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      Pediatric Subspecialties


What does a Pediatric Neonatologist do?
What are the career opportunities?
What Board, if any, certifies a Pediatric Neonatologist?
What is the lifestyle of a Pediatric Neonatologist?
What is the compensation of a Pediatric Neonatologist?
How do I become a Pediatric Neonatologist?
Where do I find out about available programs?
When do I apply?
Why should I choose to become a Pediatric Neonatologist?

What does a Neonatologist do?
A neonatologist provides comprehensive care for critically ill premature and full-term infants from birth until discharge from the Neonatal Intensive Care Unit (NICU). Neonatologists often begin their work by providing antenatal consultation in the context of preterm labor or a fetus who has one or more congenital anomalies that require preparation for the birth and coordination of services. In addition to the day-to-day management of critically ill infants, neonatologists also attend high-risk deliveries, providing supportive care of infants from birth, and frequently perform technical procedures such as endotracheal intubation and placement of central venous and arterial catheters.

Many aspects of a neonatologist's position vary with the setting and the neonatologist's interests. Most neonatologists work in a newborn intensive care unit (NICU), either in an academic or private hospital setting. Some neonatologists also provide long-term follow-up of high-risk infants, others specialize in the care of infants who require Extracorporeal Membrane Oxygenation (ECMO), and some care for lower-risk newborns in the newborn nursery. A broad spectrum of clinical problems affect infants in the NICU, including conditions associated with preterm birth, difficulties in the transition from intrauterine to extrauterine life, and serious congenital anomalies, including congenital heart disease. Beyond intensive care medicine and technical procedures, the role of the neonatologist also importantly includes family counseling to assist families and the NICU team in addressing and coping with uncertainties in the infant's prognosis, the appropriate course of medical care, and/or ethical dilemmas.

What are the career opportunities?
Neonatology is a hospital-based subspecialty. A NICU is housed either within a birthing hospital or a free-standing Children's Hospital that lacks in-house delivery services. In either case, newborns born at other hospitals can be transported to a NICU for further care. Specifics of a neonatologist's role depends upon the designated acuity of the NICU (Level I being the lowest acuity providing basic neonatal care to well newborns to Level III care, where surgical subspecialties, ECMO services and mechanical ventilation are offered, with Level II providing intermediate care for stable, non-mechanically or short-term ventilated infants). Neonatologists practice primarily in a group practice, which can be affiliated either with an academic or private practice organization. Virtually all academic and some private neonatology practices are affiliated with residency and fellowship training programs.

There are a number of academic opportunities available to neonatologists. These include laboratory, translational, clinical, epidemiological and/or health services research; educating teaching (medical students, residents, fellows, nurses, nurse practitioners, and/or physician assistants); and quality improvement and/or administrative activities. In addition, there are clinical and academic leadership opportunities available within neonatology at the local, regional, national and international level.

What Board, if any, certifies a Neonatologist?
Neonatologists are certified by the American Board of Pediatrics (ABP) Sub-board of Neonatal-Perinatal Medicine. The initial subspecialty examination is offered in the Spring, every two years. In order to be eligible to take this exam, applicants must first complete a 3-year residency in Pediatrics and a 3-year fellowship in Neonatal-Perinatal Medicine, as well as achieve ABP certification in General Pediatrics.

What is the lifestyle of a Neonatologist?
Each neonatology practice has a structure and scheduling model designed to meet clinical needs and the group's mission. Examples include a private practice model in which a neonatologist covers during the day (or night) for a day or week at a time, a partner covering the opposite shift. In an alternative to this model, a neonatal nurse practitioner or pediatrician covers at night with the neonatologist available, from home, for back-up calls. In academic practice, a more likely arrangement involves assigning the neonatologist to certain weeks of research or administrative activities and other weeks of clinical NICU coverage, on rotation with a group of residents, nurse practitioners and/or fellow(s). Night coverage is variable: some programs require attending physicians to participate in in-hospital night coverage; in others, night coverage is provided by neonatology fellows, nurse practitioners and/or residents and the attending neonatologist takes call from home.

What is the compensation of a Neonatologist?
Compensation of neonatologists is generally among higher levels for pediatric subspecialties, with some notable geographic variation depending upon the practice location. Further, neonatologists in private practice generally earn substantially more then those in academic medicine. For additional salary information, click here or here.

How do I become a Neonatologist?
To become a Neonatologist, you must complete a three year fellowship in Neonatal-Perinatal Medicine after completing a residency in Pediatric or Medicine-Pediatrics. There are also alternate pathways for those who have a strong research background or have completed a previous fellowship. Neonatology participates in a match that occurs in the Autumn of each year. Currently, there are more slots available for fellows than there are applicants, so applicants are rarely unable to find an accredited fellowship position.

Where do I find out about available programs?
Information about Neonatology fellowship programs is available through the Organization of Neonatal-Perinatal Medicine Training Program Directors (ONTPD) website (which provides a listing of all fellowship programs), the ACGME and ERAS Fellowships. The ONTPD directory provides contact information for the individual program directors and other useful information; the ERAS site has links to the websites of participating programs.

When do I apply?
The timeline for applying is posted on the ONTPD website. Nearly all training programs in Neonatal-Perinatal Medicine utilize ERAS and the NRMP match. The application process begins 1.5 years before the anticipated start date of fellowship (typically in the 2nd year of Pediatric residency). Applications are submitted by mid-November, with interviews taking place through the Winter and Spring. The rank order list is due in mid-September with match day taking place in early October of the 3rd year of residency for a start date of July 1 of the following year. Information about the match and statistics can be found at the NRMP website.

Why should I choose to become a Neonatologist?
Neonatology is a fascinating, exciting and extremely rewarding field that provides the opportunity to combine skills in critical care medicine with in-depth study of physiology, developmental biology, and postnatal growth, maturation and development of premature and critically ill newborn infants. At the same time, Neonatology offers tremendous opportunities to partner with parents and colleagues from other disciplines to optimally address an infant's medical challenges and, sometimes, ethical dilemmas. As a baby’s and family’s first pediatric caregiver, the neonatologist enjoys both the challenge and fulfillment of intensive care of the most fragile of patients. Neonatology is also a field of many unanswered clinical and scientific questions and, thus, provides endless research opportunity. Further, there has been steady job availability for neonatologists over many years in a variety of practice settings. The many options in Neonatology career pathways, combined with the medical, technical, scientific and intellectual challenges of the field, make Neonatology a versatile and dynamic subspecialty.

For more information about Neonatology, visit these websites:
AAP Section on Perinatal Pediatrics
Organization of Neonatal-Perinatal Medicine Training Program Directors (ONTPD)
ERAS Fellowships

Subspecialty journals:
Journal of Perinatology
NeoReviews and NeoReviewPlus
NICHD Cochrane Neonatal Systematic Reviews
Archives of Disease in Childhood (Fetal and Neonatal Edition)