So You Want to Be a Pediatric Intensivist

So you want to be a pediatric intensivist. You love children and want to help take care of some of the sickest patients in the hospital. Let’s debunk the public perception myths and give it to you straight. This is the reality of pediatric critical care.

What is Pediatric Critical Care?

Pediatric critical care is the specialty of medicine focused on the treatment of seriously ill children from birth to 18 years old and beyond.

Much like pediatricians, pediatric intensivists are masters of physiology and pharmacology. They use the wide breadth of knowledge from medical school and residency and apply it at the bedside on a daily basis.

On any given day, a pediatric intensivist could be called to take care of a burn patient, a type I diabetic in a diabetic crisis, or a patient with a respiratory infection on a ventilator, each with their own set of needs. As such, they need to have a working knowledge of every body system and the various ways that things can go wrong with each one.

Furthermore, pediatric intensivists see patients across the entire developmental spectrum. Patients that are up to 1 month old have different needs than patients who are 1 month to 1 year old or 2-4, 5-10, or 10-18 years old. Each developmental range has different normal values for vital signs, lab results, drug doses, and so on. Pediatric intensivists have to always consider the patient’s specific disease or condition within the context of their age.

Unlike many other specialties within pediatrics, pediatric intensivists perform a variety of different procedures. They perform intubations for children needing ventilatory support. They place arterial catheters for children needing blood pressure monitoring and venous catheters for the safe delivery of some medications. They place chest tubes for children with pneumothoraces or pleural fluid collections. And they perform a number of procedures for children needing artificial organ support — whether that be the heart, lungs, kidneys, or another organ.

There are a few ways to categorize a pediatric intensivist’s work.

Academic vs Community/Private Practice

First, there’s academic vs community and private practice.

Academic pediatric intensivists are typically employed by a hospital or university affiliated with a medical school. They will split their time between treating patients in the hospital and teaching. Many academic positions also require administrative involvement or committee work within the hospital.

In contrast, community pediatric intensivists are employed by a community children’s hospital and private practice pediatric intensivists are employed by a private group that provides care to a children’s hospital. They will generally have less academic involvement; however, hybrid positions exist.

Relative to other specialties, the day-to-day life of a pediatric intensivist in the academic vs private practice vs community setting does not differ much. Given the nature of pediatric critical care, physicians working in this specialty will almost always work in the hospital setting and take care of a wide variety of critically ill patients.

In terms of lifestyle, there is also little difference between academic, private practice, and community pediatric intensivists. On-call responsibilities are more dependent on the specific hospital or group that you work for than they are on the type of practice. In some hospitals, you may be required to be on call several nights a week. In others, you may have a more typical 8-5 schedule with on-call responsibilities occurring less frequently.

In terms of compensation, pediatric intensivists working in private practice or community settings will typically earn more than their academic colleagues. According to the 2020 MGMA Physician Compensation Report, the average salary is between $290,000 and $372,000 per year.

This brings me to the next way of differentiating a pediatric critical care doctor’s practice which is critical care vs pediatric sedation.

Critical Care vs Pediatric Sedation

Whereas most pediatric intensivists will work in a hospital’s pediatric intensive care unit and care for critically ill children, some will perform primarily pediatric sedation. Pediatric sedation is typically offered within a children’s hospital or radiology center where you have children who are too young developmentally to know to stay still. In order to perform the required study or procedure, these children are given sedatives and monitored by a pediatric critical care physician to ensure there are no unforeseen issues.

Some pediatric intensivists will do pediatric sedation in addition to their pediatric ICU responsibilities whereas others will do it full-time.

In terms of compensation, pediatric intensivists working predominantly in sedation will generally earn less than their pediatric ICU colleagues.

Misconceptions About Pediatric Critical Care

Let’s clear up some of the misconceptions about pediatric critical care.

The biggest misconception is that it’s a sad job. Unlike adult critical care, the majority of children admitted to the pediatric ICU improve and ultimately leave the ICU. Multiple studies estimate that the mortality rate for children admitted to the pediatric ICU is only around 3%, meaning that approximately 97% of children recover. This isn’t to say that you won’t experience death or sad outcomes; however, it is less common than you might think.

Many people also believe that respiratory infections make up the bulk of a pediatric intensivist’s workload. In reality, pediatric intensivists see a broad spectrum of patients with a variety of issues.

How to Become a Pediatric Intensivist

To become a pediatric intensivist, you must complete 4 years of medical school, followed by 3 years of pediatric residency, and 3 years of pediatric critical care fellowship. Some will opt for an additional chief year during residency to increase their competitiveness for fellowship.

There are also dual pediatric critical care and anesthesiology fellowship programs that are 5 years in duration and allow pediatricians to become dual-board certified in pediatric critical care and anesthesiology upon completion.

