How to Become a Neonatologist

Career Description

A Neonatologist is a medical doctor who uses critical care medicine to address the health of premature or critically ill newborns and infants. In providing this care, Neonatology Physicians often assist in the delivery of babies, diagnose and treat conditions and coordinate overall care with an Obstetrician, Registered Nurses and other pediatric career professionals.

Ultimately, what differentiates a Neonatologist from a Pediatrician is the critical nature of the patients seen. Whereas Pediatricians are able to solve most newborn health problems, Neonatologists focus on the high-risk and most complex cases which usually involve premature births. Included in their scope of practice are the treatment of babies with birth defects, serious illnesses, infections and pre-birth developmental problems. They may also be present during high-risk cesarean deliveries, or during any deliveries which have the potential to compromise an infant’s health.

“A Neonatologist is basically a Physician who specializes in taking care premature and sick-term newborns,” Stephanie A. Wellington, MD, a Neonatologist practicing in New York City, explained. “We see babies from birth until they are discharged home. Depending on the degree of prematurity or the severity of illness, this may last from 24 weeks gestation until 3 to 6 months.”

Wellington added that this career is rewarding on many levels. She noted that Neonatologists tend to perform more procedures than general Pediatricians, and therefore they get to know and support many families throughout their childbirth journeys.

Education & Training

To become a Neonatologist, the first step is to enroll in an undergraduate degree program. While a degree in a related science is not required, these areas of study can help serve as a solid foundation for medical school.

Usually during the final two years of an undergraduate degree program, students register to take the Medical College Admissions Test (MCAT). Once the scores are received, learners must submit them along with applications and letters of recommendation to medical schools of interest.

Upon being admitted to a medical school program, medical students can expect to spend two years in classroom settings followed by two years of hands-on clinical rotations. During lectures, medical school students will learn about foundational psychological and scientific theories of medicine, as well as developmental biology, postnatal growth, development and maturation. During clinical rotations, students gain their first direct patient experience in the specialties of pediatrics and working with Surgeons, X Ray Techs, Nurse Anesthetists and others.

Following medical school, prospective Neonatologists will pursue a three year residency with a focus on pediatrics. Supervised by teaching staff, this is when learners will gain an understanding of patient care for children, emergency scenarios and inpatient care environments. After three years of pediatric training under the supervision of a Physician, they will then begin a neonatology fellowship. Finally, Neonatologists must become certified by the American Board of Pediatrics and by the Sub-board of Neonatal-Perinatal Medicine.

“After undergraduate school you then go on to medical school, and then complete a three-year pediatric residency. Then, because neonatology is a sub-specialty, an additional three years of training through fellowship is required,” Wellington confirmed. “The education and training process is rigorous.”

She further explained that Pediatric Residents spend three to four months in the Neonatal Intensive Care Unit during their training. During this rotation, they learn complex procedures such as intubation, umbilical line placement and PICC line placement. In addition to these procedures, prospective Neonatologists learn about the clinical management of neonates and delivery room resuscitation.

Advancement

To advance in a healthcare career as a Neonatologist, professionals can choose to pursue avenues other than clinical care. For example, Neonatology Physicians can decide to enter the realms of either academia or research, both of which offer many opportunities. Professional growth can also stem from consulting or entering more administrative roles within a hospital or other healthcare facility.

“As most units have residents there’s already a teaching component involved, so making the transition to education is relatively easy,” Wellington said. “Typically, what most Neonatologists do is go on a research path, join committees or go onto run their own unit. There is research in many areas in prevention of prematurity such as identifying the best methods in ventilating preterm newborns or looking at the impact of infection in the fetus and newborn.”

Experience & Skills

Effective Neonatologists should undoubtedly possess strong leadership skills, enabling them to take charge during high-stress, emergency and pressurized situations. They should also have the physical endurance to work long hours, and the manual dexterity to operate tools and equipment on tiny babies

As the field of pediatrics is constantly evolving, Neonatologists must further possess a breadth of knowledge across the field of medicine as a whole. Being able to perform and evaluate research can also be beneficial to a Neonatology Physician’s overall understanding of changes within the field. Communication and interpersonal skills are involved in this career as well, as they can greatly assist these doctors in working alongside other professionals and relaying information to families.

“In addition to the medical knowledge required in this role, I would say that interpersonal skills are critical,” Wellington stressed. “Even if you’re not the one running the unit, you will still oftentimes be the one in charge at a given time. So, team building, leadership and managerial skills are all incredibly important for Neonatologists to possess.”

Personality

Traits which assist Neonatologists in providing quality care include empathy and compassion toward the families of infants in need. In times of crisis, being able to work well as part of a team is integral. Being able to remain calm and collected amidst emotionally challenging circumstances is important as well.

“Communication is key, particularly when caring for patients who cannot speak for themselves and when small changes in clinical status can result in devastating outcomes,” Wellington stressed. “Team members, Physicians, Nurses, Therapist, and parents must work together for the best outcomes.”

