Neonatolgy PA

[HopefulPA77]

Hey everyone, was just curious if anyone had any information about being a PA in Neonatology.  I was looking through the list of residencies on appap and saw a few residencies in Neonatology.  However, I tried to look up a few things about that specialty and was having a hard time finding all the answers I wanted.  For example are PA's in Neonatology common or is this a small group that will be hard to find a job in?  Also was trying to look into the salary to see how much someone makes on average.  However, most importantly I wanted to look into to see if the PA's in this field enjoy it and what are the pros and cons of that particular specialty.  Please feel free to comment even if you aren't a Neonatology PA yourself, but maybe you have some information on the topic.  Thanks! 

[lkth487]

I'm not a PA - and there is a PA here in neonatology who posts who may be able to give you more information.  But I am a pedi resident going into neonatology and I can tell you what I know.

 

• 10 years ago, it would have been hard to find a job at most places - now everyone is hiring.  The job at that point was saturated by NNPs (Neonatal Nurse Practitioners) but given the increasing size of many NICUs, the resident work duty hours, and the relatively slow growing supply of NNPs, many places have PAs.  In fact, most places I know in the northeast now have at least a few PAs.  I don't think you'll have any problems - my institution now is hiring PAs and NNPs interchangeably.
• I would recommend a residency to be maximally employable, and to gain confidence in the job, but the predominant way to train in the field is still on the job.  There are many residencies now, and more are popping up.  Off the top of my head, there is Kentucky, Pittsburgh, Seattle, CHOP, Nationwide, UNM, etc.  I'm sure there are more now.
• The PAs at my institution work 3 12h shifts per week - and the con is that given the setting, you should of course expect to work a combination of days, nights, weekends and holidays.  Really no way to get around there.  There are VERY few places where you have NP/PA coverage during the day and the neonatologist only coverage at night - but those are very small units and it is not common.  Generally speaking, in any ICU/ED type job, you will be working all hours.
• The other con might be the limited age range of people you treat - most of the problems are genetic or prematurity related (or result from prematurity).  That might be too limiting for some.  For me, I never want to see 'lipitor' on the med rec ever again.  So that's a pro, not a con.  But it's what drives a lot of pediatric residents from pursuing nicu.
• Babies can range from very healthy who are just here for a 48 hour rule out sepsis workup, or just feeding and waiting to gain enough weight to go home, to a super sick baby on ECMO, and everything in between.  
• I think the salary, based on the NNP survey I saw, was 115k or so for the average?  But don't quote me on that.  I don't know much about that.

[EmPA26]

I'm a second year PA student, and plan on working in Neonatology as about half of my pre-PA experience was in the NICU. I agree with most of what @lkth487 said. In my area (SE), there are mostly NNP's, but the number of PA's is steadily growing. Neonatology is a booming field and growing across the board.

As for pros and cons its really about what you want. For me, the plus side is that I get to practice at a higher acuity level while still getting to know the families and build a relationship (you become really close with the parents of those 23/24 weekers who are there for months). Also, the hours appeal to me as I would HATE a M-F 9 to 5. In the units where I have worked, the hours are 4 x 10 days or 2-3 x 16 nights (work 5 days per pay period). In my area, there are 3 academic centers, so the fellows mostly cover at night. In the private NICU's like Pediatrix run units, schedules vary from 10-24 hr shifts. The downsides for me, are the monotony of mostly treating the same few things, working weekends and holidays and the biggest is that while its always hard when your patient dies, its a million times harder when that patient is a days old infant.

Career planning wise- I'm on the fence about a residency, as I have pretty decent NICU experience. The one thing I am considering it for is that you get protected learning time and more hands on. I'm worried if I go straight into a job, I will get stuck with all the lower acuity babies. If you have no NICU experience, you definitely need a residency or at least 2 good rotations in school. For salary, use the NNP salary for your area to compare.

If you have never worked or even shadowed in a NICU, I'd encourage you to go spend some time there, even if only as a volunteer. Most units need volunteers to hold and rock the babies who are in withdrawal and many of the NNP's that I know would be happy to have a student!

