I am board certified in Pediatrics (99) and Neonatal-perinatal medicine ( 03 )
1. Neonatology is NOT a "grueling" career. Sorry. Not even close.
Yes, I can be very busy. Friday I worked 27 hrs and didn't get any sleep. I admitted 7 babies ( 4 after midnight ) and a few of them were very sick.
However, there is nothing I would rather be doing than staying up at night taking care of sick babies. I left yesterday at 11 AM feeling tired, but extremely satisfied at a job well done.
A very wise man once said "
Pick a job you love, and you'll never work a day in your life"
I find that neonatology is a very happy career. Yes there are plenty of sad cases, but I think you can say that about any career that involves patient care. By far, the success stories far outweigh the bad ouctomes. This has little to do with death, since sometimes the death of a patient is a good outcome. Virtually every neonatologist I know ( and I know quite a few since I trained at the largest program in the USA ) is happy and really loves their job. I just don't see that in other specialties. We work hard, but we love our work.
To me, something "grueling" involves hard work that is very unpleasant. I consider walking up 8 flights of stairs carrying a suitcase to be "grueling"
Delivering newspapers at 430 Am is grueling. Working at TGI Fridays waiting tables is grueling work. Digging ditches is grueling.
Working in a busy NICU with fantastic nurses and medical staff is a blast. Pretty far from grueling. IMO medicine in general is not for wimps that don't want a little hard work. Most residencies involve long hours. There are many careers where physicians work longer than I do ( and remember, there is no silly 80 hr rule after you graduate residency and fellowship! )
2. Neonatology is NOT a thankless career. I would go so far as to classify this statement as being totally *****ic!
IMO, ANY medical student that needs their ego stroked by being showered with "thanks" is going into medicine for the wrong reason. Go and deliver pizzas if you need instant gratification. Forget medicine
You can measure a person's character by how they act when nobody is watching.
What does this statement have to do with medicine?
Well, there are so many things we do as physicians for our patients and their families that will never be rewarded with a thank you. The radiologist that picks up something subtle on an MRI won't get thanked by the patient. A pathologist that sees some very subtle anomaly at the periphery of a frozen section will not get thanks from the patient. A phychiatrist that helps a person with schizophrenia or dementia is unlikely to be thanked. ETC ETC.
How am I thanked? I am thanked every single day hundreds of times. I might resuscitate a newborn and do a particularly good job, and a few days later I see a proud mother holding her healthy newborn as she is wheeled out to the car. She has no idea that I did a good job and took care of her baby and allowed him/her a normal transition. Seeing them is enough thanks.
Picking up a major problem with subtle clinical signs, and taking care of it before it becomes a big problem is enough thanks. Ordering an echocardiogram on a baby in the nursery who has weak femoral pulses, who perhaps would have been sent home if you didn't take the time to be thorough, and finding a coarcation , saving him from later being admitted in very dire straits, is plenty of thanks
Perhaps oldbear proffessor will agree, but sometimes I am a little bit embarrassed at the attention and overwhelming thanks we can get from families. I much prefer it when a job really well done is really something that I and the staff know what happened, but the family really doesn't fully comprehend to a point when then fawn all over you. Seeing a hapopy mother holding her baby is quite rewarding. Seeing families at the mall ( even though I almost ALWAYS forget their name.....I can remember the size chest tube I used or the kid's last sodium 3 years later but not the name!! ) and seeing a healthy little toddler that used to be quite ill, is very gratifying.
Hearing " I'm glad you're on call tonight" from the NICU nurses is plenty of thanks. Earning the respect of staff is thanks
Yesterday morning I took a 7 day old severely asphyxiated newborn off the ventilator and she died shortly thereafter. I'm not sure that I expect thanks for treating the family like I would like to be treated. Moving them to a private room so the mother doesn't have to hear other babies crying and remind her that her baby will never cry. But taking care of her and making an otherwise awful moment in her life, just a little bit easier is really worth a lifetime of thanks as far as I am concerned.
3.
These are NICHD data from the EARLY 90's. As you can see, the data do not support your statement.
Yes there are certainly many infants in the NICU population that survive with severe morbidities but even in the highest risk groups, the majority of infants survive and do well.
In case you didn't know, tiny prematures are not the only kids admitted into NICU's. In fact, then are the minority. Most of the NICU graduates treated in NICU's in America do extremely well. I am not going to debate the minutia. We are working hard to improve outcomes. Better technology means sicker patients will survive, and with that will naturally come other unfavorable outcomes. However, with any other critical care cohort, there will always be patients with adverse outcomes. These will ALWAYS be the minority though
I staff our development clinic and see the high risk NICU graduates. I see the good and the bad. Most of the graduates, even in our high risk groups are doing awfully good considering how sick they were ( and these are just the high risk kids! )
I would also like to mention the bias against surviving neonates in this post by DOC05.
Go to any adult or pediatric ICU and follow head injury patients, near drownings, trauma , stroke, cardiac arrest or other very critically ill patient and quantify the deficits in THESE patients. You will find a high degree of neurologic morbidities for example in patients with significant closed head injuries.
I'm not sure we have bias against agressively teating critically ill adult and pediatric trauma patients since they have a higher risk of long term problems.
It is difficult to tell many times which critically ill ICU patient will be completely normal and which one will be impaired
FINALLY, my take home message for the original poster : Neonatology is a fantastic career. I love it. IF I could start over, I wouldn't choose any other career ( see if all other physicians in other specialties can say that. I don't think so )
However, each person should pick a career that they love. The high school students here should worry first about college. Then medical school.
In medical school clinical rotations, try to imagine yourself doing EVERY specialty where you rotate. This will help in selecting the best career fit, since it's pretty difficult to change career once you start.
NOT!
Yes, we've met.
