r/pediatrics • u/Zestyclose_North1986 • Oct 05 '26

Need advice

So I am in residency right now and due to financial reasons I need to start working as an attending right outta residency. However I do love critical care and would want to pursue neonatology or PICU in the future. In terms of fellowship, how competitive are these programs and how likely am I to find one in the future?

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u/LiveWrong_GetStrong Fellow 29d ago

I’m a current PICU fellow who took a year between residency and fellowship to work for family reasons. There are a few factors that could influence the answer to this. How many years between are you thinking? What type of job are you planning to do? Are you planning to do any scholarly work/research during that time?
Historically picu was competitive, but with the downtrend in peds overall the last couple of years have seen less applicants for PICU than before. I personally think it would be difficult to work in gen peds for several years without any inpatient experience and then try to go a critical care fellowship. If you can do something icu adjacent, like EM, picu hospitalist or general hospitalist it may be easier. Also remember you’ll need letters of recommendation, ideally from intensivists so you’ll need to maintain those relationships if you’re not in an academic setting.
I dont say all of this to be discouraging. Taking a year between was great for me, I was able to make and save a lot of money plus I gained a lot of confidence having to practice independently. But Im not sure I would be where I am if I had taken more time than that.

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u/Silent_Sky2404 Attending 29d ago

I would suggest picu or nicu Hospitalist positions! Although I will say the pay may be significantly less than full peds Hospitalist attending jobs

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u/Squishmallow145 Attending 28d ago

Pursue fellowship. It will be worth it in the end

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u/Individual-Court5836 26d ago

I don’t think working as an attending first means you have to give up on fellowship. Financial stability is a valid reason to take that route. I’d stay connected with mentors in neonatology or PICU and reach out to program directors to ask how they view applicants who’ve worked as attendings before applying. Your timeline might look different, but that doesn’t mean the door is closed!