Hi! So I’m really interested in becoming a neonatologist and was wondering if anyone could give many any information about the job? I’m curious about what the hours are like, the pay, what exactly the job is because there isn’t a great explanation online, and about how hard it is to get through all the years of schooling. I really like the idea of a career caring for people especially in medicine!
Thanks!
Neonatal - perinatal medicine is pediatric subspecialty.
Neonataology requires a 3 year pediatric residency (or a 4 year meds-ped residency) plus an additional 3 years of fellowship training.
4 years medical school + 3 years peds residency + 3 years neonatal fellowship = 10 years
Here are some websites that may answer some of your questions–
[Pediatric Subspecialties: Neonatalogy](http://www.pedsubs.org/SubDes/Neonatology.cfm)
[What is a Neonatologist?](What is a Neonatologist? - HealthyChildren.org)
[A Career in Neonatology: Information for Students and Teachers](http://www.neonatology.org/career/default.html)
[A day in the life of a neonatologist: Dr. Josephine Enciso](What's It Like to Be a Neonatologist? | UCLA Med School)
[Everyday Life of a Neonatologist](Everyday Life of a Neonatologist | Woman - The Nest)
[A Routine In-Patient Day in the Life of a Neonatal Fellow](Neonatology Fellowship | NYU Langone Health)
After fellowship, neonatalogists work irregular hours, often 8-12 hours shifts that rotate between day shifts and night shifts weekly since NICUs require 24-hour coverage. They will work or be on call on weekends and holidays (this is true of most medical specialties) --how frequently will depend on how big the practice group is and how many patients are in the NICU.
IIRC, a occasional poster Bigredmed is a neonatal specialist. If you have specific questions, you can try to PM him.
I think big red is pediatric plum/critical care and works in PICU, not NICU but he would have more insight than most. Kirstin5792 is also a pediatric resident (looks like she’s going to be chief resident next year) but I don’t know what subspecialty she’s doing (if at all).
I will say that based on my brief experiences as a student, neonatalogists must be willing/able to deal with parents in the absolute worst moments of their lives. Rather than going home with a newborn like all their family and friends did, they will be in the hospital every day watching their kid be poked and prodded with tubes coming out of everywhere and wondering if they will ever take the baby home. Mom’s pregnancy and the family history will obviously be big factors and the kid certainly isn’t telling you that info. A higher percentage of your patients will survive compared to an adult ICU but babies will regularly die and/or come out disabled. You will not watch that child grow up - that’s the regular pediatrician’s job. It’s an intense job that can be hugely rewarding but you have to be able to handle the lows in order to experience those highs.
My experience is that my daughter spent 13 weeks in the NICU. In our case, it was a big unit with half the doctors being ‘regular’ employees and half being Kaiser employees. I think 2 of the 4 of each were there most days, and 1 of the 8 was on call all night for a few nights in a row, then off for a long time (like 3 weeks). I think one of the differences is that there is no private practice for NICU doctors, they are hospital employees or Kaiser employees. My daughter was a ‘regular’, so the Kaiser docs only took care of her if there was an emergency when they were on call, but I did know one of those docs pretty well as he was there when she was born and had to intubate her at least once on a night he was on call.
There is a lot of loss in the NICU. Many of the babies die, some have life long conditions, there are decisions that need to be made whether to save a life or not to intervene medically. You are dealing with very emotional parents. The highs are high and the lows are awful, and it happens daily.
@collegeperspn
I am Peds Critical Care (so take care of “big” kids in the ICU…and no pulmonary training in the CCM pathway in peds @iwannabe_Brown) but work in a combined neonatology/peds critical care private practice (not common, long story).
Anyways, WOWMom is correct about the length of training. 10 years at a minimum after college graduation.
The majority of patients in the NICU are there because they were born premature. The edge of viability is 22 weeks gestation, so roughly half way through a normal pregnancy. Mortality rates in the NICU are highly dependent on gestational age with nearly 100% mortality if born at 22 weeks 0 days, somewhere north of 80-85% if born at 24 weeks, and less than 4% if born at 32 weeks. The risk of substantial complications goes down in similar fashion with longer gestations. There are babies born at term who come to the NICU as well, particularly if they’re born with birth defects that require surgery such as omphalocele or spina bifida among many others.
As a neonatologist then, you are an expert in dealing with the unique physiologies and complications of being born before you’re truly “cooked” and fully developed. That includes special concerns related to the respiratory and GI systems, unique nuances in renal function, and supporting neurocognitive development in the long term so that the NICU graduate has the best possible chance to compete with kids born at term.
NICU pays well within the scope of pediatric specialties, but generally make less than adult critical care or even adult hospitalists.
