Will a neonatology rotation help me decide if pediatrics is for me?

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J143

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I'm trying to decide if pediatrics is for me. I didn't think I was going to like it but discovered late in my 3rd year that I seem to light up everytime I see a kid patient. Anyhow, I'm in the process of trying to set up pediatric sub I's and am trying to decide if doing a neonatology rotation will help me make my decision. Most of the Peds rotations are already filled where I am and I'm feeling like if I can't get a peds rotation that a neonatology rotation might still help me with my decision b/c at least I'd be working with babies. Any thoughts?

J143

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Granted, this is coming from only a rising 3rd year...

I spent last summer on a project in the NICU. Attended daily rounds for a month. I left with the impression neonatology was rather dissimiliar to general peds. The attendings mentioned liking taking care of sick kids as opposed to well ones, the physio and pharm, and of course working w/ babies. Neonatology is intensive care, applied to a special population. However, compared to other ICU's, the NI seemed to focus on a more focused set of problems than, say, in the PICU.

Again, please keep in mind this is only coming from a rising 3rd year; I still hope it is of some value...
 
I'm a rising 3rd year probably doing peds...

From everything I hear NICU is NOT a good introduction to peds and whether you'd like it, unless you are interested in NICU itself. It is about the hardest peds rotation during residency, and most people dread it. I was warned away from it as a clerkship in very strong terms. It is long hours and endless hours of rounding, and treating the very smallest, sickest kids you will ever see. Also, as a med student you get to do much less, because the patients are so sick and small. It is depressing watching 24 weekers fight for their lives when they are the size of your hand-try trying to do an lp on a 750 gram baby! Many of them stay for months as they are operated on/fed/given antibiotics/ECMO etc.

I realize I'm sounding really negative-I actually have spent some time in the NICU on my current rotation, and there are parts that are good-like when a kid finally goes home. But there are plenty of kids who don't make it home, and I'd hate for you to be scared away from peds by a NICU rotation, when it is for many people a few months of torture in the middle of a wonderful peds residency experience.
 
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Notstudying,

How would you compare working in the PICU to the NICU? Understand it to be somewhat "easier" workflow on a daily basis, but much, much more difficult when a patient dies (compared to the nicu).
 
I've only seen people working in both, not done it myself. From what I have seen the PICU is more like actual peds in terms of the variety of sizes and ages of patients, and the wide range of diagnoses. The hours are equally difficult. I think it is hard regardless when a patient dies-in either case there will be patients that you are almost relieved to see pass away (I know this sounds cold, but there are children in both the PICU and NICU who are so neurologically or physically devastated that it is the best thing for them, as opposed to a lifetime of invasive medical treatments with no chance for function). Then there are the kids who you think are doing fine, then bam, they crash. Had one in the NICU recently and it was really hard on everyone.

Not sure about the workflow.
 
Originally posted by J143
I'm trying to decide if pediatrics is for me. I didn't think I was going to like it but discovered late in my 3rd year that I seem to light up everytime I see a kid patient. Anyhow, I'm in the process of trying to set up pediatric sub I's and am trying to decide if doing a neonatology rotation will help me make my decision. Most of the Peds rotations are already filled where I am and I'm feeling like if I can't get a peds rotation that a neonatology rotation might still help me with my decision b/c at least I'd be working with babies. Any thoughts?

J143

It's the only peds rotation worth doing:laugh:


Seriously, it depends on the size and acuity of the NICU.
You may get significant exposure to a well- baby nursery and at least learn the newborn exam.....or you may end up following a chronic unit where most of the patients have a lot of smoldering chronic issues , or perhaps a nice busy unit in a spiffy hospital with everything in between ( like us )

The previous people that posted about the NICU being nothing representative of pediatrics are absolutely correct. It is a different world, but it is a very nice rotation where you will learn a tremendous amount, provided the rotation is good to begin with.

