i followed with a ped surgeon just a few days before taking my step one (i don't think it was a horrible decision). he said that it's competitive fellowship since there aren't many of them, just as the poster above has said. it's about 2 applicants per slot. however, there aren't many ped surgeons around, even in this large city of ChiTown. He had about 10 cases scheduled and wasn't going to leave till 9-10 PM at night. if there were more ped surgeons out there, his work load wouldn't be as heavy. also, he has to cover at another hospital nearby as well as take ER trauma calls at another university hospital. ped surgeons, on average, make less money than other surgical subspecialties.
the bread and butter of ped surgery training is infants with cardiac defects, but it seems most of what he ends up doing in the "real world" is older child (5-12 range) operations for inguinal hernia repairs and GI stuff like gastroschisis, biliary atresia, pyloric stenosis and imperforate ani. Very few, if any, cardiac cases unless trauma is involved.
go fig. still piqued my interest.
-s.