Becoming a Neonatologist
The Paths We Took
I would never have predicted that I’d be doing what I’m doing now.
In high school, I enjoyed my science classes, but I also loved art. I debated which subject to pursue in college, but my family encouraged me to go into chemistry.
“You can make a living as a chemist and appreciate art as a hobby,” they said.
I started college as a professional chemistry major; however, during my junior year I realized that I didn’t enjoy spending all of my time in the chemistry lab. A friend suggested that I “try out” a microbiology class, and suddenly I was introduced to the world of health care. Then one of the professors in the biology/microbiology department suggested that I take the MCAT. I was unsure about taking the exam, since I didn’t know if I’d be an attractive candidate to medical school and I had never pictured myself as a doctor.
But I applied and looked at several schools in Texas, including Baylor College of Medicine. I decided that BCM would be too expensive for me and went to Louisiana State University Medical College in New Orleans.
During medical school, I thought I wanted to be a pediatric surgeon. Within a day and a half of starting my surgery clerkship during third year of medical school, however, I realized I would not have family or friends to speak of if I tried to live the schedule of a surgeon. In comparison, I found that I enjoyed being in the delivery room (during my obstetrics clerkship) and, even more, I enjoyed taking care of the babies in the NICU (during my pediatrics clerkship). To make the decision between obstetrics and neonatology, I did a high-risk obstetrics elective, and I found that my heart left the delivery room when the baby left for the nursery. This solidified my decision to pursue neonatology.
I went through pediatrics residency training here at Baylor College of Medicine. I am biased about the pediatric training at BCM: the patient volume and the spectrum of disease states that I was exposed to made me feel prepared to handle pretty much any pediatric problem; it also prepared me for the pediatric subspecialty that I had chosen. You get a lot of exposure to different pediatric subspecialties at Baylor, either as you call the subspecialist to a patient’s bedside or as you go through a subspecialty rotation formally. Baylor also has research opportunities and a strong emphasis on continuing medical education.
I trained in the BCM Neonatal-Perinatal Medicine Fellowship Program and I now teach in it, and I am unabashedly biased about the exposure and training that our fellows get. We have a referral nursery at Texas Children’s Hospital, where about 60% of infants are transported from other hospitals and the other 40% are “inborn” from delivery rooms at St. Luke’s and The Methodist hospitals. The Texas Childrens’ Hospital NICU typically has 60 Level 3 NICU babies and 50 Level 2 NICU babies at any given moment. The diagnoses encountered in the NICU vary from “routine prematures” to infants with complex congenital heart disease to babies with unusual genetic syndromes, to name a few. We also have a 20-bed Level 3 NICU at Ben Taub General Hospital, which tends to provide more of a community neonatology experience, with all infants being inborn. With such a variety of neonatal pathologies, our fellows do not typically have difficulty passing the neonatology board certification exam.
Our fellows also get lots of good labor and delivery experience, and they have ample chances to get great procedure skills. We run a neonatal intensive care transport service (Texas Children’s Hospital Kangaroo Crew®), and fellows have the option of going out on transport to get exposure to this aspect of neonatology.
So, after four years of college (in my case, five years), four years of medical school, three years of pediatric residency, and three years of neonatology fellowship, I finally become a real person—at least that is what I called it when I finished my training and joined the BCM Section of Neonatology.
The time was well spent, however.
Now I sit on our Fellowship Committee—selecting, teaching, and guiding the next generation of neonatologists. We like to see well-rounded fellowship candidates with good letters of recommendation and good scores; a little research experience is helpful but not a requirement.
I also find it’s good to practice in an academic setting; you have a lot of partners—you’re not practicing in isolation.
A neonatologist takes care of both the patient and the family. A lot of what you do is education; you work to stabilize the patient and to educate the family. There’s a lot of drama in the intensive care unit, and the work can be emotionally and physically exhausting. When you leave after a tough night or day, you “sleep it off”, then you go back and see how the babies are doing. Every time I labor at the bedside of a sick baby and, as we exert our training and effort, I see him or her stabilizing, I get amazing gratification knowing that I may have played a part in giving a young person a good start.
