Journey to Becoming A Neonatologist

What is a Neonatologist

In order to accomplish becoming a neonatologist, it is important to understand exactly what a neonatologist is. A neonatologist is a medical specialist whose focus is on babies — the newborn, ill, and premature. Some people like to think of a neonatologist as a baby doctor.

A neonatologist is in fact a medical doctor who cares for babies; however, he is not a pediatrician, who is commonly referred to as a baby doctor. While a pediatrician is trained to solve most health problems associated with newborns, a neonatologist trains specifically to handle the most complex and high-risk newborn situations.

For this reason, if a newborn has a serious illness, injury, or a birth defect, or is premature, a neonatologist often assists at the time of delivery. If one of these problems is detected previous to the baby being born, a neonatologist may consult with the obstetrician about the care of the baby during the mother’s pregnancy. If a baby’s condition should call for surgery while the baby is growing inside the womb, a neonatologist is normally part of the surgical consulting team.

Neonatologist Education

The education required for becoming a neonatologist is generally as follows:

• Four years of high school
• Four years of college
• Four years of medical school to earn an M.D. or four years of osteopathic medical school to earn a D.O degree
• Three years to complete a pediatric internship and residency
• Three years to complete a neonatology fellowship

As a medical school graduate, you will receive your M.D. degree, but won’t be able to practice medicine on your own yet. What you need to do next is to become a general pediatrician. This is accomplished by attending a pediatric training program also known as a residency.

This is a three-year program that consists of clinical, hospital, and emergency room experience under the tutelage of the pediatric staff. The pediatric resident treats patients under close supervision, attends lectures and educational conferences, and is exposed to pediatric emergencies on the hospital night shift. The pediatric resident also experiences multiple pediatric sub specialties such as neonatal intensive care or pediatric intensive care.

Following the pediatric residency is an additional three years of training known as a neonatology fellowship, which is the final portion of becoming a neonatologist. The time is spent between treating baby ailments in a neonatal intensive care unit under the watch of veteran neonatologists and performing related clinical research.

Not only will you learn how to treat a wide range of neonatal conditions and diseases, you will also write an article concerning a research project relating to newborns. For instance, a research project might include the brain development of a newborn or infectious diseases that affect a newborn.

In the first year of the fellowship, the primary goal is clinical skill development and identification of research interests. This includes:

• Familiarization of clinical administration for the various chronic and acute neonatal ailments
• Familiarization of advance technical skills needed for neonatal treatments
• Developing leadership skills and learning teaching and supervision techniques
• Developing enhanced skills needed for managing Neonatal ICUs
• Becoming certified as a Neonatal Resuscitation Program instructor and provider
• Investigating research opportunities and choice of research project

In the second year of the fellowship, teaching and clinical skills are expanded, with an extra focus laid on research. This includes:

• Increased skills in neonatal cardiac care
• Management of transport for critically ill babies
• Continued work on neonatal research project

In the third and final year of the fellowship, the focus is primarily on completing the neonatal research project in preparation for peer presentation. There is a further refining of clinical skills and the fellows become more active in education and leadership with respect to their patients.

The American Board of Pediatrics conducts several important examinations that must be passed before you can become a licensed neonatologist:

• First, there is a series of national medical examinations taken in medical school and the first year as a Pediatric resident. The successful completion of these will license you for practicing medicine in your state
• Second, there is a pediatric set of board examinations that are taken the year following your pediatric residency. These certify you as a pediatric specialist
• Finally, there are the exams that are taken upon completion of your neonatology fellowship which certify you as a sub specialist in neonatal-perinatal medicine

Neonatologists must deal with all manners of infant problems. In the majority of neonatal ICUs, approximately half of the babies treated are full-term, being born after their thirty-seventh week of gestation. The other half are premature, born before their thirty-seventh week of gestation.

Premature babies aren’t sick in the traditional sense; it’s that their bodies aren’t fully developed. Premature babies can therefore experience a wide range of issues that can require advanced care and around the clock monitoring of vital signs. For example:

• Their lungs may not be fully developed which may require additional oxygen or the assistance of a breathing ventilator
• The ratio of an infant’s surface area compared to the infant’s bodily volume is large and has little bodily fat, so premature babies must be kept warm by means of an external heat source such as an incubator
• Their liver may not be fully developed, so there is a tendency to become excessively jaundiced, which can lead to brain impairment
• Their immune system may not be fully developed, so infections are a particular problem
• Their stomach and intestines may not be fully developed and unable to handle breast milk or baby formula, requiring intravenous feeding
• Their brain may not be fully developed, leading to breathing difficulties and choking

Full-term infants have their own sets of problems that require admittance to a neonatal ICU and can be just as problematic and random. For example:

• Perinatal asphyxia, which is oxygen deficiency during birth, can lead to problems including heart or kidney failure, as well as seizures
• Congenital birth defects may have occurred which can include heart, brain, or gastrointestinal abnormalities
• Pneumonia, meningitis, or blood infections which can be acquired before or shortly after birth
• Injuries acquired during or after the birth of the baby

Neonatologist Job Opportunities

A majority of neonatologists are employed in large hospitals or medical centers. They immediately take over the care of a baby as determined by low birth weight, life threatening condition, or hospital policy. They may also take charge of a baby when referred by the baby’s pediatrician.

Some private practice neonatologists may work in multiple hospitals. Normally, neonatologists do not treat babies in a private office external to a hospital or medical center. Typically in the setting of larger hospitals, a neonatologist spends his time in a neonatal ICU, a well baby nursery, the delivery room, a follow up clinic for high risk infants, educational conferences and administrative meetings, and performing the role of teacher for medical students, interns, and residents.

Neonatologist Salary

The question of the salary for a neonatologist is not a simple one. The range of salary depends on these factors:

• Region of the United States
• Number of years of experience
• Practicing in rural or urban settings
• Number of patients seen
• Practicing in a private hospital or an academic center
• Amount of time spent on call
• Performing direct patient care or practicing a supervisory role
• Any profit-sharing or other reward programs

Generally, the starting salary for a new neonatologist is around $75,000. However, a veteran neonatologist can receive upwards to $250,000.

There have been tremendous technical improvements in neonatology, including ventilators to improve lung functions and extra-corporeal membrane oxygenation. Other astounding advances include infant cardiac surgery and heart transplants, making it possible to save critically ill infants that would not have survived twenty years ago.

However, it is surprising that neonatal ICUs generally do not use computers effectively. Neonatal ICUs also share little information with each other and there is no uniform standard of care. But the area that needs the most improvement is prenatal care. Premature birth prevention leads to more healthy babies than trying exotic technologies to save a baby after birth.

Medical advances have dramatically improved the rate of survival of a premature baby, but the percentages of births resulting in a premature baby have remained about the same. The increased use of fertility drugs and cocaine abuses cause an increase in premature babies; it is an issue that needs resolving.

It takes fourteen years after graduation from high school to become a licensed neonatologist. After the second year of med school, a majority of your time is spent in direct patient care, albeit under careful supervision.

The path leading to becoming a neonatologist is a long and arduous one, but it has its moments of sheer joy. Although the path is a long one, the profession is a rewarding and interesting one, as there will always be new things to learn and practice as the medical field advances.

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