Pediatric Critical Care

[LMM15]

I have been doing thinking about what kind of specialty I would want to go into and what kind of lifestyle I would have. I am very interested in trauma and emergencies. But, even thought emergency medicine is "emergency", ER doctors could treat anything from a cold to an almost dead patient.

I have recently been looking into critical care medicine, and more specifically pediatric critical care. It seems like that would be a great fit for me, actually dealing with all of the critical patients, and children which I love. I'm wondering though what the lifestyle would be like. What kind of hours do pediatric CC doctors work? Are they set hours like an ER doctor or is a lot of it on call? How hard is it to have a family life? I know that it would be better for a family if I could see them everyday, so it that possible, or would there be multiple days a week that going home isn't an option?
And lastly, what is the job outlook like for critical care, and especially pediatric critical care? I don't want to be thinking about a specialty that is overpopulated or is not going to be around by the time I'm finally done with med school, residency, and fellowship.

I know thats a lot of questions...
Thank you in advance!

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[Stitch]

As for most specialties, the lifestyle and practice model varies significantly between different places. I'm pretty sure there will always be a need for critical care physicians, but obviously no one knows for certain what the market will look like ten years from now. In general, there aren't enough PICU people and there are currently a fair amount of jobs open. My suspicion is that scenario won't change a whole lot in the near future.

Many picu schedules have begun to follow day shift/night shift type work which is nice because you are either there or not there. This is especially true of the larger academic models, but smaller less busy units they may do 24 hour shifts. Some places there even require general peds/hospitalist coverage, but this is fairly uncommon. I do think picu is one of the busier lifestyles, but cardiology or heme/onc have it a lot worse. PICU is hard in the sense that you're going to be working nights and weekends for the rest of your life, and since there aren't as many critical care docs out there (as opposed to NICU for example) there are going to be more nights and weekends to cover. Academic centers allow for protected time, which means fewer shifts and a break from a busy, high acuity unit. In return you make a little less money and are expected to teach and contribute to the hospital in an academic way (which can be any number of things). If you are a clinician in academics, you may end up doing 12 twelve hour shifts a month plus whatever scholarly time you put in. Some people do more service and some less depending on your interests and institutional needs. There's a great deal of flexibility. Private practice settings are becoming more common and tend to pay more but also expect you to work more shifts (maybe 16 twelve hour shifts a month). There aren't usually any expectations outside of your shifts.

The common attraction for intensivists is generally a love of physiology, procedures and patient management on a very detailed minute to minute or hour to hour manner. The unit really is a physiology lab.

 

[ruralsurg4now]

Huh, PICU attendings at academic centers work overnight shifts? I sort of thought it would be like adult ICU attendings, where they're "on" but the sucker fellows are the ones who have to actually respond to most pages from nurses or residents.

 

[IlDestriero]

Huh, PICU attendings at academic centers work overnight shifts? I sort of thought it would be like adult ICU attendings, where they're "on" but the sucker fellows are the ones who have to actually respond to most pages from nurses or residents.

We have in house PICU attendings. I guess it would depend on the size of the PICU and the patient acuity. We also have a step down type unit which is managed by NPs and covered by one of the PICU attendings.

 

[ruralsurg4now]

We have in house PICU attendings. I guess it would depend on the size of the PICU and the patient acuity. We also have a step down type unit which is managed by NPs and covered by one of the PICU attendings.

Oh, what do the fellows do then?

 

[IlDestriero]

Oh, what do the fellows do then?

Manage things while the attending does more important things, like sleep and watch TV. I mean write papers and think important thoughts solving the great problems of our time.
They're there if needed after hours, but the fellows manage the unit. They also go to all the codes/rapid response calls.

 

[ruralsurg4now]

Manage things while the attending does more important things, like sleep and watch TV. I mean write papers and think important thoughts solving the great problems of our time.
They're there if needed after hours, but the fellows manage the unit. They also go to all the codes/rapid response calls.

Oh, OK, that's what I thought I had said before, that the fellows are the ones getting hammered by all the calls and stuff. I guess the difference was I sort of assumed the attendings were taking home call [EDIT: although I guess it's not really "call" if they're just doing a 12-hour shift] whereas you're saying they're in house.

By the way, I like the "write papers and think important thoughts" line. Nothing like getting second author for doing nothing! Sucker residents!

