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Rural Neonatologist?

DrScott

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    Hey everyone,

    I recently made a decision to pursue some type of pediatric subspecialty. I am leaning towards Neonatology. However, my wife has thrown a wrench in everything because she wants to live in a small, rural area. Most likely it will be a small town in Arizona, California, or Texas. Does anyone have any information about the possibility of being a neonatologist in a small, rural community. Is it even possible? I have done some searches and it looks like all the NICU's are in bigger cities. Does anyone have some insight into this topic? Thank you,

    Scott
    U. of Arizona Medical Student
     

    oldbearprofessor

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      DrScott said:
      Hey everyone,

      I recently made a decision to pursue some type of pediatric subspecialty. I am leaning towards Neonatology. However, my wife has thrown a wrench in everything because she wants to live in a small, rural area. Most likely it will be a small town in Arizona, California, or Texas. Does anyone have any information about the possibility of being a neonatologist in a small, rural community. Is it even possible? I have done some searches and it looks like all the NICU's are in bigger cities. Does anyone have some insight into this topic? Thank you,

      Scott
      U. of Arizona Medical Student

      Hi Scott:

      It depends on how small you're looking for here and whether you're willing to do a combination of pedi and neonatology. Usually, it takes a hospital of about 1200-1500 or so deliveries/yr to support a full-time neonatologist. It's also usually a good idea for the neonatologist in these smaller towns to live fairly close (i.e. within a 15 minute or so drive) from the hospital since they don't stay in house all night when there is only one or two neos in the town. There are tons of small towns that meet this description that have neonatologists, but not too many "really" small rural towns that do :) Of note is that the neonatology work-force analysis in 2000 said that 4% of neonatologists worked in rural settings, but they didn't define rural.

      http://www.neonatology.org/career/default.html

      On the other hand, if you're willing to mix a little pedi and neo, you can go somewhat smaller and still make a living. Not a particularly easy living though!

      One final possibility is to work 24-hour in-house shifts in a large NICU and commute to your rural home. This might not appeal to you, but some folks will do this type of shift work or work one week a month in order to have the rest free to live in a different city or town.

      Hope this helps.

      Regards

      OBP

      who couldn't imagine being the ONLY neonatologist in any sized city -so much for completely free nights - even if someone else is on-call, if a disaster happens, they'll call YOU!
       

      DrScott

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        oldbearprofessor said:
        Hi Scott:

        It depends on how small you're looking for here and whether you're willing to do a combination of pedi and neonatology. Usually, it takes a hospital of about 1200-1500 or so deliveries/yr to support a full-time neonatologist. It's also usually a good idea for the neonatologist in these smaller towns to live fairly close (i.e. within a 15 minute or so drive) from the hospital since they don't stay in house all night when there is only one or two neos in the town. There are tons of small towns that meet this description that have neonatologists, but not too many "really" small rural towns that do :) Of note is that the neonatology work-force analysis in 2000 said that 4% of neonatologists worked in rural settings, but they didn't define rural.

        http://www.neonatology.org/career/default.html

        On the other hand, if you're willing to mix a little pedi and neo, you can go somewhat smaller and still make a living. Not a particularly easy living though!

        One final possibility is to work 24-hour in-house shifts in a large NICU and commute to your rural home. This might not appeal to you, but some folks will do this type of shift work or work one week a month in order to have the rest free to live in a different city or town.

        Hope this helps.

        Regards

        OBP

        who couldn't imagine being the ONLY neonatologist in any sized city -so much for completely free nights - even if someone else is on-call, if a disaster happens, they'll call YOU!

        Thank you obp! When you say work one week a month, how is that possible? Both scenarios(24 hour shifts and 1 week/mos) sound appealing to me but I am just curious how the 1 week/mos option is even viable. Are you saying that I would then also work as general peds in my rural community?

        Could you answer me one more important question, please??? If I am a person who wants to do as little research as possible, hates primary care settings, likes to do procedures, and need to pull down a decent salary(this one is my wife's criteria since I quit a good paying job to go to medical school), which specialty would be the better fit: Critical Care, ER Peds, or Neo.

        Do you know of any resources that have a list of all the NICU's in the country? I could take a look at that to see possibilities for rural locations.

        Any further insight you could give me would be greatly appreciated. Thanks so much OBP!!!
         
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        oldbearprofessor

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          DrScott said:
          Thank you obp! When you say work one week a month, how is that possible? Both scenarios(24 hour shifts and 1 week/mos) sound appealing to me but I am just curious how the 1 week/mos option is even viable. Are you saying that I would then also work as general peds in my rural community?

          Could you answer me one more important question, please??? If I am a person who wants to do as little research as possible, hates primary care settings, likes to do procedures, and need to pull down a decent salary(this one is my wife's criteria since I quit a good paying job to go to medical school), which specialty would be the better fit: Critical Care, ER Peds, or Neo.

          Do you know of any resources that have a list of all the NICU's in the country? I could take a look at that to see possibilities for rural locations.

          Any further insight you could give me would be greatly appreciated. Thanks so much OBP!!!

          Hi - in private practice there are various working scenerios that are possible. For example, I know of one doctor who covers 7 straight days of a community hospital NICU (24/7) and then goes home (100 miles away) for a while - I'm honestly not certain if it is a 1/3, 1/4 or 1/5 (i.e. work one week out of 3, 4 or 5) deal he has, but presumably this is proportional to how much $$ you want to make. I've known several neonatologists to cover NICU's as 24 hour shifts as their job. Exactly how many shifts = what salary is unknown to me and would certainly change before you get there, but I suspect that a 1 in 4 to 1 in 6 arrangement is reasonably consistent with a decent salary. There are a few others around here who are better at knowing the details of hours/salary. Whether you would also do some general pedi depends on you and where you lived. I would expect in a fairly small town that it is likely that you will have to do some cross-coverage in the ER or general pedi call.

          With regard to research, you will have to do a 3 yr fellowship which includes about 60% or so research time and you will need to complete a project. This can be clinical or basic science. You might like it - don't be sure that clinical outcomes research won't appeal to you. It is entirely possible to have a neonatology job after fellowhip in which you are not involved in any research.

          I will pass on helping you choose between critical care, ER and neo - all are compatible and incompatible with your goals, depending on how you structure your career. I think it is fairly hard to avoid doing some "primary care" in a pediatric ER though. I would pick the one you like the best. In the end, you have to face these patients and their families every day - which do you like the best?

          For job ideas, why not look at this site. It'll give you an idea of what is out there.

          http://www.neonatology.org/jobs/index.html

          Regards

          OBP

          who hated the ER, liked the PICU but loves babies!
           

          edmadison

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            Dont forget that there are major medical centers that are not in major metropolitan areas, such as University of Iowa and University of Virginia. There are a number where you could live 20 minutes or so away and still be in the boonies, such as the University of Rochester. They are there, you just have to took for them.

            Ed
             

            kickazzz2000

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              edmadison said:
              Dont forget that there are major medical centers that are not in major metropolitan areas, such as University of Iowa and University of Virginia. There are a number where you could live 20 minutes or so away and still be in the boonies, such as the University of Rochester. They are there, you just have to took for them.

              Ed

              Im in a rural nicu as we speak. East Carolina University in Greenville, NC. 5 minutes from here is the middle of nowhere!

              Now if you will excuse me, I got a Chest tube to pull, an admission note to write, and a cheesesteak to eat. :thumbup:
               
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