Why are there no Osteopathic Pediatric Surgery residencies/fellowships

[medicine1]

I was looking through the "Opportunities" list through the AOA, but I cannot find any pediatric surgery residency/fellowship programs listed.
http://do-online.osteotech.org/pdf/sir_opplist.pdf
I am also curious as to why there are only 33 approved Pediatric Surgery Fellowships in the United States? And most programs only take one or two residents per year to every other year. I am also curious as to why Pediatric Surgery cannot have its own residency program that is 5-6 years long (analogous to neurosurgery), rather than do a 5 year general surgery/thoracic surgery program, than a 2-3 year fellowship.

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[LovelyRita]

Who knows. Probably because the powers that be believe we should not need to do surgery on the little children, that we should just do cranial instead.

 

[medicine1]

If there are anatomical structural problems that can only be fixed with surgical intervention, then how is this against our osteopathic philosophy?
There isn't. When an infant is born with structural abnormalities such as patent ductus arteriosus, intestinal intussuseption,etc., children require surgical intervention. Dr. Still had surgery as part of the original osteopathic curriculum.

 

[LovelyRita]

I know. I'm just being cranky and facetious.

 

[medicine1]

 

[medicine1]

Doc Pilot wrote the following:

Yesterday, 06:12 PM #2
Pilot Doc
Registered User
100+ Posts


Join Date: Mar 2002

Why only 33? It's a small field. The population of young children who need the services of a fellowship trained peds surgeon is very small.

Why no osteopathic? Osteopathy is a small field also, compounding the above effect. Are there any osteopathic children's hospitals with the referral area to support such a training program anyway?

Why is peds surg not its own field? Gsurg and Nsurg are VASTLY different - I can't think of any operation that both specialties perform. The peds and general surgery skill sets share MUCH in common. Keep in mind, the system is designed to benefit the programs, not the trainees. The peds surg programs get more than enough fully trained general surgeons vieing for spots. They presumably come in capable of independent operative and medical management of commonly encountered problems. Why the #$^ would training programs want to start recruiting medical students instead?
http://forums.studentdoctor.net/showthread.php?t=179518

 

[medicine1]

I have to disagree with pilot doc in many respects.
First and foremost, Neurosurgery used to only accept applicants that had already finished their general surgical residency. And yes, there are many DO children's hospitals to date, with referral hospitals in the near vicinity. Pediatric surgeons are scarce, and we need more of them. I know of too many children dying because there are too few pediatric surgeons around. I really hope to see a further push for a five-six year pediatric surgery residency program in the near future.

 

[EMTLizzy]

I have to disagree with pilot doc in many respects.
First and foremost, Neurosurgery used to only accept applicants that had already finished their general surgical residency. And yes, there are many DO children's hospitals to date, with referral hospitals in the near vicinity. Pediatric surgeons are scarce, and we need more of them. I know of too many children dying because there are too few pediatric surgeons around. I really hope to see a further push for a five-six year pediatric surgery residency program in the near future.

Pilot made a very valid point. Consider the total number of DO specialists. There more more primary care DO's than specialists because of the DO focus on primary care.

Yes, there is a need for pediatric surgeons but the AOA needs be sure that the GME programs available for those in primary care and general surgery are of the highest quality before adding new subspecialties.

Quantify "many". There are far from "many" childrens osteopathic hospitals in the country. And exactly how many children do you personally know who are in need of a pediatric surgeon that this has become such a crusade for you?

 

[OSUdoc08]

I was looking through the "Opportunities" list through the AOA, but I cannot find any pediatric surgery residency/fellowship programs listed.
http://do-online.osteotech.org/pdf/sir_opplist.pdf
I am also curious as to why there are only 33 approved Pediatric Surgery Fellowships in the United States? And most programs only take one or two residents per year to every other year. I am also curious as to why Pediatric Surgery cannot have its own residency program that is 5-6 years long (analogous to neurosurgery), rather than do a 5 year general surgery/thoracic surgery program, than a 2-3 year fellowship.