The role also comes with a need for strong morals and integrity as ethical dilemmas are known to arise when infants are critically ill. Enthusiasm for the field of pediatrics is important too because this keeps Neonatologists interested in their work and dedicated to furthering their education and knowledge.

“Neonatologists should be professionals who can be laser-focused when needed, and who can also look at the big picture,” Wellington emphasized. “Whether you’re managing smaller or larger units, any details and small changes in a baby’s status can make a big difference. Work flow and making sure staffing is adequate will also help make sure the unit runs effectively.”

Lifestyle

“Neonatology is a great career choice, although days can be hectic,” Wellington noted. “There are times though when you can be off with no call and achieve some work-life balance.”

As Wellingtons alluded to, Neonatologist shifts can be long and stressful. These professionals may be assigned to work evenings, nights or weekend shifts,and sometimes, 24 hour shifts. Being placed on call is also to be expected in this career.

“The lifestyle can be hectic depending on where you work,” Wellington shared. “Units vary from having Neonatologists who work during the day and take call from home, to 24-hour shifts or rotating shifts. The unit is open 24 hours, so there has to be some degree of flexibility of working days, nights and weekends to meet the needs of all patients.”

She added that a typical day for her begins with rounding on each patient. The neonatal team consists of the Neonatologist, a Nurse, residents, Nurse Practitioners or Physician Assistant, a Respiratory Therapist and maybe a Nutritionist and a Social Worker. They discuss each patient at the bedside, and parents are invited to participate in the discussion of their newborn.

Labs and X Rays are reviewed and the plan is made for the day. After these “rounds”, the Neonatologist will review any outstanding information, examine the patients, attend high-risk deliveries when needed, write notes, update families and admit any new admissions. They will also usually provide educational training during this time.

Employment

Now is a great time to consider beginning a career in healthcare as a Neonatologist! This career is projected to grow 22 percent over the course of the next decade. This strong career outlook results from a greater understanding of prenatal complications, as well as advanced technology making more prenatal tests and procedures possible.

Most commonly, Neonatologists work at children’s hospitals, hospitals, medical facilities and occasionally outpatient facilities. More specifically, they practice within newborn intensive care units (NICU) or special care units.

“I think there are a lot of Neonatologist positions available out there, just not all in New York. This is because of the over-saturation of hospitals in the city,” Wellington clarified. “I often receive offers from all over the country, so I know they’re out there.”

Earnings

Due to the lengthy educational requirements and expertise required, Neonatologist careers are quite lucrative. The median annual wage for this occupation is $175,310. However, Neonatologist salaries are known to range from $69,940 to $310,000 per year. Earnings may vary depending on employment setting, years of experience, geographic location and hours worked.

“Neonatologist salaries do vary, usually staring is around $180,000. There seems to be higher starting salaries in other areas of the country,” Wellington shared. “Neonatologist can supplement their salary with ‘moonlighting,’ or working another position, and taking additional calls.”

Unions, Groups and Associations

The American Academy of Pediatrics (AAP) is an organization that promotes optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults. To accomplish this, the AAP supports the professional needs of all members.

The National Perinatal Association is an organization that brings members who are interested in perinatal care together to share, listen and learn from each other. The organization further supports and advocates for babies and families at risk across the country.

The International Neonatology Association is an organization which aims at improving newborn survival. The organization also seeks to improve standards of education in the field of neonatology.

Getting Started

• Consider volunteering or working for a hospital or other healthcare facility
• Enroll in an undergraduate degree program
• Research Neonatologist careers
• Shadow a Neonatologist and ask questions
• Take the Medical College Admissions Test
• Apply to medical schools
• Graduate from medical school and enter a residency
• Complete a fellowship

All statistics are provided by the Bureau of Labor Statistics.

Meet the professional: Stephanie A. Wellington, MD

Age: 49
Practice: Level III NICU at Bellevue Hospital Center
Location: New York City, NY

What is the single biggest suggestion you would give to someone wanting to get into this career?

“I often tell my residents that a career as a Neonatologist is either something you love or something you hate. There really is no middle-ground. You really have to be sure of your commitment to the practice, prior to entering the field. The career can be very demanding.”

What’s the number one mistake people make when trying to get into this career?

“I think this career can test your confidence due to the more challenging procedures. This can shake people’s confidence. It shook mine in the beginning. You just have to be confident and continue to work hard to succeed.”

What is the question people should ask about this career but rarely do?

“What are the support systems like? For example, who are the people who will be around you to help support your work? Nurse practitioners and Nursing Assistants are excellent supporters. Yet, some units have Neonatologists work on their own. They should ask about the support system in place to know what they are getting into. Having support from other skilled professionals can be very important.”

Why did you choose to become a Neonatologist?

“I liked the combination of high acuity at times with working with the families. I like being able to do procedures and work with babies. I love the babies.”

If you could describe in one word what makes you successful, what would it be?

“Compassionate.”

Credentialing organization: The American Board of Pediatrics and the sub-board of Neonatal-Perinatal Medicine