Whats going on with Pediatric Anesthesiology Match?

[skankhunt42]

Hey all- future Peds Anesthesia fellow here. Wanted to throw something out there....

So in the upcoming A&A there is going to be an article on the current state of the Pediatric Anesthesiology Fellowship Match:

Pediatric Anesthesiology Fellowship Positions: Is There a Mismatch?
Cladis, Franklyn P. MD, FAAP*; Lockman, Justin L. MD, MSEd†; Lupa, M. Concetta MD‡; Chatterjee, Debnath MD, FAAP§; Lim, Doyle MD, MMM, FAAP‖; Hernandez, Michael MD¶; Yanofsky, Samuel MD, MSEd#; Waldrop, William B. MD**
Anesthesia & Analgesia: December 2019 - Volume 129 - Issue 6 - p 1784-1786

I read a copy ahead of print. Long story short this past cycle- a staggering 53% of programs did not fill! There were something like 140 applicants for almost 200 spots nationwide. While over the past year or so some programs have retracted, a lot of the 'top' programs are still unabshedly putting out 16-20 fellowship spots a year. This means essentially 1/4 Peds Fellows are going to CHOP or Boston Children's. Hard to call yourself elite when you accept 25% of applicants nationwide.

If you talk to faculty around the country- most will say that at best there are 70-75 pure pedi jobs that become available each year. So this means that a full 50% of graduates will not work in pure Peds. Oh, and this doesnt even touch on the fact that programs feel that we should be producing 200+ pedi anesthesiologists per year.

Fellows are cheap labor, so I can see why a high volume prestigious programs (ahem CHOP and BCH) would unapologetically take a high amount of fellows. But it seems there needs to be a national discourse over the number of spots offered and whether people should be pursuing this fellowship at all.

I'm nervous moving forward about finding a pure pedi job. I've already had some people advise me to add on a Peds CV year to make sure I get a job. I know some of the gripping about jobs more reflects geography (EG if you move to Nebraska you can find a pure pedi Job). But wanted to get people's thoughts?

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[psychbender]

So, if they think there are only 70-ish pure peds jobs opening each year, why is it that they want to churn out 200+ fellows each year? I mean, I know the obvious answer (cheap labor), but do they have an official justification for their position? Do they have a sense that there is still a high demand (like 130+ positions per year nationally) for 50% peds practice out in the private sector? I admit, I am not really familiar with the peds anesthesia market, aside from some general academic center sentiments (wanting fellowship to be two years, and all fellows to pursue some subspecialty training or research).

Those match numbers seen like peds is on par with CCM for competitiveness. Pretty much any resident with a pulse can get a spot at a CCM fellowship, but most will not get an anes-CCM job. Our fellows are more spread out, though, with usually no more than ten graduating from a single program (out of, I think 130ish graduates) each year. Many programs seem to actually only have one to three fellows, even if approved for five or more.

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[ToKingdomCome]

Yup this seems like CCM in terms of competitiveness and also Job wise

 

[Mikkel]

So, if they think there are only 70-ish pure peds jobs opening each year, why is it that they want to churn out 200+ fellows each year? I mean, I know the obvious answer (cheap labor), but do they have an official justification for their position? Do they have a sense that there is still a high demand (like 130+ positions per year nationally) for 50% peds practice out in the private sector?

Fellowships do more of a disservice to residents who need strong subspecialty training than actually addressing a supposed nationwide need for super specialized anesthesiologists. Every fellowship position takes cases away from a regular resident.

I think it makes sense for the academics to push the fellowships, since the more fellows you have, the more residents will feel like they need the extra training to feel competent in basic stuff like peds, who will then fill those fellowships in a feedback cycle.

It's diabolical.

 

[skankhunt42]

So, if they think there are only 70-ish pure peds jobs opening each year, why is it that they want to churn out 200+ fellows each year? I mean, I know the obvious answer (cheap labor), but do they have an official justification for their position?