 

[Nivens]

I didn't realize that PICU docs in private practice often take in-house night call (work night shifts). My understanding was usually hospitalists/nocturnists cover ICUs at night, but I admit that isn't based on much at all.

 

[LMM15]

So the way it sounds is that PICU docs, and ICU in general then, tend to work a 12 hour shift and then get off. I was figuring it would be mostly on call. I imagine that working 12-16 twelve hour shifts a month, as mentioned above, would be easier to have a "regular" life than being on call most of the time. Or would those 14-18 days "off" be mostly filled with on call work and paperwork and things like that? Do most of you all find it more preferable to work a standard 12 hour shift or to work a shorter shift with more on call work?

 

[Stitch]

I didn't realize that PICU docs in private practice often take in-house night call (work night shifts). My understanding was usually hospitalists/nocturnists cover ICUs at night, but I admit that isn't based on much at all.

Some private practice places have home call. That model depends on unit acuity, though there are definitely some academic centers that still do home call as well. NPs, residents, and fellows cover the unit when you're not there. I'm not sure that I've seen pediatric hospitalists cover it, though it's possible.

So the way it sounds is that PICU docs, and ICU in general then, tend to work a 12 hour shift and then get off. I was figuring it would be mostly on call. I imagine that working 12-16 twelve hour shifts a month, as mentioned above, would be easier to have a "regular" life than being on call most of the time. Or would those 14-18 days "off" be mostly filled with on call work and paperwork and things like that? Do most of you all find it more preferable to work a standard 12 hour shift or to work a shorter shift with more on call work?

It depends. In PP your time off has no obligations in general. In academics, you have fewer overall shifts, but you have other obligations to fill some of that time. Neither is better or easier, it's just what fits your personality. I think it's difficult to work a lot of shifts in a higher acuity unit and not burn out. So the academic model or lower acuity PP model definitely offer some variety or 'escape' from seeing dying kids all the time. Personally I love not having to wear a pager while at home. I work my shift and come home. But I also love being involved in the hospital in other ways, including teaching and quality assessment/improvement.

 

[michigangirl]

At academic centers where attendings take in house call, the fellows generally run the unit and as ildestriero said, attendings are there to oversee complex decision making and procedures. At our hospital where peds anesthesia doesn't stay in house, the peds intensivist is also the person in house with the most airway experience, and will oversee alpha traumas, rapid responses. Ditto to everything stitch and IlDestriero said. PICU acuity has evolved over the years- and leaving a 40 bed unit with three Ecmos, a vad, a kid on isoflurane for asthma, 3 difficult airways and three fresh post op cardiacs .. etc. with no attending immediately available is a thing of the past for us. Also means I can live wherever I want because I'm not taking home call.

 

[Nivens]

At our hospital where peds anesthesia doesn't stay in house...

If you're in house, then anesthesia is in house ;P

 

[ruralsurg4now]

It's not really "in house call" if it's just your 12-hour shift. I mean, it's the same as saying you're on call during the normal work day.

 

[michigangirl]

It's not really "in house call" if it's just your 12-hour shift. I mean, it's the same as saying you're on call during the normal work day.

Semantics my friend. These shifts vary from 15-24 hours, never said it was 12 hours. The only point that matters here is whether there is a PICU attending in the hospital 24 hours a day.

 

[michigangirl]

If you're in house, then anesthesia is in house ;P

True that, but that only applies about 30 percent of all nights at our hospital (myself and three other PICU/anesthesia colleagues)

 

[ruralsurg4now]

Semantics my friend. These shifts vary from 15-24 hours, never said it was 12 hours. The only point that matters here is whether there is a PICU attending in the hospital 24 hours a day.

Don't worry, I'm not into trying to make other peoples' lives miserable with some contest over whose life is worse. Hence the smiley. It's gotta be rough taking care of sick kids regardless and I know I wouldn't want to do it. (I wouldn't want to take care of healthy kids, but for a totally different reason. They're brats, lol. Like, seriously, learn to accept an otoscope, FFS.)

 

[ruralsurg4now]

I think also I'm always a little surprised when I hear about in-house call because it's so rare among attendings. Off the top of my head, I'd say it's basically just some anesthesiologists (depending on your job) and I guess some intensivists (also highly dependent). Most everyone else is either "you get called in" (which for my money is sometimes worse and if I could get a room at the hospital for call, I might do it, but then again I'm single) or pure shift-work.