A Community Neonatologist Shares Her Specialty With Us

Session 72

Dr. Leslie Pineda is a private practice Neonatologist in Orlando. We talk about her inspiration to go to the NICU and what she likes, dislikes, and more.

I am constantly looking for physicians who would make great guests here on the show. If you know someone who might make great guests here, send them my way at ryan@medicalschoolhq.net.

[01:33] An Interest in Neonatology

Leslie's mom is a NICU nurse who have been doing it for over 30 years. So she was basically exposed to the field at an early age. She would go visit her at work and back when the babies were still in a nursery, she'd get to see her mom and get the babies through the windows. Through the years, she always knew she wanted to do pediatrics.

"I would branch off and think of different things but I always kept falling back to neonatology."

As to why not a NICU nurse like her mom, Leslie explains she wanted to make the "big decisions." The bedside was fun but she wanted to pursue further and get to lead the team and make the decisions as the team leader.

Other specialties that crossed her mind included emergency as she enjoyed doing procedures. As a resident, she also looked into Pediatric Emergency medicine which she also found exciting because of the procedures and the acuity. Ultimately, she realized she enjoyed working with babies the most.

What she likes about the environment is that you're able to get that long-term relationship with the patients within the hospital stay. Understand that some babies could stay there for months and so you really get to know the family. You see them everyday and take care of them all the time. So you're able to make that relationship with them and get that long-term care while also that short-term acute management you'd have to do at the beginning or when they get sick in the parts in between.

[05:25] Traits that Lead to Becoming a Good Neonatologist

Leslie says you have to want some excitement and that adrenalin rush of taking care of a potentially really sick baby. One must also like the interaction with the families since you're not talking with the baby. At the end of the day, it's about being able to tolerate all your interactions with family members and parents concerning the baby's care.

[06:23] Types of Diseases

Neonatologists often deal with premature babies. Especially up to less than 35 weeks, they will automatically come to the NICU although full-term babies may come to them as well if they're having some trouble transitioning from intrauterine life and maybe having some respiratory issues like retained fetal lung fluid.

You may also encounter some hypoglycemic full-term babies as well if their infants of a diabetic mother. You may also have meconium aspiration or if it's a very stressful delivery, sometimes a baby could get stuck because they're so big They could be into so much stress so they would have to be watched in the NICU and taken cared of in the NICU.

"A lot of different pathologies, not just the premature babies that everybody thinks of."

[07:56] Community Hospital vs. Academic Hospital

As to why Leslie chose community over academic, she admits it had a lot to do with location. Growing up in Orlando, she always knew she wanted to come back there. Why she chose private practice is there's a lot of emphasis on the educational side and research studies, which she still gets to have in her current position.

[08:30] Typical Day of a Neonatologist

Aside from mostly inpatient, Leslie says there's also outpatient follow-up in certain groups. But for her, she does 100% inpatient. Typical day for her, as she describes, is that each day is a little bit different. They cover multiple hospitals with differing levels.

In the main hospital, they come in the morning and take sign out from the outgoing person from overnight about what happened to the babies you'll be following. They huddle with the respiratory therapists and the deliver team, as well as all the neonatologists on for the day. They'd deal with the charged nurses and the pharmacists, even research nurses. They all huddle just so they all know where patients are going or if they expect any deliveries or anybody is going for a surgery.

Then they'd review all the numbers and they'd round as a multi-disciplinary team, talking to the families. They'd talk about the plans and after lunch, they'd carry out all the plans they said they would do and touch base again with the families. And then you sign out to the person covering overnight.

"We round as a multi-disciplinary team... we go to each patient's room and talk to each family, talk about the plan, talk about the numbers as a big team."

[11:03] Doing Procedures, Taking Calls, & Work-Life Balance

In terms of procedure, neonatology is procedure-heavy. You're putting endotracheal tubes in the delivery room and NICU. You're putting umbilical lines, doing test tubes, needle decompressions, etc.

For calls, Leslie takes about three-night calls a month on average. This is basically dependent on the size of the group you're with since you split it among them. That being said, she thinks she still has enough time for life outside of the hospital. Sometimes, you get to go home early and spend time with family. Other times, you may do a 24-hour call so you lose two days there. So it depends on what your schedule is like for that week or month.

[12:36] The Training Path

Leslie illustrates the training path to becoming a full-fledged neonatologist. After premed, you do four years of medical school and then you do your three years of pediatric residency. Then you do three more years of neonatology fellowship. You then take your boards after that.

At the moment, there are no further opportunities to subspecialize after neonatology. However, she says people are actually looking into doing a neuro neonatal kind of things. This is just in talks, but who knows.

In terms of its competitiveness for matching, Leslie thinks it's average compared to all the other pediatric fellowships. For a student to become a competitive applicant, just show some interest in neonatology research or some research.

"Fellowship is geared towards doing some research as part of the training program."

[14:15] Bias Towards DOs and Working with Primary Care and Other Specialties

Leslie doesn't really see any bias towards DOs in that she had co-fellows who are DOs. She has also worked with other DO physicians even in her private practice whom she describes as excellent.

What she wished pediatricians knew about what she does to help patients is that they're not trying to avoid taking the patients. Sometimes they work hard to try to keep them on the regular nursery service. This is in order for the babies to not be taken away from their moms and get to stay with their moms and bond. But they're ready in case they need to take care of the baby and hopefully be able to send the baby back to their mom (if they're a full term baby who just needed time to transition).

Nevertheless, she doesn't really see any big issues related to pediatricians transferring patients to them. They don't mind consulting on so they can decide together whether or not they can stay a little bit longer with the mom before they take them or just take them over the NICU and keep them.

Other specialties they work the closest with include neurologists, infectious disease doctors, cardiologists, pulmonologists, gastroenterologists, and practically everybody.

"We're like the primary care physician for the preemie."

[17:45] Special Opportunities Outside of Clinical Medicine

Leslie says the research route is one opportunity outside of clinical medicine. She explains why research is very hot in neonatology right now.

"Neonatology is such a fast-changing field. We just started resuscitating 22-weekers and we're just doing all these new things to improve outcome."

[18:30] What She Knows Now that She Wished She Knew Before and the Most and Least Liked Things About Being a Neonatologist

Leslie wished she knew that the hours can be a little bit stressful especially when you still have to take overnight in-house call or do a 24-hour call. It's hard since you really like you do and she enjoys everything she does as well as the patients and the people she works with. But it can just be so taxing to stay overnight or do a 24-hour call.

What she likes the most about being a neonatologist is working with the babies and the families which she finds very rewarding. And then when they see an acute patient and then when they come back and see you when they're two or three, the feeling is so rewarding. And more so, if they were a 22 o3 23-weeker who was really fighting the odds.

On the flip side, what she likes the least is seeing families in a very stressful situation and it's hard for them to understand the things happening. Leslie says how this can be stressful even for the team. Since you want to do what's best for the baby but sometimes, they're just so premature that it's hard. They're really fighting against the odds. You can see the toll it takes on the parents and she says it's just so hard to see this.

In order to handle such relationships, they have been working hard in their group to involve the families in the decision-making and in the rounds. They try to get them very involved. It's not them telling the parents what they're going to do. But it's all of them talking and making a decision. They get to hear the plan as a whole team in the room.

"Parents do get involved and that helps with communication. It helps with the stress level because they're really part of the team."

[21:27] Major Chan