I think no one feels that 200+ is appropriate. Its just 2-3 big 'prestigious' programs are not blinking and taking an obscene amount of Fellows each. Hey- it beats hiring CRNAs. In the meanwhile, the smaller mid market type of programs (2-4 spots) aren't getting filled and are likely going to have to shut down. It wouldn't suprise me if in 5 years if Peds is still a match you see basically only fellowships at the 8 largest Peds centers in the nation. Don't know if thats good- but thats the way it is going.....

 

[skankhunt42]

Fellowships do more of a disservice to residents who need strong subspecialty training than actually addressing a supposed nationwide need for super specialized anesthesiologists. Every fellowship position takes cases away from a regular resident.

Couldn't agree more....we have moved into an era where to do a TNA or ear tube these programs will try to convince you you need to be a Pediatric Anesthesiologist. A lot of this is reflecting aggressive expansion by Pediatric hospitals to soak up the bread and butter Peds stuff. If you are in a moderate sized city, any little procedure (even a 10 y/o getting an appendectomy) is done at a Peds facility. Its interesting how this has trickled into fellowship programs. Where I trained for residency, the pediatric anesthesia faculty would sit and describe the 'art' of a high turnover ENT room. Granted they are fast at it (because its 80% of their volume. But I thought Pedi Fellowships were for the TEF's and Omphaloceles in newborns..... Not the art of doing 10 ear tubes in a day.....

 

[nimbus]

I don’t have first hand knowledge of any peds programs but the training is what makes a program elite, not the selectivity. If they have enough volume and case complexity to provide an educational experience to all the fellows, that is what matters. Seems to me like it would be better for a few “elite” programs to train the bulk of pediatric sub specialists and for the lesser programs to just close up shop.

 

[skankhunt42]

If they have enough volume and case complexity to provide an educational experience to all the fellows, that is what matters. Seems to me like it would be better for a few “elite” programs to train the bulk of pediatric sub specialists and for the lesser programs to just close up shop.

I hear you but don't 100% agree. I always tried to look at it in terms of fellows per procedure. As someone who just did the tour of all these places, if you do the case #/ fellow math the big prestigious places actually look the worst. A lot of the 2-4 fellow size places actually had the most cases per fellows.

Even this math can get goofy. One place I interviewed at said they had something like 100,000 anesthetics per year...but they were including two affiliated hospitals that the fellows never rotate at! When I specifically asked the new figure was 50,000 at the hospital I would be at. I punched the math and it was average for all programs.... I ranked that program last lol.

 

[deleted171991]

Yup this seems like CCM in terms of competitiveness and also Job wise

This seems like CCM plus anesthesia. There are a ton of 100% CCM jobs out there.

 

[HalO'Thane]

I for one would love to see the number of available pediatric anesthesia fellowship spots drop dramatically. When you have that many unfilled spots it means that you guaranteed to have poorly qualified candidates going into the field who might choose the fellowship route because they may not be very good at anything else. That will not be good for the field long-term. There has been an explosion of fellowship spots over the past 15 years without a proportional increase in complex, specialty level cases. This has been driven purely by greed and shortsightedness on the part of program directors and Children’s Hospital’s.

Most of the surgical fields seem to keep a very small number of pediatric fellowship spots and tend to attract the best of the best and only the people that really want to be there. I’m not sure why pediatric anesthesia should be the opposite of that.

My advice to fellowship applicants: Be open to doing a mixed practice. If you have to be in a specific geographical region then I would suggest studying the job market in that area before jumping into a fellowship as your prospects may actually be better if you are a generalist. If you absolutely want to work in a Children’s Hospital you should probably plan to subspecialize further to increase your marketability. This can include either peds cardiac, pediatric chronic pain, or pediatric acute pain/regional.

 

[CubsDynasty]

I've seen many, many people in recent years use peds as a means to an end to go to a desirable location or practice more than anything. Most seem to go after the match when they have difficulty with the job market, and then end up only doing a mixed practice. If a job at Children's Hospital USA is desired it seems to be more important that you have a bigger name behind you and/or that you have that second fellowship.

