One contributor described this specialty as ‘the last bastion of
true general surgery.’ The work is varied and challenging and
requires creative solutions since you are addressing problems not
just for the short term, but potentially for the next 70-or-so years
of the patient’s life. The specialty covers a broad range of areas
including urology, gastrointestinal, non-cardiac thoracic and neck
surgery in infants and children.
To succeed in this specialty you need to possess a broad range of
surgical skills and have an understanding of different malformations
and disease processes. Communication skills are vital, as is the
ability to empathise with children and their families.
At times the workload can be busy. Paediatric Surgeons provide a
range of secondary, tertiary and quaternary services and are based
in Auckland, Hamilton, Wellington and Christchurch. They also care
for patients from elsewhere in New Zealand and from the South
Pacific. The surgery is mainly consultant-driven and is largely
based across the public hospitals of the region. Paediatric surgeons
are increasingly involved in providing outreach services, so the
work can entail regular travel to smaller centres to hold clinics
and perform day surgery.
There are about 15 specialists nationwide, and there is incredible
breadth in the tasks that these specialists currently perform. There
is also a trend for paediatric surgeons to develop sub-specialty
areas of expertise for the rare and more complex conditions. With
growing recognition of the importance of providing quality services
and equity of access to these services, it is likely that there will
be an expansion in the extent of outreach paediatric surgery. In
many areas of New Zealand paediatric surgeons provide regular
clinics and operating lists to the smaller regional hospitals.
If you are interested in pursuing a career in this field you should
first talk with practising specialists and work with them if
possible. You will need to complete BST and it would be useful to
gain some paediatric medical experience. It is now possible to enter
the specialty training programme in paediatric surgery at the end of
BST so you should indicate your interest early to the Chairman of
the RACS Board of Paediatric Surgery, c/o Executive Officer, RACS,
Spring Street, Melbourne, Victoria 3000 (phone 00613 9249-1200).
One contributor commented that the specialty does not require huge
numbers across Australasia, but that surgeons who show promise are
always able to gain employment. It is projected that there will be a
shortage of paediatric surgeons in Australasia from 2005. The
process for selection onto the specialty training programme is
rigorous and fair, with the top three or four candidates getting
selected over each of the last 2 years. Historically, New Zealanders
have had a high success rate getting onto the specialty surgical
training programme in paediatric surgery.
A number of paediatric surgeons have successfully taken time out to
start a family during training and the Board of Paediatric Surgery
has allowed part time training in several instances. Travel is an
important aspect of training: you cannot expect to complete your
entire training period in New Zealand and it is likely that you may
spend up to two years in Australia. The Board of Paediatric Surgery
will organise this for you. Worldwide there are many reputable
training centres for post-Fellowship registrars and New Zealand
graduates are very highly regarded. Contributors agreed that it is
useful for you to become familiar with the international community
of paediatric surgeons since this community is relatively small and
most paediatric surgeons know each another.
One contributor commented that travelling around the world after
gaining Fellowship can be unsettling and may affect your financial
circumstances, but that it is also interesting and provides you with
international contacts that will remain for the rest of your career.
Most of the recent graduates in paediatric surgery have spent two
years of training overseas. Consultant paediatric surgeons recognise
the importance of maintaining a good balance between work and
family.
Huge breadth of expertise is required as the specialty covers
urology, general surgery and non-cardiac thoracic surgery (although
most surgeons see this as a positive feature). You must be careful
not to overlook details or symptoms: infants and children recover
quickly but they can also deteriorate quickly. There is less margin
for error. You regularly encounter new and unfamiliar cases and rare
conditions, which is part of the challenge of the specialty. On-call
commitments can be 1:3 or 1:4 since there are relatively few
paediatric surgeons, although it is unusual to have to work after
midnight (most children have gone to bed by then!).
One contributor commented that the training period is long
and hard but that it is worthwhile if you enjoy the work. You should
take opportunities to travel. If you are interested in pursuing the
specialty it is recommended that you contact one of the paediatric
surgeons for an informal discussion.