I have a student per week, for a 6 day rotation, and we pretty much tailor the week to whatever the student wants.
Even if you are doing peds, the scope of the rotation is too much for a 3rd year, so we make it fun and try to teach you what you need to know about newborns, to cover your shelf exam and USMLE and anything else you might to know about fluids, nutrition, ventilators, etc and I have an interest in inflammation so we cover a lot of that stuff ( unless I see you starting to fall asleep! )

The Black Colored Neonatology Spiral Notebook/ Manual ( by Gomella ) is by far the best manual for neonatology ( for a student and peds resident )
 
Hello all,

Probably the only reason I'm considering peds is because of my interest in neonatology. I've got a few questions though...What is the typical lifestyle like for a neonatologist in group practice - average weekly hours, call frequency, etc? What is the salary range? What is the current job market like and what do you think it will look like in the future? Lastly, which programs are generally regarded as the top tier in neonatology? Thanks!
 
I was also considering neonatology...how competitive is it to get in? Does one need to do a university based peds residency to be considered?
 
Originally posted by dj_smooth
I was also considering neonatology...how competitive is it to get in? Does one need to do a university based peds residency to be considered?

It's not competative at all.
At least not for some of the smaller programs.

However, if possible you should try to train at one of the bigger and better programs and these are a little bit more competative.

No a University based residency is not required.

I actually sat on our Fellowship admissions committee for 2 years, so I know the type applicant we wanted, and those that we interviewed.

Of course, if we get a candidate from a Univ program with 240 USMLE's and shining LOR's, you are heavily recruited.
However, there are not enough of these applicants to go around, and in fact a lot of slots ( even at better known programs ) are filled by FMG's , DO's and people from small peds programs with average numbers or so-so LOR's

We never took anybody that wasn't good, but we offered people interviews that I didn't feel deserved them, because sometimes people look much better in person than on paper ( it works in the opposite direction too )
 
Originally posted by jargon124
Hello all,

Probably the only reason I'm considering peds is because of my interest in neonatology. I've got a few questions though...What is the typical lifestyle like for a neonatologist in group practice - average weekly hours, call frequency, etc? What is the salary range? What is the current job market like and what do you think it will look like in the future? Lastly, which programs are generally regarded as the top tier in neonatology? Thanks!

Jargon,

What is the typical lifestyle like for a neonatologist in group practice - average weekly hours,

it varies tremendoudly between private practice and academic jobs. Even then there is tremendous variability. I will list the practice style of me and 3 of my friends ( academic and 1 private)
I am in a 5 doctor group covering one large Level 3 NICU with referral coverage from 3 other hospitals. We take call only in our main center, and have Nurse practitioners at our affiliated sites. I do one week on service about every 5 weeks, which involves Monday-Thursday 8 AM to 5, where I round on all the babies in the NICU. We usually have between 30 and 40 babies. I also have an NNP with me so my life is made much easier/ On my week on service I also work 24 hrs on Friday, and round on Saturday until noon, when the Saturday person for that weekend takes over. Then I do 24 hrs on that Sunday. The remainder of my life is taking the night call for the day service doctor, which with 4 partners basically covering M-Thur Night and one of us doing the Saturday, I pull anywhere from 4 to 6 nights a month. AND THAT'S IT. It totals up to working about 11-14 days a month. We usually schedule it so we have at least 5 days off in a row without any call or work at all. When we are off, we are off. All of our work is in hospital. There are no middle of the night calls at home. I love it. When I am working, and there is nothing happening ( like now ) I can read, watch TV or surf the web. I also have an NNP in house with me who takes care of all the little issues.


My friend is in a very large ( 12 or 15 doctor) group in F t Worth. She is also in private practice. They work every day, seeing their patients, and then hand off to the night call doc for that particular day ( usually by 1 PM ) They also cover about 7 hospitals in DFW, and she takes call for them, so she is typically on every 3 or 4 nights. Some in house and some on pager. IF there is a sick baby at one of their hospitals, then she goes in and evaluates them ( unlike my group, where our NNP, just transfers the patient to our NICU) She works a lot more days than I do, and really doesn't get paid any more, ( actually I think she gets paid less than me since we just got a big raise) but she's the low doc on a very large totem pole working for a very large national group so that's understandible.


