An Open Letter to Our Residents about Pediatric Anesthesia

Dear anesthesiology residents (our future professional colleagues),

First, congratulations on choosing an outstanding career in anesthesiology.  We are thrilled to have you join our field, and we know you have been inspired by many role models along the way.  You have chosen an exciting and rewarding career path – no matter what you do next!  While you decide, we would like to take a moment to teach you about finding your ikigai.   

Ikigai is a Japanese concept that represents a “reason for being,” and is the intersection of 4 important domains: (1) your talents and strengths, (2) what you love, (3) what the world needs, and (4) how you can make money.¹  Most people settle for a job that meets two of these domains; many physicians are lucky to find something that fulfills three.  Pediatric anesthesiology fulfills all 4 for us and many others!

There are some false rumors circulating about careers in pediatric anesthesiology.  We have seen outstanding residents, including many budding pediatric anesthesiologists, decide against specialization based on these rumors.  While we support you and the decisions you make about your career, we want to be sure you are basing them on accurate information.  In case you find your ikigai and decide to pursue it, we thought we would clarify these rumors. 

False Rumor #1: There are more graduates than jobs in pediatric anesthesiology. 

Right now, there IS a mismatch between fellowship applicants and fellowship positions – with more fellowship positions than applicants. Candidates for fellowship have great opportunity to explore and match into the fellowship of their choice. This mismatch continues beyond fellowship. In recent years, there have been more job openings in pediatric anesthesiology than national fellowship graduates; as a result, some centers are facing critical shortages.  A recent internal poll of pediatric anesthesia leaders demonstrated that nearly 100% were hiring (unpublished data). It’s a great time to be looking for a job in pediatric anesthesiology (and even better in pediatric cardiac anesthesia)!  

False Rumor #2: The job market will be saturated in the future.

Workforce needs is a complex and multifaceted issue that considers graduations, retirements, population, birth rates, surgical disease incidence, staffing ratios, and proportion of children who are anesthetized by subspecialty-trained pediatric anesthesiologists, among other things. The Society for Pediatric Anesthesia (SPA) has recently created a task force to analyze these trends. Due to decreases in fellowship enrollment during COVID-19, there is currently a great need for pediatric anesthesiologists that we suspect will remain for years.

False Rumor #3: There may be pediatric jobs, but not the job type you want.

A June 2023 survey (unpublished data) of graduating pediatric fellows conducted by author JLL on behalf of SPA showed that, for respondents who entered the workforce, over 94% were hired into exactly the type of job they desired in terms of practice setting, patient population, and geographic preference. This is incredibly favorable for our trainees and departments alike, and promotes the beginnings of a long, satisfying career trajectory.

False Rumor #4: Pediatric anesthesia fellowship will decrease your lifetime wealth.

To be clear, we love our jobs, have found our ikigai, and cannot imagine doing anything else. Importantly, while additional training is a huge initial opportunity cost compared to taking a high-paying private job, we believe that professional wellness and longevity of career are directly related to finding meaningful and rewarding work.  Put differently: careers in pediatric anesthesia are usually long and happy, filled with gratifying experiences and enduring relationships. Ikigai! This is why we are pediatric anesthesiologists.  

But what about the money?  Variations in how practices handle call compensation and other incentives certainly affect total compensation for various subspecialists and generalists alike.  For example, many private and academic practices compensate more for subspecialty board certification, including pediatric anesthesiology.  This, in addition to various perks offered by academic practices such as tuition benefits, competitive retirement benefits, and sabbaticals, makes it difficult to compare what may seem like apples to oranges when considering different career pathways.  Suffice it to say that the rumor about pediatric anesthesiologists and lifetime wealth is simply wrong.  In our institutions, we are annually paid more than our adult counterparts. Consider the increase in lifetime earnings also in the setting of an anticipated longer and happier career when you find your ikigai! To make the math simple, one year of working for $500k compensates for 10 years of making $50k more money per year. So, imagine what happens when you work a few extra years at the end of your career because you love it too much to quit.

There are several anecdotes of residents foregoing fellowship training for high-paying private practice jobs. We propose that when you find a subspecialty in anesthesiology that captures your interest, invigorates you to go to work every day, and makes you feel like you are making a difference (again… ikigai!), you should not be lured away by high salaries, sign-on bonuses, and other up-front perks. Invest the time to follow your passion and pursue a 1-year fellowship.  Over time, the opportunity cost will be negligible.  

Wealth comes in many forms. At the income levels you will soon be earning, the non-financial forms will likely matter more down the road to you (and your loved ones) than relatively small differences in money. Pediatric anesthesiologists enjoy lower burnout rates⁵, high job satisfaction, greater diversity of clinical environments, great impact on future patient health, unmatched variability in patient population, and generally positive working relationships with surgeons, colleagues, and OR staff. It is no surprise that many residents love their pediatric rotations.  That is why we are saddened when false rumors affect life and career choices.  

We would bet you will find more ikigai among your pediatric anesthesiology faculty than among other physicians you have encountered throughout your medical school and residency training. Ask them and find out for yourself.


So, what are you waiting for? Learn more about a career in pediatric anesthesiology today!

Justin L. Lockman, MD, MSEd
Immediate Past President, Pediatric Anesthesiology Program Directors’ Association
Associate Professor and Associate Chair, Education
Department of Anesthesiology and Critical Care Medicine
Children’s Hospital of Philadelphia

Aditee P. Ambardekar, MD, MSEd
Professor and Residency Program Director
UT Southwestern Department of Anesthesiology and Pain Management
Children’s Health, Dallas

References:
1.    Garcia H, Miralles F. (2017) Ikigai: the Japanese secret to a long and happy life. Penguin Life.
2.    “Pediatric Anesthesiology Fellowship Advice.”  StudentDoctor.net https://forums.studentdoctor.net/threads/pediatric-anesthesiology-fellowship-advice.1484246/#post-23972769. Accessed 5 December 2023.
3.    “Pediatric Anesthesiology Fellowship Application.” StudentDoctor.net https://forums.studentdoctor.net/threads/pediatric-anesthesiology-fellowship-application-2024.1474771/ Accessed 5 December 2023.
4.    “Anyone who has don/is planning to do a Peds fellowship. What are the pros and cons?” Reddit.com. https://www.reddit.com/r/anesthesiology/comments/15k890h/anyone_who_has_doneis_planning_to_do_a_peds/  Accessed 5 December 2023.
5.    Hyman SA, Card EB, De Leon-Casasola O, et al.  Prevalence of burnout and its relationship to health status and social support in more than 1000 subspecialty anesthesiologists. Regional Anesthesia & Pain Medicine 2021;46:381-387.