Wondering Which Specialty to Choose? Consider This

Jodi Smith, MD, PhD
Jodi Smith, MD, PhD
7 Min Read

Smith is a pediatric neurosurgeon.

When young medical students consider their career trajectories, there are an incredible number of variables to consider: What are my passions? What kind of hours do I want to work? What specialties will help me pay down my student debt the fastest?

I believe the strongest consideration ought to be given to the kinds of patients a physician will work with throughout their career. As a pediatric neurosurgeon, I’m proud to have spent my medical career working with children to give them the best chance at a good life after life-threatening or life-altering brain conditions such as brain injuries or tumors. Working with children has been a passion of mine since my pediatric neurosurgery fellowship. I learned early in my career that children are the best patients, and pediatric work is some of the most rewarding in medicine.

Yet, there’s a shortage of pediatric specialists, and I’m deeply concerned.

A Large Need

Across the U.S., there is a shortage of pediatric specialists — especially in neurology and surgical specialties. The Child Neurology Foundation reports that the number of child neurologists in the U.S. is thought to be 20% below the national need.

Pediatric medical subspecialists and pediatric surgical specialists care for children with unique healthcare needs. Since physicians in many pediatric subspecialties are in short supply, children and families face challenges in accessing timely healthcare. Such shortages mean traveling long distances to obtain care, waiting weeks or months to get an appointment with a subspecialist, going without care altogether, or getting care from providers with less specific training. Pediatric neurosurgery in particular is a field that demands not only medical expertise, but also a profound sense of compassion.

A variety of factors may be driving trainees away from pediatrics. According to younger members of my own practice, many aspiring physicians worry about the emotional toll of treating terminally ill children. Lower compensation could also be a concern.

Giving Children a Second Chance

Despite legitimate concerns about the field, pediatric specialties can also be immensely rewarding. Though I’m a part of an independent practice, I spend all my time at one of the Midwest’s top children’s hospitals. The lasting relationships one establishes with that hospital’s patients in pediatric specialties are unlike anything else in the medical field.

One of my patients, Sarah, was only 16 years old when she first went to the hospital with significant memory problems. She had no idea about the cavernous malformation in her brain and the hemorrhage that was slowly affecting her health.

After a second bleed occurred the day she was scheduled for surgery with me, her circumstances devolved from routine to dire. The surgery to remove the hemorrhage, and to address the cavernous malformation and the surrounding seizure took several hours — nearly twice as long as it would have taken if a second bleed had not occurred early that morning. But for Sarah, all the stars were aligned, and she made a full recovery. She was able to return to high school and graduate. I stayed in touch with her over the years to keep up with her progress.

Another patient of mine, Tyler, was a passionate basketball player with a brain tumor and seizures at the young age of 10. During surgery to remove his tumor and give him a chance to have a normal childhood, he developed nearly uncontrollable bleeding.

“Don’t give up. He’s not giving up. Don’t give up,” I thought while I worked exhaustively to stop the bleeding and give him that second chance. Today, Tyler remains tumor and seizure free, and is playing basketball at a highly competitive level.

Not every pediatric case has a happy ending, but a child’s ability to heal is an underrated phenomenon. Their condition often improves faster than adult patients, and that can be rewarding in its own way.

Looking to the Future

Pediatric specialties are gratifying, but the world of business and medical administration haven’t always created the easiest pathways for new physicians to join this line of work. In response to the shortage of pediatric surgeons, the American Association of Neurological Surgeons, along with organizations from several subspecialties and other areas of healthcare and medicine, signed a letter to Congress in March 2021 asking for action to address this shortage.

The letter outlined the need for $50 million in funding to help recruit and retain clinicians who provide healthcare to children and adolescents. Encouraging more pediatric specialists to join the field would give children access to the medical care they need. In June 2023, HHS announced a new $15 million Pediatric Specialty Loan Repayment Program. While this is a good start, more investment is needed long-term.

As I reflect on my journey as a pediatric neurosurgeon, I am reminded of the incredible joys and challenges that come with this career path. I have found joy in my journey as a pediatric neurosurgeon and I believe in the importance of empowering young physicians to pursue pediatric neurosurgery, which is not just a professional choice but a calling.

As we look to the future, it is my hope that more medical students will be inspired to embark on this remarkable journey of healing, hope, and compassion, ensuring a brighter future for our youngest patients and their families.

Jodi Smith, MD, PhD, is a pediatric neurosurgeon at Peyton Manning Children’s Hospital at St. Vincent in Indianapolis.

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