 

[HopefulPA77]

2 hours ago, EmPA26 said:

I'm a second year PA student, and plan on working in Neonatology as about half of my pre-PA experience was in the NICU. I agree with most of what @lkth487 said. In my area (SE), there are mostly NNP's, but the number of PA's is steadily growing. Neonatology is a booming field and growing across the board.

As for pros and cons its really about what you want. For me, the plus side is that I get to practice at a higher acuity level while still getting to know the families and build a relationship (you become really close with the parents of those 23/24 weekers who are there for months). Also, the hours appeal to me as I would HATE a M-F 9 to 5. In the units where I have worked, the hours are 4 x 10 days or 2-3 x 16 nights (work 5 days per pay period). In my area, there are 3 academic centers, so the fellows mostly cover at night. In the private NICU's like Pediatrix run units, schedules vary from 10-24 hr shifts. The downsides for me, are the monotony of mostly treating the same few things, working weekends and holidays and the biggest is that while its always hard when your patient dies, its a million times harder when that patient is a days old infant.

Career planning wise- I'm on the fence about a residency, as I have pretty decent NICU experience. The one thing I am considering it for is that you get protected learning time and more hands on. I'm worried if I go straight into a job, I will get stuck with all the lower acuity babies. If you have no NICU experience, you definitely need a residency or at least 2 good rotations in school. For salary, use the NNP salary for your area to compare.

If you have never worked or even shadowed in a NICU, I'd encourage you to go spend some time there, even if only as a volunteer. Most units need volunteers to hold and rock the babies who are in withdrawal and many of the NNP's that I know would be happy to have a student!

 

Thanks for the advice.  I have worked in an Adult ICU now for about 2 years so I don't have any experience with small infants, but I at least understand the idea and knowledge to a point of an ICU acuity (even though I am sure there are numerous differences).  I am starting PA school next month and we get to select teo specialties to do rotations in; therefore, I wanted to do Critical Care for sure but have been contemplating Neonatology as well. I just didn't know if they would even have PA's in that specialty in each state so glad to know the field for PA's is growing rapidly it sounds like.  

[TheFatMan]

If you are pre-PA, consider the University of Colorado's "Child Health Associate/Physician Assistant" program. It is 3 years long and is tailored to pediatric and neonatal medicine.

[PACrankset]

15 hours ago, hmmmm3 said:

If you are pre-PA, consider the University of Colorado's "Child Health Associate/Physician Assistant" program. It is 3 years long and is tailored to pediatric and neonatal medicine.

Just an FYI although the CHA/PA Program has some additional content on peds it is not tailored to that. It is tailored to PA practice across the lifespan. It does have a PICU concentration if you are really into it.

[TheFatMan]

Thanks for the clarification.

[CorpsmanUP]

I currently work in Neonatology doing Locums work and am pretty familiar with the national job market. Ikth487 made some very good points that I would like to expand on.

• 10 years ago, it would have been hard to find a job at most places - now everyone is hiring.  The job at that point was saturated by NNPs (Neonatal Nurse Practitioners) but given the increasing size of many NICUs, the resident work duty hours, and the relatively slow growing supply of NNPs, many places have PAs.  In fact, most places I know in the northeast now have at least a few PAs.  I don't think you'll have any problems - my institution now is hiring PAs and NNPs interchangeably.
  • This is a very accurate description of the situation. Some clarifications are that there are now more NNPs retiring than graduating every year. In 2010 there were 50+ NNP programs nationwide, as of 2016 there were 33, with more closing. Universities are not getting enough applicants or faculty, and are focusing on FNP and PNP primary care programs. Also, peds residency requirements went from 3 months to 2 months three years ago, meaning academic centers took a HUGE hit to their available manpower hours. PAs are prevalent in the NE, SE, and NW, still relatively rare in CA due to the nursing union. It is a growing field for multiple reasons (It is the 3rd largest profit center in most hospitals and generates on average 65%+ of most pediatric departments) yet is declining in available manpower. 