 

[PieOHmy]

All the comments above are spot on.
The fellowship craze is doing a disservice to everyone.
I do cover a large hospital where I take all comers and did not do a fellowship .
fellowship is for suckers who have no confidence in themselves in my opinion

 

[deleted126335]

All the comments above are spot on.
The fellowship craze is doing a disservice to everyone.
I do cover a large hospital where I take all comers and did not do a fellowship .
fellowship is for suckers who have no confidence in themselves in my opinion

 

[skankhunt42]

fellowship is for suckers who have no confidence in themselves in my opinion

So I guess you could do that TEF in a 5 day old at a general hospital?

Like I said above, a lot of this has been fueled by Pediatric Hospitals convincing the world that a healthy 15 y/o boy with a small tear in his meniscus needs to be done at Boston Children's. As such, you should have a pediatric Anesthesiologist doing this case- which would be about as easy as it gets.

Still, there is much pathology out there that is best done by fellowship trained pediatric anesthesiologists. EG- any patient under 2 years of age should not be touched by a generalist.....

 

[deleted162650]

EG- any patient under 2 years of age should not be touched by a generalist.....

You’re joking right?

 

[Mman]

EG- any patient under 2 years of age should not be touched by a generalist.....

🤣

It takes that extra year of fellowship to hold that mask with the sevo for a healthy 18 month old getting ear tubes!

I'd suggest people doing pediatric fellowships take jobs that include taking care of adults. The idea (popular in academics) that you can only take care of teeny little premies is just bizarre. You can do regular adult anesthesia in addition to pediatrics. It's the best of both worlds because it pays way more.

 

[Mikkel]

I've seen many, many people in recent years use peds as a means to an end to go to a desirable location or practice more than anything. Most seem to go after the match when they have difficulty with the job market, and then end up only doing a mixed practice. If a job at Children's Hospital USA is desired it seems to be more important that you have a bigger name behind you and/or that you have that second fellowship.

I've said it in other fellowship threads, but I'll say it again.

Those "coveted" location jobs at whatever subspecialty hospital tend to be far worse than what you can get in other areas as a generalist.

Why? The employers have the upper hand... the labor market is in their favor. If you don't accept their garbage salary, they'll tell you to take a hike, because they'll definitely find some other sucker to take that crap job.

Be careful what you ask for with a fellowship, because you could end up far worse in the long run.

 

[Southpaw]

EG- any patient under 2 years of age should not be touched by a generalist.....

yeah that’s crazy...

most of what you said before the quoted statement sounds good, but you just need to follow the money and you’ll have the answers.

 

[dchz]

I've said it in other fellowship threads, but I'll say it again.

Those "coveted" location jobs at whatever subspecialty hospital tend to be far worse than what you can get in other areas as a generalist.

Why? The employers have the upper hand... the labor market is in their favor. If you don't accept their garbage salary, they'll tell you to take a hike, because they'll definitely find some other sucker to take that crap job.

Be careful what you ask for with a fellowship, because you could end up far worse in the long run.

I noticed you said in OTHER areas. That's not saying much. Anyone could live in BFE and make money because the supply of anesthesiologists are so low.

What about in the same "coveted" locations as generalists? They are generally better, right? So given the same geographical locations, there are some fellowships worth doing.

I definitely agree there is an over supply of Peds fellowships. However, from our previous conversations i get the feeling that you think the best jobs are the ones in BFE and anyone trying to live in a big city don't see the big picture. I definitely don't agree with that sentiment.

Geograhpically equal, most fellowships gets you SOME advantage over generalists. Some advantages aren't worth the extra year lost in income. So some people definitely could end up worse by doing a fellowship.

But if the choices are do fellowship and gain a little advantage in coveted area or move to BFE. A lot of people rather do fellowship than move to BFE.

 

[Mikkel]

I noticed you said in OTHER areas. That's not saying much. Anyone could live in BFE and make money because the supply of anesthesiologists are so low.