Coverage models are highly variable and so there is little what could be considered “typical”. Because there are a number of babies born early, even just at 32-34 weeks, that benefit from specialized neonatal care, there are NICU’s in towns as small as 50-60k people (very uncommon in other pediatric specialties). These smaller Level 1 NICU’s see less acutely ill patients, the so called “feeder/growers” and fewer patients overall, so they may be staffed only by one physician per week who might be available 24 hours/day for 7 days at a time. Other NICU’s, usually in bigger cities, take care of much sicker patients - levels 2 and 3 depending on their resources - along with even more specialized ones that have surgeons in addition to neonatologists available to treat more complex conditions that require surgery. The bigger units with sicker babies may have rotating night coverage (night float - where they’re on only at night for a week at a time), or they may take call either in the hospital or from home 1 to 3 times per week when they’re on service.
To be clear, neonatologists are critical care physicians in every sense of the word. Sometimes the perception is that neonatologists just rock and hold babies all day. Nothing could be further from the truth. Acutely sick neonates often have failure of multiple organs that need to managed and balanced to ensure a successful outcome. Neonatologists are experts at resuscitation, mechanical ventilation, cardiac support, fluid management, and treatment of infections among other things.
And yes, you are often dealing with people on the worst day of their lives. You will have babies that die despite everything you do. You will have parents make decisions that rip you to pieces and make you feel like you are torturing their child. But you also get to help babies who are among the sickest of any patients anywhere in your city or town no matter the age. You will be an expert, one that even other physicians will be unable to match in terms of knowledge of your patients (but you will have forgotten most of the information that your friends will want to know about their normal healthy kids).
Let me know if you have anymore questions
BRB
So peds pulm is an entirely separate fellowship/subspecialty from critical care? Any idea why they are separate in peds but one specialty in adults?
Although your patients are babies, you will have to be very good at dealing with adults who are probably in a situation quite different from the one they expected. …
@iwannabe_Brown
I’m pretty sure that adult critical care and pulm are usually separate fellowships, though there are a goodly number of combined pulm/crit care programs. Both IM and EM residents are eligible for critical care fellowships.
IM grads can do a 3 year combined pulm-critical care program. Or they can do a 2 year critical care only fellowship. Or they can do a 2 year pulmonology only fellowship.
EM grads can do a 2 year critical care fellowship, but aren’t eligible for the combined pulm-crit care programs.
Both EM and IM critical care boarded docs work as intensivists.
@iwannabe_Brown @WayOutWestMom
The birth of the modern ICU really is directly tied to the development of mechanical ventilators. So critical care really started out as a sub field of anesthesia, and because of the emphasis on ventilation, the natural overlap was with the pulmonologists. The unique setup in which they’re kind of combined, kind of separate is probably due to that historical origin in which there were/are a number of people who want to be pulmonologists without the critical care portion but because of the overlap, there is only so much “extra” time needed to get boarded. I’ve seen it with a lot of my mentors who went through fellowship in the 70’s and 80’s before there was so much standardization and there was a lot of “just tack on an extra year of ABC and be dual trained”. There are a number of people who are NICU/PICU, Pulm/PICU, NICU/Cards and Cards/PICU from that time period and when you ask, they’ll say it was another year to finish their research and seemed like a good option, so I imagine it’s a similar sort of thing in the IM world.
The development of critical care fellowships out of EM is a relatively new phenomenon (given that EM itself is a relatively new boarded specialty).
As for the very distinct separation between pulm and PICU in the peds world, that mostly has to due with what Peds pulmonologists really focus on - Cystic Fibrosis. Obviously there is more to the field than that, but CF is such a big deal, that it is really the foundation upon which Ped Pulm as a field rests, particularly in a historical perspective. Asthma, chronic home ventilation, sleep medicine, pulmonary hypertension, aerodigestive conditions, and the like certainly are major components of pediatric pulm practice now among other things.
The other thing that I think is different between IM and Peds is that once upon a time, Peds residents did monstrous amounts of time in the NICU (mainly to function as cheap labor) - on the order of 6-9 months of just NICU over the course of 3 years, and maybe a month of PICU. There’s a lot of differences between the NICU/PICU, whereas IM residents get a much more standardized ICU experience. A well trained IM resident probably comes out of training fairly well equipped to handle being a MICU attending - and historically when there was so much less supervision and they were used to functioning independently there was only so much extra time needed to really be exceptional in critical care. So it worked out to tack it on to a pulm fellowship. Meanwhile, there was more to PICU that was ‘new’ to a graduating peds resident, which when coupled with the standardization of peds fellowships to 3 years in the early 90’s and the research requirements, ruined any chance of combining Pulm and CC for children.