Because there isn't a need for that number of graduates at the current time. If the demand of such physicians rises, then perhaps that will change. Since D.O. applicants are eligible to apply for ACGME programs, there is no incentive to open more programs, since the demand is not there.

 

[medicine1]

UMNDJ-SOM has pediatric surgery as part of its curriculum for Surgery residents. I am glad to see this. I will try to find more programs.
The AOA currently recognizes 15 children's hospitals/centers for internship/residency programs in pediatrics that include ped. surg. in the curriculum, but nothing specific about fellowship training in particular.

Why am I on a mission? I find Ped. Surg. a calling, and will continue to pursue this issue.

National SIDs and Infant Death Report:

Infant Mortality (highlights from the Centers for Disease Control and Prevention, National Vital Statistics Reports, Volume 52, Number 2, "Infant Mortality Statistics from the 2001 Period Linked Birth/Infant Death Data Set," Sept. 15, 2003)

The infant mortality rate in the United States is 6.8 infant deaths per 1,000 live births. In 2001, infant deaths totaled 27,523.
The three leading causes of infant death are congenital malformations, low birthweight, and SIDS; together these accounted for 44 percent of all infant deaths in 2001.
Between 1995 and 2001, the overall U.S. infant mortality rate fell by over 10 percent. Recent progress in reducing the number of SIDS deaths has highlighted the role played by behavioral and environmental risk factors in infant mortality. For example, mortality rates are generally higher for infants whose mothers are unmarried or who smoked during pregnancy. Infant mortality is also higher for male infants, multiple births, and infants who are born preterm or at low birthweight.
Birthweight and period of gestation are the two most important predictors of an infant's health and survival. Infants born too small or too soon have a much greater risk of death and both short-term and long-term disability than those born at term (37-41 weeks of gestation) or with birthweights of 2,500 grams or more.

In the year 2000, the 10 leading causes of death for infants under one year old in the U.S. were:

1. Congenital Anomalies 5,743
2. Short Gestation 4,397
3. SIDS 2,523
4. Maternal Pregnancy Complications 1,404
5. Placenta Cord Membranes 1,062
6. Respiratory Distress 999
7. Unintentional Injury 881
8. Bacterial Sepsis 768
9. Circulatory System Disease 663
10. Intrauterine Hypoxia 630
(Source: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, "10 Leading Causes of Death, United States: 2000, All Races, Both Sexes")

http://www.sidsprojectimpact.com/pages/5/

 

[Gerota]

First of all- you probably need to get further along in your medical education- as you seem a little misguided.

1) Most surgery programs have rotations in peds surgery, at least any respectable one.

2) Neurosurgery and general surgery have nothing in common. Whereas half of pediatric surgery crap is bowel surgery. General surgeons dont know anything about neurosurgery, where there is any trauma patient that comes in, the Gsurg trauma team handles any injury - whether it be a GSW to the heart or a vascular injury...except NEUROSURGICAL TRAUMA. The brain is a whole different entity

3) Your data about causes of death in children- what the hell does that have to do with anything. Just because kids die from congenital abnormalities doesnt mean there werent enough peds surgeons to save them! A lot of children with Birth defects have genetic syndromes plus some conditions Tertology of fallot, Transpositions etc, duodenal atresia, TE fistulas- are very serious and can have high mortality.

Most peds surgeons arent that busy- at least the ones at my program, my friends surgery program, and at my medical school. There isnt enough cases to go around as is buddy.

Get your facts straight.