What about in the same "coveted" locations as generalists? They are generally better, right? So given the same geographical locations, there are some fellowships worth doing.

I definitely agree there is an over supply of Peds fellowships. However, from our previous conversations i get the feeling that you think the best jobs are the ones in BFE and anyone trying to live in a big city don't see the big picture. I definitely don't agree with that sentiment.

Geograhpically equal, most fellowships gets you SOME advantage over generalists. Some advantages aren't worth the extra year lost in income. So some people definitely could end up worse by doing a fellowship.

But if the choices are do fellowship and gain a little advantage in coveted area or move to BFE. A lot of people rather do fellowship than move to BFE.

Sure, there are advantages to doing a fellowship so you can get a job over a generalist in saturated labor markets.

I would discourage trying to go to those markets after training because the pay will be low and cost of living high.

I would also stay clear of BFE, because the payor mix tends to be poorer. Well off major urban areas otherwise not desirable are the ideal.

 

[somedumbDO]

So I guess you could do that TEF in a 5 day old at a general hospital?

Like I said above, a lot of this has been fueled by Pediatric Hospitals convincing the world that a healthy 15 y/o boy with a small tear in his meniscus needs to be done at Boston Children's. As such, you should have a pediatric Anesthesiologist doing this case- which would be about as easy as it gets.

Still, there is much pathology out there that is best done by fellowship trained pediatric anesthesiologists. EG- any patient under 2 years of age should not be touched by a generalist.....

Now for simple ear tubes I wouldn’t agree, but look at the recommendations from SPA they advocate for peds for kids 2 and younger to be done by peds anesthesia. Heck, look at peds surgery society and peds Uro surgery they recommend less than 5 yr old kids be preformed by peds Anesthesia. Your license your choice but if something happens intra/post and a generalist didn’t differ to peds anesthesia when either available or even in adjacent hospital good luck w the jury. No matter how good my residency was I am not taking back a AVR/MVR for surgery, or covering the ICU overnight.

 

[IlDestriero]

I don’t have first hand knowledge of any peds programs but the training is what makes a program elite, not the selectivity. If they have enough volume and case complexity to provide an educational experience to all the fellows, that is what matters. Seems to me like it would be better for a few “elite” programs to train the bulk of pediatric sub specialists and for the lesser programs to just close up shop.

I agree with this position. Marginal and/or small programs should probably contract and/or close if necessary, and if the Boston Children’s of the world can train 12 or more fellows and provide them with superior training and case load then they probably should continue to do so.
It’s interesting that my Google-fu let me down and it wasn’t obvious where to see how many fellows are approved in each class at various big name programs. Going to the program’s sites didn’t reveal that data either in a cursory search.
Many of our peds fellows don’t want 100% peds jobs. I wouldn’t have done the fellowship if I wasn’t planning on an exclusively peds job.
The major centers keep expanding and expanding and sucking up more of the peds market and there are still long waits, etc. I’m not sure what’s driving that change. For example, Atlanta Children’s is building a new hospital that will pretty much double the size of the hospital. They wouldn’t be building it if they didn’t expect to fill it. So wait a couple years, do the fellowship, and apply there. 😉

 

[Southpaw]

Now for simple ear tubes I wouldn’t agree, but look at the recommendations from SPA they advocate for peds for kids 2 and younger to be done by peds anesthesia. Heck, look at peds surgery society and peds Uro surgery they recommend less than 5 yr old kids be preformed by peds Anesthesia. Your license your choice but if something happens intra/post and a generalist didn’t differ to peds anesthesia when either available or even in adjacent hospital good luck w the jury. No matter how good my residency was I am not taking back a AVR/MVR for surgery, or covering the ICU overnight.

should you be doing regional, epidurals, or neuro cases? Would you think it reasonable if these respective anesthesia subspecialty societies stated their procedures/cases should only be done by fellowship trained physicians? What about if some ortho society claimed regional should only be performed by fellowship trained physicians?

