Treating Tiny Humans as a Neonatal and Perinatologist

Session 182

Dr. BeverleyRobin is an academic Neonatal-Perinatologist. We talked about the types of patients, communicating with parents, what a normal day looks like, and much more!

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[01:12] Interest in Neonatology

Beverley was previously a respiratory therapist prior to going to medical school and worked in the newborn ICU as a respiratory therapist. So she had been in the newborn ICU for quite a while. Then she went back to medical school.

She says her clinical experience as a respiratory therapist made such a huge difference in going to medical school because it allowed her to appreciate what it was like on the other side. And she’s better able to understand all the allied health professionals.

Beverley explains the term is a little bit misleading because perinatal is in the term of what they do so they’re considered neonatal-perinatal physicians. But in truth, they are neonatal physicians. They are positioned to take care of babies in newborn intensive care, which is a common misconception that they’re all premature babies and they’re all tiny. But it really isn’t the case.

A percentage of their patients are premature babies. But they also have many patients who are full-term and have a variety of medical conditions. Whether it’s complex heart disease, or various other congenital anomalies and those types of things.

“Even though we’re called neonatal-perinatal medicine physicians, we really focus on the neonatal side.”Click To Tweet

The perinatal part of what they do involves antenatal counseling. They’re talking to families who are about to have a preterm baby delivered or a baby delivered with a complex situation. They often work closely with a perinatologist but that is not their area of medicine. What really drew Beverley to this field is being able to walk families through this experience.

[04:55] Traits That Lead to Becoming a Good Neonatologist

Beverley emphasizes the ability to work under pressure and be able to make decisions quickly and multitask. And then on the other side of that, it’s important to have emotional interpersonal skills.

You have to be able to work in a team and lead a team. You have to show compassion, have insight and awareness, as well as a high emotional IQ because you will need to conduct some of those very difficult conversations.

“When you're dealing with parents whose baby is critically ill or dying, you need to walk with those parents and be present for them.”Click To Tweet

[05:54] Typical Day

Beverley says they take turns being on both clinical service and calls. When she’s on clinical service, she usually gets in at 7:30 am. But has the opportunity to look at the overnight events, the lab tests, and the various things that happened overnight with the patients. If she has time, she’d examine patients.

They also do a multidisciplinary huddle, which is a big part of the day. They meet with all the physicians, residents, trainees. They also meet with various representatives from different areas – pharmacy, lactation, the clerk, cleaning people, etc.

They talk about the day, any hotspots, and patients who are critically or going off the unit for procedures. Thereafter, she starts rounds with trainees on their team as she works in an academic institution. They have medical students as well as respiratory therapy and nursing students. They also have a pharmacist and nutritionist, and they go to each patient’s bedside. She would then examine the baby if she hadn’t yet. The trainees would present the patient, and they talk about them and make a plan. And then if the family is present, they would explain their plan and get input from them.

A large portion of her afternoon is spent doing some lectures. Sometimes they have meetings like perinatal M&M. Beverley’s day usually ends at around 4:30 where she “signs up a service.” Service refers to the patient she’s responsible for to the oncoming position so that they can take care of them overnight.

During the day too, she goes to the delivery room, attending deliveries of high-risk patients. Or she would be doing antenatal consults with parents who are having a baby that’s going to be born either prematurely or with complex conditions. And then sometimes too, she will do consultations in the mother-baby unit in the pediatric ICU.

All of their patients are hospitalized. But somebody with an interest in neonatology could have a private practice and outpatient practice caring for those kinds of patients post-NICU admission.

“Somebody with an interest in neonatology could have a private practice and outpatient practice caring for those kinds of patients post-NICU admission.”Click To Tweet

[10:47] Opportunity for Procedures

Beverley adds that procedures are part of their job. They perform in the delivery room where they may resuscitate infants, sometimes all the way to needing CPR chest compressions. They also do endotracheal intubation, where they put in a breathing tube. They do umbilical lines where they put lines directly into the umbilical cord.

They also perform thoracentesis, which is removing air from the chest when there’s a pneumothorax between the lung and the chest wall. They would then would put some of those patients in a chest tub. Sometimes, they would do pericardiocentesis on a child with pericardial effusion.

Other procedures they perform include peripheral IDs, interosseous access, putting in an indwelling urinary catheter, among others.

'It is a very hands-on profession.'Click To Tweet

[11:59] Taking Calls and Life Outside of The Hospital

Beverley describes a call as taking care of the existing patients, putting out fires when there are some. Sometimes they get consultations or they get patients transferred in from other institutions.

Interestingly, she adds that there’s also a lot of teaching that goes on at night and have training at night purposely because there are different kinds of opportunities for them to learn. Also, because they feel trainees have more opportunity to do learning at night.

Therefore, she believes that life outside of the hospital is doable. That being said, it also means you will have to spend a lot of time in the hospital because there has to be a physician 24/7. And it does require being on call at night and certainly some of the weekends too.

[14:32] The Training Path

After you do a three-year pediatrics residency, you can then do a neonatal fellowship, for an additional three years. Fellows are required to publish or to produce some kind of work that allows them to be eligible to sit for the board exam. And those three years are focused on research and a lot of hands-on clinical experience.

Beverley says that neonatology is a very competitive subspecialty, in fact, the largest of the subspecialties in pediatrics.

They’ve only had their program for about two years. There are now more than 100 programs in the country. For the last couple of years, there are only a few spots that have been left open for matching.

[15:54] Overcoming the Bias Against DOs

Beverley says the negative bias towards DO physicians has decreased and changed. She has colleagues who are DO physicians and her current trainee is also a DO physician. So she really doesn’t think this is an issue.

[16:48] Message to OB-GYNs

Beverley underlines the need for more collaboration prior to the baby being born. They communicate with the parents. But then very often, they don’t know what each other has said. And so, it’s very important to be able to collaboratively come to a decision with the family.

In terms of research areas, the border of viability is a very hot topic that varies between regions of the country. And she could see a divide between what the perinatal people envision and the perception of the neonatologist.

[19:45] What She Wished She Knew Before Going into the Field

Beverley is actually having a hard time answer this question as someone who had spent her whole life in the newborn ICU. That being said, she stresses the importance of recognizing work-life balance. Just recognize the amount of time you need to spend in the hospital.

'The amount of time that we do spend in the hospital is something very important to consider.'Click To Tweet

[20:29] Most and Least Liked Things

Beverley loves the procedures and the teaching part of her specialty. The sicker the patients, the more interesting and the more things she’s able to do.

With a neonate, you don’t have a relationship the same way as you might have an older patient or an older patient in pediatrics. In neonatology, the relationship is fostered between you and the parent or the caretaker because sometimes parents aren’t involved. She has had families who have kept in touch with her over the years because she has made a big difference in their lives. And they certainly have in her too.

What she likes the least, on the other hand, is the charting, documentation, and all the administrative work. They spend a lot of time charting, creating notes, and attending notes.

'This is something that nobody talks about when you're in training, but as a physician, you have to bill.'Click To Tweet

At the end of every day, she has to go through the patient criteria, their status, their severity of illness, their weight, etc. And then she has to bill accordingly.

[22:22] Final Words of Wisdom

Neonatology or just the NICU scares a lot of people because it’s very unknown. But the times are changing a little now. Beverley remembers being in training when a lot of nurses who were very protective wouldn’t let you touch the babies. But she thinks that’s changing now.

And so, if this is something you’re interested in but you’re scared of it at the same time, consider spending time in the newborn ICU just to see what it is and what happens. Because if you don’t really know what it is and you don’t really get into that environment, it would be hard to tell and it can be intimidating.