Another friend is in academic medicine. He does mopstly clinical work, anywhere from 9-10 months a year rounding in the level 2 or level 3 at a children's hospital. He takes call every other weekend or every 3rd and is on home call ( when he is covering the level 3 unit ) every 3 or 4 nights, and often has to come in.
The rest of the months he does some clinical research projects. His salary is about half what we are making in private practice, but it's a fun job. It's fun working in academic medicine. I just can't see taking all those weekend calls for 100K/yr



The final example is a friend doing academic medicine. She is in a research job and has 10 months a year protected time where she works on her research. She does a few night calls a month, at the medical school affiliated hospitals ( home call) and 2 months on the level 3 nursery service at the children's hospital.
She has to get grant funding and be productive to get promoted and to keep her job. She makes even less money than my friend that does the clinical academic job, but again, she loves her research and gets to travel to a lot of research meetings at the College's expense, and gets to hang out with lots of smart ( or pseudosmart) people.



Salary range:
Somebody posted that the median income for neonatologists was over 300,000.
I think that's a bit high based on my experience

Academic starting salary 80,000-100,000
Private practice starting salary 140,000-240,000

Most people I know in private practice are making mid 200's



Best programs: ( my rating)
1. Baylor ( I am biased! ) Biggest NICU. Great teaching program. Huge network of graduates. Everything's bigger and better in Texas.
2. CHOP ( children's hosp of Philadelphia). Regarded as the best program ( and probably is)
3. Cincinatti Childrens. They have an awesome faculty there with a few of the guys that are really the leaders of lung development ( Drs; Jobe and Whitsett) Very nice unit too
4. Rainbow Babies. Dr's Martin and Fanaroff are legendary. (Richard Martin is one of the nicest guys I've met in medicine)
5. Miami Childrens _ Dr bancalari is also very well known and respected. Big busy unit
6.Stanford and Denver Children's-
7. Ohio State--a lot of the Baylor faculty recently moved to Columbus and are establishing a top notch program there, though it's not as well known as the others

IF you are interested in lung research : Miami or Cincinatti
Glucose or nutrition : Baylor or Denver
Bilirubin metabolism : Stanford
Control of breathing or fetal alcohol syndrome : Rainbow babies
 
HiFi, you rock. Since you might have interviewed at a few places before stopping at Baylor, do you have any observations on the east coast neonatology programs?

A few other questions...

What do you think the job market will look like in the near and far future? I'm not curious about reimbursement, but finding a job in a location you like.

Also, how did your experience as a resident compare with that as a fellow/attending?

Finally, thanks for supporting all us curious folk!
 
Originally posted by Gator05
HiFi, you rock. Since you might have interviewed at a few places before stopping at Baylor, do you have any observations on the east coast neonatology programs?

A few other questions...

What do you think the job market will look like in the near and far future? I'm not curious about reimbursement, but finding a job in a location you like.

Also, how did your experience as a resident compare with that as a fellow/attending?

Finally, thanks for supporting all us curious folk!


E Coast programs.
Boston Childrens is a very well respected program. I forgot to mention it last time.
A friend of mine, from the year behind me in fellowship is going to be faculty at UMDNJ...or whatever you call it ( Robert Wood johnston? In New Jersey. He says it's a good place. Also, I happen to know the director of Neonatology at a hospital in Manhassat , long island but I don't think they have a fellowship.
I don't know too much though about East Coast other wise since I never had the desire to live there . Sorry

I interviewed at rainbow babies. Univ Mich, Baylor, and Cincinatti only because I loved Cincinatti and Baylor so much I didn't want to waste time doing other interviews

The job market is fantastic at the moment.
When I was a second year resident, people told me I was crazy and that I would never ever get a job as a neonatologist, because I guess the job market was bad 5 or 6 years ago. I think those people were wrong because the job market is pretty good now.
Certain areas are saturated, but nothing like Peds cardiology for example.
Currently there are a few openings for neonatologists in private practice in the state of Michigan.