 

[medicine1]

There are different types of pediatric surgeons, and not just general ped. surgeons. There are ped. neuro. surg., ped. otolarygology surg., Ped. cardiovascular surg., ped. thoracic/pulmonary surg., ped. plastic surg., ped. orthopedic surg., etc.(http://www.guideline.gov/summary/summary.aspx?ss=14&doc_id=3420&string= )
Pediatric surgery is a broad field. Perhaps your friend needs to relocate.
I personally know 10 children who have died with congenital heart defects that might have been helped with with a pediatric cardiovascular surgeon.
Yes there are ped. surgery rotations, but are there any residencies/fellowships offered at Osteopathic Hospitals?
And if there are, does anybody know where and which osteopathic hosptals have these programs?
My data on children's deaths reflect that there is a need for more research and residency/fellowship training to help children with a myriad of surgical needs.

 

[DO_Surgeon]

There are different types of pediatric surgeons, and not just general ped. surgeons. There are ped. neuro. surg., ped. otolarygology surg., Ped. cardiovascular surg., ped. thoracic/pulmonary surg., ped. plastic surg., ped. orthopedic surg., etc.(http://www.guideline.gov/summary/summary.aspx?ss=14&doc_id=3420&string= )
Pediatric surgery is a broad field. Perhaps your friend needs to relocate.
I personally know 10 children who have died with congenital heart defects that might have been helped with with a pediatric cardiovascular surgeon.
Yes there are ped. surgery rotations, but are there any residencies/fellowships offered at Osteopathic Hospitals?
And if there are, does anybody know where and which osteopathic hosptals have these programs?
My data on children's deaths reflect that there is a need for more research and residency/fellowship training to help children with a myriad of surgical needs.

Most DO programs do have rotations in peds surgery. I know for a fact that Grandview in Dayton, does three months of peds surgery at Childrens during their third year. Doctors in Columbus does a couple of months at the childrens hospital which has an ACGME peds fellowship. Mercy in Des Moines was sending their residents to Childrens in Dayton, but now they are keeping them in house and working with a new peds surgeon that just started.

The reason why there are no DO peds fellowships is most likely do to the fact that there probably hasnt been a DO go through a program. In order to the AOA to grant a residency or fellowship there must be a board certified DO in that field to become the director of the program. Peds surgery is extremely competitive just do to the fact there are so few spots each year. I have met several MD residents that told me that they would like to pursue peds but didnt have the resume to get into any of the fellowships. And as I have said many times, the surgery world is still an uphill battle for DO's. It would be very difficult (not impossible) for a DO to slide in and take one of the few precious spots in a peds fellowship.

Some of the subspecialties do not require a peds surgery fellowship first. I believe Peds CT is GS residency, CT fellowship, and then additional Peds CT fellowship (10+ years of training). Keep in mind that many of the peds neuro, ct, ent, etc are at large academic insitutions where DOs tend not to be found. The ones that are out in "private" practice at various childrens hospitals, etc tend to be the ONLY peds CT surgeon, etc so call and the lifestyle wouldn't be the greatest.

When I interviewed for GS, Dr. Reed at Mercy in Des Moines told me that they have had graduates enter all areas of surgery subspecialty with the exception of peds. The competition is high, but if that is truely your calling, then go for it! I have no idea what year you are in your medical training, but my advice would be to try to get into a ACGME GS residency that has one of the few peds fellowships and work your ass off. Don't wait and hope for a peds fellowship to come from the AOA because I highly doubt that will come.

 

[Gerota]

"There are different types of pediatric surgeons, and not just general ped. surgeons. There are ped. neuro. surg., ped. otolarygology surg., Ped. cardiovascular surg., ped. thoracic/pulmonary surg., ped. plastic surg., ped. orthopedic surg., etc."

YOUR INVESTIGATING IS AMAZING! THANKS FOR THE LESSON! FYI THREE OF THOSE CATEGORIES ALL TRAINED VIA G SURGERY TO GET THERE. PLUS MOST PEDS G SURGEONS ARE TRAINED TO DO ALMOST EVERYTHING EXCEPT NEURO AND CV. PEDS THORACIC SURGERY???? AS I AM ROTATING THROUGH THORACIC NOW- I HAVE NEVER EVER HEARD OF A PEDIATRIC THORACIC SURGEON!!