 

[Mman]

Now for simple ear tubes I wouldn’t agree, but look at the recommendations from SPA they advocate for peds for kids 2 and younger to be done by peds anesthesia. Heck, look at peds surgery society and peds Uro surgery they recommend less than 5 yr old kids be preformed by peds Anesthesia. Your license your choice but if something happens intra/post and a generalist didn’t differ to peds anesthesia when either available or even in adjacent hospital good luck w the jury. No matter how good my residency was I am not taking back a AVR/MVR for surgery, or covering the ICU overnight.

standard of care (at least where I practice) says those cases do not require pediatric anesthesiologist. I mean hell it's only been a board certified specialty for what, 2 years now?

 

[dannyboy1]

Seems that it is practice specific. I did a decent amount of peds in residency but joined a practice where everything 12 and under gets the peds guys. I would feel a bit apprehensive even doing the healthy 18 month old tonsil. It’s been a while....

 

[skankhunt42]

You’re joking right?

Ah yes, everyone cited the old 18 month old getting ear tubes....

How about a 2 year old needing nephrectomy for a wilms tumor?

I guess I agree, the easiest of peds cases probably can be done by a generalist. But broadly speaking, the younger the more benefit having a Peds Anesthesiologist.

I'm not for this fellow driven garbage. Ear tubes and TNAs can and should be done by everyone. But I do feel at a certain point there is a role for the Pedi Anesthesiologist.

 

[Mman]

Ah yes, everyone cited the old 18 month old getting ear tubes....

How about a 2 year old needing nephrectomy for a wilms tumor?

I guess I agree, the easiest of peds cases probably can be done by a generalist. But broadly speaking, the younger the more benefit having a Peds Anesthesiologist.

I'm not for this fellow driven garbage. Ear tubes and TNAs can and should be done by everyone. But I do feel at a certain point there is a role for the Pedi Anesthesiologist.

you are the one that said every case under 2 needs a peds anesthesiologist. By volume, I bet 90% of cases in the country under 2 are BMT, frenulectomy, adenoids, tonsils, circumcisions on ASA 1 patients.

Sure, the 650 g bedside ex-lap in the NICU could use a peds anesthesiologist. But the vast majority of "pediatric" cases are completely healthy kids having minor procedures that board certified anesthesiologists are qualified to care for. Sick patients, weird syndromes, and major surgeries can benefit from the pediatric anesthesiologist.

 

[IlDestriero]

you are the one that said every case under 2 needs a peds anesthesiologist. By volume, I bet 90% of cases in the country under 2 are BMT, frenulectomy, adenoids, tonsils, circumcisions on ASA 1 patients.

Sure, the 650 g bedside ex-lap in the NICU could use a peds anesthesiologist. But the vast majority of "pediatric" cases are completely healthy kids having minor procedures that board certified anesthesiologists are qualified to care for. Sick patients, weird syndromes, and major surgeries can benefit from the pediatric anesthesiologist.

When you’re at the mecca you think all peds cases are Asa 3+ because that’s what you see every day. Ironically the fellows lose out on the asa1 tubes and tonsils because they’re doing the Cranis, NICU abdominal catastrophe ex laps, airway disasters, etc.

 

[WholeLottaGame7]

Now for simple ear tubes I wouldn’t agree, but look at the recommendations from SPA they advocate for peds for kids 2 and younger to be done by peds anesthesia. Heck, look at peds surgery society and peds Uro surgery they recommend less than 5 yr old kids be preformed by peds Anesthesia. Your license your choice but if something happens intra/post and a generalist didn’t differ to peds anesthesia when either available or even in adjacent hospital good luck w the jury. No matter how good my residency was I am not taking back a AVR/MVR for surgery, or covering the ICU overnight.

Yeah it's not just anesthesia pushing these requirements. A lot of children's hospitals are angling for this new level 1 pediatric surgery verification process that has a lot of requirements, including requiring 2 and under being cared for by a pediatric anesthesiologist and recommending it for 5 and under.