 

• I would recommend a residency to be maximally employable, and to gain confidence in the job, but the predominant way to train in the field is still on the job.  There are many residencies now, and more are popping up.  Off the top of my head, there is Kentucky, Pittsburgh, Seattle, CHOP, Nationwide, UNM, etc.  I'm sure there are more now.
  • I second this opinion. There are four more programs in development now that I know of. UK is the longest running one since 2005, the rest have all developed in the past three years due to the change in residency requirements taking required NICU rotations from 3 to 2 months. Very few PAs will have the previous health care experience to step into a NICU and pick things up on the go. Neonatology is a very specialized field and very little of adult medicine translates. Dedicated didactic time, off service rotations (both things you will not get with OJT) and the number of hours in the hospital make a residency invaluable. I was taking q4 call my first month on service. Our new grad NNPs were not allowed to work nights until nine months in, and still had a month long orientation on nights with a partner before they were allowed to work overnight. To put it in perspective, one of the NICU RNs went to PA school and came back to do the residency because she saw the difference in education.

 

• The PAs at my institution work 3 12h shifts per week - and the con is that given the setting, you should of course expect to work a combination of days, nights, weekends and holidays.  Really no way to get around there.  There are VERY few places where you have NP/PA coverage during the day and the neonatologist only coverage at night - but those are very small units and it is not common.  Generally speaking, in any ICU/ED type job, you will be working all hours.
  • Not much to add here, you will work some combination of days, nights, and weekends. 10, 12, and 24 hour shifts are common. Some places have attendings in house at night, others you are first call at night with no attending in house. There is a very broad range in autonomy because of this.

 

• The other con might be the limited age range of people you treat - most of the problems are genetic or prematurity related (or result from prematurity).  That might be too limiting for some.  For me, I never want to see 'lipitor' on the med rec ever again.  So that's a pro, not a con.  But it's what drives a lot of pediatric residents from pursuing nicu.
  • For me, having done trauma/ER in the military previously; one of the joys of Neo is that when my pager goes off, it is never the babies fault.  Much of primary care and ER in the civilian sector is the result of poor life decisions. I VERY RARELY have to deal with patient non compliance (parents) or insurance companies, unlike primary care.  Another factor I enjoy with Neo is that you are managing all physiologic systems and consults are just that, consults. You will make the final decision on patient management, as every NICU I have worked in are closed units. 

 

• Babies can range from very healthy who are just here for a 48 hour rule out sepsis workup, or just feeding and waiting to gain enough weight to go home, to a super sick baby on ECMO, and everything in between.
  • This. being able to manage a sick PPHN kid or cardiac lesion going on ECMO is a nice challenge to balance out the numerous 48 sepsis rule outs. 

 

• I think the salary, based on the NNP survey I saw, was 115k or so for the average?  But don't quote me on that.  I don't know much about that.
  • Think 115-160K depending on region for 36 hrs a week, locums is more.

[EmPA26]

23 hours ago, CorpsmanUP said:

• I would recommend a residency to be maximally employable, and to gain confidence in the job, but the predominant way to train in the field is still on the job.  There are many residencies now, and more are popping up.  Off the top of my head, there is Kentucky, Pittsburgh, Seattle, CHOP, Nationwide, UNM, etc.  I'm sure there are more now.
  • I second this opinion. There are four more programs in development now that I know of. UK is the longest running one since 2005, the rest have all developed in the past three years due to the change in residency requirements taking required NICU rotations from 3 to 2 months. Very few PAs will have the previous health care experience to step into a NICU and pick things up on the go. Neonatology is a very specialized field and very little of adult medicine translates. Dedicated didactic time, off service rotations (both things you will not get with OJT) and the number of hours in the hospital make a residency invaluable. I was taking q4 call my first month on service. Our new grad NNPs were not allowed to work nights until nine months in, and still had a month long orientation on nights with a partner before they were allowed to work overnight. To put it in perspective, one of the NICU RNs went to PA school and came back to do the residency because she saw the difference in education.

    

Can you say where the 4 developing residency programs are? I'm applying next year.