"Pediatric surgery is a broad field. Perhaps your friend needs to relocate."

AS I HAVE TRAINED IN NYC AND LOS ANGELES AND KNOW THE OR SCHEDULES AT BOTH MY INSTITUTIONS I CAN ASSURE YOU THAT EVEN AT HIGH POWERED ACADEMIC TERTIARY CENTERS- THE PEDS ATTENDINGS DON'T COME CLOSE TO HAVING A BUSY SCHEDULE LIKE THEIR ADULT COUNTERPARTS.

I personally know 10 children who have died with congenital heart defects that might have been helped with with a pediatric cardiovascular surgeon.

ARE YOU SURE AN INTERVENTION WAS INDICATED OR PROVEN TO IMPROVE OUTCOME. THAT IS A SHAME IF WERE UNABLE TO HAVE AN INTERVENTION. MANY OF THE CONGENITAL HEART DEFECTS NEED TO BE TREATED AT TERTIARY REFERAL CENTERS AND CHILDREN NEED TO BE PLACED ON ECHMO BYPASS. MAYBE THE ISSUE WAS TIME TO GET TO THESE CENTERS?

"My data on children's deaths reflect that there is a need for more research and residency/fellowship training to help children with a myriad of surgical needs."

RESEARCH - SURE THAT WOULD BE GREAT, BUT THAT ENTAILS GENETIC TESTING AND UNDERSTANDING HOW TO PREVENT THESE DEFECTS (FOLATE SUPPLEMENTS IN PREGNANCY ETC). YOUR DATA DOES NOT PROVE ANYTHING, FYI- IF YOU FIND A PEER REVIEWED ARTICLE REGARDING THE LACK OF PEDIATRIC SURGEONS CAUSING THESE DEATHS- I WOULD BE VERY INTERESTED. JUST SHOWING NUMBERS REGARDING DEATHS CONTRIBUTED TO CONGENITAL ANOMALIES DOES NOTHING FOR YOUR ARGUMENT.

I CANT SAY COMMENTS ON DO SURGERY PROGRAMS, AS I AM MD AND TRAIN AT ALLOPATHIC SURG PROGRAM- HOWEVER I HAD MANY FRIENDS AT NYCOM WHO WERE SUPERSTARS- I AM SURE WITH HARD WORK THEY COULD BE COMPETITIVE FOR PEDS SURGERY PROGRAMS AND OVERCOME ANY STEROTYPES.

 

[Elysium]

Um, I think it's great that you're on a crusade and all, but probably you should actually finish your basic sciences before you get all worked up about the lack of ped surgery fellowships. I promise that if there was a dire need for these types of surgeons that both the AOA and AMA would ensure that these children were being treated. There really isn't a conspiracy at work, I swear. I think it's just a field that's small secondary to the general lack of need.

 

[medicine1]

Dr Michael Allshouse,D.O. is a Pediatric Surgeon!!!
Professor
Director, Division of Pediatric Surgery at East Tennessee State University’s James H. Quillen College of Medicine and ETSU Physicians and Associates.
http://com.etsu.edu/default.asp?V_DOC_ID=1304

 

[medschoolsoon]

Dr Michael Allshouse,D.O. is a Pediatric Surgeon!!!
Professor
Director, Division of Pediatric Surgery at East Tennessee State University's James H. Quillen College of Medicine and ETSU Physicians and Associates.
http://com.etsu.edu/default.asp?V_DOC_ID=1304

I know this is an old thread, but I came across this name and this is the DO that I shadowed with and wrote my letter. He is an AMAZING doctor and what finally sold me on the DO profession. He also emphasized that specialties were a great possibility with hard work. He is now the residency director at the children's hospital in Denver (which is one of the top 10 children's hospitals in the country). He's also a professor of general surgery at the University of Colorado med school. If you want any more info on him, PM me.