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BuckyBadger

Work-Life Balance as a Neonatologist

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Hello, I am a 3rd year medical student interested in neonatology, but have heard that the work-life balance is pretty difficult and it can be hard to be a good husband/father (or wife/mother) because of the schedule. Most of the practices that I have seen or heard about generally have doctors work ten 24hr shifts per month, which is a 24hr shift every 3 days so you're either on call, post-call, or pre-call all the time. I have talked with a handful of neonatologists about this but I was wondering if I could get a broader perspective on this topic? Thank you!

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Thanks for your post this relevant question! I wished my English were to explain my thoughts on this, but I hope you get what I mean :)

Neonatology is not always an easy speciality, especially in the early career. Workhours can be many and hard, and I think we all have felt that the work-life balance has been shifting over to the other side... BUT, caring for newborn infants and their families is very very rewarding with lots of positive feedback, and team work in its true sense. Neonatal staff (not only the doctors) are generally great persons (positive selection), with both integrity and open, reflective minds. Although neonatology is much about knowing and managing complex patophysiology, it is also an art of nursing care, and an art of meeting and caring for families.

For myself, I have been mixing clinical work with research to get a better work-work balance :) 

You probably also know that neonatology is not only about "saving lives" in spaceship-like level-3 care (the most techn advanced NICUs). In fact, the bulk of neonatology is about level-1 and level-2 problems which is lower-tech and less exhausting (physically and mentally). And further, probably the hottest topics for the future is neonatology in the developing world, as preterm birth is now the major cause of the global <5-mortatily. In other words, you are able to tailor your own professional profile.

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Thanks for this excellent post, being in level III NICU with 50+bed capacity, it is not quite easy to cope with but with careful time distribution one can relax as well and give time to family. This is how I distribute my time.

If you are frontline person ( meaning first respond to L & D calls, code pink) then you have to be little quick. usually in morning we distribute patients according to team, usually 7-8 patients per person will get. they are mix with sick and feeder and grower. try to quickly through the patient , ask bed side nurse any overnight issue, check ins and out, do relevant exam and write your note, preferably before rounds as you may be called any time for c section or any delivery. once your notes are done, present your cases in rounds, we usually present case on our turn and no need to stay in whole round of NICU. once your patient are done, your work is done, now you are free, if any discharge of your patient, just quickly dictate, check at the end of week  about discharge summaries if needed any update. now you can chat, relax and enjoy your free time. give handover at 1700hrs and go home.

similarly if you are on nights , organize yourself . usually 2-3 patients needs your attention in night, rest of them are usually routine cases like jaundice, increasing feeds, check ins and out etc. finish your night rounds with the team quickly focussing on particular patients and thats it. get time to rest, read or whatever time you want to devote to research etc.

This is how I distribute my time. hope it will help

Naveed

 

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I am a final year fellow at a US training program, so I am looking at jobs right now. I think both Stefan and Naveed have said many valid things; I will write from a US perspective as your profile indicates you are also US based.

First, to take a step back, neonatology is a fellowship under pediatrics, so, as a 3rd year medical student you will need to plan on matching first to a pediatrics residency (preferably one with a large/high acuity NICU) and completing your training in general pediatrics before moving on to neonatology.  I would urge you to look at programs with broad training pediatrics because you may decide in the intervening years that you enjoy other areas of pediatrics and this is OK.

Assuming you proceed to neonatology fellowship, many (but not all) are front loaded, especially large academic programs like the one I train in.  This means your first year will have very poor work-life balance.  However, I have obtained a research grant to protect some of my time and I currently do ~12 weeks of service a year, 1 overnight call a week.

Jobs:  Broadly speaking there are 3 types of jobs based on how you are compensated and these may lead to a mix of research and patient care at either level III/IV (to use the AAP designations) or level II/III.  Most level I jobs in the US are taken by general pediatricians, not neonatologists.