In terms of competitiveness, pediatric critical care is one of the more competitive pediatric subspecialties along with pediatric emergency medicine, pediatric cardiology, and pediatric gastroenterology.

As for the type of medical student that typically goes for pediatric critical care, they are usually detail-oriented, patient, love working with children, and enjoy a fast-paced work environment.

Subspecialties within Pediatric Critical Care

After completing fellowship, there are a few options for additional subspecialization.

Pediatric Cardiac Critical Care

Pediatric cardiac critical care is a 1-year fellowship that provides additional training in acute cardiac diseases and congenital heart problems in critically ill infants, children, and adolescents. Physicians who pursue this fellowship will receive additional training in extracorporeal membrane oxygenation, or ECMO, post-cardiac surgical care, transplantation care, ventricular assist devices, and echocardiography. It should be noted that there are various other pathways to pediatric cardiac critical care including anesthesiology, neonatology, and pediatric cardiology to name a few.

Pediatric Neurocritical Care

Pediatric neurocritical care is a 1-year fellowship that provides additional training in a wide variety of neurologic illnesses and injuries. Pediatric neurologists may also apply for fellowship in pediatric neurocritical care.

What You’ll Love About Pediatric Critical Care

There’s a lot to love about pediatric critical care.

To start, you get to see an incredibly wide variety of patients – both in terms of age and pathophysiology. One minute you could be playing peekaboo with a baby recovering from surgery and the next you could be talking to a diabetic teenager about video games. In addition, having the opportunity to use all of the information you learned in medical school and consider all of the nuances of patient care in different age ranges can be incredibly fun and rewarding.

In terms of lifestyle, pediatric critical care has a lot to offer. Similar to emergency medicine, most pediatric intensivists don’t take work home with them. Unlike other specialties that are married to their pager and have to answer calls at all hours of the day, you don’t own your patients as a pediatric intensivist. When you clock out, your patients become the responsibility of the next physician on shift. When you’re off, you’re truly off.

There is also some career flexibility. If you reach a point in your career where you no longer want to spend nights in the hospital, you can transition to a pediatric sedation role and work more regular 9-5 business hours.

Lastly, pediatric intensivists have the opportunity to collaborate with various other specialties while still remaining the quarterback of the patient’s care. Given the variety of conditions that pediatric intensivists treat, they regularly consult with various surgical and non-surgical specialists. Interacting with colleagues and coming up with a care plan is often incredibly enjoyable. But no matter how many other physicians you consult with, you will often be the final decision-maker in the patient’s care – with some exceptions of course.

What You Won’t Love About Pediatric Critical Care

While pediatric critical care is an awesome specialty, it’s not for everyone.

To start, treating children who are sick, or in some cases dying, is always difficult. Having to tell a family that their child isn’t going to make it is never easy, even for the most experienced of physicians. You may also encounter patients who have been mentally or physically abused – and that can be difficult to cope with emotionally.

Additionally, patients without good family support can be challenging to navigate. Some families are disconnected from the realities of their child’s condition and may have unrealistic expectations about what their child’s recovery will look like.

Although there are benefits to the lifestyle of a pediatric intensivist, you will likely have to work nights and weekends on a regular basis. This can be both emotionally and physically taxing – especially when you expand it over the course of a career as you practice into your 40s, 50s, and 60s.

Pediatric intensivists also have more complex patients requiring multisystem approaches. As such, things like orders and charting take up a greater amount of time on a per-patient basis – time that could instead be spent with patients or away from work.

Lastly, having to collaborate with other specialties comes with its own set of challenges. Occasionally you will encounter a “too many cooks in the kitchen” situation where each specialist recommends something different. In these cases, you are often forced to be the mediator, weigh the pros/cons of different treatment plans, and be political about why one plan may be better in that situation than another.

Should You Become a Pediatric Critical Care Doctor?

How can you decide if becoming a pediatric intensivist is right for you?

If you want a specialty where you can take care of sick children and utilize the full spectrum of medical knowledge, pediatric critical care has you covered.

You should be patient, detail-oriented, and enjoy working in a fast-paced environment.

You should also enjoy doing procedures and be comfortable communicating with patients and families – both the good news and the bad.

And you should be willing to spend long nights and weekends in the hospital if it means making a lifelong difference in your patient’s health.

Are you hoping to become a pediatric intensivist? To get into medical school, match into pediatric residency, and get into a pediatric critical care fellowship, you’ll need to crush your exams and be a well-rounded applicant. As you look at resources and companies to work with, seek out those who are actual M.D. physicians, not Ph.D. or other types of doctors that didn’t go to medical school. Look for those who have achieved stellar results themselves, a track record of success with positive ratings from customers, and a systematic approach so you know you’ll always receive high-quality service. If you decide on Med School Insiders, we’d love to be a part of your journey in becoming a future physician.

If you enjoyed this article, be sure to check out So You Want to Be a Pediatrician or another specialty in our So You Want to Be series.