 

[WholeLottaGame7]

All the comments above are spot on.
The fellowship craze is doing a disservice to everyone.
I do cover a large hospital where I take all comers and did not do a fellowship .
fellowship is for suckers who have no confidence in themselves in my opinion

We've got a generalist or two who have tons of confidence in taking care of kids, unfortunately confidence alone is not the only prerequisite for good patient care. One probably has as many unplanned PICU admissions from our ASC as most of our peds attendings do from all locations, despite doing way less kids and mostly ASA 1s/2s.

I'd rather have a colleague who recognizes their limitations and can defer to a better trained colleague if available, rather than hurt people out of a fragile ego.

 

[WholeLottaGame7]

Those comments said, right now there are way too many peds fellowship spots, and SPA needs to grow some balls and limit the number to be commensurate with demand.

 

[deleted162650]

I don’t even know why we have peds fellowships. They’re just little adults.

 

[nimbus]

I don’t even know why we have peds fellowships. They’re just little adults.

Yeah we just need little anesthesiologists to take care of the little adults. Problem solved. Mini surgeons too.

 

[ambiturner]

There are data, although old, that suggest there are less airway complications when children are taken care of by pediatric anesthesiologists.

there are also newer data that cardiac complication rates in children increase as faculty non-clinical time increase.

so your best bet is to have your kid taken care of by a pediatric anesthesiologist who does no research!

 

[DM27]

My anecdotal experience through colleagues and residents who have come through is that there is overall a lack of enthusiasm for pediatrics as a fellowship for the following reasons (some of these are being repeated from above).

1) Not enough true peds-anesthesia jobs out there
2) Pay for pediatric anesthesia can be situationally less competitive or even with pure generalist salaries
3) If you end up not doing/getting peds as a job for whatever reason the skills gained are felt to be less applicable to a generalist job than cardiac/icu/regional so it doesn't serve as an especially useful "backup" if things don't shake out well job-wise
4) At places where you do get a peds job you are more likely to be pigeonholed into doing just peds

These are by no means true or verified reasons, but they are the main reasons residents who have come through our program have given as to why they are no longer considering peds if they initially were. I can see some merit/logic behind these arguments and it is somewhat reflected in what graduated colleagues who have peds exposure have said. We used to produce a large amount of residents who went into peds fellowships and it has bottomed out from 4-6 a year to closer to 0-2 with no change in our peds experience.

I do a lot of cardiac so I work one-on-one often with CA-2s and again with late CA-3s and whenever we talk about prospective fellowships (CA-2s) or eventual fellowship decisions (CA-3s) this is where I hear these reasons repeated over and over again.

 

[mmag]

Why are there so few high acuity pure pedi jobs available? Most major pediatric centers have CRNAs who do peds in a low supervisory ratio. CHOP alone has 23 CRNAs. More programs are hiring CRNAs for Pedi cardiac cases (Lurie, UCSF, etc). If the reason we need CRNAs is because there's a shortage of anesthesiologists, couldn't all those practices convert to physician only with improvement in patient care?

 

[somedumbDO]

should you be doing regional, epidurals, or neuro cases? Would you think it reasonable if these respective anesthesia subspecialty societies stated their procedures/cases should only be done by fellowship trained physicians? What about if some ortho society claimed regional should only be performed by fellowship trained physicians?

Listen I get it slippery slope phenomenon, where do you draw the line? I get the argument for proficiency, But there has to be a Iine drawn somewhere. There’s not a lot of generalist that are lining up to do even inguinal hernia cases on kids that are X 24 week preme, And those are the easy cases.

 

[dhb]

In France recommandations are for a pedi trained anesthesiologist to care for kids under the age of 1, which makes sense imho.

 

[PieOHmy]

i dont wanna do ANY kids. 2, 4 6 less than 1... none of them. I dont like kids, and they dont like me..

 

[deleted162650]

i dont wanna do ANY kids. 2, 4 6 less than 1... none of them. I dont like kids, and they dont like me..

