont try to argue with me on that.

peace

I really like your line about having fun. Interventional pedi cardiology is a very high stress business. Babies do not enjoy the procedure and very often respond by having heart rates and rhythms requiring very emergent and intense intervention to say the least. But the folks I respect in the field do it because they really love what they do, and although I'm not sure they would use the word "fun" while in the cath lab with a baby with transposition being ballooned, I think they do "enjoy" it. And if you're doing what you enjoy, and are talented at it (this is a real hand-skills job), then you're right, it won't be about the $$ or the stress or the hours!

Regards

OBP

 

[Os4prez]

Yep its all about the fun!

And for what its worth - i like to ready many of your comments OBP - great information from the experienced is how i look at it. good stuff!

peace