Go to neonatology.net. There are job advertisements there ( just a small percentage of what's actually offered though)

Things are WIDE OPEN in academic medicine. There will always be jobs for qualified people in academic medicine in neonatology.

AS pediatric residencies continue to water down the training that residents get in newborn medicine, pediatricians will get less and less comfortable in management of newborn problems. I think the job market, overall , will continue to improve.

US fellowships put out a total of about 500 neonatologists per year. That sounds like a lot, but not really. Many of the older docs are retiring. There are many private practice opportunities.
It can be difficult to narrow down a private practice job in the city of your choice though. Once all the hospitals have all the neonatologists they need, somebody has to leave, or they have to expand to hire new ones


Life as a resident was fun, but frankly, I got bored with general peds. I didn't feel like I was qualified to give parenting advice, since I don't have kids. I always felt like a fraud ! I liked critical care. I thought I knew a lot of neonatology when I finished my residency, adn then I started my fellowship and soon found out I knew Jack Squat! I would highly recommend applying to Baylor. The unit is so huge and so busy ( avg level 3 census was around 70 when I was there....up until last July ) and in 1 month, you would see so many problems. I felt like at the end of my first month, with all those terrifying night calls, I was ready for anything. After I was finished I really felt like I had gained a tremendous amount of experience, even though you learn from working with so many veteran docs, that you need to keep learning and that you need to have a deep respect always for how little you actually know, even if you have a lot of training and expertise.


Life as an attending is even better, but sometimes I miss somebody telling me what to do, when I am stumped and have to make a tough decision. I guess we all need to grow up eventually.

I wouldn't worry about the job market 10 years down the road.
I always told myself, I'd rather do something I enjoy in a sh*TTy job market than do something I didn't like just to have job security


I don't mind answering questions on this thread. I happen to be on call tonight and it's early and I seem to have a lot of free time ( though I probably just jinxed myself )
 
HiFi, here's to a quiet night for you....

More questions! In your perspective, how does neonatology vary from peds critical care? I've heard fellows talking about length of stay, closed unit perspective, emotional difficulty with older kids who are terminally ill...any other thoughts?

Lastly (though I can't promise...), any comparison to peds anesthesiology?
 
Originally posted by Gator05
HiFi, here's to a quiet night for you....

More questions! In your perspective, how does neonatology vary from peds critical care? I've heard fellows talking about length of stay, closed unit perspective, emotional difficulty with older kids who are terminally ill...any other thoughts?

Lastly (though I can't promise...), any comparison to peds anesthesiology?

I think it's quite different. I can't put it into exact words, but we seem to be more relaxed and less impulsive.
We always had a 3rd year critical care fellow that would rotate through the NICU during their 3rd year, and we always found that everything was absolute and uf upmost urgency with them.

There is also a great deal more variety in the PICU.
Infants with clotted off BT shunts, toddler near drownings, 6 yr olds that drank methanol, teenagers with GSW, MVA or asthma.

NICU seems some variety, but we treat a lot of the same problems, compared to the PICU

I don't think most people that do critical care have much issues with death. You really get used to it. We've all seen so many deaths. Some good deaths, and some slow ans horrible traagic deaths. You learn to deal with it, or if you can't you belong in adifferent line of work. Personally, the way I deal with it is by knowing that I gave the patient the best level of care they could receive, and that I told the family the truth, and gave them as much information as they needed to make informed choices, and do what was in the best interest for their child. When the kid dies, you just remember that you did your best and move on to the next one.

That is easier when you are dealing with a newborn. Much more difficult with a 5 year old that gets hit by a car

OK, I jinxed myself, I just got a sick kid with mec aspiration, so that's it for tonight
 
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