Job type 1: Academic Clinical - You will probably do service for ~4-6 months a year in 2-3 weeks blocks depending on your other responsibilities to the university and department.  Your service will likely be a mix of level II/III/IV (and possibly deliveries/consults if your consult or delivery services are busy enough to need a separate attending) and is based on what your institution needs and what you negotiate.  Level II service will typically NOT require in house call and is often not very demanding.  Level III/IV service can be exhausting and many people arrange their lives to have no obligations outside of work for those weeks.  Call at these location is often in house overnight.  Frequency of call is largely a function of how large the academic faculty is.

Job type 2: Academic researcher - You will do ~1-3 months service/year, often at a level III/IV.  The more you bring in in grants, the less service you do.  I have many colleagues who do as little as 6 weeks service/year.  Service, when you do it, is as above.

The thing to remember about overnight call in most academic jobs is that 1) you probably were NOT providing patient care in the morning, just at your desk doing admin work or research and 2) You probably have fellows and/or residents taking most of the calls for you, so you really only pay attention to one of two kids, set them up for the night and then ask the fellow to wake you up if there are issues.

Job type 3: Private practice - Mostly level II/III (although a colleague who graduated a couple of years ahead of me has a private practice level IV job in Seattle).  The schedules for service and call here vary widely.  I've heard of all sorts of things from being on for multiple days in a row a few days a month, to alternating weeks of days and nights, etc.  The '10 24h calls' thing is misleading because it makes it sound like its you against the world for those 10 days and it isn't.  You'll either have nurse practitioners doing most of the front line work or the volume will be quite low compared to fellowship, so I'd really think of it more like 10days I'm working and 10 days I'll either be a zombie because it was a bad night or (more likely) I can go to my kid's soccer game just fine.

In the US the real trade off is in private practice you'll work more but get paid more.  In academic jobs you'll get paid less and put up with academic bureaucracy, BUT you'll also have access to academic resources to help you pursue projects of interest which may not be financially lucrative.

 

Also, one further option for providing neonatal care in the US is being a hospitalist which would allow you (in the right job) to work in a NICU without being a neonatologist.  The pay is decent (not as good as a neonatologist but at least as good, if not better than a general pediatrician in the community), the hours are better than a neonatologist and you will always have a neonatologist to back you up on procedures, etc.

Hope this helps

Bimal

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@bimalc what a great post! I recently discussed work hours and content with colleagues from the US and Canada, and it seems that during the 52week year, not that many weeks are actually placed on site in the NICU. I heard one saying that his fulltime year included only ~20 weeks of clinical service, and then work consisted of time-set teaching, leading projects etc-etc. Is that really so for most neonatal specialists / consultants in the US?

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On 8/21/2017 at 3:41 AM, Stefan Johansson said:

@bimalc what a great post! I recently discussed work hours and content with colleagues from the US and Canada, and it seems that during the 52week year, not that many weeks are actually placed on site in the NICU. I heard one saying that his fulltime year included only ~20 weeks of clinical service, and then work consisted of time-set teaching, leading projects etc-etc. Is that really so for most neonatal specialists / consultants in the US?

Very sorry that I had not seen this response/question earlier.  20-24 weeks in the ICU is a very typical 'full time' clinical load in academic neonatology in the US; I have seen some more like 18 and one or two closer to 26-30 weeks.  The remainder is, as you suggest, devoted to academic pursuits.  This (along with patient mix/acuity and the opportunity to work with trainees) is one of the major draws of academic neonatology in the US compared to private practice.

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@bimalc Thanks for further input in this topic. Well yes, your setup seems to be great and to me, proving that you in the US have understood the importance to invest in time for research and development. Around here, positions combining clinical work and (hospital-funded) academic work is rare.

Unless it was such a big thing to become accredited as a clinician in the US, I'd be happy to take the leap over the Atlantic (given that family could be convinced), with a luggage of clinical epi skills and top-notch ideas :)

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