I get the feeling most adults don’t like you either.

 

[skankhunt42]

It really will be interesting to see how fellowships react to this environment. Clearly spots need to be retracted, but I have a felling CHOP and BCH will continued unabashed. Hopefully I won't regret this path but when I'm doing 50% healthy kids in Topeka Kansas....I'll definitely be wondering if my fellowship year was worth it. 😵

 

[austintr]

It really will be interesting to see how fellowships react to this environment. Clearly spots need to be retracted, but I have a felling CHOP and BCH will continued unabashed. Hopefully I won't regret this path but when I'm doing 50% healthy kids in Topeka Kansas....I'll definitely be wondering if my fellowship year was worth it. 😵

Topeka's not bad, but I'd move a bit further east to Lawrence or somewhere closer to KC. Fewer stabbings per capita, less meth for the most part. Better food, nicer houses.

 

[AdmiralChz]

Yeah the drop-off in competitiveness in Peds Fellowship has been fairly surprising. As people have said the top programs with heavy sick/young/specialized care are going to always be competitive but the smaller programs with not much to differentiate are having trouble filling.

It wasn't even 1-2 years ago that the pediatric fellowship directors came up with a highly ill-advised plan to covert the fellowship into a mandatory 2-year program with subspecialty offerings (pain, CV, regional). Given the jobs out there for such are pretty rare and don't pay an inordinate amount more than generalist ones (and often pay less for more work because... academics!), this would have been disastrous for the specialty. One can wonder if the push to have pediatric folks cover all "kids" less than 12 or so an attempt to artificially inflate their own demand... cynical for sure, but it certainly is possible.

 

[nimbus]

One can wonder if the push to have pediatric folks cover all "kids" less than 12 or so an attempt to artificially inflate their own demand... cynical for sure, but it certainly is possible.

It’s a self fulfilling prophecy because a generalist who continues to take care of kids straight out of residency will remain comfortable taking care of kids. One who doesn’t take care of any babies for 10 years will lose that competence. We don’t take care of any kids at my hospital so one of the major reasons that I go on medical mission trips is to maintain some basic competence taking care of kids and babies. Who knows what the future holds.

 

[ambiturner]

Why are there so few high acuity pure pedi jobs available? Most major pediatric centers have CRNAs who do peds in a low supervisory ratio. CHOP alone has 23 CRNAs. More programs are hiring CRNAs for Pedi cardiac cases (Lurie, UCSF, etc). If the reason we need CRNAs is because there's a shortage of anesthesiologists, couldn't all those practices convert to physician only with improvement in patient care?

Those practices leverage attendings with CRNAs for easy rooms that generate revenue and will supervise CRNAs and trainees 1:1 for high morbidity cases (cardiac, neonates). Thus adding cardiac CRNAs is to gain extra hands rather than supervise at high ratios (or if you’re cynical, to free up attendings to sit in their offices on cath/EP days).

 

[deleted162650]

I go on medical mission trips is to maintain some basic competence taking care of kids and babies.

That’s smart. Nobody really cares if you knock off some 3rd world kid. 😉

 

[nimbus]

That’s smart. Nobody really cares if you knock off some 3rd world kid. 😉

It’s a bigger deal if you knock one off there. You never get invited back.

 

[deleted162650]

It’s a bigger deal if you knock one off there. You never get invited back.

Where do you go? With what org?

 

[nimbus]

Where do you go? With what org?

I’ll PM

 

[dchz]

Ah yes, everyone cited the old 18 month old getting ear tubes....

How about a 2 year old needing nephrectomy for a wilms tumor?

I guess I agree, the easiest of peds cases probably can be done by a generalist. But broadly speaking, the younger the more benefit having a Peds Anesthesiologist.

I'm not for this fellow driven garbage. Ear tubes and TNAs can and should be done by everyone. But I do feel at a certain point there is a role for the Pedi Anesthesiologist.

Enlighten my ignorance. What skills are required in the wilms tumor case besides a volume line of some sort.