What Makes a Neonatologist? A Program Director Weighs In

Session 101

Dr. Patrick Myers joins us to talk about what he looks for as a fellowship program director, what makes a good neonatologist, and his own unique journey to this specialty. Out of training for about eight years now, Patrick also shares what they’re looking for in candidates if this is something you’re interested in.

Meanwhile, be sure to check out all our other episodes on Meded Media.

[01:30] Interest in Neonatology and Real-Life Experience

Patrick realized he wanted to be in Neonatology until after his entire residency class matched into Neonatology. He spent a year being a peds hospitalist as he experienced a ton of deliveries.

He thinks the fellowship match is helpful in terms of streamlining and getting everybody a chance to get their application out to several people. 

A big downside is if you decide you want to do something else when you're already two years in. 

For residents taking an extra year to figure things out to become a better applicant, Patrick thinks doing a chief or hospitalist year is great. Being to able to work with other people in an actual, real setting allows you to understand your work skills. In fact, Patrick considers having this kind of real-life experience as a gold mine. 

This shows programs that these people really love the field and they're going to have so many more skills than people who just went straight through.

Patrick started medical school when he was 29 years old. He was a Theater major. He just got married at that time and had to work. Desire is another thing he looks for in applicants.

[05:55] Traits that Lead to Becoming a Great Neonatologist

The ability to solve problems is very important so you really have to love problem-solving. Especially in Neonatology, there is a variety of illnesses so you always have to be solving problems. 

Other essential traits include exceptional communication skills and empathy. Moreover, you'd be working with a lot of other specialties. You should know how to negotiate and pull divergent views together and still come up with a really good plan.

[07:45] Common Cases in Neonatology

Except for rheumatology, all of medicine is in neonatology. In NICU, the kids are sick and a lot of them are ventilated and unstable. 

What differentiates it from PICU or Neuro ICU or medical or surgical ICU is that a lot of their really sick kids stay for a long time. It's not unusual for kids to stay at their unit for 100-200 days. Some of their kids have even stayed with them since birth to a year.

The hardest thing to manage is children with underdeveloped lungs so there's that balancing act. Either help the lungs and keep the kid alive, but mechanical ventilation for 10 to 100 days is actually bad for you. 

[10:10] Letters of Recommendation

To figure out whether an applicant for residency is a good communicator, Patrick explains they try to 2-3 very open-ended questions to let people be comfortable and talk. He personally evaluates how people treat his support staff. These are his section administrators, the people touring you, the fellows.

Patrick also highly values letters of recommendation from fellowship directors you have a personal relationship. He further shares this tip to ask a director if they could write you a really good or superior letter of recommendation. If you get any hint of body language that it isn't an equivocal, enthusiastic yes, then do not take that letter.

There's medical literature on interviews that talk about a lot of the code phrases in letters of recommendation. It tells you of phrases that program directors look for.

Already two years as a program director, Patrick admits it took him a while to write good letters. Because you want these people to go out, be successful, and get a really good fellowship. 

But sometimes when you're selling somebody the way you want them to, you actually aren't. You could say one thing but others may read it in a different way. So it takes a bit of skill to get this down.

Nevertheless, the letter of recommendation is just a tiny piece of the application so you can make it up in so many different ways.

[14:24] What They're Looking for in Applicants:

There are about a hundred NICU fellowships and what he does is different than other directors do. But first things first, know your audience. You don't want to apply to a hundred programs. Around 10-15 that fit you would already be good. It has to fit you and your goal.

Patrick comes from an academic program and his goal is to generate leaders in the field of neonatology over the next 5, 10, or 20 years. So he's looking for that capability to be a very good clinician. This is hard to prove but essentially, just do well on all your rotations in residency. Patrick actually looks all the way back to your medical school rotations.

He also looks for that potential in research. Although not mandatory, you should at least be able to spark their interest. He's looking for someone who is able to demonstrate interest, curiosity, and the desire to solve problems.

Some people could come in with really good publications and that's an easy one to show them you're interested. But that's rare. So you have to be able to show them at least some interest. 

[17:10] Writing Personal Statements

The personal statement is also very crucial. Patrick says that out of the 100+ applications and personal statements they've read, 95 said they love neonatology because they love babies and this baby and this family changed their life. But he admits his brain just hurts reading them because everybody says the same thing.

Tell them a unique story and what fires you up. Tell a story of something you've done and done well. 

For instance, you love dancing and been doing it since you were three. Then you've got great grades despite dancing 15 hours a week. You kept doing it in college and you're still going to do it now. But you've discovered your passion is being a doctor in neonatology. This shows the admissions committee your commitment, work ethic, and balanced life.

The hardest applications for them to read are those that are trying to build their application. They've done a hundred things for one week each. There's so much stuff on the paper that they can actually tell what's meaningful and what's not. They simply want to know about you. But instead of them knowing you, they might just think you have a very busy CV.

Instead of saying so much stuff, tell a story that demonstrates your longevity. Being a subspecialist, you're going to be doing this even when you're 65. Investment is what Patrick is looking for.

[20:00] What the Residency Application Looks Like

The application comes in different chunks. The personal statement is a letter that's 500-1000 words long. You can put anything you want in there. Patrick recommends you do research if you're interested in an academic place. Otherwise, if you apply and not say anything about research, people could get confused.

You have to give 3-4 letters of reference. You can also get more than that. The important thing here is to get good people that are known in the community. More importantly, these are people who can enthusiastically talk about you.

In one of those references, there's a summary letter of your pediatric program director with a very specific language that they will use.

They will also look at all your medical school transcripts. Most medical schools make a summary statement about who you are. They will probably have a paragraph that would say what you did and what's unique about you during medical school.

All in all, it ends up being around 40 pieces of paper on an average person. This would also include your hobbies, posters, presentations, papers you wrote, visa status, permanent address, languages spoken, etc.

If you're looking for programs, look at their websites and reach out. Work those connections you have with the nurses. They should know stuff about the program directors and the programs. Patrick personally wants applicants to know his worst before they get to the program. Talk to the junior people.

[25:00] Procedures in Neonatology: Should You Have a High Level of Dexterity?

Patrick is 100% convinced that they can teach students every skill they need to have. You need to have some manual dexterity but you don't need to be able to play the classical piano for two hours. The level is relative.

Moreover, the biggest thing in neonatology is intubations. In neonates, the airway is very different than even kids or adults. Some of their kids are very tiny, the smallest kid they've intubated is 275 grams. The airway changes all the time.

That's one of the hallmarks of neonatology is you're constantly developing underneath. All that being said, you've got to have the skill level to intubate along that spectrum.

They also put in test tubes. They catheterize the umbilical, arterial, and venous lines. This takes a little bit of time. Nevertheless, Patrick is never worried about people's ability to do procedures.

[27:40] What Makes Neonatology Fellows Stand Out the Most

Patrick explains there's a variety of ways for people to be successful. And the people who are successful as a fellow are sometimes different who become ultimately successful